Fresh thinking about the evidence needed for a healthier UK

The Health Foundation is working with Dr Harry Rutter from the London School of Hygiene and Tropical Medicine to develop a new model of evidence that will inform public health research, policy and practice. 

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As part of this work Dr Rutter and co-authors from the Health Foundation have published a new Viewpoint paper – The need for a complex systems model of evidence for public health – in The Lancet, which outlines the need for new approaches to designing and evaluating population-level interventions to improve health.

Key points

  • We are faced with many big health challenges in our society. Their complex nature is an ongoing problem for public health research and policy.
  • Such challenges often involve multiple factors operating over many decades in systems that adapt as changes occur. For example, the distribution of obesity in a population might be impacted by changes to food, employment, transport or economic systems.
  • The traditional linear model of research is not suited to tackling these challenges. This is because it focuses largely on changes in individuals, not the population as a whole, and because it tends to look at isolated interventions rather than the contexts in which they take place.
  • There is growing recognition that we need a new evidence model that looks at public health problems, and our potential responses, in terms of a complex systems approach.

Full reference: Rutter, H. et al.  The need for a complex systems model of evidence for public health The Lancet, 13 June 2017

Related: Building a new system for the generation and use of public health evidence

 

Personalised letters and a “taster session” help double attendance at NHS stop smoking services

Gilbert H, Sutton S, Morris R, et al. Start2quit: a randomised clinical controlled trial to evaluate the effectiveness and cost-effectiveness of using personal tailored risk information and taster sessions to increase the uptake of the Unstop Smoking Services. Health Technol Assess. 2017;21(3):1-206.

Attendance at NHS stop smoking services (SSS) almost doubled after smokers were sent letters showing their personalised risk of serious illness if they continued to smoke alongside invitations to try the service.

Less than 5% of smokers attend these services in England and numbers are on the decline, although this is one of the most effective ways of stopping smoking.

A personalised risk letter was sent to 2,636 smokers alongside an invitation to a local taster session. 17.4% attended, compared to 9.0% of 1,748 smokers who received a standard letter advertising the service. The letter and invitation to a taster session also increased the number who had quit smoking by six months (9% vs. 5.6%).

This proactive recruitment looked likely to be cost effective over a person’s lifetime compared to the usual non-specific invitation.

Those recruited represented only a small proportion of smokers wishing to quit and who may be more motivated than most. There remains a need across all of society to increase accessibility to stop smoking services.

Smoking cessation in secondary care: acute and maternity settings

Self-assessment framework for NHS acute trusts to develop local action to reduce smoking prevalence and the use of tobacco | Public health England

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The self-assessment tool breaks down the NICE guidance into 4 areas:

  • systems required to implement the guidance
  • communication required
  • training that will help staff to successfully implement the recommendations
  • treatments that should be available to support staff and service users

This self-assessment tool supports all of the recommendations applicable to acute services in the NICE guidelines on Smoking cessation in secondary care.

Please save the self-assessment file to your computer and click ‘enable editing’ before using it.

Public Health England has also developed a suite of resources including a self-assessment tool to support the implementation of NICE guidance in mental health settings.

View the full framework here

Shaping healthy cities and economies: the role of clinical commissioning

NHS Clinical Commissioners, December 2016

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NHS Clinical Commissioners

This report showcases how clinical leaders in England’s core cities – the eight largest cities outside of London – are looking at how the services they commission can improve not only the health but social and economic wellbeing of their populations. The report finds that in these areas, clinical commissioners are working with a wide range of partners to go beyond traditional boundaries to combat health inequalities and social exclusion, increase skills and employment and to attract inward investment to help realise the potential of their local economies.

 

Changing risk behaviours and promoting cognitive health in older adults

A summary of reviews supporting the commissioning of interventions across a range of health behaviours for older adults. | Public Health England

This resource is intended for local authority and clinical commissioning groups to identify what types of interventions they should focus on to help the uptake and maintenance of healthy behaviours and promote cognitive health among older adults living in the community.

It is also intended for providers of lifestyle behaviour change programmes to support the development of evidence-informed prevention packages for older adults.

It is produced in a way that makes it accessible to public health managers and practitioners working in the public, private and third sector.

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Image source: http://www.gov.uk

Producing a joint strategic needs assessment for mental health

The Centre for Mental Health has published Meeting the need: what makes a ‘good’ joint strategic needs assessment (JSNA) for mental health or dementia?

This report explores how five local councils across England went about understanding the mental health needs of their communities, and taking action to meet them more effectively.

The report finds that JSNAs for mental health and dementia can help to direct investment, improve services and help local agencies work together more effectively. To have the biggest impact, they need a clear purpose, effective leadership and advocacy, and partnerships that continue after the JSNA is completed to ensure that they lead to action.

Report author Andy Bell highlights eight key success factors behind the creation of an effective and impactful needs assessment:

Effective Health and Wellbeing Boards: findings from 10 case studies

Local Government Association, 2016

Building on the research published in the LGA’s ‘state of the nation report’ on health and wellbeing boards (HWBs), ‘The Force Begins to Awaken’, these ten pen portraits of effective (HWBs) provide an understanding of what an effective HWB looks like and highlight some of the outcomes that HWBs have been able to secure.

The pen portraits of each of the ten HWBs provide an understanding of what an effective HWB looks like and explore the conditions for effectiveness. The pen portraits also highlight some of the outcomes that effective HWBs have been able to secure.

Read more here.