Seminar Series in Health Policy at the Centre for Health Economics & Organisation

The Centre for Health Economics & Organisation (CHSEO, Nuffield College, University of Oxford) is a research unit focused on whole-system analysis of the English health sector and selected local health economies. It was created in December 2010 and is funded by the Department of Health. 
The CHSEO has organised four seminars in October and November as part of its Seminar Series in Health Policy. The inaugural seminar was delivered by Bill McCarthy, Interim Managing Director of the NHS Commissioning Board. It was an exceptional opportunity to hear about current developments related to the health reform and to get know McCarthy's vision for the enormous challenge he is facing.      
The next speaker is Martin Chalkley (Thursday 3rd November, 4.30pm), who will be discussing the impact of the National Tariff on productivity. Subsequent seminars concern the impact of Foundation Trust status and the revalidation of doctors. MOre information is available here.

Check the new links (and the old ones as well!)

This blog is inherently "work in progress". We try to continuously improve it. After a short summer break, we have added this time two new links to the evergrowing list on the right hand side. They are all useful links for keeping up to date with current health related policy developments, and also for in depth analyses.

The new additions today are the website of Health Services Research Europe, which hosts a very handy database of about 150 European projects on the provision of health care in the EU. The second one is the Lancet website on Health Policy, which is aimed at a broader public and which focusses both on health, but also on employment and housing related policies, thereby embracing the perspective of "Health in all policies". Both of them will make excellent lunch break entertainment for those eating in front of their computers.

Increasing the visibility of Primary Care Research

Thomson Reuters Web of Science is the platform that is used for assessing the bibliometric impact of research. As a matter of fact, the UK Research Assessment Exercise (an evaluation of the quality of research undertaken by British higher education institutions) will soon be using such estimates under the new Research Excellence Framework. It is therefore good news that Thomson Reuters has introduced in its database a Subject Category ‘Primary Health Care’ and brought 14 journals that were previously included under other categories, under this heading. Chris van Weel provides more details on the issue.

What is evidence based health policy?

Over and over again, I hear the claim that we do not know what evidence based health policy is. It is particularly discouraging to hear it from people who do not object to the need for an evidence based approach to medicine. Maybe a post can contribute to help readers (and myself) clarify the relevant concepts.

Sackett's definition of evidence based medicine can help us here:

Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values.

The problems of making policy are inherently different from those of clinical practice. However, the three core aspects (research, professional expertise and values) apply very much the same. An evidence based approach to health policy aims to integrate the best research evidence with policy expertise and population values.

What type of research is relevant to Health Policy? There is no doubt that clinical questions are relevant to health policy. As a matter of fact health systems should be able to offer those clinical management options (prevention, diagnosis, treatment, rehabilitation) that offer the best results. But the latter processes of care are only some of the processes that occur at any time in a health system. And we also need information on the structure and the outcomes of health care, making many other questions that have to do with the organization and delivery of health care at least as relevant as clinical issues.

How many general practitioners do we need? What patient-physician ratio should we aim for? Does the Quality and Outcomes Framework improve quality of care? Does it increase inequalities? Would commissioning as proposed in the current health reform (as today) solve more problems that it will create? Should we pay consultants as we pay GPs? Should we offer cosmetic surgery under the NHS? Would NHS money be better spent on social care?

Evidence Based Medicine faced great barriers in its journey from revolutionary concept to mainstream approach to clinical practice. Unfortunately, I cannot anticipate a different path for evidence based health policy: many policy makers are no less evidence illiterate than the average physician some years ago. It is a challenge, but the impact our success can have on people´s health and lives is potentially immense and well worth the effort.

Can economic recession be good for your health?

The immediate post-communist economic collapse of some eastern European countries resulted in a dramatic decrease in life expectancy. There is evidence that mental health is negatively impacted during economic crisis, resulting in an increased suicide rate. Economic crises are surely bad for your health. Or are they?

We know that a richer country is not necessarily a healthier one when applied to across different countries (see for example US vs their Caribbean neighbours such as Cuba or Costa Rica). What may be less well known is that poorer can actually mean healthier, if we consider individual countries from a longitudinal perspective. But is that really so counter-intuitive? Believe it or not, numerous studies have established the counter-cyclical nature of the association between mortality and economic growth, with a suggested lag of about 2 years. Many health indicators improved in Cuba as a result of the "special period" in the nineties, including a decline in all-cause mortality and in the rates of death from diabetes and cardiovascular disease. Is it possible that we could see similar effects in the UK?

As usual, the devil is in the detail. The impact is greater for children and men than for women. And whether this impact is positive or negative very much depends on the relative impact of the affected conditions on the population's health. Cardiovascular risks factors tend to be better under control during crises and so is the case for motor vehicles accidents. On the contrary, mental health is negatively affected.

Below a few references for further reading:

Catalano R, Goldman-Mellor S, Saxton K, Margerison-Zilko C, Subbaraman M, LeWinn K, Anderson E. The Health Effects of Economic Decline. Annu. Rev. Public Health 2011. 32:431–50

Riva M, Bambra C, Easton S, Curtis S. Hard times or good times? Inequalities in the health effects of economic change. Int J Public Health. 2011 Feb;56(1):3-5.

Tapia Granados JA, Ionides EL. The reversal of the relation between economic growth and health progress: Sweden in the 19th and 20th centuries. J Health Econ. 2008 May;27(3):544-63.

Stuckler D, Meissner C, Fishback P, Basu S, McKee M. Banking crises and mortality during the Great Depression: evidence from US urban populations, 1929-1937. J Epidemiol Comm Health 2011

Stuckler D, Basu S, Suhrcke M, Coutts A, McKe M. The public health eff ect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet 2009; 374: 315–23

Tapia-Granados JA. Economic growth and health progress in England and Wales: 160 years of a changing relation. January 2011. Working paper available at: http://sitemaker.umich.edu/tapia_granados/files/econ_growth___health_engl__wales_f-2.pdf

Barbara Starfield

I heard yesterday the tragic news that Barbara Starfield died this week. She was an outstanding researcher who provided the evidence for the multiple benefits of Primary Care. I would ow her so much as a Family Physician, but I will miss dearly Barbara much more as a mentor and a friend. She was a strong and inspiring woman, and she was the driving force that made me focus my research on Primary Care as an instrument for improving the health and conditions of populations. I had also the immense honour of privilege of working with her in research and in teaching and in both facets she simply excelled. I find it hard to imagine a world without Barbara. We will miss you so much.

Ann McPherson in memoriam

I was today at Ann's funeral at Wolvercote Cemetery. I knew I was paying tribute to an outstanding person, but it was later at the memorial at Balliol College when I just begun to grasp the magnitude of her contributions and her impact on those who were  around her.

Her work will be continued through a number of initiatives including Health Talk Online, Youth Health Talk, Teenage Health Freak, and the Oxford Health Experiences Institute (HEXI), supported by the Ann McPherson Tribute Fund, and others such as Health Care Professionals for Assisted Dying.

Do you want to work in the Health Services and Policy Research Group?

Would you like to join us and work at the University of Oxford in our top rated Primary Care Department? We are now recruiting for a Research Officer. You can find here further details in relation to this exciting opportunity. Application deadline is Monday 20 of June.

Integration is key to the success of NHS reforms

David Cameron delivered yesterday a telling speech suggesting that the Government was ready to change their approach to the reforms. It seems that the government has indeed listened to what the professionals and the public had to say about the reforms. Cameron aimed to appease unrest both within and outside General Practice by guaranteeing that both consultants and nurses will be involved in the commission process, that commissioning consortia will be expected to be fully operational only when they are ready, and not necessarily by April 2013 as previously envisaged, and that competition will be only pursued where it may benefits patient care and choice.

However, the most significant commitment was to ensure that the new system made integration of acre a priority: "clinical senates" consisting of senior medical professionals will oversee integration of NHS services across local areas and, even more astonishing, Monitor, the NHS watchdog that had been previously commissioned with the task of ensuring fair competition, will have a duty to promote integration of care.

Although not inherently opposed, the goals of higher integration and more competition seem difficult to reconcile. It is a shame that nobody dared to ask Mr Cameron what he meant by integration, such an elusive concept. But elusive or not greater integration is good your health.

Liberating the NHS

Much is being (and will be) written about the Health and Social Care Bill, which sets out the reform of the English National Health Service.

The bill can be accessed here, and its progress through the House of Commons and the House of Lords can be tracked here. Editorials in the two main British medical journals are not particularly supportive. The Lancet poses a revealing question "The end of the National Health Service?", while the British Medical Journal uses Boris Karloff's characterization as Frankenstein to illustrate what it is called "Dr Lansley's [the current Secretary of Health] Monster".

Joint OECD and EC Health Report

The OECD report Health at a Glance focuses on health issues across the 27 European Union member states, three European Free Trade Association countries (Iceland, Norway and Switzerland) and Turkey. It summarizes in 42 indicators comparable data covering a wide range of topics, including health status, risk factors, health workforce and health expenditure in these countries. This publication is the result of a collaboration between the OECD, and the European Commission and the full report is accessible here.

Improving the contribution of health services research to evidence based policy

Health services researchers may dream that the New Year resolution of policy makers is to make their policies more evidence based. There are a few things that need to happen in order to help them succeed. A recent policy brief provides an overview of major research priorities based on stakeholder involvement at national and European level, and it offers possible directions for improving the contribution of health services research to policy. The research has been conducted as part of the HSR Europe project. This project is led by a consortium of five major health services research institutes in Europe and is funded through the Seventh Framework Programme of the European Commission with the aims of identifying, evaluating and improving the contribution of Health Services Research to the health policy process in Europe.