Category Archives: Public Health Advice to NHS Commissioners

Physical activity and the environment

by NICE (2018)

This guideline covers how to improve the physical environment to encourage and support physical activity. The aim is to increase the general population’s physical activity levels. The recommendations in this guideline should be read alongside NICE’s guideline on physical activity: walking and cycling.

Recommendations

This guideline includes recommendations on:
•strategies, policies and plans to increase physical activity in the local environment
•active travel
•public open spaces
•buildings
•schools

Click here to view this guidance

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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.

Three updated Cochrane Reviews assessing the effectiveness of influenza vaccines

By The Cochrane Library (2018)

Three Cochrane Reviews have been newly updated to incorporate the latest available evidence on vaccines for the prevention of influenza. These reviews, which focus on the prevention of influenza in healthy adults, healthy children, and in the elderly, form a long-running series by the same author team, and are available in full on the Cochrane Library:

Vaccines for preventing influenza in healthy adults

Vaccines for preventing influenza in healthy children

Vaccines for preventing influenza in the elderly

Click here to view these reviews

Substance misuse services: The quality and safety of residential detoxification

By the CQC (2018)

This briefing flags up concerns, identified during the course of CQC’s inspections, about some independent sector services that offer residential care to people undergoing detoxification from drugs and alcohol. In 2016/17, it is estimated that about 1% of people in alcohol and drug treatment received this type of intervention. The briefing, which includes recommendations, is for providers, commissioners and other local and national bodies that play a part in assuring the quality of substance misuse services.

Click here to view this briefing

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.

 

Return on investment of public health interventions: a systematic review

Masters R, et al. J Epidemiol Community Health 2017;0:1–8. doi:10.1136/jech 2016-208141

Click here to read this article

ABSTRACT
Background Public sector austerity measures in many
high-income countries mean that public health budgets
are reducing year on year. To help inform the potential
impact of these proposed disinvestments in public
health, we set out to determine the return on investment
(ROI) from a range of existing public health
interventions.
Methods We conducted systematic searches on all
relevant databases (including MEDLINE; EMBASE;
CINAHL; AMED; PubMed, Cochrane and Scopus) to
identify studies that calculated a ROI or cost-benefit ratio
(CBR) for public health interventions in high-income
countries.
Results We identified 2957 titles, and included 52
studies. The median ROI for public health interventions
was 14.3 to 1, and median CBR was 8.3. The median
ROI for all 29 local public health interventions was 4.1
to 1, and median CBR was 10.3. Even larger benefits
were reported in 28 studies analysing nationwide public
health interventions; the median ROI was 27.2, and
median CBR was 17.5.
Conclusions This systematic review suggests that local
and national public health interventions are highly costsaving.
Cuts to public health budgets in high income
countries therefore represent a false economy, and are
likely to generate billions of pounds of additional costs
to health services and the wider economy.

Specialist substance misuse services for young people: a rapid mixed-methods evidence review of current provision and main principles for commissioning

By Public Health England (2017)

PHE commissioned The Children’s Society to undertake scoping research, to understand some of the opportunities and challenges currently facing those now responsible for commissioning and delivering young people’s specialist substance misuse services and to outline some critical good practice principles. Four main commissioning principles have been developed for the commissioning and provision of specialist substance misuse provision for young people, based on the findings, research and evidence-based guidelines.

Click here to view this report