Joint Commissioning Research Articles

Tackling health inequalities through integrated care in English police custodies: an inclusion perspective and model of care

PurposeThe purpose of this research is to identify novel ways of tackling health inequalities of underserved populations. It explores the opportunities presented by the changes in health and social care legislation to employ historically underused services, such as police custody healthcare providers, in addressing health inequalities.Design/methodology/approachThis research analyses the policy approaches to tackling health inequalities in the UK in the past 40 years with an emphasis on those experienced by the people detained in English police custodies. It analyses the current model of healthcare in police custody and proposes a novel integrated model of care and joint commissioning opportunities in funding it.FindingsPolicies to tackle health inequalities have largely failed, as they became entrenched. But recent changes in the health and social care legislation in England offer opportunities to address them by employing historically underused healthcare services, such as those operating in police custodies.Research limitations/implicationsThe research does not touch upon ethical considerations related to the patient privacy aspect of integrated care. Interventions by and interactions with police custody healthcare providers would be visible to all professionals with access to the patient’s health record. As with all novel interventions or innovative models of care, the effectiveness of such clinical interventions remains to be established by further research. It opens a new line of research on quality improvement through integration of care and explores understudied aspects of joint commissioning of integrated care.Practical implicationsIt offers health commissioners and public health leaders the opportunity to employ police custody healthcare services in reaching their population health management objectives and meeting their health inequalities objectives at local level. It also gives police and crime commissioners the opportunity to address the health drivers of criminal behaviour that overlap with health inequalities. It offers funding opportunities presented by jointly commissioning services at lower costs to both police and health commissioners alike. It improves the health outcomes of historically underserved populations by facilitating access to health and social care services and facilities.Social implicationsReducing health inequalities and disparities in health outcomes can decrease the costs of the healthcare services over the long term and might contribute to reducing criminality by addressing inequities and some health drivers of criminal behaviour.Originality/valueThe paper explores understudied opportunities offered by the recent changes in health and social care legislation in England and includes underused resources to tackle health inequalities.

Coordinated optimization control strategy of hydropower and thermal power AGC units

With the rapid increase of penetration level of new energy power generation, the construction of auxiliary service market is facing new challenges. The stricter requirements of the power plant unit AGC are proposed by the power system. How to coordinate and control the output of hydropower and thermal power units to increase the use of hydropower while meeting the requirements of AGC regulation is a problem to be solved. Under the condition of interconnection of units in the whole network, an optimal control strategy for joint commissioning of hydropower and thermal power plants that meets the performance conditions of ‘two rules’ is proposed in this paper. The strategy establishes the connection between hydropower and thermal power units. Combined with the output characteristics and economic characteristics of hydropower units and thermal power units, a coordinated optimization control strategy model of hydropower and thermal power AGC units suitable for the ’two rules’ assessment rules is proposed for each objective and constraint condition in the joint scheduling of hydropower and thermal power. The optimal mathematical model with multiple objectives is constructed to realize the distribution of AGC among different types of power plants and units, which can give full play to the regulation ability of hydropower and thermal power. The proposed strategy achieves the efficient use of clean energy and reduces the grid’s overall operating costs to achieve energy conservation and emission reduction. Simulation results verify the superiority of the proposed strategy.

Experiment and Simulation of the Startup Processes for the Supercritical Carbon-Dioxide Closed Brayton Cycle

The startup process is the crucial transition phase of the supercritical carbon-dioxide Brayton cycle, so it is essential to focus on and investigate the transient performance for the system’s safety and stability. The pressure in the buffer tank approaches the safety upper limit with different startup schemes during the joint commissioning of the compressor and heater in a MWe-scale experiment system, while the maximum temperature is 309 °C. Hence, dynamic simulations are carried out to explore the dynamic startup characteristics from a cold state or a warm state to the turbine pre-start condition, in which 60% of the rated mass flow rate and 67% of the rated compressor speed are reached in the end. The results show that, when starting from a cold state, the startup scheme of simultaneously heating and speeding up has a limited effective application scope. Two venting operations during the above process help the system establish heat regeneration and promote temperature uniformity in the system. Furthermore, when starting from a warm state with an existing temperature gradient in the system, the startup scheme of simultaneously heating and speeding up is more effective and has a more extensive range of control.

Translation Methods in Informative Text of an Assessment Report on Joint Commissioning and Test of the HN Urban Rail Transit Equipment System (excerpt)

Translation Methods in Informative Text of an Assessment Report on Joint Commissioning and Test of the HN Urban Rail Transit Equipment System (excerpt)

Community paediatricians’ experience of joint working with child and adolescent mental health services: findings from a British national survey

ObjectivesChildren and young people (CYP) presenting to paediatric or child and adolescent mental health services (CAMHS) often have needs spanning medical and psychiatric diagnoses. However, joint working between paediatrics and...

Joint BASHH–FSRH conference

The annual joint meeting brings together the BASHH and the Faculty of Sexual and Reproductive Health (FSRH) at the Royal Society of Medicine (RSM) in central London. It takes place...

Commissioning social care for people with dementia living at home: Findings from a national survey.

To explore the complexities, circumstances, and range of services commissioned for people with dementia living at home. A national survey was used to collect data from English local authorities in 2015. Commissioners of services for older adults were invited to complete a questionnaire. An exploratory cluster analysis of nominal data was conducted using a TwoStep procedure to identify distinct groups. A total of 122 authorities (83%) responded to the request. Four approaches to commissioning were identified, reflecting commissioning practices at the organisational, strategic, and individual service user levels. Commissioning at the service user level was most apparent. Bivariate analysis found that these configurations were not associated with the types of dementia specific services provided but were related to the number available. Authorities delivered a greater range of specialist services when joint commissioning between social care and health partners was undertaken. However, the joint commissioning of services was less observed in services specifically for people with dementia than in generic services for all older people. There was limited evidence that local circumstances (population configuration and deprivation levels) were associated with this approach to commissioning. The significant role of health partners in the delivery of social care services to support older people living with dementia in their own homes is evident. As the population with dementia ages and physical health needs increase, how dementia specific services differ from and complement those services available to all older people warrants further investigation.

Commissioning of cryogenic system for China Spallation Neutron Source

China Spallation Neutron Source(CSNS) cryogenic system provides supercritical cryogenic hydrogen to neutron moderators, including a helium refrigerator, hydrogen loop and hydrogen safety equipment. The helium refrigerator is provided by Linde with cooling capacity of 2200 W at 20 K. Hydrogen loop system mainly includes cryogenic hydrogen pipes, hydrogen circulator cold-box and accumulator cold-box. Cryogenic hydrogen pump, ortho-para convertor, helium-hydrogen heat-exchanger, hydrogen heater and accumulator are integrated in hydrogen circulation cold-box, and accumulator cold-box. Hydrogen safety equipment includes safety valves, rupture disk, hydrogen sensor, flame detector and other equipment to ensure that cryogenic system in dangerous situations will go down, vents, or takes other measures. The cryogenic system commissioning work includes four steps. First, in order to test the refrigerating capacity of refrigerator, when acceptance testing, refrigerator internal heater was used as thermal load. Second, using simulation load as heat load of moderator, hydrogen loop use helium instead of hydrogen, and cooled down to 20 K, then re-warming and test the leak detection of hydrogen loop system. Third, base on the step 2, using hydrogen as working medium, and optimized the control logic. Forth, cryogenic system with the moderators joint commissioning. Now, cryogenic system is connected with the moderators, and the forth step will be carried out in the near future.

Discourses of joint commissioning.

Increasing attention has focused on the role of joint commissioning in health and social care policy and practice in England. This paper provides an empirical examination of the three discourses of joint commissioning developed from an interpretative analysis of documents by Dickinson etal. (2013; BMC Health Services Research, 13) and applied to data from our study exploring the role of knowledge in commissioning in England. Based on interviews with 92 participants undertaken between 2011 and 2013, our analysis confirms that the three discourses of prevention or empowerment or efficiency are used by professionals from across health and social care organisations to frame their experiences of joint commissioning. However, contrary to Dickinson etal., we also demonstrate that commissioners and other stakeholders combine and trade off these different discourses in unexpected ways. Moreover, at sites where the service user experience was central to the commissioning process (joint commissioning as empowerment), a greater sense of agreement about commissioning decisions appeared to have been established even when the other discourses were also in play.

Revealed: The Underlying Flow, Masked by Predictive Risk Tools but Uncovered by Dynamic Simulation used in Joint Commissioning

Revealed: The Underlying Flow, Masked by Predictive Risk Tools but Uncovered by Dynamic Simulation used in Joint Commissioning

G463(P) Determining the health needs of children with special educational needs

Introduction The goal of the SEND reforms is to improve the outcomes of children with special educational needs (SEN) and disabilities. One key strategy is to improve the coordination and integration of education, health and care services through joint commissioning. Commissioning can only be effective when services are designed around the needs of their services users. Little is known about the health needs of disabled children for whom the lack of data for planning purposes is the single biggest challenge to better outcomes. Aim To describe the health problems and services use of children with SEN. To pilot an approach to data collection for services planning. A third objective, to assess the quality of medical reports, is reported separately. Method We reviewed all the medical reports submitted between January and June 2014 for a Statement of Special Educational Needs (SSEN). Additional hospital statistics were collected. Results Data were analysed on 125 children, 78% boys and 22% girls, median age 6.9 years (1.9–14.8). 65% of children were known to community paediatrics and 25% to CAMH services. 6% of children were LAC, 5% on CP plan, and 15% excluded from school. 39% children had autism, 7% ADHD, 26% SEMH, 9% physical needs, 8% sensory impairment (all types), 26% SLCN, 46% learning difficulties (all types), 8% SpLDs. 55% of the children had multiple needs, 6% were complex special needs. In the previous year 62% children attended hospital outpatients (1–16 visits), 10% of children were admitted to hospital (1–4 admissions) and 23% of children had been seen in A&E (1–7 visits). 50% of children were known to hospital specialities, 50% to S&L, 16% physiotherapy, 30% OT services. Many children had associated health problems (19% medical, 18% nutrition, 9% continence). Conclusions Children with SEN have extensive health needs and are high users of health services. Our data is likely to be an underestimate as we only analysed hospital statistics and medical reports whose quality varied. SSEN reports provide important health data. Data collection and analysis from a broader range of services continues. The new Education, Health and Care process provides an opportunity for prospective data collection for services planning.

Gaming and Simulation for Railway Innovation

Background. Gaming simulation allows decision-makers to experiment with sociotechnical systems, similar to computer simulation. However, the value of these tools in comparison with each other remains uncertain, especially when focusing on their real-life application in systemic innovation processes.Aim. This article builds a framework based on the literature related to innovation of complex systems in a multi-actor environment and intends to use this framework to differentiate between the value of computer simulation and gaming simulation in innovation processes.Method. Using a case study of the introduction of gaming simulation to ProRail, the Dutch railway infrastructure manager, this article explores the advantages and disadvantages of using the two tools in situations where radical innovations need to be invented, explored, tested, and implemented in an incumbent system.Results.Computer simulations, as closed exercises, allow for more radical innovations to be studied. The openness of gaming sessions as well as the need for gamers to interact with a recognizable system inhibit the use of gaming simulation in envisioning radical innovations. However, they are more suitable for the joint commissioning of research and the stepwise testing of small-scale improvements. Gaming simulation is therefore a more appropriate tool for planning a concerted transition in a multi-actor setting.Conclusion.Computer simulation better allows for the building of experimental niches, and gaming simulation better helps in the concerted planning of the implementation of innovations. The article ends with concrete directions for further research as well as ideas about combining the two tools.

How effective is joint commissioning? An exploration of processes, practices and outcomes in five English localities

Purpose: This paper investigates the issue of joint commissioning in the context of English health and social care, evaluating its purposes, processes and outcomes. Background: Over time, health and social care policy has placed growing emphasis on the importance of a commissioning-led approach and on the need for more effective health and social care partnerships. Combining these two agendas together, policy has increasingly started to focus on the need for greater joint commissioning of health and social care. And yet, current policy rhetoric about the importance of joint commissioning often seems to lag behind the reality at ground level despite the fact that aspirations for effective joint commissioning date back many years. At least part of the difficulty seems to lie in the fact that joint commissioning is, by definition, more complex than commissioning in single agency settings; joint commissioning almost inevitably brings additional challenges because of the need to develop effective partnerships between health, social care and beyond. Objectives: This paper investigates the very different experiences of joint commissioning in five English localities. Each site has been the subject of an 18 month study employing a number of quantitative and qualitative tools of data collection to build up an in-depth case study of joint commissioning locally. Conclusions: We will illustrate the very different practices and processes which are operated in the name of joint commissioning in these sites and make some tentative conclusions about the type of impacts these have had in terms of service user outcomes.

How effective is joint commissioning? A study of five English localities

PurposeThis paper reports research undertaken into the practices, processes and outcomes of joint commissioning at five English localities. This paper reflects on the implications of this study for the practice of joint commissioning.Design/methodology/approachA case study approach to the research was adopted where the assumptions about what joint commissioning should deliver in five “best practice” sites. These hypothesised relationships about organisational processes, services and outcomes were then tested through the collection of primary and secondary data. Methods of data collection included an online tool based on Q methodology, documentary analysis, interviews and focus groups.FindingsVery little of what we found seemed to relate directly to issues of joint commissioning. Respondents often spoke of joint commissioning conflating it with issues of commissioning or joint working more generally. We found a variety of different definitions and meanings of joint commissioning in practice suggesting that this is not a coherent model but varies across localities. Little evidence of improved outcomes was found, due to practical and technical difficulties.Research limitations/implicationsJoint commissioning is not a coherent model and is applied in different ways across different contexts. As such we may need to ask very different questions of joint commissioning to those typically asked.Practical implicationsIt is important that local sites are clear about what they are trying to deliver through joint commissioning or else risk that it becomes an end in itself. Some of the current reforms taking place in health and social care risk pulling apart existing relationships that have taken significant time and resource to develop.Originality/valueThis is one of the first large‐scale studies of joint commissioning conducted in England.

Making sense of joint commissioning: three discourses of prevention, empowerment and efficiency.

BackgroundIn recent years joint commissioning has assumed an important place in the policy and practice of English health and social care. Yet, despite much being claimed for this way of working there is a lack of evidence to demonstrate the outcomes of joint commissioning. This paper examines the types of impacts that have been claimed for joint commissioning within the literature.MethodThe paper reviews the extant literature concerning joint commissioning employing an interpretive schema to examine the different meanings afforded to this concept. The paper reviews over 100 documents that discuss joint commissioning, adopting an interpretive approach which sought to identify a series of discourses, each of which view the processes and outcomes of joint commissioning differently.ResultsThis paper finds that although much has been written about joint commissioning there is little evidence to link it to changes in outcomes. Much of the evidence base focuses on the processes of joint commissioning and few studies have systematically studied the outcomes of this way of working. Further, there does not appear to be one single definition of joint commissioning and it is used in a variety of different ways across health and social care. The paper identifies three dominant discourses of joint commissioning – prevention, empowerment and efficiency. Each of these offers a different way of seeing joint commissioning and suggests that it should achieve different aims.ConclusionsThere is a lack of clarity not only in terms of what joint commissioning has been demonstrated to achieve but even in terms of what it should achieve. Joint commissioning is far from a clear concept with a number of different potential meanings. Although this ambiguity can be helpful in some ways in the sense that it can bring together disparate groups, for example, if joint commissioning is to be delivered at a local level then more specificity may be required in terms of what they are being asked to deliver.

Barriers to intersectoral working to improve health: A qualitative study

BackgroundThe National Health Service (NHS) is undergoing dramatic changes. Currently established partnerships are thus likely to be significantly disrupted by the radical reforms outlined in the Public Health White Paper....

Professional roles and responsibilities in meeting the needs of children with speech, language and communication needs: joint working between educational psychologists and speech and language therapists

There is a large population of children with speech, language and communication needs who have additional special educational needs (SEN). Whilst professional collaboration between education and health professionals is recommended to ensure an integrated delivery of statutory services for this population of children, formal frameworks should be developed for the exchange of information during identification and assessment of needs and planning of intervention strategies. In this study an audit was carried out to examine practical and conceptual issues which might arise in a piloted communication system between educational psychologists and speech and language therapists. Whilst it was found that 62.8% of newly referred children with SEN had some history of co‐existing communication and education needs, it was shown that duplication of work exists and communication is onerous. It was also shown that schools were not fully informed about children’s needs. Joint commissioning of services is required to facilitate individual practitioners in collaborating to serve the needs of these children.

Joined‐up Rationing? An Analysis of Priority Setting in Health and Social Care Commissioning

Joint commissioning is an important part of the current health and social care context and will continue to be crucial in the future. An essential component of any commissioning process is priority setting, and this paper begins to explore the idea of integrated priority setting as a key element of health and social care commissioning. After setting out the key terminology in this area and the main priority‐setting processes for health and social care, the paper describes a number of barriers that might be encountered in integrated priority setting. We argue that there are significant barriers in financing, accessibility, evidence and politics, and it is important that such barriers are acknowledged if priority setting is to become a component of joint commissioning. While these barriers are not insurmountable, the solution lies in engagement with a range of stakeholders, rather than simply a technical process.

Integrated Commissioning: New Contexts, New Dilemmas, New Solutions?

Ideas about joint commissioning between the NHS and social care have been around for a long time ‐ since at least the publication of Practical Guidance on Joint Commissioning for Project Leaders by the Department of Health in 1995, and stemming from the roots of joint planning and joint finance way back in the mid‐1970s. Achievements have generally not been spectacular, but the issue is now squarely back on the policy stage with a rebranding: ‘integrated commissioning’. This implies a shift from ad hoc and opportunistic partnering to something more systemic and long‐term. However, the policy context is now very different, and the scale of ambition hugely heightened. This article examines whether integrated commissioning is an idea whose time has come.

Two Approaches to the Joint Commissioning of Mental Health Services

Two Approaches to the Joint Commissioning of Mental Health Services