Forging social care policy amid the white heat of a White Paper

Posted on April 23, 2012 by Bob Erens| Comments Off

By Martin Knapp

With the Government’s White Paper on Social Care expected soon, all eyes are turned to an area of just a few hundred square metres inWestminster. There, three major Government departments (Health, Treasury, Number 10) will be negotiating (perhaps fighting out) what policies will be included. Whilst we await details, we can expect the White Paper to cover future funding arrangements for long-term care and to set out what needs to be done to improve the delivery, quality and regulation of care and support. Proposals for better integration of health and social care are certain to feature.

The widely welcomed recommendations of the Dilnot Commission report from July 2011, setting out options for financing long-term care, would commit the Government to higher spending at precisely a time when budgets are being cut across the public sector. Many of the other suggestions outlined by the Coalition within months of coming to power – in its vision statement for social care published in November 2010 – might need to be reined in given the economic climate.

So how far can researchers help policy makers in this field? Can we help to deliver improvements in areas, such as the provision and financing of long-term care, that have challenged many of us before us?

PIRU’s role is building a platform of evidence to help the Department of Health to develop the Government’s proposals. We have, for example, been reviewing the evidence on levers that might be pulled to improve the quality of social care. Our literature review suggests that investment in staff training can offer some returns. Likewise, focussing on commissioning may make a difference. We are examining possible financial incentives. However, the evidence base is less than comprehensive in each of these areas.

We are also reviewing research from abroad and in this country on the ways and benefits of achieving closer integration between health and social care. It’s a debate with a long history. However, no country has achieved satisfactory integration of these sectors – each has different challenges. Indeed, even when we look at other countries that have successfully moved further than us on this issue, the picture is clouded by other variables. For example, health and social care systems offer a number of different interfaces with welfare benefits and housing systems. So there are no easy answers.

A familiar plea from the academic community in such circumstances is to call for further research. More realistic advice amid the white heat of Government policy making is to advocate that considerable care be taken in the implementation process. Where evidence is lacking, it will be vital to make sure that consultation is thorough and combined with sound modelling of the impacts of change.

Martin Knapp is Professor of Social Policy, Director of the Personal Social Services Research Unit at the London School of Economics and Political Science, and Director of the NIHR School for Social Care Research.

 

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Desperately seeking the Steve Jobs of healthcare modelling

Posted on April 4, 2012 by Bob Erens| Comments Off

by James Barlow  

We know that health services need a shake-up. How else can we meet ever increasing demand while holding down costs and improving quality and productivity? But shake-ups, involving novel combinations of technology, services and infrastructure, can do a lot of damage – and still fail to achieve their goals.

Pilots can help but may not reflect the resource-constrained realities of mainstream roll-out. We need better ways to link up the context, process, costs and outcomes of potential innovations at different system levels.

Simulation models can do just this, allowing experimentation with different courses of action in a safe, quick and cheap way. They often temper perspectives that tend to over-estimate the reliability of prediction and bring uncertainty out in the open.

Such models for healthcare planning have been developed since the 1960s, improving communication between diverse stakeholders by creating a shared representation of the whole system. Latterly, powerful computers plus improved graphics and animation have helped, increasing both the potential and accessibility of models. Yet, despite success stories and academic endorsement, the technique has yet to catch on with many clinicians, health managers and policy-makers.

What’s the hold-up? As in many fields that require the adoption of sophisticated communications technology, it’s the ‘Steve Jobs’ problem. Simulation modelling needs to be a lot easier for the non-technically minded, so it feels like a dream, not a scary nightmare. In short, models and their results should be accessible to stakeholders with no or limited experience of modelling.

The pressure is mounting for this development. There is an increasing push on academia, the health services and the health care consultancy industry to ensure that appropriate analytical tools are created, driven partly by the new Cumberland Initiative (www.cumberland-initiative.org). But policy makers, though accustomed to simulation modelling at a Whitehall level, have yet to recognise fully its potential more locally.

We need all these sectors to back a step-change in presentation and usability now if simulation modelling is to become truly embedded in healthcare decision-making at all levels. Sadly, we can’t recruit into healthcare planning the current generation of 10 year olds who would probably find all of this technology more intuitive and easier to use than do their parents. We also cannot afford to delay important changes in service delivery until those 10 year olds find themselves running the NHS.

James Barlow is Professor of Technology and Innovation Management at Imperial College London. He is a co-investigator with PIRU and Co-Director of the Health and Care Infrastructure Research and Innovation Centre.

 

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Too much spin can seriously damage the health of spin-offs

Posted on February 7, 2012 by Nicholas Mays| Comments Off

By Nick Mays

The recent Department of Health report, ‘Innovation, Health and Wealth’* tells an intriguing story about the potential economic benefits of the NHS. It goes further than rehearsing how it helps to develop a healthy, productive and economically active population. The report also states that the NHS supports the life sciences industry. So far, so good. But more controversially, it contends that, ‘by exporting innovation, ideas and expertise’, the NHS provides new business opportunities abroad for UK-based companies.

This interesting argument for NHS innovation is on top of the report’s central case that innovation helps ‘deliver more health benefit for a given public resource’. The report engages directly with understandable concerns that commerce might overtake health considerations by stressing the importance of robust evaluations that do not bend to industry pressures. Indeed, it makes some sound proposals to strengthen the hand of NICE, whose rigour and independence are exemplary.

Nevertheless, I would sound a warning. Amid the talk of promoting UK plc, there remains a risk of getting carried away and heaping NHS praise on developments of dubious overall benefit – if only to help secure overseas markets. Such a step would not only be bad for the NHS, it could also damage UK business in the long-run.

How might this happen? Surprisingly easily. All of us in research are aware of how studies and evaluations, however robust, can quickly lose their nuanced, shaded complexities in the hands of eager advocates. A study full of doubts, caveats and question marks can, once passed to an enthusiastic PR department, suddenly be transformed into a panacea.

Both the NHS R&D community – and UK business – should bear in mind the example of the US Food and Drug Administration (FDA). Although FDA approval is often refused, that’s not necessarily bad for business: the FDA’s rigour – and willingness to say ‘no’ – means that anything bearing its kite mark will be acceptable for sale anywhere. We should, likewise, be careful to maintain the NHS as a globally trusted brand.

So we should be wary not just about ensuring robust evaluation. We should also keep a close eye on the way those evaluations are presented publicly and, in particular, to the media. It is easier to lose a reputation than it is to gain one. In the long-run, too much spin could seriously harm the Health Service’s valuable business spin-offs.

Nicholas Mays is Director of the Policy Research Unit in Policy Innovation Research (PIRU) and Professor of Health Policy at the London School of Hygiene and Tropical Medicine.

*To read ‘Innovation, Health and Wealth’ go to: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131784.pdf

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Alternatives to the chemical cosh

Posted on November 7, 2011 by jokemp| Leave a comment

By Bob Erens

There is wide concern about anti-psychotic drugs being prescribed far too readily for patients with dementia, particularly in care homes. The so-called ‘chemical cosh’ has been blamed by government-commissioned research for the premature deaths of 1,800 people a year.

And the side-effects on an estimated 180,000 UK dementia sufferers can be profound, including social withdrawal, accelerated cognitive decline as well as dizziness and unsteadiness that can lead to falls.

That’s why the Care Services Minister, Paul Burstow, wants a dramatic two-thirds reduction in prescription levels. But what can be offered instead for patients with dementia who may wander or become agitated or aggressive?

The Department of Health has asked PIRU to look at alternatives to these antipsychotic drugs. There are lots of potential options including massage, music therapy, light therapy, physical activity and exercise interventions, cognitive training interventions, better behaviour management therapy as well as specific training and education for care givers.

The big question is what works, in what circumstances and for which patients? We hope to come up with some answers and also identify the research gaps so that these drugs are used only as the last resort.

PIRU is bringing speed and expertise to reviewing a vast swathe of existing research (there are already over 30 literature reviews of more than 400 research papers). We should be able to nail down what is known and what requires further study. We have excellent partners at the EPPI-Centre, Institute of Education and at Collaborations for Leadership in Applied Health Research and Care: Cambridgeshire and Peterborough (CLAHRC CP).

The PIRU investment will be money well-spent if, at the end of our project, we can make a real difference to vulnerable people’s lives and help turn Paul Burstow’s laudable policy ambition into a practical reality. Our work could give doctors, nursing staff and carers the confidence to employ better treatments that enhance dignity and well-being during the twilight years of life.

Bob Erens is Deputy Director of PIRU

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How PIRU aims to make a difference

Posted on November 7, 2011 by jokemp| Leave a comment

By Nick Mays

Governments these days are less interested in simply supplying services and much more concerned to guarantee results, regardless of how services are provided. That’s true particularly for healthcare. After all, what is healthcare policy meant to achieve? Fundamentally, it is designed to make people healthier within a reasonable budget. So, just as pharmaceuticals and devices require scientific proof of effectiveness, PIRU is now helping to apply more of that rigour to healthcare policy-making.

We are, for example, involved in developing the Government’s programme to improve the rehabilitation of drug users. In the past, agencies might typically have been funded simply to provide a service. They would have reported what they had done, but with no financial link to their real achievement.

In contrast, today, Ministers increasingly want to pay for performance, for the measurable impact that rehabilitation services have, for example, on drug users’ behaviour. That sounds good in theory. But to make this approach work, you need to know clearly what you want to achieve, what progress you can reasonably expect, which indicators you want to use to measure achievement, how much it is worth to you and what you can afford.

This is where PIRU comes in. We are experts in evaluation and in establishing, for example, what is likely to work according to available evidence. So, in terms of the rehabilitation programme, we are helping eight pilot sites right from the start, to develop a realistic payment for performance regime based on our knowledge and experience of what works and for whom.

For example, we are bringing to bear the recent evidence from the Quality and Outcomes scheme in the UK that pays general practices for their performance and applying it to the development of the drug rehabilitation pilots.

Our early involvement also means that, when the outcomes of this programme are finally evaluated, we’ll have more than anecdotes that contribute to a ‘feel good story’. We will really know whether important goals were achieved and we should have some idea of the cost of achieving these important outcomes. That will inform long-term policy choices such as whether to roll-out the programme and also whether to apply it to other services such as for alcohol dependency.

We have not always been involved, like this, at the start of a programme. However, we are a relatively new research unit and we hope policy-makers will increasingly appreciate the extra value gained by using our speed of response and expertise in evidence analysis during the earliest stages of policy development.

We’ve been funded primarily to advise policy-makers at the Department of Health. But we are not cheerleaders for Government. We are independent academics. They have asked us to help find out what works and what does not work, so they can build on success.

Nick Mays is Director of PIRU

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