Jon Warren

Prospective pilot evaluation of the effectiveness and cost-utility of a ‘health first’ case management service for long-term Incapacity Benefit recipients

BACKGROUND In line with the NICE guidance, an NHS-commissioned case management intervention was provided for individuals receiving Incapacity Benefit payments for ≥3 years in the North East of England. The intervention aimed to improve the health of the participants. METHODS A total of 131 participants receiving the intervention were compared over 9 months with a (non-equivalent) comparison group of 229 receiving Incapacity Benefit payments and usual care. Health was measured using EQ-5D, EQ-VAS, SF-8, HADS and the Nordic Musculoskeletal questionnaire. Socio-demographic and health behaviour data were also collected. Fixed-effects linear models with correlated errors were used to compare health changes between groups over time. A preliminary cost-utility analysis was also conducted. RESULTS The comparison group measures of health were stable over time. Starting from comparatively poor initial levels, case-management group generic (EQ5D, EQ-VAS) and mental health (HADS-A, HADS-D and SF8-MCS) measures improved within 6 months to similar levels found in the comparison group. Musculoskeletal (Nordic 2) and health behaviours did not improve. Tentative estimates of cost-utility suggest an intervention cost in the region of £16 700-£23 500 per QALY. CONCLUSIONS Case management interventions may improve the health of Incapacity Benefit recipients. Further research is required to help confirm these pilot findings.

Go slow: an umbrella review of the effects of 20 mph zones and limits on health and health inequalities

BACKGROUND Transport is an important determinant of health and there is a well-established association between socio-economic status (SES) and risk of road accidents. Effective traffic calming interventions such as 20 mph zones and limits may therefore improve health and reduce health inequalities. METHODS Systematic review methodology was used to identify systematic reviews of the effects of 20 mph zones (including speed limits and road humps) and 20 mph limits on health and SES inequalities in health amongst adults and children. RESULTS Five systematic reviews were included. Overall, they provide convincing evidence that these measures are effective in reducing accidents and injuries, traffic speed and volume, as well as improving perceptions of safety in two of the studies. There was also evidence that such interventions are potentially cost-effective. There was no evidence of the effects on SES inequalities in these outcomes. CONCLUSION Twenty mile per hour zones and limits are effective means of improving public health via reduced accidents and injuries. Whilst there was no direct evidence on the effects of interventions on health inequalities, targeting such interventions in deprived areas may be beneficial. Further controlled evaluations that specifically examine SES effects are required.

Applying Qualitative Comparative Analysis (QCA) to evaluate a public health policy initiative in the North East of England

Abstract This paper presents a Qualitative Comparative Analysis (QCA) analysis of data produced as part of the evaluation a Nation Health Service commissioned intervention in the North East of England. QCA is a case-oriented method that allows systematic comparison of cases as configurations of set memberships based on their attributes and the relationship of these to particular outcomes. QCA provides an alternative to conventional quantitative approaches which are generally concerned with isolating the independent effect of one variable whilst controlling the influence of others. Instead, QCA allows for interactions between multiple attributes and recognises that the same outcomes may be generated by different configurations of attributes. The intervention evaluated provided case management for individuals who were out of work due to ill health, and had been for three years or more. It aimed to improve the health of individuals and move them closer to the labour market. The intervention and a comparison group were assessed at base line (T1), after 3 months — (T2) after 6 months (end of the intervention — T3) and after 9 months (three months post intervention — T4). The size of the respective populations at each time point were, Intervention group at T1, N = 131, T2, N = 44, T3, N = 79, T4, N = 95. Comparison group at T1, N = 229, T2, N = 188, T3, N = 166, T4, N = 154. General health was measured using EQ5-D (a standardised instrument for use as a measure of general health outcome) and SF-8. Two condition specific measures were included: the Hospital Anxiety and Depression Scale (HADS) and the Nordic Musculoskeletal questionnaire. Data was also collected on socio demographics (gender, age, housing tenure), social capital (contact with family and friends and participation with the wider community), and work history (previous jobs, time spent in the job, time spent on sickness absence). The aim of the QCA analysis was to identify whether individuals with certain characteristics or combinations of characteristics benefited from the intervention. In order to do this the cases were sorted according to whether their EQ-5D VAS (Visual Analogue Scale) scores (a self rated measure of general health) narrowed or did not narrow towards the population norm for the measure between baseline (T1) and (T4) 9 months (three months post intervention — T4). Cases which narrowed towards the UK population norm of 82.48 were judged to be experiencing a health improvement whilst those whose scores did not narrow towards the norm were judged to not have experienced a health improvement. A crisp set (cs) QCA analysis was then performed. The paper assesses the benefits of using QCA, and asks whether it can provide a viable and practical tool for social policy evaluations.

The new politics of disablement (2nd ed.)

References Farrell, M. 2010. Debating special education. London: Routledge. Hornby, G. 2011. “Inclusive education for children with special educational needs: A critique.” International Journal of Disability, Development and Education 58 (3): 321–9. Hornby, G., and R. Kidd. 2001. “A transfer from special to mainstream – Ten years later.” British Journal of Special Education 28: 10–17. Hornby, G., and C. Witte. 2008. “Follow-up study of ex-students of a residential school for children with emotional and behavior difficulties in New Zealand.” Emotional and behavior difficulties 13: 79–93. Ruebain, D., and S. Haines. 2011. Education, disability and social policy. Bristol: The Policy Press. Warnock, M. 2005. Special educational needs: A new look. London: Philosophy of Education Society of Great Britain.

‘The unwilling and the unwell’? Exploring stakeholders’ perceptions of working with long term sickness benefits recipients

This paper draws on qualitative research with Incapacity Benefit (IB) stakeholders in the North East of England, UK. Stakeholders’ experiences of working with long-term sickness benefits recipients reveal multiple barriers that both sick and disabled people, and themselves as practitioners, clearly face. Reflections on what ongoing welfare reform could mean for future practice for both stakeholders and recipients will be explored. The findings suggests that whilst stakeholders recognise the complex barriers faced by those receiving sickness benefits, a wider moral dialogue between ‘deserving’ and ‘undeserving’ is being created and sustained as a result of negative stereotyping of sickness benefits recipients.

After Atos Healthcare: is the Employment and Support Allowance fit for purpose and does the Work Capability Assessment have a future?

In June 2014 the BBC reported that it had seen a number of UK Department for Work and Pensions documents relating to the Employment and Support Allowance (ESA). These documents, which included six memos written by civil servants and government advisers, tell us very little that we did not know already; namely that the ESA is in crisis, and that waiting lists for assessment and appeals are unacceptable. However, what is significant is that these concerns are being raised within the Department for Work and Pensions itself. The underlying drift is that the question of whether the current model of ESA and Work Capability Assessment is sustainable is now firmly on the UK government’s radar.

Inequalities in mental health and well-being in a time of austerity: Baseline findings from the Stockton-On-Tees cohort study

Since 2010, the UK has pursued a policy of austerity characterised by public spending cuts and welfare changes. There has been speculation – but little actual research – about the effects of this policy on health inequalities. This paper reports on a case study of local health inequalities in the local authority of Stockton-on-Tees in the North East of England, an area characterised by high spatial and socio-economic inequalities. The paper presents baseline findings from a prospective cohort study of inequalities in mental health and mental wellbeing between the most and least deprived areas of Stockton-on-Tees. This is the first quantitative study to explore local mental health inequalities during the current period of austerity and the first UK study to empirically examine the relative contributions of material, psychosocial and behavioural determinants in explaining the gap. Using a stratified random sampling technique, the data was analysed using multi-level models that explore the gap in mental health and wellbeing between people from the most and least deprived areas of the local authority, and the relative contributions of material, psychosocial and behavioural factors to this gap. The main findings indicate that there is a significant gap in mental health between the two areas, and that material and psychosocial factors appear to underpin this gap. The findings are discussed in relation to the context of the continuing programme of welfare changes and public spending cuts in the UK.

Whose Side Are We on and for Whom Do We Write? Notes on Issues and Challenges Facing Those Researching and Evaluating Public Policy.

Becker (1967) poses the question Whose side are we on?, a question which has become an enduring part of discussions within social scientific methodology. This paper explores the key issues in Beckers argument and considers its relevance to researchers today, locating this within a consideration of evaluation-based research and policy. Many of the issues Becker discusses remain relevant, yet what has changed radically is the context within which academics operate. In an era when academics and their research are becoming increasingly commodified, this paper contends that the question of who the academic serves and writes for is increasingly important.

‘We are volunteers and that sometimes gets forgotten’: exploring the motivations and needs of volunteers at a healthy living resource centre in the North East of England

Aims: This article explores the motivations and needs of volunteers in the delivery of community health services at a healthy living resource centre in the North East of England, United Kingdom. Methods: Four focus groups involving a total of 16 participants were conducted between March and May 2013. All sessions were digitally recorded with prior consent from participants. Data were then transcribed, thematically coded and analysed using NVivo software. Results: Relevant training tailored to individual needs is required in order to avoid alienating volunteers. Successful communication is also central to fostering positive relationships between volunteers and staff members within organisations. Finally, it is vital that the contribution volunteers make is fully recognised and appreciated. Conclusion: The place of volunteers within public services and their role in delivery have become increasingly prominent in recent years. Training, alongside clear communication and recognition of the contribution volunteers make, can help improve the experiences of those choosing to volunteer within the health services.

Help for heroes? Evaluating a case management programme for ex-service personnel in the United Kingdom

Aims: There is increasing recognition of the health and social needs of ex-service personnel, but the UK evidence base on interventions is small. This article presents the findings from an evaluation of a vocational case management programme co-funded by the National Health Service (NHS) to prevent ill health among ex-service personnel. Methods: Qualitative, semi-structured interviews with 15 ex-service personnel were conducted. Five interviews with case management staff were also undertaken. Data were transcribed, thematically coded and analysed using NVivo. Results: Ex-service personnel valued the service and consistently highlighted ‘being listened to’, ‘being made to feel valued by programme staff’, ‘having their problems taken seriously’ and ‘being treated as an individual’ as the most valuable aspects of the programme. Respondents particularly valued the personal support that case managers provided and the environment in which the service was delivered. Conclusion: Case management is a viable way in which the military, health professionals and support services can provide ongoing support for ex-service personnel in transitioning successfully to civilian life.