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Background Community hospitals have been part of England’s health-care landscape since the mid-nineteenth century. Evidence on them has not kept pace with their development. Aim To provide a comprehensive analysis of the profile, characteristics, patient experience and community value of community hospitals. Design A multimethod study with three phases. Phase 1 involved national mapping and the construction of a new database of community hospitals through data set reconciliation and verification. Phase 2 involved nine case studies, including interviews and focus groups with patients (n = 60), carers (n = 28), staff (n = 132), volunteers (n = 68), community stakeholders (n = 74) and managers and commissioners (n = 9). Phase 3 involved analysis of Charity Commission data on voluntary support. Setting Community hospitals in England. Results The study identified 296 community hospitals with beds in England. Typically, the hospitals were small (< 30 beds), in rural communities, led by doctors/general practitioners (GPs) and nurses, without 24/7 on-site medical cover and provided step-down and step-up inpatient care, with an average length of stay of < 30 days and a variable range of intermediate care services. Key to patients’ and carers’ experiences of community hospitals was their closeness to ‘home’ through their physical location, environment and atmosphere and the relationships that they support; their provision of personalised, holistic care; and their role in supporting patients through difficult psychological transitions. Communities engage with and support their hospitals through giving time (average 24 volunteers), raising money (median voluntary income £15,632), providing services (voluntary and community groups) and giving voice (e.g. taking part in communication and consultation). This can contribute to hospital utilisation and sustainability, patient experience, staff morale and volunteer well-being. Engagement varies between and within communities and over time. Community hospitals are important community assets, representing direct and indirect value: instrumental (e.g. health care), economic (e.g. employment), human (e.g. skills development), social (e.g. networks), cultural (e.g. identity and belonging) and symbolic (e.g. vitality and security). Value varies depending on place and time. Limitations There were limitations to the secondary data available for mapping community hospitals and tracking charitable funds and to the sample of case study respondents, which concentrated on people with a connection to the hospitals. Conclusions Community hospitals are diverse but are united by a set of common characteristics. Patients and carers experience community hospitals as qualitatively different from other settings. Their accounts highlight the importance of considering the functional, interpersonal, social and psychological dimensions of experience. Community hospitals are highly valued by their local communities, as demonstrated through their active involvement as volunteers and donors. Community hospitals enable the provision of local intermediate care services, delivered through an embedded, relational model of care, which generates deep feelings of reassurance. However, current developments may undermine this, including the withdrawal of GPs, shifts towards step-down care for non-local patients and changing configurations of services, providers and ownership. Future work Comparative studies of patient experience in different settings; longitudinal studies of community support and value; studies into the implications of changes in community hospital function, GP involvement, provider-mix and ownership; and international comparative studies could all be undertaken. Funding The National Institute for Health Research Health Services and Delivery Research programme.

This paper argues that gender segregation influences patterns of underemployment and the relationships that underemployment has with the subjective well-being of men and women. Previous studies have paid little attention to how gender segregation shapes underemployment, an increasingly prominent feature of the UK and European labour markets since the economic crisis of 2008. Using data from the UK Annual Population Surveys, this paper examines time-related underemployment: people working part-time because they cannot find a full-time job. The paper asks whether there are gender differences in underemployment trends and in the links between underemployment and subjective wellbeing. The results suggest that the probability of underemployment is growing at a faster rate among women rather than men and that underemployment is most common in the jobs that women are more likely to perform, namely in female-dominated occupations, the public sector, and small organisations. Underemployment is least common in male-dominated occupations and industries and in the private sector. Moreover, for employees with longer tenures, underemployment has more negative relationships with the subjective well-being of women than with that of men. These findings imply that gender segregation in labour markets is a crucial factor to consider when researching underemployment and its consequences.

Owing to increasing labour market flexibilization, a growing number of people are likely to experience unemployment and, as a consequence, lower mental health and well-being. This article examines cross-national differences in well-being and mental health between unemployed people who engage in voluntary work and those who do not, using multilevel data from the European Quality of Life Survey on unemployed individuals in 29 European countries and other external sources. This article finds that, regardless of their voluntary activity, unemployed people have higher levels of well-being and mental health in countries with more generous unemployment benefits. Unexpectedly, the results also suggest that regular volunteering can actually be detrimental for mental health in countries with less generous unemployment benefits. This article concludes that individual agency exercised through voluntary work can partially improve well-being but the generosity of unemployment benefits is vital for alleviating the negative mental health effects of unemployment.

Although reduced working time and furlough policy initiatives are widely regarded as important for economic and business reasons, little is known about their impacts on workers’ mental health at the onset of COVID-19 pandemic. Using data from the UK Household Longitudinal Panel Study data from 2018 to February 2020 and April 2020 and change score analysis, this study aims to compare mental health changes between those who worked reduced hours, were furloughed and left/lost paid work. The results suggest that at the onset of COVID-19 reduced working time and furlough can protect workers’ mental health, but only for men not for women. The gender differences remain significant even after controlling for housework and childcare responsibilities at the onset of COVID-19. These results highlight the importance of distributing paid work more equitably and formulating gender-sensitive labour market policies in protection of workers’ mental health.