Category Archives: Public Health Advice to NHS Commissioners

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.

 

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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

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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.

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Commissioning infant feeding services

By Public Health England (2016)

Public Health England and Unicef UK have developed guidance to support the commissioning of evidence-based interventions to improve breastfeeding rates across England. The toolkit consists of three parts: infographics which highlight the key issues; good practice guidance for commissioners; and guidance on effective data collection, monitoring and reporting.

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Alcohol-specific activity in hospitals in England

By the Nuffield Trust (2015)

Alcohol misuse costs the UK economy an estimated £7.3 billion per year. In England alone, estimates suggest that over 15,000 people die from alcohol-related illnesses each year.

The costs to the NHS of alcohol-related harm arise from a number of areas. For example, up to 35% of all Accident & Emergency (A&E) attendance and ambulance costs may be alcohol related. In 2013/14, over a million hospital admissions were as a consequence of an alcohol-related diagnosis, and this figure is increasing. The effect is not only evident in hospital care, with 22 to 35% of GP visits estimated to be related to alcohol. The true impact of alcohol on the health service is likely to be even higher than this.

This report analyses both trends in A&E visits and trends in hospital admissions that are attributable to alcohol-specific activities. Based on the findings it explores opportunities for preventative action.

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Excellence in continence care: practical guidance for commissioners, providers, health and social care staff and information for the public

By NHS England (2015)

This guidance finds that increased preventative services, good quality, easily available information and advice, as well as integrated health and social care could have a significant impact on the numbers of children and adults suffering with continence issues and the severity of their health and social problems. It brings together the most up-to-date evidence based resources and research to support commissioners and providers of health services to enable them to make real and lasting changes to raise standards of care for continence. It encourages greater collaboration between health and social care, working in partnership with the third sector, as set out in the NHS Five Year Forward View.

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Making it better together: a call to action on the future of health and wellbeing boards

By Local Government Association (2015)

This call to action outlines a set of proposals to local system leaders and the government to strengthen the impact and leadership of health and wellbeing boards across the country. It also outlines the LGA and NHS Clinical Commissioners shared commitment to support boards to reach their full potential as system leaders driving forward changes that will improve the health of their communities.

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