Rob Baggott

Health and health care in Britain

Health and Illness - Medicine and the Medical Profession - Critical Perspectives on Health Care - The Evolution of the British Health Care System - The Health Care System Today - The Management of Health Care - Allocating Resources to Health Care - The Purchaser-Provider Split - Primary Health Care - Care in the Community - The Experience of Health Care - The Health of the Nation - Conclusion

Public Health: Policy and Politics

Preface Public Health Concepts and Frameworks The Historical Context of Public Health Public Health in the Twentieth Century Health Strategies in the UK Public Health in a Global Context Public Health and the NHS Public Health Beyond the NHS Public Health Services The Health and Wellbeing of Children and Young People Health and the Environment: Pollution and Accidents Climate Change and Sustainable Development Food Safety, Security and Sustainability Diet, Nutrition and Obesity Illicit Drugs Alcohol and Tobacco Socio-economic Factors and Health Inequities and Inequalities Policy Conclusion

A benchmark too far: findings from a national survey of surgical site infection surveillance

BACKGROUND The national surgical site infection (SSI) surveillance service in England collates and publishes SSI rates that are used for benchmarking and to identify the prevalence of SSIs. However, research studies using high-quality SSI surveillance report rates that are much higher than those published by the national surveillance service. This variance questions the validity of data collected through the national service. AIM To audit SSI definitions and data collection methods used by hospital trusts in England. METHOD All 156 hospital trusts in England were sent questionnaires that focused on aspects of SSI definitions and data collection methods. FINDINGS Completed questionnaires were received from 106 hospital trusts. There were considerable differences in data collection methods and data quality that caused wide variation in reported SSI rates. For example, the SSI rate for knee replacement surgery was 4.1% for trusts that used high-quality postdischarge surveillance (PDS) and 1.5% for trusts that used low-quality PDS. Contrary to national protocols and definitions, 10% of trusts did not provide data on superficial infections, 15% of trusts did not use the recommended SSI definition, and 8% of trusts used inpatient data alone. Thirty trusts did not submit a complete set of their data to the national surveillance service. Unsubmitted data included non-mandatory data, PDS data and continuous data. CONCLUSION The national surveillance service underestimates the prevalence of SSIs and is not appropriate for benchmarking. Hospitals that conduct high-quality SSI surveillance will be penalized within the current surveillance service.

Health consumer and patients' organizations in Europe: towards a comparative analysis

Despite the rise of health consumer and patients’ organizations (HCPOs) in modern health‐care systems, studies are few and far between. In particular there is a lack of comparative research across Europe and at the pan‐European level. In an effort to address this gap, an expert workshop was held in Vienna in February 2006. This involved 22 delegates from 10 European Countries and was funded by the European Science Foundation (ESF). The workshop reviewed the development of HCPOs in Europe and their role in the policy process in order to establish a platform for further research in this field. It found evidence of an increase in HCPOs across European countries, increased engagement with policy makers and political institutions, and the creation of alliance organizations bringing together HCPOs across the sector. However, variations between countries were observed, relating to different political, cultural and health system contexts. There was no consensus on whether the rise of HCPOs constituted a new social movement. An increase in HCPO activity at the pan‐European level was noted, reflecting the increased interest of EU institutions in health policy. At both domestic and European levels, concerns about the representativeness and legitimacy of HCPOs were raised as well as questions about their independence (notably with regard to the drugs industry). HCPOs face a number of obstacles including: lack of capacity and resources, fragmentation and the power of more established interests within the health‐care system. The workshop concluded that further research is needed in this field, in the form of a comparative study of HCPOs in European countries and an analysis of their activities at the pan‐European level.

Evaluating Health Care Reform: the Case of the NHS Internal Market

The NHS internal market, introduced in an atmosphere of controversy, continues to generate much disagreement. This article examines the evidence on the impact of this policy with regard to a range of criteria, including efficiency, accountability, effective planning and co-ordination, patient choice and service quality, equity, and the culture of the NHS. It explores the different ways in which this evidence is perceived and seeks to make explicit the assumptions and biases of those involved in the debate about the reforms. The article also examines the policy process behind the reforms and the extent to which it has added to the problems of evaluation. By way of conclusion, the implications for future health care reform are considered and a number of procedural changes suggested.

Influencing the national policy process: the role of health consumer groups.

Introduction  Whilst recent research has focused on consumer involvement at local level in the UK, there have been few studies of the representation of user, carer and patients’ interests nationally. This paper concentrates on the role of health consumer groups in representing the collective interests of patients, users and carers in the national policy process.

Health, lifestyle, belief and knowledge differences between two ethnic groups with specific reference to tobacco, diet and physical activity

AIMS   To compare physical activity levels, body mass index, habitual diet, tobacco use and prevalence of non-communicable disease between the two ethnic groups and to identify predictors for differences between groups. BACKGROUND   Tobacco use, poor diet and physical inactivity are major lifestyle risk factors for chronic cardiovascular diseases, certain cancers, diabetes and chronic lung diseases. There are higher risk and incidence of these diseases in some ethnic groups, for example Asians have higher incidence of diabetes. DESIGN   Cross sectional survey. METHODS   Cross sectional survey of Asians of Indian descent and white British adults conducted between October-December 2009. Main outcome variables were lifestyle behaviours and BMI. Self-reported disease diagnosis was also collected. In a regression analysis, predictors of outcome variables were demographic variables and beliefs/attitudes/knowledge towards lifestyle behaviours. RESULTS/FINDINGS   Body mass index, tobacco use and non-communicable disease (except diabetes) were lower in Indians. Indians reported lower physical activity levels and greater salt use than Whites. Tobacco use was higher in Whites, but knowledge, attitudes and beliefs were similar between Whites and Indians. CONCLUSION   Health risk behaviour and morbidity are different between the two ethnic groups. Gender, age, educational level, beliefs, attitudes and knowledge do not explain these differences. Health promotion that aims to improve knowledge will probably not work and innovative methods are needed to improve health in high risk groups.

Reliable surgical site infection surveillance with robust validation is required

We would like to thank Lamagni and her colleagues from the Health Protection Agency for their interest in our paper. While they state in their letter that post-discharge surveillance (PDS) is not used for benchmarking, and therefore NHS hospital trusts which conduct PDS are not penalized, we should like to point out that inconsistencies were also found among inpatient and readmission data which are used for benchmarking. Therefore trusts could be penalized. They also claim that the national surveillance programme, which collects inpatient and readmission data, produces reliable data. However, one of the authors of the Lamagni letter appears to contradict this in an article in the Journal of Infection Prevention (January 2013 issue): Wilson discusses various data collection methods, such as prospective, active, passive, staff reporting, telephone follow-up of laboratory reports only, liaison with ward staff and case note review, and states how each of these methods has a ‘major effect’ on reported surgical site infection (SSI) rates. All of these data collection methods are permissible in the current national surveillance programme, yet Wilson goes on to argue that a national surveillance system must prescribe data collection methods that minimize the risk of selection and measurement bias, thereby enabling comparisons between hospitals. Wilson further states e in effect supporting the claims of our paper e that reliable surveillance methods are desirable if data are to be trusted by surgical teams and also calls for robust validation systems. We should also like to point out the unreliability of using readmission data as a surrogate for post-discharge data. In the current climate many organizations are developing admission avoidance strategies. Increasingly patients with SSIs that may have caused readmission a few years ago may now be treated effectively in the community with therapies such as vacuumassisted closure, expert nursing wound management or

Implementation and development of alcohol policies in the workplace a study in Leeds and Leicestershire

This paper presents the findings of a comparative study of workplace alcohol policies at the local level in Leeds and Leicester in 1991 and 1992. The aim of the study was to identify the factors most likely to lead to the adoption of an alcohol policy by employers and to examine the process by which policies were designed, initiated and developed. In the first phase, the main factors associated with the adoption of formal written policies, such as employer characteristics and head office initiatives, were identified from the analysis of postal survey data. In the second phase, qualitative data from detailed interviews with employers drawn from the postal survey sample revealed two distinct alcohol policy types: those with a disciplinary focus and those with a health focus. The majority of policies were of the disciplinary type, but both types were applied highly inconsistently. In most cases, implementation strategies were poor and staff training was absent. The study also identified a number of transmission mechanisms through which alcohol policies were initiated.

Representing Whom? U.K. Health Consumer and Patients’ Organizations in the Policy Process

This paper draws on nearly two decades of research on health consumer and patients’ organizations (HCPOs) in the United Kingdom. In particular, it addresses questions of representation and legitimacy in the health policy process. HCPOs claim to represent the collective interests of patients and others such as relatives and carers. At times they also make claims to represent the wider public interest. Employing Pitkin’s classic typology of formalistic, descriptive, symbolic, and substantive representation, the paper explores how and in what sense HCPOs represent their constituencies. We found that policymakers themselves are less concerned with formal mechanisms adopted by groups and are more concerned with credibility, in particular whether HCPOs carry the confidence of their constituents. While some concerns about legitimacy remain, particularly in relation to funding from commercial interests, we argue that HCPOs bring a unique perspective to the policy process and to focus purely on formalistic representation provides only a partial understanding of their representative role and a constrained view of their collective moral claims.