Department Of Health And Social Security Research Articles

The politics of health policy knowledge transfer: the evolution of the role of British health economics academic units

Economics is now central to health policy decision making, within government departments and the National Health Service. We examine how and why a health economics academic unit – the Centre for Health Economics (CHE) at the University of York, England – was created in 1983, funded and commissioned to provide research evidence to the British government, specifically the Department of Health and Social Security (DHSS) and its successors. Building on the knowledge transfer literature, we document the origins of this relationship and the different strategies deployed by successive governments and researchers. This paper demonstrates the value of historical methodologies such as oral history and textual analysis that highlight the limitations of existing knowledge transfer theories, by foregrounding the role of politics via the construction of individual relationships between academics and policy-makers.

'Modernization of Our Hospital System': The National Health Service, the Hospital Plan, and the 'Harness' Programme, 1962-77.

This article augments the literature on the British experience of planning by examining attempts to plan the hospital system between 1962 and 1977. The Hospital Plan for England and Wales of 1962 proposed the construction of a suite of new 'District General Hospitals'. Underpinning this proposal was a belief in the value of standardized designs and construction methods, both of which were subsequently investigated in detail by the Ministry of Health and the Department of Health and Social Security (DHSS). The history of this project reveals the challenges of putting centralized planning into practice. Yet while the standardization programme was scaled back in 1975, the article suggests that the drive to 'plan' modern Britain perhaps lasted longer than might initially be thought, into the 1980s, with implications for the way that the broader history of this period is framed.

Women’s perceptions of a midwife’s role: An initial investigation

The role of the midwife has evolved over the years, influenced by a number of social, political and educational factors ( Department of Health and Social Security (DHSS), 1970 ; Her Majesty’s Stationery Office (HMSO), 1984 ; Tew, 1986 ; Donnison, 1988 , Department of Health (DH), 1993 ; Kitzinger, 2005 ; DH, 2007 ; National Institute for Health and Clinical Excellence (NICE), 2008 ). However, little is known about how the contemporary role of the midwife is perceived ( Lavender and Chappie, 2002 ). Some changes were not based on any evidence or health economics (DHSS, 1970; HMSO, 1984). Health costs have predominantly been based on the cost of service provision, rather than costs of unnecessary intervention being considered. The Birthplace study did take into account health economics including intervention costs (Shroeder et al, 2012); therefore, if service changes are made to reflect the benefit of health economics with the new maternity pathway payments (DH, 2012), this may impact on how the role of the midwife is perceived in the future. This qualitative study was conducted to gain understanding of women’s perceptions of the role of the midwife. Four focus groups were conducted (n=9) to identify perceptions of the midwife’s role from women experiencing care from different care providers; women in different periods of their childbearing experience; women who had previous experience of childbearing; and those who had no previous experience of childbearing. Thematic analysis of the transcripts identified four themes: empowerment influence of midwives; influences of media, friends and family; role of monitoring and technology; and influence of doctors. The conclusion was that the model of care and care provider influenced women’s perceptions of the role of the midwife. Women experiencing a consultant-led model of care viewed the role differently to those experiencing amidwifery-led model.

Do We Really Need to Thank the Beatles for the Financing of the Development of the Computed Tomography Scanner?

It is commonly believed that the revenues from the selling of the Beatles' records by Electric and Musical Industries (EMI) allowed the company to develop the computed tomography (CT) scanner. Some went to define this as the Beatles' gift to medicine. However, significant controversies and discrepancies arise from analysis of this statement, making its correctness doubtful. The details of financing required for the CT development and the part of EMI in financial input have never been publicly announced. This work analyzes the financial contributions to the CT development and investigates if the revenues received from the sales of the Beatles' records were used for the creation of the CT scanner. Timeline of the development of the EMI CT scanner and the financial inputs of EMI and British Department of Health and Social Security (DHSS) were assessed. Without salary expenses to Godfrey Hounsfield and his team, the development of the CT scanner cost EMI approximately £100,000. The British DHSS's expenses were £606,000. Hence, the financial contribution of DHSS into the development of the CT scanner was significantly bigger than that of EMI. Accordingly, British tax payers and officials of British DHSS are to be thanked for the CT scanner. The Beatles' input into the world's culture is valuable and does not require decoration by nonexistent connection to the development of CT. A positive aspect to this misconception is that it keeps in public memory the name of the company that developed the CT scanner.

Optimized Conditions of Model Processing for Ready-to-eat Style Galbi-jjim Prepared by Sous-vide and Cook-chill System

To develop ready-to-eat (RTE) style Korean traditional Galbi-jjim, the optimal conditions for sous-vide cooking and cookchill preparation and the sensory properties of the cooked products were investigated. During heating, the meat core temperatures reached within 30 min and 45 min when a water bath and combination oven were used, respectively. Chilling to within 45 min was conducted to meet the standards for microbiological safety set by the UK Department of Health and Social Security (DHSS) Guideline. Galbi-jjim that was vacuum-cooked in a water bath was much more tender than that of Galbi-jjim prepared using the cook-chill method, but had no difference in any reheating methods. The average sensory scores of juiciness and the overall acceptance of Galbi-jjim were significantly higher when water bath cooking was used, and there were no differences in reheating methods. In conclusion, the serial methods of sous-vide processing and rapid chilling can be applied to produce RTE traditional Galbi-jjim, and this can be conducted while meeting the standards specified in safety guidelines.

Implementing a clinical academic career pathway in nursing: criteria for success and challenges ahead

The UK Clinical Research Collaboration’s (UKCRC) proposals for new arrangements aimed at making it easier—or possible—for nurses and midwives to combine research and clinical careers have raised levels of excitement within the profession. On a good day, it feels like nursing and midwiferya are steadily becoming more research savvy, both in terms of the research-mindedness of those delivering and managing care and a growing capacity to get research grants, do useful research and supervise research students. And these proposals are part of the good news in that regard. On a not so good day, these initiatives feel piecemeal, hard to make sustainable and only going a very small way to realise the potential of research within and around nursing activity. There have been other capacity-building schemes. In the late 1960s, the English Department of Health and Social Security (DHSS) proposed and funded the ‘Study of Nursing Care’ programme of research, which produced seminal works and started the research careers of a number of individuals who became some of the profession’s first research leaders such as Jean McFarlane, the first Professor of Nursing in England. Further DHSS fellowships were awarded in subsequent decades also giving a significant boost to another wave of future research leaders. More recently, we have seen the Health Foundation Fellowship and Partnership schemes, which have funded the research (and leadership training) of around 30 young researchers, and a funding alliance between the English Department of Health and the Higher Education Funding Council for England aimed at developing research capacity in nursing and the Allied Health Professions. In Scotland, the predecessor bodies to the Scottish Funding Council continually invested in research in these professions and benefits have been identified in a number of scoping exercises such as that described by Alison Tierney summarised at http://www.sehd.scot.nhs.uk/cso/Publications/rm35/rm35-00.htm. The present UKCRC proposal, like the Scottish approach, has featured arrangements to enable and encourage the forming of links between universities and the Journal of Research in Nursing ©2008 SAGE PUBLICATIONS Los Angeles, London, New Delhi and Singapore VOL 00 (00) 1–3 DOI: 10.1177/ 1744987108101952

Admission guidelines for head injuries: variance with clinical practice in accident and emergency units in the UK.

Guidelines for the initial management of head injuries were formulated by neurosurgeons and a multidisciplinary group of clinicians and administrators attending a seminar convened by the UK Department of Health and Social Security (DHSS). Analysis of data collected previously by the Royal College of Radiologists in nine accident and emergency units in the UK shows that admitting practice varied between centres and was very different from that recommended subsequently in the guidelines. Only 49 per cent (range 22 to 71 per cent) of patients who had skull X-rays and possessed symptoms and signs warranting admission were admitted to hospital and 14 per cent (range 1 to 20 per cent) of those without appropriate symptoms and signs were admitted. Rates of admission for patients with a history of unconsciousness, which according to the guidelines is not a criterion for admission, were up to ten-fold higher than for comparable patients with no such history. Implementation of the guidelines could have a substantial effect on clinical practice and could reduce admissions of patients who had skull X-rays by up to 46 per cent.

Ideology, Social Science, and Public Policy: The Debate over Transmitted Deprivation

In June 1972, Sir Keith Joseph, then Secretary of State for Social Services, referred in a speech to a ‘cycle of deprivation’, and a large-scale Department of Health and Social Security (DHSS)–Social Science Research Council (SSRC) Research Programme on Transmitted Deprivation was established. Earlier work has explored the cycle speech and Research Programme with regard to the history of the concept of the ‘underclass’, the career of Keith Joseph himself and his subsequent attitude to the SSRC, and in terms of the links with New Labour's focus on ‘cycles of disadvantage’. Nevertheless, in general, both have been neglected by historians. This article explores the origins of the 1972 speech, noting continuities between the cycle and Sir Keith's earlier concern with ‘problem families’, and placing it in the context of wider thinking on family planning and poverty. It traces the establishment of the DHSS–SSRC Research Programme, and examines tensions between civil servants and social science researchers, and within the SSRC itself. The article argues that the cycle speech and Research Programme are important and neglected aspects of contemporary history, illustrating significant continuities in late nineteenth and twentieth-century thought on poverty, and offering intriguing insights into the outlook of a generation of social scientists.

Bringing practice up to date: progress with nurse prescribing

Baroness Cumberlege (2003) has described the introduction of nurse prescribing in the United Kingdom. Her report on Neighbourhood Nursing (Department of Health and Social Security (DHSS), 1986) was followed by the establishment of an Advisory Group on Nurse Prescribing, which was asked to consider the extension of prescribing rights to nurses working in the community. The key recommendation of the Advisory Group's report (Department of Health (DH), 1993) was that specially trained district nurses and health visitors should be able to prescribe from a limited list of products. The legislation to implement this was passed in 1992. There followed a prolonged series of pilots, aimed at establishing the clinical effectiveness and economic impact of nurse prescribing. The national roll-out of this programme was not completed until 1998.

Legal aspects of consent 8: children under the age of 16 years.

Case Scenario: Mrs Gillick questioned the lawfulness of the Department of Health and Social Security (DHSS) circular HN[80]46 which was a revised version of part of a comprehensive memorandum of guidance on family planning services issued to health authorities in May 1974 under cover of circular HSC(IS)32. The circular stated that in certain circumstances a doctor could lawfully prescribe contraception for a girl under 16 without the consent of the parents. Mrs Gillick wrote to the acting administrator formally forbidding any medical staff employed by the Norfolk Area Health Authority (AHA) to give 'any contraceptive or abortion advice or treatment whatever to my daughters whilst they are under 16 years without my consent.' The administrator replied that the treatment prescribed by a doctor is a matter for the doctor's clinical judgement, taking into account all the factors of the case. Mrs Gillick, who had five daughters, brought an action against the AHA and the DHSS seeking a declaration that the notice gave advice which was unlawful and wrong and which did or might adversely affect the welfare of her children, her right as a parent and her ability to discharge properly her duties as a parent. She sought a declaration that no doctor or other professional person employed by the health authority might give any contraceptive or abortion advice or treatment to any of her children below the age of 16 without her previous knowledge and consent. Gillick v. West Norfolk and Wisbech AHA and the DHSS [1985].

Nurse prescribing: the sensible way forward?

The Government is intent on bringing in limited prescribing for nurses as part of its drive to improve and develop the NHS. However, do nurses really understand the implications of what they are embarking on? Prescribing should be directed at knowledgeable and experienced clinical nurses who will benefit patients and clients by being able to prescribe. In 1986, Baroness Julia Cumberlege, who chaired a government study into the nursing services provided outside hospital, was convinced that the government should, ‘agree a limited list of items and simple agents which may be prescribed by nurses as part of a nursing care programme and issue guidelines to enable nurses to control drug dosage in well defined circumstances’ (Department of Health and Social Security (DHSS), 1986).

Task force to review services for drug misusers

In the past ten years there has been enormousgrowth in the size and the range of services forpeople who misuse illicit drugs. The blueprint forservice development was a report from theAdvisory Council on the Misuse ofDrugs entitledTreatment and Rehabilitation (Department ofHealth and Social Security, 1982). In response,growth of the non-statutory sector was particularly encouraged and the whole venture wasfunded through a series of Department of Healthinitiatives aimed at both the prevention of thespread ofHIVinfection and the ofdrugdependence. The time was right in the mid-1980s for the renaissance of harm reduction.The government was willing to accept anymeasures to prevent an AIDS epidemic, non-statutory agencies were in the ascendancy, andthe fieldlacked any convincing viewon treatmenteffectiveness. Guidance from the Advisory Council on the Misuse ofDrugs (Department ofHealthand Social Security, 1988; Department ofHealth, 1993), however, was careful not toendorse wholesale adoption of a harm reductionapproach, but rather to see, for example, needleand syringe exchange schemes and substituteprescribing as useful elements of a public healthstrategy which both contained the spread of HIVand initiated the process of becoming drug free.The Department of Health has run an effectiveHIV control programme but, as perceptions ofrisk from HIV have diminished, new concernshave come onto the drugs agenda for the late1990s. Fear of an AIDS epidemic has beenreplaced by fears of criminal activity, and thependulum has again swung against too liberal aninterpretation of harm reduction. Prescribingdrugs for drug misusers has always beencontentious and expensive; therefore, a reversalofthe harm reduction policywas expected when,in 1994, Ministers set up a task force to reviewthe effectiveness ofservices . . in relation to theprincipal objective of assisting drug users toachieve and maintain a drug free state ...(Department of Health, 1996a). The task forceconsisted of 11 members.Tackling Drugs Together (Department ofHealth, 1995) committed the Department ofHealth to produce purchasing guidance for1997-1998, based on the task force review.Tackling Drugs Together identified a reductionin the acceptability and availability of drugs toyoung people, an increase in the safety ofcommunities from drug-related crime, and areduction in the health risks and other damagerelated to drug misuse as key elements ofgovernment strategy. In response, the task forceset out to map and categorise existing services,and to conduct a multi-centre study of treatmentprocesses and outcomes, referred to as NTORS(National Treatment Outcome Study). NTORSisa prospective, uncontrolled trial which hasrecruited 1110 subjects. The central finding fromNTORSso far is that treatment works in termsof reducing drug involvement, improving health,reducing criminal activity, and improving psychological well-being.All four modalities investigated (in-patient, residentialrehabilitation, methadone maintenance andmethadone reduction) have shown benefit, maintained at six-month follow-up.It is of interest formental health workers that the percentage ofpeople reporting feeling hopeless about thefuture fell from 63 to 44% and those expressingsuicidal thoughts from 29 to 16%.The follow-upwill continue for fiveyears.The task force is imprecise in categorisingmethadone programmes and is content thatany prescribing programme delivers both socialand health benefits. However, Raistrick (1997)has argued that the specific purposes of substitute prescribing must be understood by bothpurchasers and providers. These purposes, mostsimply characterised as social control, individualtreatment of dependence and protection of thepublic health, have implications for the source offinance, case management and service deliverysystems. The Amsterdam model (Plomp et al,1996) has successfully operationalised roles forgeneral psychiatrists, general practitioners andpsychiatrists specialising in substance misuse,and recognises that doctors are used to caring forindividuals rather than acting as agents of socialpolicy. Clarity of purpose should form the basisof substitute prescribing.Surprisingly the task force rather neglects therole of the general psychiatrist. This is

The effects of policy changes on community nurses

National Health Service (NHS) reforms have sought to refocus the purpose of health care by shifting the provision and commissioning of health services from the secondary to the primary care sector (Department of Health and Social Security (DHSS) 1987, the NHS and Community Care Act 1990, Department of Health (DoH) 1989, 1992a). However, short termism in policy making has tended to create health care policies which are often unconnected and divergent in their implications (Williams et al 1993, Salter 1994). As a result, community nurses are having to manage such contradictions in a general management structure where access to professional leadership is increasingly elusive (Kitching 1993). This paper explores some of the impact of these reforms on the organisation of patient care and examines the role of community nurses within a primary care led NHS.

Variation in Operation of English Child Protection Registers

SUMMARY English child protection register statistics reveal wide and persistent variations between authorities, but over time their rank order remains moderately stable. Socio demographic characteristics of areas combined with differing policies and practices in keeping the register have been found to explain much of the variability. While statistics of children on registers are not valid measures of the incidence of child maltreatment, registers themselves appear to play a useful part in local child protection systems. FUNCTION OF CHILD PROTECTION REGISTERS Child protection registers in England came into being as one of three main means of improving inter-agency communication in the handling of 'non-accidental injury' to children. In 1974, following the Inquiry into the death of Maria Colwell, the Department of Health and Social Security (DHSS) advised local and health authorities to form Area Review Committees (now Area Child Protection Committees) to over see local policy and training arrangements; to ensure that case confer ences were held following every suspected case; and to set up a 'central record of information' (the register) which was 'essential to good com munication between the many disciplines involved' (DHSS, 1974). In contrast to the system of mandatory reporting established in the USA, no legal duty to report cases was established in the UK, but the government laid down procedures for agencies to follow (DHSS, 1976; 1980). At this stage registers were still seen mainly as tools to aid inter agency communication, especially in the early identification of cases, and as sources of data for management and research purposes. Their usefulness was disputed: it was reported that they were not much used by local professionals in many areas—which obviously

Historical experiments predating commercially available computed tomography.

Computed tomography (CT) was a revolution in radiology. Commercially available CT scanners appeared in 1972, a joint effort between the EMI Company, Atkinson Morley's Hospital, London and the Department of Health and Social Security (DHSS). The name of Sir Godfrey Hounsfield will always be associated with these developments. Like most developments in science the breakthrough came by standing on the shoulders of giants and many experiments can, with the curious wisdom of hindsight, be considered precursors to CT. Gabriel Frank's patent in 1940 showed apparatus for back-projection CT and Takahashi developed equipment in the 1940s for reconstructing from a sinogram; in both cases using an optical "computer". A medical CT scanner was reportedly constructed in 1957 in Kiev. Transmission CT was performed by Kuhl in 1965. Cormack built an experimental scanner in 1963. Oldendorf identified what was needed for successful CT as early as 1960. Throughout the 1960s a host of independent workers were busy on the mathematical problems of reconstructing from projections with both medical scanning and non-medical applications in mind. Experiments in early emission tomography influenced the development of CT. With imagination one can even see how close "classical" tomography, as started even before 1920, came to the realization of CT. The pioneering British radiographer Watson stands out from a galaxy of inventors. The lecture at Radiology and Oncology '91 in Brighton was a thumbnail sketch of the origins of radiological CT. A fuller story is told elsewhere (Webb, 1990).

Mortality associated with captopril and enalapril: a report from the DHSS Hypertension Care Computing Project

In 1986, the Committee on Safety of Medicines published a report suggesting that enalapril may have an adverse effect on renal function. The prescription event monitoring scheme subsequently published figures on adverse drug reactions and mortality for patients treated with enalapril. They concluded that enalapril did not have an adverse effect on renal function and survival. Similar data were not available for captopril, as the drug was marketed before prescription event monitoring had been developed. In the Department of Health and Social Security (DHSS) Hypertension Care Computing Project (DHCCP), 368 hypertensive patients treated with captopril and 371 treated with enalapril were followed for an average of 3.1 and 1.6 years, respectively. Thirty-two patients died; none had renal failure as an underlying cause of death. The death rate was similar in both drug groups, at 17.5 (enalapril) and 24.0 (captopril) per 1000 patient-years. The present report shows that, for patients treated for high blood pressure, the relative risk of mortality with captopril compared with enalapril was 1.37, an insignificant difference (95% confidence interval 0.63, 2.98).

Long term domiciliary oxygen treatment for chronic respiratory failure reviewed.

The use of long term domiciliary oxygen therapy in the Sheffield area from June to August 1987 has been surveyed. Of the 74 patients prescribed long term domiciliary oxygen therapy, 64 were visited at home. These had arterial blood gas tensions or oxygen saturation measured (while breathing oxygen and air), and the indications for long term domiciliary oxygen therapy were examined retrospectively. Fifty two patients had chronic bronchitis and emphysema, the remainder having pneumoconiosis, bronchiectasis, fibrosing alveolitis, and congestive cardiac failure. Of the 54 cases where indications for treatment could be compared with the Department of Health and Social Security (DHSS) guidelines, only 23 (43%) met the full DHSS criteria before the start of treatment. The median length of treatment was 16 months. At follow up 51 patients had an arterial oxygen tension (PaO2) greater than 8.0 kPa when breathing oxygen. They had a significantly higher PaO2 when breathing air than before long term oxygen therapy (6.7 (SD 1.2) kPa before oxygen treatment, 7.6 (1.4) kPa on reassessment). A similar change was seen in the 23 patients assessed as recommended by the DHSS (6.1 (0.8) kPa; 7.2 (1.2]. PaO2 during the breathing of air was less than 7.3 kPa at reassessment in only 21 (33%) patients. Thirteen patients had carboxyhaemoglobin concentrations above 2.5%, the 95th centile of the distribution in nonsmokers in the laboratory.

Compulsory Screening: advertising AIDS in Britain, 1986-89

Since 1986 we have witnessed a succession of mass media campaigns that have aimed to provide information about HIV infection and AIDS. From the now notorious Department of Health and Social Security (DHSS) iceberg and tombstone motifs designed to imprint the word ‘AIDS’ on the ‘general public’ consciousness, to the Health Education Authority’s (HEA’s) attempts to address the ‘realities’ of heterosexual sexual behaviour, the campaigns have been widely criticised both for their reliance upon fear tactics and for not meeting their ostensible aims of changing behaviour. In this paper we will propose that not only is this due to inherent contradictions in the use of the advertising media for the purposes of health education, but also that the real impetus of the campaigns has not been educational at all.

Visual impairment training reviewed

Summary A two‐and‐a‐half‐year research project commissioned by the Department of Health and Social Security (DHSS) was completed in April 1988. It involved a study of the training provided for workers with the visually impaired ‐ Mobility Officers (MOs) and Technical Officers (TOs) ‐ and the work carried out by them. The purpose of the research was to clarify how the training related to the requirements of the work in terms of social services provision and the needs of visually impaired people. The outcome of this work was the report, Beyond Vision: training for work with visually impaired people, (Maychell, forthcoming). This article summarizes the key issues of the report.

The role of confidential enquiries in the reduction of maternal mortality and alternatives to this approach

The aim of confidential enquiries into maternal deaths is to identify weaknesses in the maternal health care system with a view to remedying them. The method of confidential enquiry is explained using the British system as an example. The reasons why this apparently useful practice is not more widely adopted can in some countries include fears of litigation or lack of trust in confidentiality. Alternative approaches to maternal death audit are discussed.