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This chapter examines why managed clinical networks are an appropriate approach to sustainable healthcare, and discusses the conditions for the effectiveness of these multi-stakeholder, clinician-led modes of organizing. It describes the development of a national clinical network to achieve system-wide improvement in the provision of publicly funded cardiac surgery services in New Zealand, and the subsequent evolution of a broader network encompassing the whole cardiac care patient pathway.

The case study of the two cardiac clinical networks focuses on the emergence and evolution of the networks over a four-year period from 2009. Data were collected from interviews with key stakeholders of both networks and from internal and published documentary evidence. Analysis of the case study is informed by network theory and prior studies of managed clinical networks.

Progress made towards the achievement of the goals of the initial cardiac surgery network encouraged a broadening of focus to the entire cardiac care pathway and the establishment of the national cardiac network. An important benefit has been the learning and increase in understanding among the different stakeholders involved. Both clinical networks have demonstrated the value of clinician engagement and leadership in improving the delivery of health services, and serve as a best practice model for the development of further clinical networks for health services that require a national population base.

The case study analysis of the two cardiac clinical networks identifies five mutually reinforcing themes that underpin network effectiveness: network structure, management and governance, and internal and external legitimation. These themes encompass a number of factors suggestive of successful managed clinical networks, and offer insights into the use of such networks in organizing for sustainable healthcare.

Adverse childhood experiences (ACEs) are highly prevalent in people with developmental disorders who engage in offending behaviour. Many violence-based risk assessment tools include items pertaining to ACEs, and may inflate risk scores in trauma-exposed groups. This paper aims to explore the relationships between ACEs, risk assessment scores, incidents of risk and restrictive practices, in adolescents with developmental disorders in a forensic inpatient setting.

Secondary analysis was conducted on clinical data for 34 adolescents detained to a developmental disorder service. Data were extracted for Structured Assessment of Violence Risk in Youth (SAVRY) risk scores and risk behaviours and restrictive practices, as measures of observed risk.

Participants exposed to more ACEs had higher SAVRY risk scores (p < 0.001, two-tailed), with elevations specifically on the historical subscale (p < 0.001, two-tailed). Neither ACEs nor risk scores were associated with the frequency of risk behaviours. Nevertheless, participants exposed to four or more ACEs were secluded more frequently (p = 0.015, two-tailed), indicating a potential association between trauma and risk severity. Those with more complex developmental disorders experienced fewer ACEs (p = 0.02, two-tailed) and engaged in self-harm behaviours less frequently (p = 0.04, two-tailed).

The inclusion of ACEs in risk assessment tools may lead to the inadvertent stigmatization of trauma-exposed individuals. Further investigation is necessary to offer clarity on the impact of early adversity on risk assessment accuracy and levels of institutional risk, and the role of developmental disorders in this relationship.

To the best of the authors’ knowledge, this study is the first to explore the relative associations between ACEs, risk assessment scores and observed institutional risk and does so in a highly marginalized population.

Forensic health-care workers are frequently exposed to behaviours that challenge and traumatic material, with notably high levels in developmental disorder (DD) services. The provision of support is key in alleviating distress and improving work functioning. This paper aims to incite clarity on whether staff in DD services are more likely to access trauma support. The prevailing needs and outcomes for this population are also explored.

Data was extracted retrospectively from a database held by an internal trauma support service (TSS) for staff working in a secure psychiatric hospital. Overall, 278 permanent clinical staff accessed the TSS between 2018 and 2020, 102 (36.7%) of whom worked in an adult DD forensic inpatient service.

Staff working in DD services were over-represented in referrals to the TSS with a greater number of referrals per bed in DD services than in non-DD services (0.94 vs 0.33). DD staff were comparatively more likely to access support for non-physical, psychologically traumatic experiences. Psychological needs and outcomes following support were comparable between staff across services.

The findings highlight the more frequent need for trauma support of staff in forensic inpatient DD settings. Embedding a culture of safety and openness, and establishing appropriate and responsive models of staff support reflect key priorities for inpatient DD health-care providers, for the universal benefit of the organisation, workforce and service users.

This study offers novel insight into levels of access to support for staff working with people with DDs.

The institution of food and cookery exhibitions and the dissemination of practical knowledge with respect to cookery by means of lectures and demonstrations are excellent things in their way. But while it is important that better and more scientific attention should be generally given to the preparation of food for the table, it must be admitted to be at least equally important to insure that the food before it comes into the hands of the expert cook shall be free from adulteration, and as far as possible from impurity,—that it should be, in fact, of the quality expected. Protection up to a certain point and in certain directions is afforded to the consumer by penal enactments, and hitherto the general public have been disposed to believe that those enactments are in their nature and in their application such as to guarantee a fairly general supply of articles of tolerable quality. The adulteration laws, however, while absolutely necessary for the purpose of holding many forms of fraud in check, and particularly for keeping them within certain bounds, cannot afford any guarantees of superior, or even of good, quality. Except in rare instances, even those who control the supply of articles of food to large public and private establishments fail to take steps to assure themselves that the nature and quality of the goods supplied to them are what they are represented to be. The sophisticator and adulterator are always with us. The temptations to undersell and to misrepresent seem to be so strong that firms and individuals from whom far better things might reasonably be expected fall away from the right path with deplorable facility, and seek to save themselves, should they by chance be brought to book, by forms of quibbling and wriggling which are in themselves sufficient to show the moral rottenness which can be brought about by an insatiable lust for gain. There is, unfortunately, cheating to be met with at every turn, and it behoves at least those who control the purchase and the cooking of food on the large scale to do what they can to insure the supply to them of articles which have not been tampered with, and which are in all respects of proper quality, both by insisting on being furnished with sufficiently authoritative guarantees by the vendors, and by themselves causing the application of reasonably frequent scientific checks upon the quality of the goods.

The history of Catholic Teacher Education is linked to the growth and development of Catholic schools that began in the early nineteenth century. The Catholic Church struggled to recruit enough certificated teachers and relied heavily on pupil teachers. This began to be resolved with the opening of Notre Dame College, Glasgow, in 1895 and St Margaret's College, Craiglockhart, in 1920. The two Colleges would merge into the national St Andrew's College in 1981. This national college would undertake a further merger with the University of Glasgow in 1999 to become part of the newly formed Faculty of Education, later School of Education. The School of Education continues to discharge the mission to prepare teachers for Catholic schools.

Aarhus Kommunes Biblioteker (Teknisk Bibliotek), Ingerslevs Plads 7, Aarhus, Denmark. Representative: V. NEDERGAARD PEDERSEN (Librarian).

THE Woolwich Borough Council have made the retirement of Dr. Baker from the post of Borough Librarian the opportunity of adopting the reactionary policy of dividing the Woolwich library system into three independent parts. They do not propose to fill Dr. Baker's post, and have made three members of the staff librarians‐in‐charge of the Woolwich, Eltham, and Plumstead libraries. Within recent years West Ham and Lewisham have adopted a similar policy; while an opposite course has been taken by Southwark and Westminster. It is obvious that an already limited income will be even more inadequate when it is administered in three separate parts. A small temporary advantage may accrue to certain localities of the borough, but the library service of the borough as a whole is bound to suffer. There is plenty of evidence that the greatest library service can be given to a district when the libraries form one organic whole. So much for the present; now for the future. Woolwich is growing rapidly in some localities, and when the inevitable library extension is required, what is going to happen ? Each of the older districts is going to be mulcted of a part of its already far from adequate share in order to finance still another separate administration. Instead of the Borough library service under one administration becoming increasingly efficient with the growth of the district, it is going to remain a series of small and comparatively ineffective units. Then there is another aspect of the question which touches us even more closely professionally. If library systems are going to be divided in this way, men and women are not going to be found willing to go through the long and special training necessary for an administrative librarian, because the position of “librarian‐in‐charge” is no return for such training. In this way, if this policy is going to spread, a much more serious blow still will be struck at the library efficiency of the country.