Category: Licensing

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Education Library Licensing Planning Training

The Topol Review: preparing the healthcare workforce to deliver the digital future

By Health Education England (2019)

The Topol Review, led by cardiologist, geneticist, and digital medicine researcher Dr Eric Topol, explores how to prepare the health care workforce, through education and training, to deliver the digital future. This independent report, on behalf of the Secretary of State for Health and Social Care, makes recommendations that will enable NHS staff to make the most of innovative technologies such as genomics, digital medicine, artificial intelligence and robotics to improve services.

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Categories
economic evaluation Licensing Planning

Effects and costs of implementing predictive risk stratification in primary care: a randomised stepped wedge trial

Snooks H, Bailey-Jones K, Burge-Jones D, et alEffects and costs of implementing predictive risk stratification in primary care: a randomised stepped wedge trialBMJ Qual Saf Published Online First: 05 November 2018. doi: 10.1136/bmjqs-2018-007976

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Aim We evaluated the introduction of a predictive risk stratification model (PRISM) into primary care. Contemporaneously National Health Service (NHS) Wales introduced Quality and Outcomes Framework payments to general practices to focus care on those at highest risk of emergency admission to hospital. The aim of this study was to evaluate the costs and effects of introducing PRISM into primary care.
Methods Randomised stepped wedge trial with 32 general practices in one Welsh health board. The intervention comprised: PRISM software; practice-based training; clinical support through two ‘general practitioner (GP) champions’ and technical support. The primary outcome was emergency hospital admissions.
Results Across 230 099 participants, PRISM implementation increased use of health services: emergency hospital admission rates by 1 % when untransformed (while change in log-transformed rate ΔL=0.011, 95% CI 0.010 to 0.013); emergency department (ED) attendance rates by untransformed 3 % (while ΔL=0.030, 95% CI 0.028 to 0.032); outpatient visit rates by untransformed 5 % (while ΔL=0.055, 95% CI 0.051 to 0.058); the proportion of days with recorded GP activity by untransformed 1 % (while ΔL=0.011, 95% CI 0.007 to 0.014) and time in hospital by untransformed 3 % (while ΔL=0.029, 95% CI 0.026 to 0.031). Thus NHS costs per participant increased by £76 (95% CI £46 to £106).
Conclusions Introduction of PRISM resulted in a statistically significant increase in emergency hospital admissions and use of other NHS services without evidence of benefits to patients or the NHS.

Categories
Healthy Settings Licensing Long-Term Conditions Mortality Nutrition Obesity Oral Health Physical Activity Planning Public Health Advice to NHS Commissioners

Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Steel, et al. Lancet 2018; 392: 1647–61

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Background

Previous studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile.

Methods

We extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters.

Findings

The leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791–15 875] in Blackpool to 6888 [6145–7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD. The population attributable fractions for all-cause YLLs for individual major risk factors varied across Upper-Tier Local Authorities. Life expectancy and YLLs have improved more slowly since 2010 in all UK countries compared with 1990–2010. In nine of 150 Upper-Tier Local Authorities, YLLs increased after 2010. For attributable YLLs, the rate of improvement slowed most substantially for cardiovascular disease and breast, colorectal, and lung cancers, and showed little change for Alzheimer’s disease and other dementias. Morbidity makes an increasing contribution to overall burden in the UK compared with mortality. The age-standardised UK DALY rate for low back and neck pain (1795 [1258–2356]) was higher than for ischaemic heart disease (1200 [1155–1246]) or lung cancer (660 [642–679]). The leading causes of ill health (measured through YLDs) in the UK in 2016 were low back and neck pain, skin and subcutaneous diseases, migraine, depressive disorders, and sense organ disease. Age-standardised YLD rates varied much less than equivalent YLL rates across the UK, which reflects the relative scarcity of local data on causes of ill health.

Interpretation

These estimates at local, regional, and national level will allow policy makers to match resources and priorities to levels of burden and risk factors. Improvement in YLLs and life expectancy slowed notably after 2010, particularly in cardiovascular disease and cancer, and targeted actions are needed if the rate of improvement is to recover. A targeted policy response is also required to address the increasing proportion of burden due to morbidity, such as musculoskeletal problems and depression. Improving the quality and completeness of available data on these causes is an essential component of this response.

 

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Accident Prevention Community Safety councils gambling Healthy Settings Licensing Local Government Planning

A ‘Whole Council’ Approach to Gambling A guide for public health and other council officers to support the revision of borough statements of policy

By London Councils (2018)

Gambling is often described as a ‘hidden addiction’ and problem gambling is now recognised as a complex public health issue that has an impact on individuals, families, and communities. This guidance outlines the areas in which public health can add value and support local gambling policies.

Click here to view this guidance

 

Categories
Evidence Based Healthy Settings Library Licensing Planning Policy makers Public Health

Development of measurable indicators to enhance public health evidence-informed policy-making

Tudisca, V. et al. Health Research Policy and Systems, 2018: 16:47

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Background
Ensuring health policies are informed by evidence still remains a challenge despite efforts devoted to this aim. Several tools and approaches aimed at fostering evidence-informed policy-making (EIPM) have been developed, yet there is a lack of availability of indicators specifically devoted to assess and support EIPM. The present study aims to overcome this by building a set of measurable indicators for EIPM intended to infer if and to what extent health-related policies are, or are expected to be, evidence-informed for the purposes of policy planning as well as formative and summative evaluations.

Methods
The indicators for EIPM were developed and validated at international level by means of a two-round internet-based Delphi study conducted within the European project ‘REsearch into POlicy to enhance Physical Activity’ (REPOPA). A total of 82 researchers and policy-makers from the six European countries (Denmark, Finland, Italy, the Netherlands, Romania, the United Kingdom) involved in the project and international organisations were asked to evaluate the relevance and feasibility of an initial set of 23 indicators developed by REPOPA researchers on the basis of literature and knowledge gathered from the previous phases of the project, and to propose new indicators.

Results
The first Delphi round led to the validation of 14 initial indicators and to the development of 8 additional indicators based on panellists’ suggestions; the second round led to the validation of a further 11 indicators, including 6 proposed by panellists, and to the rejection of 6 indicators. A total of 25 indicators were validated, covering EIPM issues related to human resources, documentation, participation and monitoring, and stressing different levels of knowledge exchange and involvement of researchers and other stakeholders in policy development and evaluation.

Conclusion
The study overcame the lack of availability of indicators to assess if and to what extent policies are realised in an evidence-informed manner thanks to the active contribution of researchers and policy-makers. These indicators are intended to become a shared resource usable by policy-makers, researchers and other stakeholders, with a crucial impact on fostering the development of policies informed by evidence.

Categories
economic evaluation Green spaces Healthy Settings Licensing Planning Well-Being

Revaluing parks and green spaces: measuring their economic and wellbeing value to individuals

By Fields in Trust (2018)

This report demonstrates that parks and green spaces across the UK provide people with over £34 billion of health and wellbeing benefits and generates savings to the NHS of at least £111 million per year. It calculates that parks provide a total economic value to each person in the UK of just over £30 per year and that this is higher for individuals from lower socio-economic groups and also from black and minority ethnic backgrounds.

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Categories
healthcare transformation Healthy Settings Licensing Planning

Developing new models of care in the PACS vanguard: a new national approach to large-scale change?

By The King’s Fund (2018)

The primary and acute care system (PACS) model is an attempt to bring about closer working between GPs, hospitals, community health professionals, social care and others. This report offers a unique set of first-hand perspectives into the experience of those leading a major programme at the national level and those living it at the local level. The insights shared will be invaluable to those constructing future national support programmes intended to facilitate transformation in local health and care systems.

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Categories
evaluation Healthy Settings Licensing Planning

Public health practitioners’ views of the ‘Making Every Contact Count’ initiative and standards for its evaluation

Chisholm, A. et al. Journal of Public Health, 2018: doi.org/10.1093/pubmed/fdy094

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Background
National Health Service England encourages staff to use everyday interactions with patients to discuss healthy lifestyle changes as part of the ‘Making Every Contact Count’ (MECC) approach. Although healthcare, government and public health organisations are now expected to adopt this approach, evidence is lacking about how MECC is currently implemented in practice. This study explored the views and experiences of those involved in designing, delivering and evaluating MECC.

Methods
We conducted a qualitative study using semi-structured interviews with 13 public health practitioners with a range of roles in implementing MECC across England. Interviews were conducted via telephone, transcribed verbatim and analysed using an inductive thematic approach.

Results
Four key themes emerged identifying factors accounting for variations in MECC implementation: (i) ‘design, quality and breadth of training’, (ii) ‘outcomes attended to and measured’, (iii) ‘engagement levels of trainees and trainers’ and (iv) ‘system-level influences’.

Conclusions
MECC is considered a valuable public health approach but because organisations interpret MECC differently, staff training varies in nature. Practitioners believe that implementation can be improved, and an evidence-base underpinning MECC developed, by sharing experiences more widely, introducing standardization to staff training and finding better methods for assessing meaningful outcomes.

Categories
cost-effective economic evaluation Finance Licensing Planning

The Prioritisation Framework: making the most of your budget

By Public Health England (2018)

Local public health teams are facing increasingly complex and challenging decisions over what services to invest in and disinvest from. The Prioritisation Framework is designed to help local authorities conduct a systematic prioritisation exercise, by greatly reducing the burden and complexity of the task.

The approach is based on Multi Criteria Decision Analysis, a recognised decision support technique which has been successfully used in a variety of contexts.

Throughout the tool, users are provided with extensive guidance and links to other relevant resources. A supporting materials pack is available from the PHE Health Economics team at healtheconomics@phe.gov.uk.

Click  here to view this tool

Categories
Evidence Based Library Licensing Planning Public Health Advice to NHS Commissioners

Does access to a demand-led evidence briefing service improve uptake and use of research evidence by health service commissioners? A controlled before and after study

Wilson, P.M. et al. BMC Implementation Science, 2017; 12(20)

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Abstract
Background
The Health and Social Care Act mandated research use as a core consideration of health service commissioning arrangements in England. We undertook a controlled before and after study to evaluate whether access to a demand-led evidence briefing service improved the use of research evidence by commissioners compared with less intensive and less targeted alternatives.

Methods
Nine Clinical Commissioning Groups (CCGs) in the North of England received one of three interventions: (A) access to an evidence briefing service; (B) contact plus an unsolicited push of non-tailored evidence; or (C) unsolicited push of non-tailored evidence. Data for the primary outcome measure were collected at baseline and 12 months using a survey instrument devised to assess an organisations’ ability to acquire, assess, adapt and apply research evidence to support decision-making. Documentary and observational evidence of the use of the outputs of the service were sought.

Results
Over the course of the study, the service addressed 24 topics raised by participating CCGs. At 12 months, the evidence briefing service was not associated with increases in CCG capacity to acquire, assess, adapt and apply research evidence to support decision-making, individual intentions to use research findings or perceptions of CCG relationships with researchers. Regardless of intervention received, participating CCGs indicated that they remained inconsistent in their research-seeking behaviours and in their capacity to acquire research. The informal nature of decision-making processes meant that there was little traceability of the use of evidence. Low baseline and follow-up response rates and missing data limit the reliability of the findings.

Conclusions
Access to a demand-led evidence briefing service did not improve the uptake and use of research evidence by NHS commissioners compared with less intensive and less targeted alternatives. Commissioners appear well intentioned but ad hoc users of research. Further research is required on the effects of interventions and strategies to build individual and organisational capacity to use research.