International Festival of Public Health

LT 2 - Health Services Research

Health Impact Review of proposed public health savings options in Manchester

Presenter: Dr Cordelle Mbeledogu, Manchester City Council

Other author(s): Neil Bendel, Manchester City Council

Abstract Text: A Health Impact Review (HIR) exercise was undertaken by Public Health Manchester to identify the potential impacts of proposed public health savings options on the health of the population. There was a focus on identifying any inequalities that might be caused by the differential impact of the savings options on specific population groups. The WHO Gothenburg consensus paper (December 1999) describes HIR as a form of Health Impact Assessment that is particularly useful when policies, programmes and projects are so broad as to make in-depth analysis infeasible . The aim is to create a convincing summary estimation of the most significant impacts on health of the policy or cluster of programmes and projects, without necessarily trying to disentangle the precise impact of the various parts of the policy or cluster on specific aspects of health .The methodology comprised:

1. An initial assessment of potential impacts of savings options using three criteria: scale of impact, timing and certainty.

2. A workshop for wider public health team, reviewing outputs of Stage 1 assessment using a modified Delphi consensus technique.

3. A validation exercise for each of the budget areas identified as having high negative impacts. Brief service reviews were interrogated to confirm that they supported the workshop findings.We identified the potential for a number of the savings options to widen health inequalities. Having identified the options with most significant potential impact on specific populations, we will collaborate with NHS and VCS partners to mitigate, as far as possible, the negative impacts of the options on health and health inequalities in the city.

Understanding of Female Genital Mutilation (FGM) in the United Kingdom

Presenter: Dr Issrah Jawad, London North West Health Trust

Other(s): None

Abstract Text: Aims: The purpose of this project was to establish the level of understanding and awareness of Female Genital Mutilation (FGM) in the UK amongst health professionals and the communities affected by FGM.

Background: FGM is a practice commonly found in parts of Northern and Eastern Africa. Migration has meant that in the UK 66,000 women are likely to have experienced FGM and 25,000 girls are at risk.

Methodology: A literature review was conducted looking at published work from the UK that addressed understanding and awareness of FGM from either the perspectives of health professionals or from communities affected by FGM.

Results: The literature review found 8 UK based studies with primary data that related to our aims. A thematic index was developed to organise the qualitative findings. The community based literature showed strong feelings of embarrassment amongst women which stopped those seeking help and strong negative reactions and criticism from health professionals when they did seek advice. Research which focused on health professionals showed a lack of understanding of both the clinical management of FGM and the cultural context in which it took place.

Conclusions: Given the numbers of women and girls affected by FGM and by extension their wider communities this subject cannot be excluded from the national public health agenda. FGM is a practice with strong cultural and community ties which is seen in the findings of this project and these influences must be taken into account when devising future policies and in training.

Population segmentation: An approach to reducing childhood obesity inequalities

Presenter: Susan Lowe, Birmingham City Council

Other author(s): Hashum Mahmood

Abstract Text: Aims:1-To investigate the relationship between socioeconomic status (inequality)and childhood obesity prevalence within Birmingham local authority

2 -To identify any change in childhood obesity prevalence between deprivation quintiles.

3-Analyse individualised Birmingham NCMP data using a population segmentation tool to better target obesity prevention strategies.

Methods:Data from the NCMP for Birmingham (2010/11 and 2013/14) was analysed using the deprivation scores from the Income Domain Affecting Children Index (IDACI) , 2010. The percentage of children with excess weight was calculated for each deprivation quintile. Population segmentation was carried out using the Experian Mosaic Public Sector (MPS) segmentation.

Results:Within Birmingham overall rates of childhood obesity (excess weight) in both Year 0 and Year 6 have changed little (static) between 2010/11 and 2013/14. However change analysis between the quintiles has shown that the gap between Year 0 and Year 6 in the more deprived quintiles has increased, whereas the most affluent quintile has seen a reduction in the gap. In terms of population segmentation the main three MPS Groups relating to children and families were Segment I, Segment O and Segment E.

Conclusion:Secondary analysis of NCMP has identified an increasing gap between Year 0 and Year 6 excess weight percentages within the deprivation quintiles. Segmentation analysis has shown the greatest number of children reside within the lower income diverse areas. The findings from this study should inform the future policy direction for tackling childhood obesity, which requires a greater emphasis on the reduction of inequalities and usage of segmentation to ensure effective use of public resource to target population appropriate interventions for reducing childhood obesity.

Financing DevoManc: opportunities for new mechanisms

Presenter: Brenda Gannon, University of Manchester

Other author(s): None

Abstract Text:

In this presentation, I provide an overview of financing in the NHS both nationally and in the context of Devolution in Greater Manchester. Current NHS spending at a National level is determined by the NHS (and now Monitor), on receipt of funding from the Department of Health. Allocations are provided to Clinical Commissioning Groups (CCGs) who determine the services they will purchase from providers. The Budget for 2015/16 is set at approximately £100bn and this is allocated across all CCGs. Resource allocation is determined by local health needs and deprivation adjustments. For 2015/16, £2bn of this is set aside for the Better Care Fund (BCF), to be utilised for integration of health and social care. This means there will be an even greater need for other savings, i.e. in hospitals. Currently hospital and mental health services account for three quarters of the budget.

In the Greater Manchester (GM) area, the CCGs are allocated approximately £6bn, split between CCG Programmes, Administration, BCF, Primary Care and Specialised Services. The BCF amount is £62m. Different financing options have been considered in recent years. Fee-for-service does not require co-ordinated accounting across primary and secondary care. Capitation funding provides financing to providers for each patient registered. The ‘Five Year Forward View’ highlights the importance of capitation and the bigger role capitated payments will play in the NHS in future.

I endorse a new variant of the capitated funding mechanism – fee per care pathway – following the individual from initial entry to the health services, throughout each year, until they exit the health services. This would allow for analysis of costs across the care pathway and potentially would help CCGs determine the most cost-effective pathways for both patient specific health outcomes and the average outcomes.

Devolution now provides an opportunity for the GM CCG to determine its own spending and analysis thereof. The requirement to integrate social care now lends itself to care pathway optimisation for each individual, ensuring all needs are met and potentially increasing efficiency in the system as a whole.

This will require careful evaluation. In this presentation, I outline an example of the new approach, along with eventual cost-effectiveness evaluation of the care pathway in the context of one of the GM priority work streams, dementia care.