Provider diversity in the NHS: impact on quality and innovation

The overall objective of the research project has been to assess the impact of provider diversity on quality and innovation in the NHS. The specific research aims were to identify the differences in performance between non-profit Third Sector organisations, for-profit private enterprises, and incumbent public sector institutions within the NHS as providers of health care services, as well as the factors that affect the entry and growth of new private and Third Sector providers. The study used both qualitative and quantitative methods based on case studies of four Local Health Economies (LHEs). Qualitative methods included documentary analysis and interviews with key informants and managers of both commissioning and provider organisations. To provide a focus to the study, two tracer conditions were followed: orthopaedic surgery and home health care for frail older people. In the case of hospital inpatient care, data on patient characteristics were also collected from the HES database. The analysis of this data provided preliminary estimates of the effects of provider type on quality, controlling for client characteristics and case mix. In addition, a survey of patient experience in diverse provider organisations was analysed to compare the different dimensions of quality of provision of acute services between incumbent NHS organisations and new independent sector treatment centres. The research has shown that, in respect of inpatient hospital services, diverse providers supply health services of at least as good quality as traditional NHS providers, and that there is ample opportunity to expand their scale and scope as providers of services commissioned by the NHS. The research used patient experience survey data to investigate whether hospital ownership affects the quality of services reported by NHS patients in areas other than clinical quality. The raw survey data appear to show that private hospitals provide higher quality services than the public hospitals. However, further empirical analysis leads to a more nuanced understanding of the performance differences. Firstly, the analysis shows that each sector offers greater quality in certain specialties. Secondly, the analysis shows that differences in the quality of patients’ reported experience are mainly attributable to patient characteristics, the selection of patients into each type of hospital, and the characteristics of individual hospitals, rather than to hospital ownership as such. Controlling for such differences, NHS patients are on average likely to experience a similar quality of care in a public or privately-run hospital. Nevertheless, for specific groups of patients and for specific types of treatments, especially the more straightforward ones, the private sector provides an improved patient experience compared to the public sector. Elsewhere, the NHS continues to provide a high quality service and outperforms the private sector in a range of services and for a range of clients.

Asynchronous flowering and within-plant flowering diversity in wheat and the implications for crop resilience to heat

Self-pollination dominates in wheat , with a small level of out-crossing due to flowering asynchrony and male sterility. However, the timing and synchrony of male and female flowering in wheat is a crucial determinant of seed set and may be an important factor affecting gene flow and resilience to climate change. Here, a methodology is presented for assessing the timing and synchrony of flowering in wheat. From the onset of flowering until the end of anthesis, the anther and stigma activity of each floret was assessed on the first five developing ears in potted plants grown under ambient conditions and originating from cv Paragon or cvs Spark-Rialto backgrounds. At harvest maturity, seed presence, size and weight was recorded for each floret scored. The synchrony between pollen dehiscence and stigma collapse within a flower was dependent on its relative position in a spike and within a floret. Determined on the basis of synchrony within each flower, the level of pollination by pollen originating from other flowers reached approximately 30% and did not change throughout the duration of flowering. A modelling exercise parameterised by flowering observations indicated that the temporal and spatial variability of anther activity within and between spikes may influence the relative resilience of wheat to sudden, extreme climatic events which has direct relevance to predicted future climate scenarios in the UK.

Farmers' management of rice varietal diversity in the mid-hills of Nepal: implications for on-farm conservation and crop improvement

Season-long monitoring of on-farm rice (Oryza sativa, L.) plots in Nepal explored farmers' decision-making process on the deployment of varieties to agroecosystems, application of production inputs to varieties, agronomic practices and relationship between economic return and area planted per variety. Farmers deploy varieties [landraces (LRs) and modern varieties (MVs)] to agroecosystems based on their understanding of characteristics of varieties and agroecosystems, and the interaction between them. In marginal growing conditions, LRs can compete with MVs. Within an agroecosystem, economic return and area planted to varieties have positive relationship, but this is not so between agroecosystems. LRs are very diverse on agronomic and economic traits; therefore, they cannot be rejected a priori as inferior materials without proper evaluation. LRs have to be evaluated for useful traits and utilized in breeding programmes to generate farmer-preferred materials for marginal environments and for their conservation on-farm.

On-farm management of rice genetic diversity: understanding farmers' knowledge on rice ecosystems and varietal development

The paper highlights the methodological development of identifying and characterizing rice (Oryza sativa L.) ecosystems and the varietal deployment process through participatory approaches. Farmers have intricate knowledge of their rice ecosystems. Evidence from Begnas (mid-hill) and Kachorwa (plain) sites in Nepal suggests that farmers distinguish ecosystems for rice primarily on the basis of moisture and fertility of soils. Farmers also differentiate the number, relative size and specific characteristics of each ecosystem within a given geographic area. They allocate individual varieties to each ecosystem, based on the principle of ‘best fit’ between ecosystem characteristics and varietal traits, indicating that competition between varieties mainly occurs within the ecosystems. Land use and ecosystems determine rice genetic diversity, with marginal land having fewer options for varieties than more productive areas. Modern varieties are mostly confined to productive land, whereas landraces are adapted to marginal ecosystems. Researchers need to understand the ecosystems and varietal distribution within ecosystems better in order to plan and execute programmes on agrobiodiversity conservation on-farm, diversity deployment, repatriation of landraces and monitoring varietal diversity. Simple and practical ways to elicit information on rice ecosystems and associated varieties through farmers’ group discussion at village level are suggested.

Abundance and diversity of wild bees along gradients of heavy metal pollution

1. Wild bees are one of the most important groups of pollinators in the temperate zone. Therefore, population declines have potentially negative impacts for both crop and wildflower pollination. Although heavy metal pollution is recognized to be a problem affecting large parts of the European Union, we currently lack insights into the effects of heavy metals on wild bees. 2. We investigated whether heavy metal pollution is a potential threat to wild bee communities by comparing (i) species number, (ii) diversity and (iii) abundance as well as (iv) natural mortality of emerging bees along two independent gradients of heavy metal pollution, one at Olkusz (OLK), Poland and the other at Avonmouth (AVO), UK. We used standardized nesting traps to measure species richness and abundance of wild bees, and we recorded the heavy metal concentration in pollen collected by the red mason bee Osmia rufa as a measure of pollution. 3. The concentration of cadmium, lead and zinc in pollen collected by bees ranged from a background level in unpolluted sites [OLK: 1·3, 43·4, 99·8 (mg kg−1); AVO: 0·8, 42·0, 56·0 (mg kg−1), respectively] to a high level on sites in the vicinity of the OLK and AVO smelters [OLK: 6·7, 277·0, 440·1 (mg kg−1); AVO: 9·3, 356·2, 592·4 (mg kg−1), respectively]. 4. We found that with increasing heavy metal concentration, there was a steady decrease in the number, diversity and abundance of solitary, wild bees. In the most polluted sites, traps were empty or contained single occupants, whereas in unpolluted sites, the nesting traps collected from 4 to 5 species represented by up to ten individuals. Moreover, the proportion of dead individuals of the solitary bee Megachile ligniseca increased along the heavy metal pollution gradient at OLK from 0·2 in uncontaminated sites to 0·5 in sites with a high concentration of pollution. 5. Synthesis and applications. Our findings highlight the negative relationship between heavy metal pollution and populations of wild bees and suggest that increasing wild bee richness in highly contaminated areas will require special conservation strategies. These may include creating suitable nesting sites and sowing a mixture of flowering plants as well as installing artificial nests with wild bee cocoons in polluted areas. Applying protection plans to wild pollinating bee communities in heavy metal-contaminated areas will contribute to integrated land rehabilitation to minimize the impact of pollution on the environment.

Genetic diversity of red-fleshed apples (Malus)

Anthocyanins are flavonoid pigments imparting red, blue, or purple pigmentation to fruits, flowers and foliage. These compounds are powerful antioxidants in vitro, and are widely believed to contribute to human health. The fruit of the domestic apple (Malus x domestica) is a popular and important source of nutrients, and is considered one of the top ‘functional foods’—those foods that have inherent health-promoting benefits beyond basic nutritional value. The pigmentation of typical red apple fruits results from accumulation of anthocyanin in the skin. However, numerous genotypes of Malus are known that synthesize anthocyanin in additional fruit tissues including the core and cortex (flesh). Red-fleshed apple genotypes are an attractive starting point for development of novel varieties for consumption and nutraceutical use through traditional breeding and biotechnology. However, cultivar development is limited by lack of characterization of the diversity of genetic backgrounds showing this trait. We identified and cataloged red-fleshed apple genotypes from four Malus diversity collections representing over 3,000 accessions including domestic cultivars, wild species, and named hybrids. We found a striking range of flesh color intensity and pattern among accessions, including those carrying the MYB10 R 6 allele conferring ectopic expression of a key transcriptional regulator of anthocyanin biosynthesis. Although MYB10 R 6 was strongly associated with red-fleshed fruit among genotypes, this allele was neither sufficient nor required for this trait in all genotypes. Nearly all red-fleshed accessions tested could be traced back to ‘Niedzwetzkyana’, a presumed natural form of M. sieversii native to central Asia.

Proanthocyanidin diversity in the EU 'HealthyHay' sainfoin (onobrychis viciifolia) germplasm collection

This study investigated 37 diverse sainfoin (Onobrychis viciifolia Scop.) accessions from the EU ‘HealthyHay’ germplasm collection for proanthocyanidin (PA) content and composition. Accessions displayed a wide range of differences: PA contents varied from 0.57 to 2.80 g/100 g sainfoin; the mean degree of polymerisation from 12 to 84; the proportion of prodelphinidin tannins from 53% to 95%, and the proportion of trans-flavanol units from 12% to 34%. A positive correlation was found between PA contents (thiolytic versus acid–butanol degradation; P < 0.001; R2 = 0.49). A negative correlation existed between PA content (thiolysis) and mDP (P < 0.05; R2 = −0.30), which suggested that accessions with high PA contents had smaller PA polymers. Cluster analysis revealed that European accessions clustered into two main groups: Western Europe and Eastern Europe/Asia. In addition, accessions from USA, Canada and Armenia tended to cluster together. Overall, there was broad agreement between tannin clusters and clusters that were based on morphological and agronomic characteristics.