Excellence in tobacco control: 10 High Impact Changes aims to achieve a sustainable and integrated approach to tobacco control at a local level. It clearly sets out the required actions for those charged with delivering tobacco control locally, and clearly identifies to senior stakeholders the need for high-level strategic support to achieve this.

Project: London is a clinic of Medecins Du Monde (UK) which aims to support migrants that need help accessing healthcare.  It has just  published its second annual report the Project: London report and recommendations 2007: Improving access to healthcare for the community’s most vulnerable.

The report finds no evidence of health tourism, with patients had been in the UK for an average of 3 years before accessing care from Project: London. Migrants are no more likely to have expensive, complicated medical needs than anyone else. It also identifies difficulties for pregnant women in accessing proper care. Although they were entitled, nearly 70% of the women had no access to care, a situation which puts both mother and child in jeopardy, and must be addressed as a matter of urgency.

Proposed changes to NHS access for migrants are unlikely to be cost effective because:

• Lack of GP access means no chance of preventing diseases
• Lack of GP access means no chance of early and affordable treatment of diseases – including those which are contagious
• Lack of GP access is likely to lead to increased pressure on already burdened A&E department.

Regeneration in European cities: Making connections is a study of successful urban regeneration schemes in mainland Europe to draw lessons for the UK from the Joseph Rowntree Foundation.

It compares regeneration at Norra Alvstranden in Gothenburg; Kop van Zuid in Rotterdam; and Roubaix in Metropolitan Lille making comparisons with similar places in the UK (Gateshead, North Southwark, and Bradford).

An extensive literature review identifies where the UK might learn from Europe. Each case study:

• sets the context;
• assesses actions and achievements;
• looks at benefits for vulnerable groups;
• sets out the main elements of the scheme;
• includes reactions from UK partners; and
• outlines implications for UK policy.

Each year, the Government decides how much to raise benefits and tax allowances. The basis for these upratings is rarely debated, yet has major long-term consequences for the relative living standards of different groups and for public finances. The impact of benefit and tax uprating on incomes and poverty from the Joseph Rowntree Foundation considers the implications of present uprating policies, which mean that some parts of the tax and benefit system are uprated by earnings growth, other parts by prices and some not at all.

The impact of continuance of these polices over the newxt 20 years will be a doubling of the child poverty rate alongside a substantial gain to the public finances. Some of this budgetary gain may be needed to meet other demands – of an ageing population for example – but the cost falls disproportionately onto poorer groups and could be raised more fairly.

Residents’ views of new forms of high density affordable living from the Joseph Rowntree Foundation explores residents’ views about living in new affordable higher density housing and how far residents’ expectations of living in high-density developments were met. In particular it explores:

• reasons for moving in;
• the impact of architecture and design;
• community cohesion, including integration across tenures;
• crime and antisocial behaviour;
• the impact of the surrounding neighbourhood;
• future housing aspirations, including whether residents wanted to move;
• housing management;
• affordability.

New statistics from the NHS Information Centre

• Expenditure on health
• NHS stop smoking statistics
• Hospital outpatient statistics
• Diagnostic waiting times

Individual responsibility for health and self-care are key themes in recent health policy development in England. The King’s Fund have addressed the issue with three papers:

• Paying the Patient: Improving health using financial incentives identifies programmes based on both positive and negative incentives, finds that financial incentives are effective in encouraging people to perform clearly defined, time-limited, simple behavioural tasks, and also in encouraging participation in lifestyle programmes.However, healthier behaviour is not maintained and financial incentives are not effective when the behaviour change required is complex, for example, giving up smoking.
• Low-income Groups and Behaviour Change Interventions: A review of intervention content and effectiveness considers interventions targeted specifically at low-income groups, this paper asks which interventions are effective in getting people to quit smoking, eat healthily and exercise. It reveals that the most frequently used techniques are providing information and encouraging people to set goals, which can be particularly effective at changing behaviour in disadvantaged groups.
• Using Information to Promote Healthy Behaviours looks at the theory and selected evidence of interventions in practice, and what this can tell us about the role of information in behaviour change programmes. Information-based health campaigns are a major part of the government’s health promotion strategy. A £75 million marketing programme has recently been announced to encourage healthy behaviour in children. This paper looks at the theory and selected evidence of interventions in practice, and what this can tell us about the role of information in behaviour change programmes.

Two more papers are due in the Kicking Bad Habits series before a final report is drafted.

Individual Budgets and the interface with health: a discussion paper was commissioned by CSIP as a stand alone piece of work to capture the issues and learning from the Individual Budgets pilot regarding the interface between Individual Budgets and Health. A “think tank” session was organised with key stakeholders from the Cabinet Office, Department of Health, In Control and Individual Budget pilot sites to discuss these emerging issues and any relevant activity.

The health impact of climate change: promoting sustainable communities - guidance document (guidance summary) has been written by the South East Regional Public Heath Group t contains advice for public health professionals on what can be done to mitigate and adapt to climate change and promote sustainable communities.

This has been a collaborative effort with the UK Public Health Association (UKPHA), Faculty of Public Health and the Chartered Institute of Environmental Health (CIEH), as well as the content verified across government.

The guidance documents ask health professionals to consider the health impacts of climate change and provide information on how societies can adapt to the most severe impacts - such as heatwaves and flooding, with adequate planning.

Ideas for minimising the future effects of climate change by reducing energy use and CO2 emissions, both in the workplace and at home are also provided

The Report of the Office of Health Economics Commission on NHS Outcomes, Performance and Productivity identifies that the collection and use of outcomes measures in the NHS is both practical and essential.   In order to do so effectively the report makes the following recommendations:

• Measurement of patient outcomes and use of that information to drive better commissioning of services should be made an explicit element of the Government’s vision of “world class commissioning”.

• Mortality and survival data should be collated and published for all condition/treatment areas at the same time as collection of other outcomes data is initiated. Data on casemix must be collected, so that the crude mortality/survival data can be adjusted for the casemix treated. Confidence intervals should be estimated and reported to permit comparisons to be made over time and between providers.

• For elective surgery, condition-specific measures should be collected beforeand after surgery simultaneously with the generic EQ-5D for all NHS patients undergoing common procedures.

• Measurement of mental health outcomes in secondary care should be reinvigorated with collection of HoNOS data being incentivised in addition to mental health providers being reminded of its mandatory nature as part of the Mental Health Minimum Data Set. Routine collection at annual intervals of the CORE-OM measure for all patients receiving community based mental health services be piloted in a range of NHS Trusts at the earliest practical opportunity in 2008/09.

• Research is required to identify a generic measure of health related quality of life that is suitable for application to mental health patients as well as recipients of other kinds of health care.

• The practicality and value of collecting and using measures of outcomes for COPD patients should be piloted by a range of commissioners and their secondary and primary care providers, commencing in 2008/09. The preferred disease specific measure is either the Chronic Respiratory Disease Questionnaire (CRDQ) or the St George’s Respiratory Questionnaire (SGRQ).

• For colorectal cancer patients, mortality data (1 year and 5 years after diagnosis) should continue to be monitored and assessed as an important but partial measure of health service productivity in this disease area given its relatively high rate of mortality. But at the same time instigation in 2008/09 of pilot programmes of routine use of the EORTC QLQ-CR38 instrument to measure outcomes in colorectal cancer patients simultaneously with the EQ-5D or an SF- series generic measure should be undertaken.

• Collection of data about the wider benefits from health services by addition of questions on patients’ experience of care to the patient questionnaires used to measure health outcomes. Aspects covered should include: access, care co-ordination, autonomy, choice, communication, confidentiality, dignity, quality of amenities and support for carers.Further research is needed into the relative values of the wider benefits referred to in recommendation 8 and by compassion with health outcomes.This should be commissioned during the course of 2008/9.

• Information on wider benefits is already collected in national patient surveys. Building on its ‘customer experience information’ project, the Department of Health should work with its counterparts in Northern Ireland, Scotland and Wales on a UK-wide stock-take of patient surveys in process and planned, and then use this as the basis for discussion with all the interested parties how to co-ordinate those surveys in future.

• After a short period of research to identify the most practical way of collecting such data, including working days lost, measurement of productivity effects should be commenced for patients being treated for mental health problems, diseases of the nervous system and diseases of the musculo-skeletal system should be identified.

• Modification of existing national surveys of a sample of the general population should be investigated as one way of collecting at a general level data relevant to the wider societal impacts of health care interventions, including impacts on carers.

• Health care professional bodies, including the Royal Colleges, should explicitly and actively support the collection and use by their members of patient outcome measures, including the provision of training in their collection and use for both existing and new clinicians.

• Training in understanding and using outcome measures should be provided to NHS commissioner and provider managers.

• Investment should be made in IT and appropriately trained staff to enable user-friendly information collection, collation and analysis of outcome measures.

• The NHS should, commencing as early as possible in 2008/09, pilot, monitor and evaluate explicit incentives to collect, collate, analyse, feedback and use patient outcome measures. Initially at least this would not be extended to rewarding providers for the measured levels of outcomes achieved, although that could be considered once experience with use of outcomes measures has accumulated.

• There should be an expectation that within 5 years (i.e. by the end of 2012/13) routine measures of patient outcomes comprising the impact of an NHS intervention in terms of patient survival, quality of life, and experience of care, are collected for the majority of NHS activity. Within 10 years it should be the exception rather than the rule to find an area of NHS activity that is not assessed and actively managed according to the outcomes achieved.

• The NHS should work with the ONS Centre for the Measurement of Government Activity to ensure that the health outcomes data used by the NHS can also used by ONS in its periodic assessments of NHS productivity and, subsequently, in the National Accounts.

The Bercow Review of services for Children and Young People (0–19) with Speech, Language and Communication Needs - Interim Report ( Executive Summary) identifies 5 key themes:

• Communication is crucial – communication is at the core of all social interaction.  Communication is a key life skill. Communication is a fundamental human right. For some children and young people, acquiring the ability to communicate is a difficult and ongoing challenge. Just as the nature and severity of their needs will vary, so will the type and extent of the help required to address them.
• Early identification and intervention are essential in order to avoid poor outcomes for children and young people – in addressing delay and disorders, the most important facts we know are the value of early intervention and the danger of its absence. If a child receives the right help early on, he or she has a better chance of tackling problems, communicating adequately and making progress. If a child does not benefit from early intervention, there are multiple risks – of lower educational attainment, of behavioural problems, of emotional and psychological difficulties, of poorer employment prospects and, in some cases, of a descent into criminality.
• A continuum of services, designed around the family, is needed – universal, targeted and specialist services are required to meet the range of needs and, as the Government envisages in its recent Children’s Plan, children, young people and their families must be at their heart.
• Joint working is critical – in planning, commissioning and delivering universal, targeted and specialist provision, it is critical that health services and children’s services, including schools, work together in support of children and young people with SLCN. No single agency can deliver any one of the five Every Child Matters outcomes for children and young people by working in isolation. Separate silos produce misunderstandings, cause divisions and can be bewildering or infuriating to parents for whose children services are delayed or denied as a result.
• The current system is characterised by high variability and a lack of equity – the current system is routinely described by families as a “postcode lottery”, particularly in the context of their access to speech and language therapy (SLT).

WHO/CDC Global Youth Tobacco Survey (GYTS) is a school-based survey designed to enhance the capacity of countries to monitor tobacco use among youth and to guide the implementation and evaluation of tobacco prevention and control programmes.

Essential Indicators

• Knowledge and attitudes of young people towards cigarette smoking
• Prevalence of cigarette smoking and other tobacco use among young people
• Role of the media and advertising in young people’s use of cigarettes
• Access to cigarettes
• Tobacco-related school curriculum
• Environmental tobacco smoke (ETS)
• Cessation of cigarette smoking

You may also be interested in our post on Fresh and alive: Mpower WHO report on the global tobacco epidemic, 2008.

• British Sign Language.com This site uses moving pictures to show the basic signs for British Sign Language.

• British-Sign.co.uk Learn BLS online

• Learnbsl.org The home of British Sign Language resources published by Stories in the Air.

• Seehear - BBC Link BBC’s BSL information page

• Deafsign.com The No.1 resource for deafness and sign language

• Sign Language E-learning for the teaching of sign language

The new updated Child Health Promotion Programme : Pregnancy and the first five years of life (CHPP) builds on the children’s National Service Framework and is intended to provide preventative services tailored to the individual needs of children and families, acting as a best practice guide for children’s services.

It aims to:

• provide greater emphasis on promoting the health and well-being of children in the early stages – pregnancy and the first five years of life
• support a model of progressive universalism – a core programme for all children, with additional services for children and families with particular needs and risks
• encourage partnership working between different agencies on local service development (e.g. general practice and children’s centres)
• focus services on changing public health priorities - obesity, breast feeding, social and emotional development

The CHPP is a valuable tool for supporting commissioners to meet obligations on breast-feeding, obesity prevention, infant mortality and the 12-week antenatal assessment. This high quality programme will help meet these vital requirements, but also help to improve general health and well-being among children and families in the community.

Working for a healthier tomorrow from Working for Health identifies ten key challenges:

• The economic costs of sickness absence and worklessness associated with working age ill-health are over £100 billion a year
• The evidence base supporting the business case for investment in the health and well-being of their employees is inadequately understood by employers
• Lack of appropriate information and advice is the most common barrier to employers investing in the health and well-being of their employees.
• The importance of the physical and mental health of working age people in relation to
  personal, family and social attainment is insufficiently recognised in our society.
• GPs often feel ill-equipped to offer advice to their patients on remaining in or returning to work. Their training has to date not prepared them for this and, therefore, the work-related advice they do give, can be naturally cautious.
• The current sickness certification process focuses on what people cannot do, thereby
  institutionalising the belief that it is inappropriate to be at work unless 100% fit.
• There is insufficient access to support for patients in the early stages of sickness, including those with mental health conditions. GPs have inadequate options for referral and occupational health provision is disproportionately concentrated among a few large employers.
• The scale of the numbers on incapacity benefits represents an historical failure of healthcare and employment support for the workless in Britain.
• Detachment of occupational health from mainstream healthcare undermines holistic patient care.
• Existing departmental structures prevent Government from fully playing its part in meeting the challenges set out in this Review.

It also makes 10 recommendations:

• Government, healthcare professionals, employers, trades unions and all with an interest in the health of the working age population should adopt a new approach to health and work in Britain.
• Government should work with employers and representative bodies to develop a robust model for measuring and reporting on the benefits of employer investment in health and well-being. Employers should use this to report on health and well-being in the board room and company accounts.
• Government should initiate a business-led health and well-being consultancy service,
  offering tailored advice and support and access to occupational health support at a market rate, geared towards small business.
• Government should launch a major drive to promote understanding of the positive
  relationship between health and work among employers, healthcare professionals and the general public.
• GPs and other healthcare professionals should be supported to adapt the advice they provide, where appropriate doing all they can to help people enter, stay in or return to work.
• The paper-based sick note should be replaced with an electronic fit note, switching
  the focus to what people can do and improving communication between employers,
  employees and GPs.
• Government should pilot a new Fit for Work service based on case-managed,
  multidisciplinary support for patients in the early stages of sickness absence, with the aim of making access to work-related health support available to all – no longer the preserve of the few.
• When appropriate models for the Fit for Work service are established, access to the service should be open to those on incapacity benefits and other out-of-work benefits. This should integrate with with employment and skills programmes and Pathways to Work should cover all on incapacity benefits as soon as resources allow.
• An integrated approach to working-age health should be underpinned by: the inclusion of occupational health and vocational rehabilitation within mainstream healthcare.
• The existing cross-Government structure should be strengthened to incorporate the
  relevant functions of those departments whose policies influence the health of Britain’s working age population.
• The existing cross-Government structure should be strengthened to incorporate the
  relevant functions of those departments whose policies influence the health of Britain’s working age population.

Reducing Drug Use, Reducing Reoffending (summary)  from the UK Drug Policy Commission considers whether the evidence supports programmes in the UK for problem drug-using offenders in the criminal justice system (CJS).  It finds:

• The principle of using CJS-based interventions to encourage engagement with treatment is supported by the evidence.
• Following a period of expansion and a focus on quantity, attention should now focus on quality.
• “Net-widening” to include additional groups of drug-using offenders in CJS‑based interventions may have negative consequences.
• Community punishments are likely to be more appropriate than imprisonment for most problem drug-using offenders.
• Prison drug services frequently fall short of even minimum standards.
• Given the sizeable investment in CJS interventions for drug-dependent offenders, we know remarkably little about what works and for whom.

Some Evidence
There is evidence to support the use of drug courts; community sentences such as DTTOs and DRRs; prison-based therapeutic communities; opioid detoxification and methadone maintenance within prisons and the community; and the RAPt 12-step abstinence-based programme.

Mixed Evidence 

Mixed evidence exists for Criminal Justice Integrated Teams; Restrictions on Bail; and the added value of drug testing as part of a community order.

No Evidence 

CARAT interventions; drug-free wings; programmes based on cognitive behavioural therapy, such as short-duration programmes and ASRO (Addressing Substance Related Offending) programmes; conditional cautions; diversion from prosecution schemes; and Intervention Orders have no evidence to support their effectiveness.

In 2007 was invited by the Prime Minister and Secretary of State for Health to look at how UK experience and expertise in health could be used to best effect to help improve health in developing countries in terms of needs as identified and expressed by people from those countries and in order to add practical value to work already under way.  This resulted in the Crisp report Global health partnerships: the UK contribution to health in developing countries.  The formal response Global health partnerships - the Government response is now available.

Person or place-based policies to tackle disadvantage? Not knowing what works from the Joseph Rowntree Foundation looks at the effectiveness of policies introduced by the Labour government since 1997 to encourage employment, education and reducing income disadvantage, focusing on policies that explicitly take account of people and places.

It finds that person and place-based policies have mostly developed separately and often in isolation from each other. This separation does not reflect the relationships between places and the poverty and disadvantage of people who live in them.

Key findings

• Most policy interventions, whether person or place-targeted, had small, favourable impacts. In the rare cases where information on expenditure was available, costs were generally offset by savings to the Exchequer.
• Both forms of intervention had significant positive impacts on particular aspects of education results and employment. However, it was not possible to determine whether person or place-based policies were better, as they tended to have different objectives that prevented direct comparison.
• Some interventions had negative consequences for the average participant or detrimental effects on some groups of participants.
• It was rarely possible to explain properly how policy interventions worked or why they failed, because the way they were intended to work.
• Evaluators judged policies to have the greatest impact if they delivered individually tailored support to the most disadvantaged people with minimal complexity. The evaluators considered policies successful if they reflected local needs and priorities and were shaped by active engagement with stakeholders, including end users.

Community empowerment in practice: lessons from Communities First looks at community empowerment in local governance and service delivery which has become a key component of government policy in the UK. However, there are critical challenges to achieving this in practice. This research sees the Joseph Rowntree Foundation use 9 case studies to consider:

It considers:

• how far partnerships have developed and evolved to empower communities;

• the relationships communities have with other representative channels;

• the extent to which communities have influenced other agendas;

• the overall impact of regeneration partnerships.

It finds that:

• Community members responded positively to the opportunities for participation provided by Communities First and, as they began to recognise their own role in promoting positive change in their community, their confidence in their abilities increased.

• Community members brought varied skills and knowledge to the partnership process but required support to develop the skills required for effective partnership working.

• Levels of community engagement were improved by providing multiple routes to participation. Highly localised forums that fed into the partnership widened community empowerment and helped to support community members of the partnerships.

• Little evidence of community influence over statutory members of Communities First partnerships and no evidence of significant mainstream ‘programme bending’ where statutory agencies prioritised actions and expenditure in the Communities First partnership area.

• Clearer links are needed between strategic partnerships at ward level and those at the local authority level. Local Strategic Partnerships or Local Service Boards are not sufficiently local or connected to the community to facilitate effective community empowerment.

• Concludes that government will need to provide incentives and sanctions to promote a greater statutory sector response to processes of community empowerment. Consideration should be given to allocating specific functions and resources to local partnerships which they can deploy. The continued commitment of community members will be conditional on ‘purposeful’ community involvement.

Neighbourhood identity: People, time and place from the Joseph Rowntree Foundation considers the formation of neighbourhood identity and it’s potential impact on regeneration. The report focuses on:

• why regeneration policies often fail in their objectives;
• why the reputations of housing estates often display a remarkable longevity and resilience to change;
• how such reputations are established and understood by those in and outside particular areas;
• the implications these reputations have for the identities of neighbourhoods and the people who live in them.