English Health Service Research Articles

Reasons for incomplete STI vaccination among men who have sex with men in an English sexual health service.

In England, vaccination for human papillomavirus, hepatitis A, and hepatitis B is recommended for men who have sex with men (MSM). However, uptake is sub-optimal and some men do not complete all recommended vaccine doses. This service evaluation aimed to explore reasons for lack of uptake for each of these vaccines among MSM in one English sexual health service and to inform improvements in service delivery to increase full dose completion rates. MSM, ≥18 years, who had previously attended NHS Solent Sexual Health for at least one vaccination, and who had not completed the full dosing regimen for at least one of these vaccines, were invited to participate in an anonymous, online survey between 14/12/2020-11/04/2021. Among 246 MSM (M = 42.1 years), the most common reason for non-vaccination was that participants thought it was unneeded and had not been recommended by a doctor or healthcare provider. None reported vaccine hesitancy. Likewise, the most common reasons for vaccination were doctor/healthcare provider recommendation (51.7-65.6%) and self-protection (60.9-68.1%). The most common reason for not having completed the full course of vaccination was being unaware that the next dose was due (30.0-37.8%). Many participants who had not completed vaccination indicated that a doctor/healthcare provider recommendation would be a motivating factor and that reminder messages and being able to book subsequent appointments in advance would facilitate vaccination. Sexual health clinicians should be encouraged to discuss STI vaccination with MSM and services should explore possibilities to improve ease and access to vaccine appointments to increase uptake and completion rates.

Outcomes for surgical procedures funded by the English health service but carried out in public versus independent hospitals: a database study

BackgroundThe outcomes of elective surgery in public versus Independent Sector Healthcare Providers (ISHPs) are a matter of policy relevance and theoretical interest.MethodsRetrospective study of all National Health Service (NHS) hospitals...

Health and household surveys in Brazil and England: The National Health Survey and the Health Survey for England.

This paper aims to analyze the characteristics of national health surveys conducted in Brazil and England by their respective Statistics institutes. For Brazil, the National Health Survey (PNS) was considered, and the Health Survey for England (HSE) for England. To this end, we show a preliminary overview of the different population profiles of the two countries. Then, a brief historical background is presented, including the common themes that are addressed in the PNS and HSE that favor comparative analyses. Finally, we compared, for example, the inequalities in access to and use of Brazilian and English health services. The results show several possibilities for comparative analysis on topics such as health perception, tobacco use, alcohol consumption, diabetes, and hypertension. However, the need to consider the specificities of the population profile of each country and the methodological characteristics of the surveys is emphasized.

The Problem of Success and Failure in Public-private Innovation Partnerships

AbstractPublic-Private Innovation Partnerships (PPIPs) are increasingly used as a tool for addressing ‘wicked’ public sector challenges. ‘Innovation’ is, however, frequently treated as a ‘magic’ concept: used unreflexively, taken to be axiomatically ‘good’, and left undefined within policy programmes. Using McConnell’s framework of policy success and failure and a case study of a multi-level PPIP in the English health service (NHS Test Beds), this paper critically explores the implications of the mobilisation of innovation in PPIP policy and practice. We highlight how the interplay between levels (macro/micro and policy maker/recipient) can shape both emerging policies and their prospects for success or failure. The paper contributes to an understanding of PPIP success and failure by extending McConnell’s framework to explore inter-level effects between policy and innovation project, and demonstrating how the success of PPIP policy cannot be understood without recognising the particular political effects of ‘innovation’ on formulation and implementation.

Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services.

Objectives:To assess clinical metrics and resource use of a 30-minute point-of-care test (POCT) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) compared to laboratory-based testing.Methods:Three English sexual health services (SHSs) were recruited as part of a study. Existing processes for CT/NG testing and treatment were assessed, and adaptions to incorporate the CT/NG POCT were developed during semi-structured interviews. Staff time and consumables data were collected by clinic staff prior to and following introduction of the POCT.Results:SHSs selected patient groups for whom the CT/NG POCT would be used. Testing and treatment process data were collected for 225 patients (n = 118 POC; n = 107 standard). The percentage of patients receiving unnecessary CT treatment was 5% (5/95) and 13% (12/93) for POC and standard care respectively. The average CT/NG pathway cost varied and was on average £61.55 for POC and £50.88 for standard care. For the two SHSs where the POCT was used during a patient’s visit, for standard and POC respectively, the average time to CT treatment was 10.0 and 0.0 days and to NG treatment, 0.3 and 0.0 days.Conclusion:Use of a 30-minute POCT at three SHSs yielded clinical benefits by reducing time to treatment and unnecessary CT treatment.

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults: Guideline V. Assessment of Cultural Factors.

(Excerpted from "The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition." Copyright © 2016, American Psychiatric Association. Reprinted with permission.).

An observational study of the use of acute hospital care by people with intellectual disabilities in England.

Providing safe, high-quality admitted-patient care for people with intellectual disabilities (IDs) requires consideration for their special needs particularly in relation to communication and consent. To make allowance for these special requirements, it would be helpful for hospitals to know how often they are likely to arise. This study set out to identify the amount and patterns of use of acute, non-psychiatric hospital admitted-patient care in England by people with ID. Patterns are considered in relation to clinical specialties, modes of admission (emergency or planned) and life stages (children and young people, working age and older adults). In each case, patterns for people with ID are compared with patterns for those without. Descriptive observational study using a major general practitioner (GP) research database (Clinical Practice Research Datalink GOLD) linked to routine national statistical records of admitted-patient care. Overall people identified by their GP as having ID had higher rates of admitted-patient care episodes and longer durations of stay than those without. Differences varied considerably between clinical specialties with rates more elevated in medical and paediatric than surgical specialties. Admitted-patient care rates for women with ID in obstetrics and gynaecology were lower than for other women, while rates for admitted-patient dental care were much higher for both men and women with ID. In an average English health administrative area with a local population of 250000 people, at any time, there are likely to be approximately 670 people receiving acute admitted-patient care. Approximately six of these are likely to have been identified by their GP as having ID. At 0.9% of hospital in-patients, this is just under twice the proportion in the population. Our figures are likely to be an underestimate as GP identification of people with ID is known to be far from complete. However, they indicate that the number of people with ID in acute hospital settings is likely to be substantially more than a recent survey of English health services indicated they were aware of. The study is intended to help guide expectations for acute hospitals seeking to audit the completeness of their identification of people with ID and to indicate their likely distribution between clinical specialties.

Limited English Proficiency and Health Service Use in Asian Americans.

The present study examined the extent to which limited English proficiency (LEP) poses a risk to health service use in Asian Americans. With data drawn from the 2015 Asian American Quality of Life Survey (N = 2594), logistic regression was used to model the odds for four outcomes (no usual place for care, no regular check-up, unmet needs for medical care, and communication problems in healthcare settings). More than 62% of the sample had LEP. In the group with LEP, the odds of not having usual place for care increased by 2.09 times, of not having regular check-up by 1.69 times, of having unmet needs for medical care by 1.89 times, and of having communication problems in healthcare settings by 4.95 times. The findings highlight the vulnerabilities of Asian Americans with LEP in health service use and provide implications for health planning and interventions.

Attitudes to, and experience of, pooled sampling for sexually transmitted infection testing: a web-based survey of English sexual health services.

Chlamydia trachomatis and Neisseria gonorrhoeae testing guidance recommends extragenital screening with locally validated nucleic acid amplification tests, with anatomical sites tested separately. Evidence supports multi-patient combined aliquot pooled sampling (PS) for population screening; evidence for within-patient PS is sparse. Within-patient PS could be more cost-effective for triple-site testing, but requires distinct clinical pathways and consideration over loss of information to guide risk assessments and treatment. We explored PS attitudes and practices amongst clinicians in England. A cross-sectional web-based survey was distributed to clinical leads of sexual health services throughout England in February 2016. Fifty-two (52/216, 23%) services responded. One service reported current within-patient PS and two were awaiting implementation. Of the 49 services not pooling, five were considering implementation. Concerns raised included the inability to distinguish infection site(s) (36/52, 69%), absence of national guidance (34/52, 65%) and reduced assay performance (18/52, 34%). Only 8/52 (15%) considered the current level of evidence sufficient to support PS, with 40/52 (77%) requesting further validation studies and 39/52 (77%) national guidance. PS was rarely used by respondents to this survey, although the response rate was low. The clinical challenges presented by PS need to be addressed through further development of the evidence base.

Coping with stigma and discrimination: evidence from mental health service users in England.

Mental health stigma and discrimination are significant problems. Common coping orientations include: concealing mental health problems, challenging others and educating others. We describe the use of common stigma coping orientations and explain variations within a sample of English mental health service users. Cross-sectional survey data were collected as part of the Viewpoint survey of mental health service users' experiences of discrimination (n = 3005). Linear regression analyses were carried out to identify factors associated with the three stigma coping orientations. The most common coping orientation was to conceal mental health problems (73%), which was strongly associated with anticipated discrimination. Only 51% ever challenged others because of discriminating behaviour, this being related to experienced discrimination, but also to higher confidence to tackle stigma. Although stigma coping orientations vary by context, individuals often choose to conceal problems, which is associated with greater anticipated and experienced discrimination and less confidence to challenge stigma. The direction of this association requires further investigation.

Educating professionals to support self-management in people with asthma or diabetes: protocol for a systematic review and scoping exercise

IntroductionSupported self-management for asthma helps people adjust their treatment in response to symptom changes. This improves day-to-day control and reduces the risk of asthma attacks and the need for emergency...

Support networks for Chinese older immigrants accessing English health and social care services: the concept of Bridge People.

As Chinese immigrants in the United Kingdom age, they experience an increasing need to access health and care services. It has, however, been reported that older Chinese immigrants have difficulties in accessing these services. This study explored the experiences of this population in using health and care services and the strategies that they adopted to address their difficulties. A grounded theory method with a two-staged research design was used. Stage 1 explored the participants' experiences of ageing and use of health and social care services through focus group interviews. Stage 2 investigated the strategies individuals used to support access to and use of services through individual interviews. Forty-four older Chinese people and 15 supporters participated in interviews during August 2011 and May 2013. These older Chinese immigrants were challenged in knowing about and in accessing services. Their difficulties were attributed to language barriers, lack of information and instrumental support, and emotional and cultural issues regarding use of health and care services. Their supporters facilitated access to services and acted as a bridge between the service and the user; therefore, they were given the title 'Bridge People'. Bridge People have different backgrounds: family and friends, public sector workers and staff from community-based Chinese organisations. The defining attributes of these supporters were: bilinguality, bicultural, multifunctionality and accessibility. There is no charge for this support; and the relationship between the Bridge Person and recipient involves trust and influence over decisions regarding use of health and care services. Bridge People should be recognised and identified by health, social care and housing services to promote engagement and use of services by older immigrant Chinese people.

Market-access agreements for anti-cancer drugs.

Newly marketed pharmaceuticals command increasingly high prices, particularly in oncology where single treatment cycles can be very costly, even though data at market approval are usually inadequate to describe thoroughly their effectiveness and cost-effectiveness. Both manufacturers and payers have shown interest in solutions to achieve rapid access for patients – known as ‘market-access agreements’. Although the literature offers a variety of definitions, these agreements can be roughly grouped under two main types: financial-based and performance-based. Financial-based schemes focus on the budget impact of a new drug and usually consist of price/dose discounts. Performancebased schemes involve collecting clinical evidence once a new drug has been marketed in a healthcare system and lead to payment only for patients responding to therapy, an objective which is methodologically and practically challenging while not without political appeal. The underlying strategy is to help reduce the likelihood of payers adopting technologies that turn out not to be cost-effective, while at the same time helping manufacturers increase market access time and take profit. Market-access agreements can also be considered an opportunistic way for manufacturers to keep official prices high such as maintaining a common European price, while granting health authorities confidential rebates, thus preventing parallel trade and undermining effective external reference pricing. The English and Italian health services have been the first countries to introduce market-access agreements on specific drugs. These contracts are now called Managed Entry Agreements (MEA) in Italy and Patient Access Schemes (PAS) in England and Wales. We focus on the area of oncology, where many new drugs are costly and fall under these arrangements. Italy

When does marketisation lead to privatisation? Profit-making in English health services after the 2012 Health and Social Care Act

Governments world-wide have attempted to use market mechanisms and privatisation to increase the quality and/or reduce the cost of healthcare. England's Health and Social Care Act 2012 is an attempt to promote privatisation through marketisation in the National Health Service (NHS). While the health policy literature tends to assume that privatisation follows from private-sector entry points, we argue that this is more likely if firms expect to make a profit. This paper examines the link between privatisation and marketisation in England drawing on 32 semi-structured interviews with private-sector and public-sector respondents, campaigners, and other experts conducted 6–10 months after the implementation of the 2012 Act.By generating a theoretical framework on the conditions of profitability we seek a better understanding of the conditions under which marketisation leads to privatisation. We find that significant barriers to profit-making remain after the reforms, including a top-down squeeze on prices, uncertainty in market rules, state dominance of funding and provision, and failures to depoliticise the market. These factors restrict private-sector involvement by frustrating profit-making. Where profits are made they are through reduced unit costs and high volumes by a longstanding incumbent in a particular market segment. This, however, restricts marketisation by reinforcing entry barriers.

Health Impact Assessment of long-term exposure to particulate air pollution: methodological and practical considerations.

Background Quantitative Health Impact Assessment (HIA) aims to create predictions of the impacts on health of changes in the human environment. Typically, this requires the assessor to bring together data on the environmental changes envisaged, the populations affected, and the health outcomes likely to be impacted by the changes. At the heart of the calculations will be a concentration-(or exposure- or dose-)response coefficient or function, quantifying how environmental change is expected to increase or decrease the rate of the health outcome in the population. Any HIA requires clear statements of the question(s) being asked: are we interested in quantifying the current health burden against a (counterfactual) cleaner scenario; or is our focus the future effects of policy changes; or perhaps both? Methods It’s been widely accepted that particulate air pollution affects mortality: although other health effects are also related, mortality dominates multiple-outcome assessments. Recent evidence has accumulated that points to risks for cardiovascular death in particular. HIAs based on mortality usually rely on the application of life-table methods to predict changes in life expectancy, but burden calculations require many assumptions, and predictions about the future many more. These, and the availability of input data for calculations, will inform the design of a HIA. These issues have arisen in EU projects such as CAFE and HEIMTSA; in work for the UK government’s Committee on the Effects of Air Pollutants (COMEAP) e.g. for their report of 2010; and as part of the English health service’s localisation agenda. Many of the issues involved will be illustrated in detail in the context of case studies of the health effects of transport policies on cities, within the current EU project TRANSPHORM.

The impact of national policy on the early diagnosis of cancer

Since the mid-90s UK governments and other policy makers have sought to develop policy that addresses the need for improved outcomes for people diagnosed with cancer. However, the strategies for cancer in Scotland, Wales and Northern Ireland are different to the policy on cancer produced under the English government. This article will examine policy developments in the English health service aimed at achieving early diagnosis of cancer with particular reference to the Cancer Reform Strategy (2007). The role of socioeconomic factors and the need for policy to address a range of cancers due to their differences in pathology and therefore diagnosis and treatment will also be considered.

Abstracts, Poster Presentation

Scenario Planning (SP) is a powerful methodology initially developed as a strategic management tool for commercial companies and is now widely used in policy settings, for future focused research in urban planning, energy production and disaster management, amongst others. It is, we believe, is also highly relevant to healthcare policy and management. SP has however been described as suffering from methodological chaos (Martelli, 2001). Also, much of the methodological development of SP is set in the practitioner domain. Researchers need to use this learning but in ways that meet academic standards. This paper presents a critical review of Scenario Planning (SP) as a research methodology, considering SP as a research strategy, associated methods and criteria by which SP may be evaluated. The review is framed around a practical example – a study to investigate the (non)adoption of RFID in the English health service. Currently, RFID adoption in the NHS is limited to isolated pilot projects. Assessment of potential costs and benefits and adoption trajectories requires an understanding of ‘alternative futures’, developed using a wide range of sources and techniques. This paper’s contribution to healthcare management research is the evaluation of SP as powerful planning and research tool, with suggestions on how certain practical challenges may be addressed. The contribution to futures studies is in a closer alignment of the methods of SP to the standards of high quality research. We welcome the opportunity to discuss the potential contribution of SP research to healthcare management in domains beyond IT/IS adoption.

About-face? About time

Voters are used to seeing their political leaders perform U-turns, and do not always view them as a sign of weakness. Whether the Liberal Democrat leader and deputy prime minister Nick Clegg will get away with his about-face on reforming the English health service remains to be seen.

Public Service Leaders as ‘Change Agents’ – for Whom?

This article examines how far senior staff in English educational and health service organizations view themselves as leaders who are ‘change agents’ for government-driven reform and independent change agendas. The contribution of external leadership development provision to shaping these self-perceptions is explored. Special attention is paid to national leadership development bodies with different degrees of formal association with government. Whatever this relationship, such provision and other development support apparently reinforced a strong sense of personal agency (choice of action) associated with being a leader, empowering senior staff to adopt a modestly mediatory stance towards both reform and leadership development provision.

The importance of being efficacious: English health and social care partnerships and service user outcomes

The need for health and social care agencies and their professionals to work in partnership is a central component of contemporary English health and social care policy. Partnership is predicated on the notion that this way of working improves services and outcomes for service users. However, as there is little evidence that partnerships improve service user outcomes, some commentators suggest that this indicates either a failure of the policy or a deficit in terms of implementation. This thesis investigates the link between health and social care partnerships and service user outcomes. Rather than adopting the types of rationalist and instrumental approach which the majority of studies in this field have done, the thesis develops a new conceptual framework for partnership which is interpretive and performative. This framework is developed and tested in four exploratory case study sites and concludes that partnership is not necessarily simply an instrument of improvement in a traditional sense. The power of partnership lies in its cultural and symbolic value. This takes partnership beyond traditional discussions of partnership and governance; rather than representing a particular mode of governance, instead arguing that partnership is an active tool of governance.