I am taking the Kings Fund Course on NHS explained and had difficulty in understanding the statistics. Iin my very early days at Cambridge I was told very firmly by my Director of Statistics, who tole the first thing to consider any statistics was to consider methology and defininitions .
The charts in question had no definitions - I am still puzzling about what has happened to housemen, registars etc in the fist chart in the detailed statistics seemed to exclude registrar, junior doctors etc and why it referred to only medial staff. Mental health was not mentioned.
So I turned to your blog, when all became clear. Your blog was just the sort of stuff I used to write in my first job in DHSS. May you and the Kings Fund continue.
We believe that a major upgrade in funding is imperative to provide resources to meet the enormity of the public health challenges that the country faces.
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A very specific issue for me as, amongst several other roles, a care home owner and lead for a coalition of independent residential care providers in Devon, is a need for a refresh of an excellent health needs assessment report produced by our local PH service in April 2014. The 74 page report gives us a detailed position statement for our care home issues and a clear baseline on priorities - sadly despite numerous requests for an update 3 years on has not been seen as necessary - this despite many care homes and nursing homes now having gone out of business, massive workforce challenges, a sizable shift in placement patterns, a continuing struggle to address preventable admissions to hospital and many delayed discharges. We know that the report in April 2014 the story was that over 5,000 admissions per year came from care homes - over 100 each week - we really need to re examine what the story is now - what has changed? is it better, is it worse? what we did? what we need to do more of? - this is what I would argue to be a vital an key role for our PH experts - I will keep trying to persuade others to agree with me - I have just attempted to seek some HEE funds to assure some resource for this work to be repeated under the heading of 'enhancing a better workforce plan for H&SC' where we were asked to submit a plan as part of an STP workforce improvement initiative - we were asked to work up a bid on Tuesday with Friday as the deadline - I know we have done our best to put a plan together taking account of the restricting limiters as to what we can and cant include - PH may be the beneficiaries of at least some dividend if successful - we really must reinstate PH as central to prevention, promotion and sustainability across H&SC NB - if you would like to see the now long out of date JSNA care home report that I still often quote from do get in touch and I will send you a copy via email or twitter.
In full agreement Greg, there's lots of additional analysis that can be done with this data and linking it to other data and wider intelligence and information to pose all sorts of questions on effectiveness, efficiency, variation and impact over time - i've got a list as long as my arm!
And yes Geraldine, agree, local authorities are facing really tough decisions and, unlike the NHS, legally cannot spend more than they receive in grants and other income. So this is the sharp end. The positive i would take is that at least we can see the data now, before the reforms it was buried in PCTs and now it is public and transparent (if needing a lot of work) and people can analyse it and draw their conclusions. Long may this transparency continue.
In addition the focus on pressing social care towards managing pressures on one part of health services ie acute, to the detriment of everything else, also severely reduces their ability to carry out their often unrecognised but essential public health work eg community development.
We have severe pressures on other aspects of public health such as housing, education, leisure services, employment status, infrastructure in including roads, cycle paths, street lighting....A response to reduce this dedicated budget is mind boggling!
Only one point I'd take issue with is the notion that we are only now entering into the realms of real terms cuts. Many places have been in that space for some time now.
Yes of course it's a false economy, audible sigh.
Other suggestion would be to try to compare the rate of change in reduced spend with some narrowly defined outcomes so as we can get a sense of impact
One other observation - would be interesting to put the current spend, and reductions in spend in the grant as narrowly defined against either the evidence around ROI (with all it's imperfections) and or the burden of illness. One of my pet grumbles is that we massively under invest in tobacco control and smoking cess compared to ROI and to the level of risk that gives to pop and individual level outcomes