Social innovation discourses see in social challenges opportunities to make societies more sustainable and cohesive through inclusive practices, coproduction and proactive grassroots initiatives. In this paper we are concerned first that the concept has been stretched in so many directions that it is at breaking point. We illustrate this by documenting the varied uses of social innovation in different academic and policy discourses. Second, we assume that, if social innovation is to be a useful concept for policy-makers, then it must tell us something about what adjustments are needed to develop an effective political economy that is social innovation ready. Finally, we argue that what is needed is more theoretical and empirical work to help social innovation to develop into an effective policy tool.

Payment by results allows the government to pay a provider of services on the basis of the outcomes their service achieves rather than the inputs or outputs the provider delivers. Social impact bonds (SIBs) are a form of payment by results which allow the financing of social outcomes via private investment. It is suggested that payment by results and SIBs will drive greater efficiency, innovation and impact in tackling social problems through focusing reward on outcomes and providing minimal prescription as to how these outcomes should be achieved. It is suggested that this may be achieved while also reducing risk for government. Here we set out the challenges likely to arise in developing payment by results models and SIBs in the criminal justice system of England and Wales. These include the uncertainty arising from defining outcomes, estimating the potential impact of interventions, measuring and attributing change, valuing benefits, demonstrating a fiscal return and getting interventions to scale. We conclude that, to a government trying to deliver ‘more for less’, payment by results may offer an attractive solution in some parts of the public sector. However, the case for this approach in the criminal justice sector, where the evidence base is contested and potential savings difficult to quantify and realize, is not yet proven.

This chapter discusses the development of outcomes-based commissioning in the UK, focusing on Payment by Results (PbR) and Social Impact Bonds (SIBs). It first considers key policies that have underpinned outcomes-based commissioning in the UK since 2010 before analysing PbR programmes and SIBs in more detail, highlighting results and some of the important issues related to these areas of policy. It shows that the themes of New Public Management (NPM) and risk management are evident in the development of PbR and SIBs, whereas the theme of social innovation is present but less prominent. The chapter also provides an overview of the social investment market and two PbR programmes, namely, the Work Programme and the Troubled Families programme. Finally, it describes two SIBs: HMP Peterborough SIB and Nottingham Futures SIB.

We review the state of evaluation within outcome-based commissioning in the United Kingdom. This is the first review to include empirical evaluations of both PbR and SIB programmes. We find a paucity of evaluation and that the quality of evaluations is not high. Moreover, studies tend to conflate the outcomes-based commissioning mechanism with the intervention or services that are funded, and are unable to assess the contribution of these separate elements to impact. Our review also highlights the challenges faced by evaluators in measuring social outcomes. We suggest ways to address these challenges.

Objectives The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. Methods 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. Results A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. Conclusions The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.