Drug and alcohol round-up

From the Department for Education, a cost benefit analysis of specialist drug and alcohol services for young people. Key findings from the Alcohol Harm Reduction National Support Team visits up to the end of the programme in March this year focus substantially on organisational and leadership aspects with emphasis on design of services, integration and assessment. The Journal of Epidemiology and Community Health includes a study on the ethnic density effect on alcohol use amongs ethnic minority people in the UK.

Migrant health

Local Government Improvement and Development has issued guidance on how to include migrants in Joint Strategic Needs Assessments. More good practice emerges from a survey of healthcare professionals who work with migrants in 16 European countries. A qualitiative study from the Netherlands looks at negative health care experiences amongst immigrants using hospital services. Being an immigrant in a high-income country is a serious risk factor for mental health problems, a team from Sweden has confirmed, adding that refugee status for women increases that risk.

UK child poverty snakes and ladders

The improvements in child poverty levels made by the UK prior to the global financial crisis could well be reversed under present circumstances, a report from the OECD suggests. In its survey of family wellbeing across OECD countries, the thinktank shows that UK child poverty levels fell more than any other OECD country, from 17.5% in 1995 to 10.5% in 2005, below the OECD average of 12.7% . Between 2003 and 2007, UK government spending on families was higher than most of its peers. However, the OECD warns that cutting back on early years services could threaten this progress, as it limits the ability of parents to get back into work. Childcare costs are one of the biggest barriers, the OECD argues, but not the only factor. Interviewed in the Guardian, one of the report's authors also suggested that how the government spends is as important as how much, comparing the UK with Nordic countries' child poverty interventions and outcomes, where "in kind" support (such as childcare) rather than direct financial support tends to be the preferred option.

Beside the seaside

The Department of Communities and Local Government has published a useful benchmarking report on smaller seaside towns, comparing data with regional and rural as well as national figures. This follows an earlier report on larger seaside towns and covers towns with a population of up to 10 000.

Diabetes care

Ethnicity disparities in diabetes management are starting to be addressed effectively, according to a study of patients with diabetes in North West London. The study's authors conclude that, along with specific attendtion being paid to South Asian groups, all ethnic groups in the population benefit from recent quality improvement measures. A systematic review of physical activity and dietary interventions for people at risk of developing type 2 diabetes found that the most effective interventions were associated with higher levels of contact frequency and certain types of behaviour change techniques (goal-setting, self-monitoring)

Scoffing at QOF?

According to research commissioned by NIHR, the GP pay-for-performance scheme, the Quality Outcomes Framework (QOF) has had minimal impact on public health in deprived areas. As well as milling the data (HES statistics, spearhead status etc.), the team from the King's Fund and the London School of Hygiene and Tropical Medicine conducted interviews with PCT and general practice staff. The gap in performance between least deprived and most deprived practices has decreased since the implementation of QOF, but differences were already small. It should be noted that QOF was never designed to address public health or inequalities issues: the report's main criticisms are reserved for the QOF system itself, which does not incentivise health improvement or public health activities, so much as efficient management of known/existing problems. The content of the 2012/13 QOF is currently being considered.

Nudge, nudge

The latest offering from the Government's Behavioural Insight Team (aka the Nudge Team) is Better choices, better deals, a paper which anticipates an increasingly consumer-empowered world. Amongst the health issues addressed is the role of the Public Health Responsibility Deal, a compact between government, food producers and retailers launched earlier this year with food-related pledges on labelling, salt content levels and use of transfats. An article in the British Journal of Healthcare Management makes a sober assessment of the science behind the nudge approach and considers whether clinicians and health sector managers should pay attention.

Screening

Guidance from DH helps commissioners and others look at how to improve uptake of antenatal screening and newborn immunisation for hepatitis B. There’s also a care pathway covering primary as well as acute care roles. DH has supported universal screening of pregnant wormen and immunisation of at-risk infants since 2001 and current uptake of screening has risen to over 95% (2009 figures). However, this new guidance points out that immunisation uptake is more uncertain, especially in the necessary later doses, as evidenced in an audit in London in 2006.

Children's Services

Variations in emergency hospital admission rates are highlighted in a report on commissioning children’s services. In 2008/9 emergency admissions for the age-group 0 – 19 ranged from 3,784 to 12,680 with a strong correlation between deprivation (based on Indices of Multiple Deprivation) and ill health. The report also considers the financial cost as well as routes to admission (Accident and Emergency attendances and referral from primary care). There is a particular focus on management of long-term conditions, especially asthma and the report provides the usual themed examples of good commissioning practice. A review of community children’s nursing services from DH examines also looks at care for children with long term conditions along with care for those with acute shorter term conditions, disabilities and those needing palliative care.

Feel the benefit?

As changes to the incapacity benefits regime begin to come into effect, BMC Public Health has published a timely systematic review of studies on individual-focused return to work initiatives for people who are disabled or long-term sick. Chief Executive of Scope, Richard Hawkes, questions the efficacy of the fitness for work test and the Disability Benefits Consortium echoes the sentiment in its report, Benefiting disabled people?

Message getting through?

Social Science and Medicine includes a study from the USA on socio-economic variation in recall and perceived effectiveness of smoking cessation campaigns. Examining data from the New York Media Tracking Survey Online and their own web survey, researchers found that smokers with lower levels of education and income were more likely to recall and find effective advertisements that included graphic imagery or personal testimony rather than those that described how to quit smoking. DH’s latest version of guidance on delivery and monitoring of local stop smoking services is now available to download. Local Government Improvement and Development has published a best practice guide for local authorities, Reducing health inequalities though tobacco control.

Mapping cancer care

Guidance on reducing mortality from cancer in deprived areas has been produced by the National Cancer Action Team (NCAT), in collaboration with the Health Inequalities National Support Teams. Aimed at Health and Wellbeing Boards and GP commissioning Consortia, the guide uses a format developed by NCAT and NHS Doncaster as part of a lung cancer early intervention project and includes some helpful discussion about benchmarking tools and data sources. The Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine has done some evaluation of whether UK Cancer plans have made a difference to geographical inequalities in cancer survival. Looking at one year survival rates across the 28 cancer networks in England between 1991 and 2006, the team found that the north-south divide in relative survival “became less pronounced” but geographical inequalities persisted for all cancers with the exception of breast cancer. Inequalities in participation in colorectal screening are evidenced in a review of uptake for the initial phase of the programme (2006-2009). Researchers at UCL found low uptake in the most ethnically diverse areas and “a striking gradient” by social and economic status, with a 61% uptake in least deprived areas but only 35% in the most deprived.

Checking the Index

Essex hit the headlines last month, when the English Indices of Deprivation were published, as it provides the location for England’s most deprived area, Jaywick. Closer inspection reveals that although the East of England does indeed play host to the most and least deprived areas, the vast majority of deprivation occurs in the North of England. Other key findings from the latest release of the include the fact that over 5 million people lived in the most deprived areas in the UK in 2008, of whom around 38% were income deprived. However, the Indices also take into account several other kinds of deprivation: employment, health and disability, education skills and training, barriers to housing and other services, crime and living environment. This issue of the Indices uses data largely drawn from 2008 and updates earlier releases from 2004 and 2007. The Guardian has a useful article on mapping the really very small areas that the Indices work with (Lower Super Output Areas).