Category Archives: Planning, Licensing

Directors of public health as ‘a protected species’: qualitative study of the changing role of public health professionals in England following the 2013 reforms

Jehu, L.M. et al. Journal of Public Health, https://doi.org/10.1093/pubmed/fdx154

Published: 07 November 2017

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Background

The Health and Social Care Act 2012 gave councils in England responsibility for improving the health of their populations. Public health teams were transferred from the National Health Service (NHS), accompanied by a ring-fenced public health grant. This study examines the changing role of these teams within local government.

Methods

In-depth case study research was conducted within 10 heterogeneous councils. Initial interviews (n = 90) were carried out between October 2015 and March 2016, with follow-up interviews (n = 21) 12 months later. Interviewees included elected members, directors of public health (DsPH) and other local authority officers, plus representatives from NHS commissioners, the voluntary sector and Healthwatch.

Results

Councils welcomed the contribution of public health professionals, but this was balanced against competing demands for financial resources and democratic leverage. DsPH—seen by some as a ‘protected species’—were relying increasingly on negotiating and networking skills to fulfil their role. Both the development of the existing specialist public health workforce and recruitment to, and development of, the future workforce were uncertain. This poses both threats and opportunities.

Conclusions

Currently the need for staff to retain specialist skills and maintain UKPH registration is respected. However, action is needed to address how future public health professionals operating within local government will be recruited and developed.

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Right care: wrong answers

Dropkin, G. Journal of Public Health, https://doi.org/10.1093/pubmed/fdx136

Published: 03 November 2017

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Background

NHS RightCare is an NHS England programme describing itself as ‘a proven approach that delivers better patient outcomes’. It identifies opportunities for savings and quality improvements, comparing each Clinical Commissioning Group (CCG) with the ‘Best 5’ of a fixed set of ‘Similar 10’ CCGs chosen using equally weighted demographic and deprivation indicators. This article tests whether these indicators are sufficient and equal weighting is appropriate, and evaluates significance.

Methods

Robust public data on lung, colorectal, and breast cancer mortality is modelled using the indicators and incidence. Peers chosen using the preferred models are compared with the Similar 10. Confidence intervals are obtained for comparator group averages. RightCare significance is simulated.

Results

Preferred models have unequally weighted covariates. Incidence is the strongest predictor of lung cancer mortality. The ‘Similar 10’ are inappropriate comparators. RightCare significance ignores variability of comparator outcomes, causing 12% Type I errors. Whilst RightCare shows 1842 annual avoidable lung cancer deaths in 80 CCGs, only 168 deaths in 8 CCGs appear exceptional using appropriate peers and CIs.

Conclusion

CCGs cannot expect to match the average performance of the RightCare ‘Best 5’. Until the methodology is examined with data of known quality, claims that RightCare is a ‘proven approach’ are unsubstantiated.

 

Public Health: Everyone’s business

by NHS Providers (2017)

NHS Providers has published Public health: everyone’s business? This second report in the Provider Voices series uses 12 interviews with health leaders from across the NHS and local government, as well as academics, to help gain an understanding of NHS providers’ role in shaping and delivering public health and care

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Sector-led improvement for public health, prevention and early intervention

By Local Government Association (2017)

The LGA is working with partners at Public Health England and the Association for Directors of Public Health to deliver sector-led improvement activity in 2017/18 for public health, prevention, and early intervention through the care and health improvement programme funded by the Department of Health.

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Welfare confidentiality: sanctions, support and behaviour change

By Welfare Confidentiality Project (2016)

Below is the overview, summarising our key first wave findings on the effects and ethics of welfare conditionality. It draws on data from interviews with 52 policy stakeholders, 27 focus groups conducted with practitioners, and 480 ‘wave a’ qualitative longitudinal interviews with with nine groups of welfare service users in England.Overview

Below are nine first wave findings papers covering each of our study’s policy areas in more detail.

First wave findings: anti-social behaviour

First wave findings: disabled people

First wave findings: homelessness

First wave findings: jobseekers

First wave findings: lone parents

First wave findings: migrants

First wave findings: offenders

First wave findings: social tenants

First wave findings: Universal Credit

Evidence based policy making and the ‘art’ of commissioning – how English healthcare commissioners access and use information and academic research in ‘real life’ decision-making: an empirical qualitative study

Wye, L. et al. BMC Health Services Research, 2015; 15: 430

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Abstract

Background
Policymakers such as English healthcare commissioners are encouraged to adopt ‘evidence-based policy-making’, with ‘evidence’ defined by researchers as academic research. To learn how academic research can influence policy, researchers need to know more about commissioning, commissioners’ information seeking behaviour and the role of research in their decisions.

Methods
In case studies of four commissioning organisations, we interviewed 52 people including clinical and managerial commissioners, observed 14 commissioning meetings and collected documentation e.g. meeting minutes and reports. Using constant comparison, data were coded, summarised and analysed to facilitate cross case comparison.

Results
The ‘art of commissioning’ entails juggling competing agendas, priorities, power relationships, demands and personal inclinations to build a persuasive, compelling case. Policymakers sought information to identify options, navigate ways through, justify decisions and convince others to approve and/or follow the suggested course. ‘Evidence-based policy-making’ usually meant pragmatic selection of ‘evidence’ such as best practice guidance, clinicians’ and users’ views of services and innovations from elsewhere. Inconclusive or negative research was unhelpful in developing policymaking plans and did not inform disinvestment decisions. Information was exchanged through conversations and stories, which were fast, flexible and suited the rapidly changing world of policymaking. Local data often trumped national or research-based evidence. Local evaluations were more useful than academic research.

Discussion
Commissioners are highly pragmatic and will only use information that helps them create a compelling case for action.Therefore, researchers need to start producing more useful information.

Conclusions
To influence policymakers’ decisions, researchers need to 1) learn more about local policymakers’ priorities 2) develop relationships of mutual benefit 3) use verbal instead of writtencommunication 4) work with intermediaries such as public health consultants and 5) co-produce local evaluations.

Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?

Cairney, P. et al.  Health Research Policy & Systems, 2017; 15: 35

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There is extensive health and public health literature on the ‘evidence-policy gap’, exploring the frustrating experiences of scientists trying to secure a response to the problems and solutions they raise and identifying the need for better evidence to reduce policymaker uncertainty. We offer a new perspective by using policy theory to propose research with greater impact, identifying the need to use persuasion to reduce ambiguity, and to adapt to multi-level policymaking systems.

We identify insights from secondary data, namely systematic reviews, critical analysis and policy theories relevant to evidence-based policymaking. The studies are drawn primarily from countries such as the United States, United Kingdom, Canada, Australia and New Zealand. We combine empirical and normative elements to identify the ways in which scientists can, do and could influence policy.

We identify two important dilemmas, for scientists and researchers, that arise from our initial advice. First, effective actors combine evidence with manipulative emotional appeals to influence the policy agenda – should scientists do the same, or would the reputational costs outweigh the policy benefits? Second, when adapting to multi-level policymaking, should scientists prioritise ‘evidence-based’ policymaking above other factors? The latter includes governance principles such the ‘co-production’ of policy between local public bodies, interest groups and service users. This process may be based primarily on values and involve actors with no commitment to a hierarchy of evidence.

We conclude that successful engagement in ‘evidence-based policymaking’ requires pragmatism, combining scientific evidence with governance principles, and persuasion to translate complex evidence into simple stories. To maximise the use of scientific evidence in health and public health policy, researchers should recognise the tendency of policymakers to base judgements on their beliefs, and shortcuts based on their emotions and familiarity with information; learn ‘where the action is’, and be prepared to engage in long-term strategies to be able to influence policy; and, in both cases, decide how far you are willing to go to persuade policymakers to act and secure a hierarchy of evidence underpinning policy. These are value-driven and political, not just ‘evidence-based’, choices.