Health Services In England Research Articles

A Qualitative Service Evaluation of the Introduction of Single Session Therapy for Families in a Child and Adolescent Mental Health Service in England, United Kingdom.

This service evaluation details the process of introducing Single Session Therapy (SST) with families to a Child and Adolescent Mental Health Service in the United Kingdom. SST is a model of short-term psychotherapy intervention which can be applied to family contexts to provide timely mental health support. This service evaluation had two objectives: (1) Review the existing evidence base and literature for SST. (2) Evaluate the implementation of a new SST treatment pathway in CAMHS, including patient experiences and satisfaction with the service. SQUIRE Guidelines are used to report on this new knowledge of healthcare. This evaluation used qualitative methods to evaluate the impact of the new service. The team also used existing frameworks within the Trust, namely discharge data, which is collected routinely as part of service evaluation. This evaluation suggests positive support for this model, and that many families appreciate and value the opportunity to build on strengths and work toward their goals as families. This project outcome appears to support some of Talmon's (1990) findings that the most commonly attended number of sessions is one, and that of those who attended only one session, many perceived the session as useful. Waiting times for our service are extremely long. The pace and structure around goals and solutions could feel both galvanising, as some reported, but others felt it was an insufficient response to the severity of their difficulties. More high-quality research is needed before judgments can be made around the cost-effectiveness or efficacy of SST over existing approaches in the United Kingdom. While implementing SST should not be used to justify reduction in existing interventions, it offers a positive additional service for young people experiencing mental health difficulties and their families.

Qualitative service evaluation of a multimodal pilot service for early detection of liver disease in high-risk groups: ‘Alright My Liver?’

ObjectiveLiver disease is a growing cause of premature death in the UK. The National Health Service in England (NHS England) has funded regional early detection programmes through Community Liver Health...

Suicide-related internet use of mental health patients: what clinicians know.

Suicide-related internet use (SRIU), defined as internet use related to one's own feelings of suicide, can be both a risk and protective factor, especially for isolated individuals. Despite its influence on suicidality, clinicians face challenges in assessing SRIU because of the private nature of internet usage. Current recommendations on enquiring about SRIU in a clinical setting concern mostly young people. To address the gap in understanding SRIU among patients of all ages, this study aims to explore mental health clinicians' experiences, attitudes and beliefs regarding enquiring about SRIU, as well as the risks and benefits it presents in the assessment and management of patients. Finally, the study aims to establish the role SRIU potentially plays in the assessment and management of patients. Twelve clinicians practising at secondary mental health services in England participated in interviews. Thematic analyses were used for data interpretation. Clinicians who participated in interviews rarely initiate discussions on SRIU with their patients despite considering this an important factor in suicidality. Age of both patients and clinicians has the potential to influence enquiry into SRIU. Clinicians recognise the potential benefits of patients finding supportive online communities but also express concerns about harmful and low-quality online content related to suicide. Integrating SRIU enquiry into standard clinical practice, regardless of the patient's age, is an important step towards comprehensive patient care. Broader training for clinicians on enquiring about online behaviours is essential to mitigate potential risks and harness the benefits of SRIU in mental health patients.

Nurturing the Capabilities to Aspire, Voice and Realise Aspirations: A Theoretical Analysis of the Transformative Potential of the National Health Service in England

ABSTRACT This article contributes to understanding the transformative potential of institutions, such as the National Health Service in England (NHS), to engage those they serve, nurturing their aspirations and capabilities to support human flourishing. In pursuing a “fully engaged” scenario as described by Derek Wanless in Securing our Future Health (2002), an argument is made for nurturing the capabilities to aspire, voice and realise aspirations. The fully engaged scenario aspires towards higher levels of public engagement in relation to individual and community health and wellbeing; more efficient use of resources; overall improvements in health outcomes and a reduction in health inequalities. The discussion offers a critical evaluation of the recent emergence of a personalised care approach in the NHS in England, and specifically the role of Health and Wellbeing Coaches, in supporting this endeavour. Core capability and aspiration concepts are explicated to develop a conceptual framework to appraise the transformational potential of personalised care approaches in the NHS in England. The ensuing analysis is especially relevant as the recently elected Labour government prepares for a new ten-year plan for NHS reformation.

Adjusting the risk-adjustment: Accounting for variation between organisations in the responsiveness of their expenditure to need

There is concern that basing healthcare budgets on risk adjustment estimates derived from historical utilisation data may reinforce patterns of unmet need. We propose a method to avoid this, based on a measure of how closely local health organisations align resources to the needs of their populations. We refer to this measure as the ‘responsiveness of expenditure to need’ and estimate it using national person-level data on use of acute hospital and secondary mental health services in England. We find large variation in responsiveness in both services and show that higher expenditure responsiveness in mental health is associated with fewer suicides. We then re-estimate the national risk-adjustment model removing the data from the organisations with the lowest expenditure responsiveness to need. As expected, higher need individuals are estimated to have higher expenditure needs when less responsive organisations are removed from the estimation of the risk-adjustment. Removal of organisations with below-average responsiveness results in the neediest deciles of individuals having an extra £163 (7%) annual need for acute hospital care and an additional £79 (27%) annual need for mental health services. The application of this approach to risk adjustment would result in more resources being directed towards organisations serving higher-need populations.

SP3.10 - Utilisation and Outcomes of Emergency Laparoscopic Resection for Colon Cancer: A Population-based Study in England

Abstract Aims To evaluate the current use and outcomes of urgent or emergency laparoscopic resection of colon cancer in the National Health Service in England. Methods 11,182 patients from the National Bowel Cancer Audit diagnosed with colon cancer from April 2017 to March 2022 in England, who underwent urgent or emergency resection, were included. Multivariable logistic and linear regression was used to quantify factors associated with use of laparoscopic surgery and compare risk-adjusted postoperative outcomes between laparoscopic and open surgery. Results The use of emergency laparoscopic resection increased from 33.0% in 2017 to 47.5% in 2022, with a temporary stabilisation during the first wave of the COVID-19 pandemic (38.9% 2020/21). In risk-adjusted analyses of 9,579 patients, patients with poorer physical status [ASA 4/5 vs 1, aOR 0.35 (95% confidence interval 0.27-0.44) P < 0.001], more advanced T-stage [T4 vs T1-T2, aOR 0.26 (0.21-0.32) P < 0.001] and M-stage [M1 vs M0, aOR 0.87 (0.76-0.99) P < 0.036] were less likely to undergo laparoscopic surgery. No association was found with age, socioeconomic deprivation, or nodal stage. Patients undergoing laparoscopic resection had a shorter length of stay [adjusted mean difference -2.55 days (-3.23, -1.87), P < 0.001], lower 90-day mortality [aOR 0.75 (0.63-0.89), P = 0.001], and lower 30-day unplanned reoperation [aOR 0.82 (0.70-0.96), P = 0.014] than patients undergoing open resection. Conclusion There has been an increased utilisation of laparoscopic surgery in the emergency setting, and it is associated with reduced hospital stay, postoperative mortality and unplanned reoperation.

Exploring General Practitioners' Management of Self-Harm in Young People: A Qualitative Study.

General practitioners (GPs) are key to the frontline assessment and treatment of young people after self-harm. Young people value GP-led self-harm care, but little is known about how GPs manage young people after self-harm. This study aimed to understand the approaches of GPs to self-harm in young people and explore their perspectives on ways they might help young people avoid repeat self-harm. We conducted semi-structured interviews with GPs from the National Health Service in England in 2021. GPs were recruited from four geographically spread clinical research networks and a professional special interest group. Data were analysed using reflexive thematic analysis. The study's patient and public involvement and community of practice groups supported participant recruitment and data analysis. Fifteen interviews were undertaken with a mean age of participants being 41 years and a breadth of experience in practice ranging from 1 to 22 years. Four themes were generated: GPs' understanding of self-harm; approaches to managing self-harm; impact of COVID-19 on consultations about self-harm; and ways to avoid future self-harm. Negative attitudes towards self-harm within clinical settings are well documented, but GPs said they took self-harm seriously, listened to young people, sought specialist support when concerned and described appropriate ways to help young people avoid self-harm. GPs felt that relationship-based care is an important element of self-harm care but feared remote consultations for self-harm may impede on this. There is a need for brief GP-led interventions to reduce repeat self-harm in young people. A study advisory group consisting of young people aged 16-25 years with personal experience of self-harm and parents and carers of young people who have self-harmed designed the recruitment poster of this study, informed its topic guide and contributed to its findings.

Investigating innovations in outpatient services: a mixed-methods rapid evaluation.

Within outpatient services, a broad range of innovations are being pursued to better manage care and reduce unnecessary appointments. One of the least-studied innovations is Patient-Initiated Follow-Up, which allows patients to book appointments if and when they need them, rather than follow a standard schedule. To use routine national hospital data to identify innovations in outpatient services implemented, in recent years, within the National Health Service in England. To carry out a rapid mixed-methods evaluation of the implementation and impact of Patient-Initiated Follow-Up. The project was carried out in four sequential workstreams: (1) a rapid scoping review of outpatient innovations; (2) the application of indicator saturation methodology for scanning national patient-level data to identify potentially successful local interventions; (3) interviews with hospitals identified in workstream 2; and (4) a rapid mixed-methods evaluation of Patient-Initiated Follow-Up. The evaluation of Patient-Initiated Follow-Up comprised an evidence review, interviews with 36 clinical and operational staff at 5 National Health Service acute trusts, a workshop with staff from 13 National Health Service acute trusts, interviews with four patients, analysis of national and local data, and development of an evaluation guide. Using indicator saturation, we identified nine services with notable changes in follow-up to first attendance ratios. Of three sites interviewed, two queried the data findings and one attributed the change to a clinical assessment service. Models of Patient-Initiated Follow-Up varied widely between hospital and clinical specialty, with a significant degree of variation in the approach to patient selection, patient monitoring and discharge. The success of implementation was dependent on several factors, for example, clinical condition, staff capacity and information technology systems. From the analysis of national data, we found evidence of an association between greater use of Patient-Initiated Follow-Up and a lower frequency of outpatient attendance within 15 out of 29 specialties and higher frequency of outpatient attendance within 7 specialties. Four specialties had less frequent emergency department visits associated with increasing Patient-Initiated Follow-Up rates. Patient-Initiated Follow-Up was viewed by staff and the few patients we interviewed as a positive intervention, although there was varied impact on individual staff roles and workload. It is important that sites and services undertake their own evaluations of Patient-Initiated Follow-Up. To this end we have developed an evaluation guide to support trusts with data collection and methods. The Patient-Initiated Follow-Up evaluation was affected by a lack of patient-level data showing who is on a Patient-Initiated Follow-Up pathway. Engagement with local services was also challenging, given the pressures facing sites and staff. Patient recruitment was low, which affected the ability to understand experiences of patients directly. The study provides useful insights into the evolving national outpatient transformation policy and for local practice. Patient-Initiated Follow-Up is often perceived as a positive intervention for staff and patients, but the impact on individual outcomes, health inequalities, wider patient experience, workload and capacity is still uncertain. Further research should include patient-level analysis to determine clinical outcomes for individual patients on Patient-Initiated Follow-Up and health inequalities, and more extensive investigation of patient experiences. This study is registered with the Research Registry (UIN: researchregistry8864). This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/138/17) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 38. See the NIHR Funding and Awards website for further award information.

Clinical effectiveness and cost-effectiveness of Structured Psychological Support for people with probable personality disorder in mental health services in England: study protocol for a randomised controlled trial

IntroductionEvidence-based psychological treatments for people with personality disorder usually involve attending group-based sessions over many months. Low-intensity psychological interventions of less than 6 months duration have been developed, but their...

Linkage of routinely collected NHS data to evaluate liaison mental health services: challenges and lessons learned.

Liaison mental health services provide mental health care to patients in acute hospital settings. Evaluation of liaison services is challenging due to their heterogeneous organisation and delivery, high case throughput and varied patient case mix. We aimed to link routinely collected National Health Service data from secondary care settings, chosen for their service characteristics, to data from primary care to evaluate hospital-based liaison mental health services in England. We planned to compare patients referred to hospital-based liaison services with comparable patients in the same hospital not referred to liaison services and comparable patients in hospitals without any liaison services. We designed and enacted a methodology to link data from: (1) Hospital Episode Statistics, a database controlled by the National Health Service Digital and (2) ResearchOne, a primary care database controlled by The Phoenix Partnership. Obtaining approvals for the steps prespecified in the methodological protocol took 907 days. Enactment following approvals took 385 days. Data supplied from Hospital Episode Statistics contained 181,063 patients from 6 hospitals (mean=30,177, standard deviation=28,875.86) who matched the inclusion and exclusion criteria. Data supplied from ResearchOne contained 33,666 (18.6%) of these patients from the 6 hospitals (mean=5611, standard deviation=5206.59). Time required for approvals and enactment was attributable to slowness of data handling processes within each data holder and to resolution of technical and organisational queries between them. Variation in number of patients for which data was supplied between databases and between hospitals was attributable to coding inconsistencies and to the limited intersection of patient populations between databases and variation in recording practices between hospitals. Although it is technically feasible to link primary and secondary care data, the current system is challenging, complicated, unnecessarily bureaucratic, time consuming and costly. This limits the number of studies that could be conducted with these rich data sources. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 13/58/08.

What is current care for people with Long COVID in England? A qualitative interview study

ObjectiveTo investigate current care for people with Long COVID in England.DesignIn-depth, semistructured interviews with people living with Long COVID and Long COVID healthcare professionals; data analysed using thematic analysis.SettingNational Health...

Landscape of Digital Technologies Used in the National Health Service in England: Content Analysis.

In England, digital technologies are exploited to transform the way health and social care is provided and encompass a wide range of hardware devices and software that are used in all aspects of health care. However, little is known about the extent to which health care providers differ in digital health technology capabilities and how this relates to geographical and regional differences in health care capacities and resources. This paper aims to identify the set of digital technologies that have been deployed by the National Health Services clinical commissioning groups (NHS CCGs) in England. In doing this, we respond to calls to shed light on the internal dynamics and variation in the form of digital capability in England in terms of health service regional differences and health diversity, equity, and inclusion. We collected 135 annual reports that belong to 106 NHS CCGs in England, comprising more than 18,000 pages in total, released from 2020 to 2021. Using this data set, we identified 2163 pages related to digital technologies and labeled them using content analysis. We follow the construct taxonomy used by digital options theory, a theory from the management information systems field analyzing organizational resource investment choices, in classifying observed technologies according to digital themes-inherent design patterns that we identified and explained. We then used a hierarchical clustering method to extract groups of NHS CCGs that implement similar technology themes. We found 31 technologies from the reports and grouped them into 9 digital themes. The 9 themes were further assigned to 1 of the 3 constructs of digital options theory, the identification of patients' requirements (we identified information portals [76/106], digital health engagement [67/106], and digital inclusion support [45/106]), the development of new work patterns (we identified telehealth [87/106], telemedicine [35/106], and care home technologies [40/106]), the realization of improvements in efficiency and public accessibility (we identified online booking [26/106], online triage [104/106], and digital mental health services [74/106]). The 3 clusters of CCGs are identified based on the 8 themes (Hopkins=0.9914, silhouette=0.186), namely (1) digitally disengaged, (2) digitally engaged, and (3) digital torchbearer. Our findings show prominent digital themes within each construct group, namely information portals, telehealth, and online triage, covering people's fundamental health information needs. Almost half of CCGs fell into the digitally disengaged group, and all London CCGs (5/106) belonged to this group. We propose that practitioners should offer specialized assistance to regions with limited digital engagement, emphasizing digital health literacy, inclusion support, and ongoing evaluation, rather than concentrating solely on technical advancements.

The Getting It right First Time (GIRFT) programme in urology; rationale and methodology.

The Getting It Right First Time (GIRFT) programme is a quality improvement initiative covering the National Health Service in England. The programme aims to standardise clinical practices and improve patient and system level outcomes by utilising data-driven insights and clinically-led recommendations. There are GIRFT workstreams for every medical and surgical specialty, including urology. Defining features of the GIRFT methodology are that it is clinically led by experienced clinicians, data-driven, and specialty specific. Each specialty workstream conducts deep-dive visits to every hospital, analysing performance data and engaging with clinicians and management to identify and share improvement priorities. For urology, GIRFT has completed deep-dive visits and published reports outlining priority areas for development. Reports include recommendations pertaining to streamlining care pathways, reducing the acuity of care environments, enhancing emergency services, optimising utilisation of outpatient services, and workforce training and utilisation. The GIRFT academy provides guides for implementing best practices specific to priority areas of care. These include important disease pathways, and GIRFT-advocated innovations such as urology investigation units and urology area networks. GIRFT offers clinical transformation, cost reduction, equity in access to care, and leaner models of care that are often more environmentally sustainable. Evaluation efforts of the programme have focussed on assessing the adoption of GIRFT recommendations, understanding barriers to change, and modelling the climate impact of advocated practices.

Varying coefficient panel data models and methods under correlated error components: Application to disparities in mental health services in England

The contribution of this paper is twofold. Firstly, it introduces novel regression models that combine two important areas of the methodological development in panel data analysis, namely a varying coefficient specification and spatial error dependence. The former allows relatively flexible nonlinear interactions; the latter enables spatial correlations of the disturbance and thus differ significantly from the other random effect models in the literature. To estimate the model, a new estimation procedure is established that can be viewed as a generalization of the quasi-maximum likelihood method for a spatial panel data model to the well-known conditional local likelihood procedure. Novel inference methods, particularly variable selection and hypothesis testing of the parameter constancy, are introduced and are shown to be effective under the complex spatial error dependence. Equally importantly, this paper makes a substantial contribution to the understanding of financing and expenditure for health and social care. In particular, we empirically analyze and explain the effects of political ideologies on the local fiscal policy in England, especially the expenditure on mental health services.

From plaster casts to picket lines: Public support for industrial action in the National Health Service in England.

This paper explores public sentiment towards strike action among healthcare workers, as a result of their perceived inadequate pay. By analysing survey data collected in England between 2022 and 2023, the study focuses on NHS nurses and junior doctors, due to their critical role in delivering essential public services. Results indicate higher public support for strikes by nurses and junior doctors compared to other professions such as postal workers, teachers, rail workers, airport workers, civil servantsand university lecturers. However, variation in support for strikes by healthcare workers is observed across societal segments. Significant disparities in support are linked to individual political affiliations, left-right ideological positionsand trust in the NHS. In short, nonconservative voters, individuals leaning towards left-wing politicsand those with greater trust in the NHS demonstrate higher likelihoods of supporting strikes by health workers. These findings carry implications for future strike decisions and highlight specific target groups for enhanced communication efforts to garner increased public support.

Evaluation of a hospital-initiated tobacco dependence treatment service: uptake, smoking cessation, readmission and mortality

BackgroundThe National Health Service in England aims to implement tobacco dependency treatment services in all hospitals by 2024. We aimed to assess the uptake of a new service, adapted from the Ottawa Model of Smoking Cessation, and its impact on 6-month quit rates and readmission or death at 1-year follow-up.MethodsWe conducted a pragmatic service evaluation of a tobacco dependency service implemented among 2067 patients who smoked who were admitted to 2 acute hospitals in London, England, over a 12-month period from July 2020. The intervention consisted of the systematic identification of smoking status, automatic referral to tobacco dependence specialists, provision of pharmacotherapy and behavioural support throughout the hospital stay, and telephone support for 6 months after discharge. The outcomes were (i) patient acceptance of the intervention during admission, (ii) quit success at 6 months after discharge, (iii) death, or (iv) readmission up to 1 year following discharge. Multivariable logistic regression was used to estimate the impact of a range of clinical and demographic variables on these outcomes.ResultsThe majority (79.4%) of patients accepted support at the first assessment. Six months after discharge, 35.1% of successfully contacted patients reported having quit smoking. After adjustment, odds of accepting support were 51–61% higher among patients of all non-White ethnicity groups, relative to White patients, but patients of Mixed, Asian, or Other ethnicities had decreased odds of quit success (adjusted odds ratio (AOR) = 0.32, 95%CI = 0.15–0.66). Decreased odds of accepting support were associated with a diagnosis of cardiovascular disease or diabetes; however, diabetes was associated with increased odds of quit success (AOR = 1.88, 95%CI = 1.17–3.04). Intention to make a quit attempt was associated with a threefold increase in odds of quit success, and 60% lower odds of death, compared to patients who did not intend to quit. A mental health diagnosis was associated with an 84% increase in the odds of dying within 12 months.ConclusionsThe overall quit rates were similar to results from Ottawa models implemented elsewhere, although outcomes varied by site. Outcomes also varied according to patient demographics and diagnoses, suggesting personalised and culturally tailored interventions may be needed to optimise quit success.

An exploration of service use pattern changes and cost analysis following implementation of community perinatal mental health teams in pregnant women with a history of specialist mental healthcare in England: a national population-based cohort study

BackgroundThe National Health Service in England pledged >£365 million to improve access to mental healthcare services via Community Perinatal Mental Health Teams (CPMHTs) and reduce the rate of perinatal relapse in women with severe mental illness. This study aimed to explore changes in service use patterns following the implementation of CPMHTs in pregnant women with a history of specialist mental healthcare in England, and conduct a cost-analysis on these changes.MethodsThis study used a longitudinal cohort design based on existing routine administrative data. The study population was all women residing in England with an onset of pregnancy on or after 1st April 2016 and who gave birth on or before 31st March 2018 with pre-existing mental illness (N = 70,323). Resource use and costs were compared before and after the implementation of CPMHTs. The economic perspective was limited to secondary mental health services, and the time horizon was the perinatal period (from the start of pregnancy to 1-year post-birth, ~ 21 months).ResultsThe percentage of women using community mental healthcare services over the perinatal period was higher for areas with CPMHTs (30.96%, n=9,653) compared to areas without CPMHTs (24.72%, n=9,615). The overall percentage of women using acute care services (inpatient and crisis resolution teams) over the perinatal period was lower for areas with CPMHTs (4.94%, n=1,540 vs. 5.58%, n=2,171), comprising reduced crisis resolution team contacts (4.41%, n=1,375 vs. 5.23%, n=2,035) but increased psychiatric admissions (1.43%, n=445 vs. 1.13%, n=441). Total mental healthcare costs over the perinatal period were significantly higher for areas with CPMHTs (fully adjusted incremental cost £111, 95% CI £29 to £192, p-value 0.008).ConclusionsFollowing implementation of CPMHTs, the percentage of women using acute care decreased while the percentage of women using community care increased. However, the greater use of inpatient admissions alongside greater use of community care resulted in a significantly higher mean cost of secondary mental health service use for women in the CPMHT group compared with no CPMHT. Increased costs must be considered with caution as no data was available on relevant outcomes such as quality of life or satisfaction with services.

A web tool for exploring the usage of medicines in hospitals in England.

Datasets on the amounts of different medicines used over time and location are a valuable resource, with the power to reveal insights into healthcare trends, cost efficiencies, and geographic disparities. In England, primary care prescription data has been openly accessible for analysis for some time through a web tool, providing significant benefits. Since 2020, the National Health Service in England has also released data on secondary care medicine usage, processed from stock control databases, which provides detailed information on medicine usage within hospitals. This is an important dataset, but until now has been available only in a raw form that requires considerable technical skills to be used for even the analysis of basic trends. I have built a web application that enables anyone to easily analyse trends in this data, which is available at hospitalmedicines.genomium.org.

How can we improve mental health crisis services for young people? A survey of mental health crisis professionals across Greater Manchester

BackgroundHealthcare providers have been under pressure to improve the provision of crisis mental health services in England. Through the process of devolution, Greater Manchester has created the Crisis Care Pathway to meet the growing demands on mental health crisis service provision for young people in the city region. At the end of the first funding cycle, this research evaluated the pathway with a focus on potential future improvements.MethodsAn online survey, including a mixture of quantitative, Likert scale items and qualitative, open-ended questions, was completed by 60 professionals working within crisis mental health services for young people in Greater Manchester.ResultsAnalysis of the quantitative data identified 6 clear areas for improvement from the evaluative indicators: delivering support at a time that works for young people; delivering the right amount of help for the right length of time; providing services which are quickly available; services and agencies working together effectively; movement between services; fully integrated services. A further 3 super-ordinate themes were developed through thematic analysis of the qualitative data that indicate areas in need of improvement: The challenge of navigation, issues of accessibility into and between services, and how to improve integration.ConclusionsThis research found 7 clear actions to enhance the provision of crisis mental health services for young people in Greater Manchester, which may be transferable to other mental health crisis service contexts.

Something in the water: opening the public health law policy window for fluoridation?

Alongside the more widely debated provisions relating to the organisation and delivery of healthcare services in the National Health Service in England, the Health and Care Act 2022 contains measures relating to public health. This article offers a critical examination of one of these, that relating to fluoridation of water supplies. The nature of this intervention as a response to problems of poor oral health is considered, and the changes made by the 2022 Act are explained. It is argued that there are clear reasons for altering the statutory framework, but that it is less immediately apparent why this development is taking place at this point in time. In order to answer this question, John Kingdon’s concept of a ‘policy window’ is deployed as a framework for understanding agenda-setting in this context. Additionally, this can facilitate analysis of the future likelihood of use of the powers conferred by the 2022 Act in this controversial area of public health.