Graham Cookson

Cancelled surgeries and payment by results in the English National Health Service

Objectives To model the frequency of ‘last minute’ cancellations of planned elective procedures in the English NHS with respect to the patient and provider factors that led to these cancellations. Methods A dataset of 5,288,604 elective patients spell in the English NHS from January 1st, 2007 to December 31st, 2007 was extracted from the Hospital Episode Statistics. A binary dependent variable indicating whether or not a patient had a Health Resource Group coded as S22 - ‘Planned elective procedure not carried out’ - was modeled using a probit regession estimated via maximum likelihood including patient, case and hospital level covariates. Results Longer waiting times and being admitted on a Monday were associated with a greater rate of cancelled procedures. Male patients, patients from lower socioeconomic groups and older patients had higher rates of cancelled procedures. There was significant variation in cancellation rates between hospitals; Foundation Trusts and private facilities had the lowest cancellation rates. Conclusions Further research is needed on why Foundation Trusts exhibit lower cancellation rates. Hospitals with relatively high cancellation rates should be encouraged to tackle this problem. Further evidence is needed on whether hospitals are more likely to cancel operations where the procedure tariff is lower than the S22 tariff as this creates a perverse incentive to cancel. Understanding the underlying causes of why male, older and patients from lower socioeconomic groups are more likely to have their operations cancelled is important to inform the appropriate policy response. This research suggests that interventions designed to reduce cancellation rates should be targeted to high-cancellation groups.

Analysing the economic justification for the reforms to social welfare and family law legal aid

The Ministry of Justice plans on saving £450 million per annum from the legal aid budget through reforms contained in the Legal Aid, Sentencing and Punishment of Offenders Act 2012.Over 60% of these savings will be found by removing whole areas of law and types of problem from the scope of legal aid support. One of the principal justifications for these reforms is the economic imperative; reducing legal aid expenditure is necessary to meet the Governments fiscal targets. This article examined whether these reforms will generate the substantial savings identified in the Governments impact assessment, or whether these costs will be passed on to other areas of government. Data from the Civil and Social Justice Survey were used to model the behavioural responses of people no longer eligible for legal aid under the scope changes. Economic costs were estimated for these responses where they will be incurred by the state, although many of these costs are likely to be underestimates. Many costs could not be estimated including, inter alia, the cost of increased criminality where people seek redress outside of the justice system. The analysis focused on family and social welfare law, which together represent 82% of the proposed savings from the scope reforms. Based upon this analysis, the Government is unlikely to save more than 40% of its prediction. At the same time, these minimal savings could generate inequality of access to justice and overburden an already struggling alternative advice sector. A significant uptake in funded mediation within family law is predicted.

Cancelled procedures: Inequality, inequity and the national health service reforms

Using data for every elective procedure in 2007 in the English National Health Service, we found evidence of socioeconomic inequality in the probability of having a procedure cancelled after admission while controlling for a range of patient and provider characteristics. Whether this disparity is inequitable is inconclusive.

Reflections on the PING! table tennis initiative: Lessons and new directions for sports development?

Purpose – The purpose of this paper is to establish the impact and effectiveness of the national PING! project implemented by a national governing body of sport (NGB) and key public sector partners in England. It establishes lessons learnt and areas to improve future programme development in this area of public sports management. In addition it is also evidencing a new approach to engaging with physical activity and sports development in local communities. Design/methodology/approach – The research study is based on a user survey with 375 respondents and two qualitative ethnographic case studies in two of the eight cities that were involved in the programme. These case studies encompassed 30 individual or group interviews, informal observations and site visits across the two cities. Findings – The research project has identified some of the key factors that lie behind the positive outcomes of the scheme, including a strong sense of participant community, diverse participant profiles, a hidden workplace im...

PP21 Organisational Influences on Variation in Rates of Caesarean Section Among English NHS Trusts after Accounting for Maternal and Clinical Risk: A Cross-Sectional Study

Background The proportion of women in England having a caesarean has increased from 9% to 24.8% between 1980 and 2012. There is increasing attention focused on the short and long term effects on the mother and the baby and efforts to have an increased understanding of associated influences. Previous research has adjusted for population case-mix (Bragg al 2010), but there has been less research on the relative impact of organisational factors which is the aim of this study. Methods A retrospective cross-sectional analysis was performed using routinely collected data from Hospital Episode Statistics dataset with over 660,000 deliveries in 144 NHS trusts in England. The dataset included all women giving birth between April 2010 and March 2011. The outcome was whether the delivery was by caesarean section. Clinical risk factors were calculated using the NICE intrapartum guideline criteria for women at increased risk of complications at the end of pregnancy. Exploratory statistical analysis of caesarean rates for each trust was performed to identify significant variation in rates (both planned and emergency). A multilevel logistic regression model was used to estimate the likelihood of women having a caesarean section given their maternal (level 1) characteristics (age, ethnicity, parity, socioeconomic deprivation), clinical risk factors (NICE Intrapartum guideline criteria) and organisational (level 2) factors (staffing, trust configuration, number of delivery beds, number of deliveries, teaching and Foundation Trust status, CNST rating and women’s experience). Results In 2010/11, 48% of women in England were categorised as low risk according to NICE Intrapartum Guidelines at the end of pregnancy. Among 660,000 deliveries, 24.8% of women were delivered by caesarean section. Unadjusted rates of caesarean section among the NHS trusts ranged from 36.1% down to 15.2%. Following adjustment for socio-demographic and clinical risk factors, adjusted rates were of a similar range but rates for individual trusts changed, and the impact of organisational factors were examined. Discussion Once adjusted for socio-demographic and clinical risk factors, it is possible to see how caesarean rates for trusts differ. We discuss the relative impact of organisational characteristics, and what requires further exploration. Routinely collected data can provide information about the type of births that women are experiencing, and provide the means to adjust trust data to take account of the profile of women giving birth in each location, and organisational characteristics. This allows trusts to benchmark its services for quality improvement and provides baseline data for exploring reasons for high and low performing outliers.