The shift of health care burden from acute to chronic conditions is strongly linked to lifestyle and behaviour. As a consequence, health services are attempting to develop strategies and interventions that can attend to the complex interactions of social and biological factors that shape both. In this paper we trace one of the most influential incarnations of this 'turn to the complex': the Medical Research Council (MRC) guidance on developing and evaluating complex interventions. Through an analysis of the key publications, and drawing on social scientific approaches to what might constitute complexity in this context, we suggest that such initiatives need to adjust their conceptualisation of 'the complex'. We argue that complexity needs to be understood as a dynamic, ecological system rather than a stable, albeit complicated, arrangement of individual elements. Crucially, in contrast to the experimental logic embedded in the MRC guidance, we question whether the Randomised Controlled Trial (RCT) is the most appropriate method through which to engage with complexity and establish reliable evidence of the effectiveness of complex interventions.

The article seeks to contribute to a re-evaluation of the role played by the contemporary health screen by exploring its relation to tense and time. Mobilizing data around operational aspects of screening for type 2 diabetes (T2D) alongside more general historical and conceptual perspectives, it challenges implicit assumptions that the screen represents either a momentary 'cut' in a longer process or a singular event with its own durational integrity. In contrast, the article argues, two distinct kinds of temporally related processes merge within any given screening episode. On one hand a rich heterogeneity of durations - physiological, technical, social, experiential - is involved. Yet this multiplicity is afforded unity and coherence insofar as the screen becomes a 'thick' site of intersection or fusion between the three major tenses. Drawing on aspects of the thought of Bergson and Deleuze as well as Mol's notion of 'ontological politics', the article reconceptualizes the screen as a 'leaky receptacle' for temporal complexity and teases out pragmatic implications of such a re-envisioning.

PurposeThe aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England.Design/methodology/approachSemi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis.FindingsAnalysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place.Research limitations/implicationsThis study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses.Practical implicationsMany of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development.Social implicationsThis study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication.Originality/valueThis paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches.

The paper posits an intervention in current debates around 'method making' in the social sciences, drawing on the experience of undertaking an ethnographic study of a community mental health team in East London. Theoretical recourse is made to the process philosophy of A.N. Whitehead and to the enduring provenance of the problem of 'suggestion' in the history of medicine and psychology. These offer rich and provocative theoretical resources with which to rethink the interpenetration of subject and object and 'feeling' and 'finding'. Whitehead's work provides a general philosophical framework whereby the ongoing subjective experience of the researcher can no longer be sharply demarcated from the 'data' encountered. Meanwhile the adoption of a 'register of suggestion' opens up insights into the inevitably selective and singular character of any given methodological procedure. It maintains the importance of affective factors at the forefront of analysis, and brings into focus the parts played by indeterminacy and risk in the research event.

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