NIHR awards new round of funding to Policy Research Units at LSHTM to support evidence-informed policy making in health and social care.
The Policy Innovation and Evaluation Research Unit (PIRU) and the Public Health Policy Research Unit (PH-PRU) at the London School of Hygiene & Tropical Medicine (LSHTM) have been awarded £10.5 million and £5.5 million respectively from the National Institute for Health and Social Care Research (NIHR) over the next five years. Multi-disciplinary teams of researchers at LSHTM and collaborating institutions will undertake research focused on current and emerging national policy priorities in England.
Since January 2011, PIRU has brought together researchers from leading research institutions to develop rigorous evidence to support innovations in health and social care policy in England. PIRU researchers aim to strengthen policy development by conducting speedy, thorough, early-stage evaluations of national initiatives across health services, social care and public health policy. Research carried out by PIRU has included work to inform policy decisions on the NHS COVID-19 contact tracing app; an evaluation of the Heatwave Plan for England; and an evaluation of novel mental health support teams to improve the social and emotional wellbeing of children and young people.
Ellen Nolte, Professor of Health Services and Systems Research, Director of the renewed PIRU, said: “This award confirms the quality of, and confidence in, the work PIRU has been delivering over the past decade. Our work has been recognised as clearly adding value to policy making. The new funding will allow us to further establish PIRU as a ‘go-to’ centre of excellence for policy evaluation. Because we work so widely across health and social care, we will be able to generate evidence and insights that will help inform much-needed cross-sectoral policy development.”
Nicholas Mays, Professor of Health Policy and current Director of PIRU, said: “For over a decade, we have been able to produce strongly policy-relevant, high quality, timely, planned and responsive work, mainly on policy innovations and pilots across an wide range of policy areas. I am very pleased that the renewed Unit will have more capacity to provide answers to pressing questions related to ways of improving population health beyond the boundaries of the NHS and long-term care system.”
The PH-PRU conducts public health research focused on the wider social and economic determinants of health. The Unit has centred its research on four broad themes: understanding what determines people’s physical and mental health, and influences health behaviour; evaluating the effectiveness and cost-effectiveness of public health interventions; generating evidence to inform strategies to reduce inequalities in health; and developing new theory and research methods, and new ways to apply them to public health challenges.
Mark Petticrew, Professor of Public Health Evaluation and Director of PH-PRU, said: “The Public Health PRU, and the Public Health Research Consortium from which it evolved has been generating equity-relevant public health research to support policy for nearly 20 years. The core challenges have changed over time, but many remain, in particular the need to tackle inequalities, and to address unhealthy environments which undermine public health. Our research programme has evolved over time too, and our current research spans a wide range of current public health priorities, including research on the commercial determinants of health, and climate change, as well as evaluations of complex public health interventions, including policies. PH-PRU and its collaborators are looking forward to the next five years.”
In total NIHR has awarded more than £100 million in funding for 20 Policy Research Units across England from January 2024. The NIHR commissions policy research to deliver relevant, timely and accessible evidence to inform national policy decisions across the health, care and public health systems.
Read more about the announcement on the NIHR website.
An NHS-funded programme delivering mental health services in schools and further education colleges has made significant early progress in its first 3 years, a study shows.
According to new analysis, there have also been considerable challenges, including supporting children and young people with more specialist needs and staff retention within the service.
The study was funded by the National Institute for Health and Care Research (NIHR) and was undertaken jointly by the Birmingham, RAND and Cambridge (BRACE) Rapid Evaluation Team and the Policy Innovation and Evaluation Research Unit (PIRU) at the London School of Hygiene & Tropical Medicine.
In January 2020, the first mental health support teams (MHSTs) in England started delivering services. The teams work directly in schools and colleges, helping staff to promote emotional wellbeing for all pupils, and supporting children and young people with mild to moderate mental health problems. The programme is jointly led by the Department of Health and Social Care, the Department for Education and NHS England. By April 2023, an estimated 400 teams will have been created, supporting around three million 5 to 18 year olds.
Researchers explored the experiences of setting up and delivering MHSTs in the first 25 ‘Trailblazer’ areas, and their analysis was published in the NIHR Journals Library. It includes survey data from nearly 300 schools and colleges; interviews with 132 people involved in implementing MHSTs; and focus groups with children and young people.
“Overall, children and young people who had contact with an MHST reported an overwhelmingly positive experience. Mental health services in schools and colleges are facing increased pressure, particularly following the pandemic, and the programme has significant potential. But teams may find it difficult to sustain activities focusing on promoting wellbeing, given the increasing demand for mental health support.”
Dr Jo Ellins, Health Services Management Centre, University of Birmingham
Positive feedback from schools and colleges showed staff felt more confident talking to children and young people about mental health issues, and were able to access advice and support more easily. Strengthened relationships between different agencies, such as education providers and mental health services, were also reported.
However, concerns were raised about the poor suitability of the cognitive behaviour therapy (CBT) approaches that teams had been trained in for some young people and some mental health conditions. While schools and colleges universally welcomed investment in ‘in-house’ mental health support, some were frustrated that MHSTs were focused just on ‘mild to moderate’ mental health issues, and concerned about the difficulties and long waiting times that children with more severe problems faced when trying to access help.
An additional challenge was achieving a balance in the different types of service offered. The researchers found that practitioners often spent the majority of their time supporting children with mental health problems, rather than working with teaching and other staff to promote good emotional health across settings.
Professor Nicholas Mays from the London School of Hygiene & Tropical Medicine, a co-author of the report, added that: “Our findings suggest that the gap between the support that MHSTs are providing and the criteria for accessing specialist help may be widening as a result of the COVID-19 pandemic. Schools and colleges in particular were concerned about the lack of available support for children and young people whose mental health needs fell between these services.”
Mental Health Minister Maria Caulfield said: “It’s excellent to see that Mental Health Support Teams are having a positive impact in schools, giving staff more confidence, improving access to advice and support, and strengthening relationships between schools and mental health services.
“This research shows there is room for improvement which I hope will be taken on board as the number of Mental Health Support Teams will increase to almost 400 by April 2023. These will cover three million children and young people – part of an extra £2.3 billion a year investment into mental health services.”
An infographic describing the findings has also been published.
Ellins J, Hocking L, Al-Haboubi M, Newbould J, Fenton S-J, Daniel K et al. Early evaluation of the Children and Young People’s Mental Health Trailblazer programme: a rapid mixed-methods study. Southampton: NIHR Health and Social Care Delivery Research Topic Report; 2023. DOI: 10.3310/hsdr-tr-130818
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.
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 >>
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 >>
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
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.
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.
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?
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.
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.
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.
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 –
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: http://onlinelibrary.wiley.com/journal/10.1111/%28... or by contacting Jean O’Reilly, Editorial Manager, Addiction, email@example.com, tel +44 (0)20 7848 0853.
For more information please contact the London School of Hygiene & Tropical Medicine press office by email (firstname.lastname@example.org) or telephone (+44 (0)207 927 2802).
Addiction (www.addictionjournal.org) 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).
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 (www.piru.ac.uk). 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 email@example.com.
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. www.lshtm.ac.uk
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
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?