Not just a postcode lottery

A report from the National Cancer Equality Initiate (NCEI), a body tasked by DH with researching the evidence for inequalities in cancer across the UK, suggests that data collection and analysis is improving. Highlighting opportunities provided by the National Cancer Intelligence Network (NCIN) in bringing together the various sources of information, NCEI’s report also identifies significant gaps in evidence (particularly as regards socio-economic deprivation, ethnicity, religion and disability) and sets some priorities for future work. Amongst these is the new cancer patient experience survey, which will take place for the first time this year. There is also the suggestion that multidisciplinary teams undertake patient level equality audits and review these annually as part of the National Cancer Peer Review Programme. Early adoption sites for this will be sought this year. NCIN also previews its Cancer Equalities Portal, which offers data by cancer type and equality group.

State of the nation

The 2009 Health Profile for England was released at the end of March. Key data include rising rates of diabetes and alcohol related hospital admissions and deaths, improvements in housing stock, activity patterns amongst children and smoking prevalence. In comparing England with countries in the EU (the 15 nations that were EU members in 2004), the UK has higher than average infant mortality rates and adult obesity levels.

What really works?

The Audit Commission takes a rather dim view of inequalities spending in its recent bulletin, Healthy Balance. After praising some achievements, it does rather suggest that there’s not too much to show for the estimated £21 billion NHS spend in 2009/10. There’s criticism of government’s lack of consistency and excess of policy and guidance, which leaves PCTs and local authorities facing “conflicting demands.” Absence of targeted spending and precise assessment is also attacked: what is needed is “much clearer sight of what is being spent and much sharper evaluation of its impact.” The report ends by bleakly quoting the conclusions of the Marmot review: “health inequalities will remain until we tackle the inequalities in society.” Findings from a study of systematic reviews in the Journal of Epidemiology and Community Health also focus on a lack of clarity as regards the effectiveness of interventions designed to tackle the wider social determinants of health inequality.

National Support Teams

DH has published a resource manual from the Health Inequalities National Support Team (HINST) which addresses various aspects of the inequalities agenda. Based on HINST’s work with Spearhead PCTs, these papers aim to set out what works in tackling health inequalities, from data collection and analysis to direct interventions. Included are 11 "how to guides," covering such topics as developing a strategic framework for community engagement and addressing the quality and cost effectiveness of prescribing in the context of long term conditions.

In care

Draft public health guidance from NICE focuses on the physical and emotional health and wellbeing of looked after children. The guidance, which has been developed by NICE and the Social Care Institute for Excellence (SCIE), is expected to be released in its final form in September. Key recommendations include the need to commission services that are “integrated, preferably on the same site,” provision for the team around the child of a “consultancy service to help consider and work collaboratively on complex cases and situations” and access to specialist services for babies and children under 5 “which offer early and preventive interventions for babies and young children to avoid placement breakdown.” Also, because of the high level of emotional and mental health issues amongst looked after children and young people, there is, throughout the recommendations, a strong focus on Child and Adolescent Mental Health Service (CAMHS) input. Responses should reach NICE by 16 April 2010.

All change

More annual reporting, this time from Change4Life, which is also a year old. But have the delightful plasticine figures made a difference? Targeting families with children aged 5-11, the strategy has made a definite hit on the brand recognition front and (according to their own tracking group) mothers have made changes to their children’s diet or activity levels. Change4Life analysis also looked at food buying behaviour. In a pilot study using Tesco Clubcard data, researchers found that the Change4Life households did “contain a large proportion of lower income families” and that there had already been some changes in purchasing, such as choosing low-sugar drinks.
Recent articles from BMC Public Health take a slightly more sober view of lifestyle change interventions: Is there a demand for physical activity interventions provided by the healthcare sector? and The influence of a high intensity physical activity intervention on a selection of health related outcomes both provide interesting reading.

How are we doing?

The Oneplace initiative and the Comprehensive Area Assessment which under pins it, offers the public a scorecard view of local service provision via a website. Oneplace has published a report of its first year, bringing together judgments from a range of inspectorates, including the Audit Commission, the Care Quality Commission, Ofsted and others. The report provides a rather broad brush approach (red and green flags) but includes the usual examples of good practice.