Commentary on the NHS Digital review on the use of mesh implants for SUI and POP

Following reports of a number of adverse consequences from women who had urogynaecological mesh implants used to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP), NHS England established the Mesh Working Group. The Mesh Working Group Interim Report, published in 2015, set out a number of actions to address the issues that had been raised. These aimed to address the three major concerns expressed by the Working Group – clinical quality, data and information and informed consent.

Since publication of the Interim Report, there has been a continued effort to better understand the implications of using mesh implants, improve services and information for women with mesh implants for SUI and POP, increase the reporting of complications and take account of further published evidence. During 2016/17, the Mesh Oversight Group worked to ensure that the recommendations of the interim report were implemented.

As part of these ongoing efforts, at the request of NHS England, NHS Digital has produced a report summarising activity within Hospital Episode Statistics (HES) data for the NHS in England, of patients who have had a procedure for the treatment of urogynaecological prolapse or SUI. The report aims to provide a clearer national picture of patients who have had such procedures.

Nick Black from the Policy Innovation Research Unit (PIRU) has provided an independent view of NHS Digital’s report.

The PIRU commentary is available here >>

The NHS Digital report is available here >>

How to commission evaluations of national policy pilots

To help policy makers who plan national pilot programmes and their evaluations, PIRU has developed a guidance document “Advice and how to commission national policy pilot evaluations”.

The document is available here >>

Payment-for-performance: incentivising quality in public services

PIRU’s event on payment-for-performance (P4P) held in February 2013 reviewed the evidence for P4P and its evaluation. The event brought together research and policy experts for an evening of presentations and a panel discussion to explore the gains that may be made by applying P4P techniques, as well as an appraisal of the limitations.

Full details and a range of post-event outputs including downloadable slides, videos of the presentations and panel discussion, interviews, summaries and blogs are available here >>

The Responsibility Deal – Supersized Health Promotion

Mark Petticrew, Professor of Public Health Evaluation at LSHTM

We can surely only get healthier, it would seem, when the public sector, academics and voluntary organisations team up with the food, drinks and leisure sectors to promote healthy living. That’s the claim behind the Government’s Public Health Responsibility Deal.


Forging social care policy amid the white heat of a White Paper

Martin Knapp, Professor of Social Policy at LSE

With the Government’s White Paper on Social Care expected soon, all eyes are turned to an area of just a few hundred square metres inWestminster.


Desperately seeking the Steve Jobs of healthcare modelling

James Barlow, Professor of Technology and Innovation Management at Imperial College London

We know that health services need a shake-up. How else can we meet ever increasing demand while holding down costs and improving quality and productivity?


Too much spin can seriously damage the health of spin-offs

Nick Mays, PIRU Director

The recent Department of Health report, 'Innovation, Health and Wealth'* tells an intriguing story about the potential economic benefits of the NHS.


How PIRU aims to make a difference

Nick Mays, PIRU Director

Governments these days are less interested in simply supplying services and much more concerned to guarantee results, regardless of how services are provided. That’s true particularly for healthcare.


Alternatives to the chemical cosh

Bob Erens, PIRU Deputy Director

There is wide concern about anti-psychotic drugs — the so-called ‘chemical cosh’ — being prescribed far too readily for patients with dementia, particularly in care homes.


Press releases

The alcohol industry is not meeting its 'Responsibility Deal' labelling pledges

16 October 2015

A new study from the London School of Hygiene & Tropical Medicine, published online today in the journal Addiction, has found that the signatories to the Public Health Responsibility Deal alcohol labelling pledge are not fully meeting their pledge. Labelling information frequently falls short of best practice, with fonts and logos smaller than would be accepted on other products with health effects.

The UK Public Health Responsibility Deal was launched in 2011 as a public-private partnership among industry, government, public bodies and voluntary organisations. Organisations involved make voluntary pledges designed to improve public health. Over 100 organisations have signed the alcohol labelling pledge, promising to “ensure that over 80% of products on shelf will have labels with clear unit content, NHS guidelines and a warning about drinking when pregnant."

This pledge consists of three required elements: (1) The number of units in the drink, (2) the Chief Medical Officers’ daily guidelines for lower-risk consumption, and (3) a warning about the risks of drinking while pregnant. Accompanying guidance states that this information should be clear, legible, displayed on the primary packaging and not difficult for consumers to find. Companies are encouraged to use a font size no smaller than the main body of information.

The London School of Hygiene & Tropical Medicine researchers looked at labelling on the 100 top-selling UK alcohol brands. The first three (required) elements were present on 77.6% of products examined. The mean font size of the Chief Medical Officers’ unit guidelines was 8.17 point and the mean size of pregnancy logos was 5.95mm. Existing guidelines on packaging inserts for medicines suggests a minimum font size of 9-12 point. Overall, alcohol labels very frequently fall short of best practice, with poor legibility and clarity a particular problem.

One finding of particular concern was that the pregnancy logo was significantly smaller on wine bottles than on beer/lager/cider containers (5.1mm vs 7.1mm). In the UK, men are more likely to drink beer than women, and women are more likely to drink wine.

New labelling guidance could be derived from existing guidance on medicines, tobacco packaging and other products which, like alcohol, carry known health risks. Compliance with labelling guidance also needs to be monitored and reported on independently of industry bodies.

Lead author Professor Mark Petticrew said, “Alcohol labelling can help consumers make an informed choice about health risks and about consumption, so it is important that it is clear and legible. Our findings suggest that this is very often not the case.”

-- Ends –

For editors:

Petticrew M, Douglas N, Knai C, Durand M-A, Eastmure E, and Mays N. (2015) Health information on alcoholic beverage containers: has the alcohol industry’s voluntary agreement in England to improve labelling been met? Addiction 110: doi:10.1111/add.13094

This paper is free to download for one month after publication from the Wiley Online Library: or by contacting Jean O’Reilly, Editorial Manager, Addiction,, tel +44 (0)20 7848 0853.

For more information please contact the London School of Hygiene & Tropical Medicine press office by email ( or telephone (+44 (0)207 927 2802).

Addiction ( is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2014 ISI Journal Citation Reports Ranking in the Substance Abuse Category (Social Science Edition).

Public Health Responsibility Deal unlikely to be an effective response to alcohol harms

26 March 2015

New research reveals weaknesses in Government’s public-private partnership with alcohol industry

Harmful alcohol consumption in England is unlikely to be reduced by the Public Health Responsibility Deal because the majority of its interventions are ineffective, poorly reported or were already happening anyway, according to two new studies published in Addiction.

The findings are part of a comprehensive independent evaluation of the Public Health Responsibility Deal conducted by researchers at the London School of Hygiene & Tropical Medicine.

Launched in March 2011, the Responsibility Deal is a public-private partnership between industry, government, public bodies and voluntary organisations in England. Organisations involved make voluntary ‘pledges’ on various areas, including alcohol, which are designed to improve public health.

Researchers analysed all publicly available data about organisations’ plans and progress towards achieving key alcohol pledges of the Responsibility Deal. They also conducted a systematic review of international evidence about the different types of interventions proposed by the organisations, in order to assess how effective the pledges would be in reducing harm from alcohol.

75% of the pledges aimed to provide consumer information and choice – interventions that are known to have limited effectiveness. The other 25% included measures such as reducing alcohol content in products.

However, the researchers also noted that where some producers and retailers reported taking measures to reduce alcohol units, these appear to mainly involve launching and promoting new low-unit products rather than removing units from existing high-unit products. This could potentially increase the total number of alcohol products on the market.

Annual progress reports from organisations on their pledges were most often found to be poor quality, incomplete or unavailable.* Only 11% of alcohol pledge-related activities were found to be a direct result of the Responsibility Deal, with 65% actions the organisations were already undertaking.**

The researchers say that while alcohol pledges may contribute to improving consumers’ knowledge and awareness, they are unlikely to be effective in reducing alcohol consumption.

Lead author Dr Cécile Knai, from the Policy Innovation Research Unit at the London School of Hygiene & Tropical Medicine, said: “We know that effective voluntary agreements are based on clearly-defined, evidence-based and quantifiable targets, which require partners to go beyond ‘business as usual’, and penalties for not delivering the pledges. However the alcohol pledges of the Public Health Responsibility haven’t met these criteria.

“Excessive alcohol consumption continues to be a major public health problem in England and needs to be addressed by effective interventions, notably those which change the market environment to make alcohol less available and more expensive. We hope our evaluation will contribute to decision-making about how to effectively tackle this problem.”

Disclaimer: The evaluation of the Public Health Responsibility Deal is part of the programme of the Policy Innovation Research Unit ( This is an independent research unit based at the London School of Hygiene & Tropical Medicine, funded by the Department of Health Policy Research Programme. Sole responsibility for this research lies with the authors and the views expressed are not necessarily those of the Department of Health. The Department of Health played no role in the design of the study, the interpretation of the findings, the writing of the paper or the decision to submit.


For a copy of the papers or to request interviews, please contact Katie Steels at the London School of Hygiene & Tropical Medicine press office on +44(0)207 927 2802 or

Notes to Editors
Paper one: Cécile Knai, Mark Petticrew, Mary Alison Durand, Elizabeth Eastmure & Nicholas Mays. Are the Public Health Responsibility Deal alcohol pledges likely to improve public health? An evidence synthesis. Addiction. DOI: 10.1111/add.12855

Paper two: Cécile Knai, Mark Petticrew, Mary Alison Durand, Courtney Scott, Lesley James, Anushka Mehrotra, Elizabeth Eastmure, Nicholas Mays. The Public Health Responsibility Deal: Will a public-private partnership with the alcohol industry motivate action on alcohol reduction? Addiction. DOI: DOI: 10.1111/add.12892

Once published, both papers will be available at:

* Progress reports were submitted by 92% of signatories in 2013 and 75% in 2014 and provided mainly descriptive feedback rather than quantitative measures. Approximately 15% of 2014 progress reports were identical to those presented in 2013.

** 432 pledge-related activities listed in plans were evaluated. Of these, 49 interventions (11%) were assessed to be 'clearly motivated by the Responsibility Deal', 104 interventions (24%) were assessed to be 'potentially motivated by the Responsibility Deal', and 279 interventions (65%) were assessed either as 'having already happened', or were 'already underway when the Responsibility Deal started'.

About the London School of Hygiene & Tropical Medicine
The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 3,900 students and more than 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and among the world's leading schools in public and global health. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice.

Choice of GP practice pilot most popular with young commuters and patients moving home

20 March 2014

A pilot scheme allowing patients to visit GPs outside the area they live in was most popular among younger commuters and people who had moved house but did not want to change their GP, according to a new report by the London School of Hygiene & Tropical Medicine.

The Department of Health’s Choice of GP pilot scheme found that while demand overall was modest, participants were generally positive about the scheme and there was little sign of major increased cost to primary care trusts (PCTs) for providing the service. Patients will be able to register with volunteer practices outside the area where they live throughout England from October 2014.

The pilot began in April 2012 for 12 months in four PCT areas of the country with volunteer practices (Westminster, Salford, Manchester and Nottingham City), and allowed patients to register with a pilot practice as an ‘out of area’ patient. Patients in the pilot could also be seen as a ‘day patient’ while remaining registered with their original practice, however, this option will not be included when the scheme is rolled out.

A total of 43 practices participated in the pilot, with approximately half of the practices in Westminster. However, 11 of the 43 pilot practices recruited no patients during the 12 months of the pilot. The authors suggest this could be because the scheme was not widely advertised in the pilot areas.

A total of 1,108 patients registered with pilot practices as ‘out of area’, with the scheme being most popular in Westminster, which accounted for 71% of all ‘out of area’ patients. Overall, patients were much younger, more likely to have better self-reported health, more likely to be in work, and twice as likely to have more than a 30-minute commute than other patients in the pilot areas.

There were four types of ‘out of area’ registered patients; patients who had chosen their new practice for convenience, for example, because it was close to their work (32.6%), patients who had moved house but did not want to change their practice (26.2%), patients who were new to the area and had registered with a pilot practice but lived outside the practice’s catchment area (23.6%) and patients who were dissatisfied with their previous practice or chose their new practice for specific services or to see a particular GP (13.9%).

Lead author Professor Nicholas Mays from the Policy Innovation Research Unit at the London School of Hygiene & Tropical Medicine, said: “While demand for the pilot was modest, our evaluation found that patients had positive views of the scheme because, for example, they didn’t need to take time off work to visit a GP or they were able to continue care with a doctor they had a longstanding relationship with after they moved house. Our findings suggest that the extension of the scheme across England later this year will appeal to a minority of the population who have these needs and in particular parts of the country.”

“However, we need to bear in mind that the pilot was only for 12 months and only in four areas of the country, so it is difficult to know precisely how the scheme will work on a larger scale and over the long term.”

Health Minister Lord Howe said: “Our recent changes to the GP contract will help patients choose a GP practice to suit them. This will support hardworking people who commute to work and cannot access their local surgery during opening times, and enable people who move house to stay with their GP if they want to.”

While patients and the majority of pilot practices were very positive about extending the scheme, health system managers were more cautious. The authors also note that patients were not in the pilot long enough for many potential drawbacks to become apparent, including issues related to receiving out of hours care while registered at a practice far from their home.

Although there were a number of practical problems to be resolved in implementing the pilot, none were seen as insurmountable if the scheme were rolled out. Managers had some concerns related to the risk that ‘out of area’ registration could lead to practice lists becoming more socio-economically segregated. Another concern was related to managing referrals and their costs if more patients found themselves living outside the area where their general practice was located.

Older patients, or patients who were satisfied with their local services, were far less interested in registering at a practice outside their neighbourhood. In choosing a practice, the report found that people felt most strongly about getting an appointment with a GP as quickly as possible and most people did not regard weekend opening as important in determining their choice of practice.

The independent evaluation was commissioned by the Department of Health on behalf of NHS England through its Policy Research Programme, as part of the core research programme of the Policy Innovation Research Unit at the London School of Hygiene and Tropical Medicine.

More details of the GP Practice Choice evaluation can be found under Current Projects, please click here >>

Early ideas for NHS policy given rapid evaluation by experts

13 June 2011

What could be offered to dementia patients as an alternative to anti-psychotic drugs? Should payment for drug and alcohol rehabilitation programmes depend on how long people stay clean when they are discharged? Could changes to dental contracts improve patient care?

Download the full press release here >>