Now showing items 1-20 of 74

    • Dudley MCP Scenario Analysis

      Frith, David (The Strategy Unit, 2018-02)
      Dudley is one of fourteen vanguard sites nationally developing the Multispecialty Community Provider (MCP) care model. The MCP involves the implementation of new organisational relationships that are intended to result in new system dynamics, incentivising the actions that can improve population health over the long term. The patient is at the centre of the MCP model of care. The MCP will bring together the services of GP practices, nurses, community health and mental health services, community-based services such as physiotherapy, relevant hospital specialists and others to provide joined up care in the community, improving outcomes and reducing demand. All this takes place in an uncertain context: the challenges facing NHS systems are headline news; NHS structures are frequently the subject of organisational change and new policy directives; funding allocations are determined on a relatively short term basis; and the impacts of the wider environment on the NHS and local health and care systems cannot be accurately predicted (e.g. how patterns of trade, competition and migration may change; what technological advances will be made and how the public will respond to them; how the supply and culture of the workforce will evolve). The Strategy Unit has been a strategic partner providing specialist support to the development and evaluation of the MCP, and the MCP Programme Board asked us to assist local stakeholders in exploring a range of plausible futures that could evolve over the intended fifteen year duration of the MCP contract. The aim of this work was not to predict the future but, through exploring a diverse set of plausible futures, to generate practical responses that would increase the effectiveness, resilience and agility of local plans, as well as providing additional assurance to regulators. Scenario work is best seen as an ongoing process: it builds social capital, provokes new insights and enables partners to explore challenging issues in a collaborative rather than competitive manner. This report is therefore only a staging post which: Describes the MCP strategy; Explores key features in the wider contextual environment; Presents three plausible future scenarios; and Records the shared learning that local stakeholders have already begun to generate following a workshop with a broad range of senior local leaders
    • Evaluation of the Dudley New Care Models Programme

      Battye, Fraser; Mulla, Abeda; Begum, Mahmoda (The Strategy Unit, 2018-09)
      The Strategy Unit led the evaluation of the Dudley Vanguard programme. This is the final system-wide report from that work. It draws on in-depth interviews with over 20 strategic level stakeholders from the Dudley system. The report looks at both the large-scale procurement process and the development of new services within the Vanguard programme. It provides an update on progress, but it also draws out lessons for both practice and policy. Readers wanting more information on the work we and our partners ICF and Health Services Management Centre did for Dudley should see the microsite we set up to house reports and disseminate lessons:
    • Lessons from the Vanguard: Innovation and Evaluation

      Battye, Fraser; Maubach, Paul (The Strategy Unit, 2018-10)
      The problems facing health and care services are so well known as to be documented in the media most days. These problems arise from a mismatch between need and provision: a mismatch where there is no reason to assume fundamental change. So innovation – in both product and process – is needed. Yet innovation doesn’t just happen. It must be encouraged and nurtured. It must also be supported with evaluative tools and disciplines: evidence is needed to inform decisions as to whether innovations are scaled, stopped or refined. This short paper suggests that evaluation and innovation are two sides of the same coin. It was produced by Dudley Clinical Commissioning Group (CCG) and its partners the Strategy Unit and draws on Dudley’s experience as a ‘Vanguard’ site under the New Care Models programme.
    • Scoping the Future (CRUK)

      Wyatt, Steven; Turner, Alison; Mulla, Abeda; Croft, Stacey (The Strategy Unit, 2015-09)
      The Strategy Unit was a partner in this project, led by the Health Services Management Centre at the University of Birmingham. The project was commissioned by Cancer Research UK to understand the capacity of endoscopy services to meet growing demand. The work included evidence collation, qualitative interviews with staff managing and delivering endoscopy services across England, quantitative modelling and analysis and triangulation of all the findings to make a series of recommendations. The findings were shared with the Independent Cancer Taskforce to inform the recently published cancer strategy.
    • Integrated Impact Assessment for Major Hospital Reconfiguration

      Frith, David (The Strategy Unit, 2016-11)
      The Strategy Unit worked as a strategic partner of the NHS Future Fit Programme in Shropshire and Telford and Wrekin from its initiation and until it was able to move to public consultation. A key output was a comprehensive Integrated Impact Assessment of acute hospital options that enabled commissioners to make a unanimous decision in a very sensitive context. This included an additional focus around women’s and children’s services.
    • Lessons from the Vanguard: Procurement

      Battye, Fraser; Maubach, Paul (The Strategy Unit, 2018-09)
      This short paper sets out learning from Dudley on the above topic. Its fundamental argument is simple: that NHS commissioners should be allowed to award an ‘Integrated Care Provider (ICP) contract’ to an NHS provider without having to undertake a large-scale procurement process. This would enable the system to reap the potential benefits of this contractual form while removing the costs of procurement and related concerns around privatisation. The paper was produced by Dudley Clinical Commissioning Group (CCG) and its partners the Strategy Unit. It draws on Dudley’s experience as a ‘Vanguard’ site under the New Care Models programme.
    • The Potential Economic Impact of Virtual Outpatient Appointments in the West Midlands: A scoping study

      de Lacy, James (The Strategy Unit, 2018-11)
      The Strategy Unit was recently approached to examine the case for a shift from traditional outpatient services to the use of virtual and remote access technologies for appropriate outpatient appointments. An essential part of this assessment was broadly scoping the potential socio-economic impacts of the shift – something that is arguably not always given enough consideration when thinking about transforming services. This work was commissioned by Andy Williams, Accountable Officer at Sandwell and West Birmingham CCG. The notion for such a shift emerged from discussions between the West Midlands CCG Accountable Officers and the Directors of Adult Social Services in relation to the wider economic impact of the NHS and how it could be improved. The introduction of virtual style appointments provides the opportunity to reduce the negative socio-economic impacts attributable to traditional outpatient services. These are in the form of; effects on productivity for businesses through work absenteeism (time off to attend and travel to/from outpatient appointments); the direct cost incurred by the individual from travel and parking, and the environmental effects of the CO2 emissions from the travel. If implemented effectively, there is the potential to also reap benefits in NHS provider efficiency and cost effectiveness. Virtual and remote access technologies such as Skype are also developing to be increasingly more refined, reliable and sophisticated. They are also becoming more accessible to patients as familiarity with such technologies continues to improve across age ranges. These factors offered the rationale for the scoping study. In addition to analysing the outpatient data, a key component of the study was the review of the evidence base for previous initiatives of where virtual appointments have been tested. It was found that the evidence around relevant interventions largely consisted of small-scale pilots in a variety of acute specialties. Using these findings, the study was able to produce high level estimates for the potential impact of a shift upon: Economic productivity impact (£ GVA), NHS impact (capacity and DNAs), Patient travel and parking costs (£) and Reduced environmental impact (CO2 emissions). The analysis provides an analytical framework for assessing the socio-economic impact of making outpatient services more accessible to patients who are in employment. It does not represent a complete business case for a service change but does estimate that considerable gains could be made – particularly in terms of productivity, which could be of significant benefit to the local economy. To determine whether this can be delivered in practice and reap the possible benefits for the health and care system, as well as the local economy, we are looking for systems who are interested in piloting and evaluating such an approach at a scale not currently available in the evidence base. This latest study built on our economic analysis undertaken with our partners at ICF International, which aimed to understand the current and potential impact of NHS spending on the wider Black Country economy.
    • A framework for understanding policy change

      Battye, Fraser (The Strategy Unit, 2021-03)
      A new policy, strategic direction or major programme is announced. How do we begin to understand, interpret and explain it? And how can we start the task of analysing and critiquing it? I see three main approaches: 1: Personal views As an individual, we might ask whether we like or agree with the proposed change. Here, we will draw on some combination of personal experience, position and world view. This is a starting point, but results are limited to expressions of individual opinion. 2: ‘Inside-out’, taking the logic of the suggested change We can ‘climb inside’ the proposal to see what we find. Here we would read about the proposal, doing our best to understand it in its own terms. We can then examine the ways its logic might play out in practice. We can test for internal coherence; we can spot likely challenges in implementation; we can also then compare it to analogous efforts. This is more useful than personal views alone. It allows a systematic assessment of any proposal. But maybe this method accepts too much? Maybe it misses something that an outside-in perspective would give. 3: ‘Outside-in’, using a framework of common features We can also view proposed changes from the outside-in. Equipped with a set of typical features, we can ask what the policy looks like from these different standpoints. This could be very useful in supplementing the ‘inside-out’ perspective. But any such set of ‘common features’ would need to be broader than current established and focused approaches to policy analysis (those contained in the Green and Magenta Books, for example). Are there ‘common features’ of policy change that could form a framework? The framework (below) is my attempt to address this question. I was prompted by running an internal Strategy Unit session on NHSE’s ‘Integrating Care’ paper. This forced me to be explicit about the ways of thinking about policy that I have absorbed and used implicitly over the years. I then developed my early drafts by drawing on different commentators’ pieces on the subsequent NHS White Paper. I read: Nigel Edwards discuss the pros and cons of approaches based on competition or collaboration. Judith Smith and Robin Miller think about whether there was continuity or break in policy direction. Hugh Alderwick looking at tensions between political and bureaucratic control - and short Vs longer term decision making. Nicholas Timmins focusing on shifts in power, concentrating on Local Vs National and Democratic Vs Technocratic tensions. The Kings Fund examining similar themes: competition and collaboration; national and local; and the place of NHS reform alongside that of social care and public health. Tony Hockley using the lenses of Prevention Vs Treatment and Equity Vs Efficiency. Donna Hall thinking about organisational and systems perspectives – and treating people as citizens, rather than as consumers. Jennifer Dixon on central ‘command and control’ and the risks of using politics to decide operational priorities. Obviously, I haven’t reflected the range and subtlety of these perspectives in a single framework (!). Instead, I’ve tried to draw out some of the main ways of looking at policy used by these different analyses. Draft framework V0.1 The resulting draft is below. The nature of the task means that there will be no such thing as ‘the finished article’, but I think there is enough to share now for comment. I don’t have a fully refined sense of audience or use, so I'm testing the waters on this too. But I suspect the framework might be useful to: Leaders and managers. It gives them a quick way to understand the main features of policy change, to help them and their teams think critically around it. We will certainly use this as part of the education and development programme in the Midlands Decision Support Centre. Strategists and analysts. The framework suggests ways that different features of a policy will tend towards success and failure. So it can be used to design local strategies and focus analytical attention; and Students interested in policy analysis. It gives them a set of common policy features and ways of thinking that should apply to multiple situations.
    • Increasing vaccine uptake

      Mulla, Abeda; Teladia, Zaheera; Jones, Eleanor; Moore, Ellie; Ward, Richard; Finlay, Freddie; Taylor, Bethany (The Strategy Unit, 2021-06)
      When the national COVID-19 vaccination programme began in December 2020, it was understood that everyone should have equal access to the vaccine, as appropriate to their need, and as prioritised by the Joint Committee on Vaccination and Immunisation. Within a few weeks however, there were early indications that there were differences in uptake amongst different population groups and in different parts of the country (The OpenSAFELY Collaborative 2021). As a result of these differences, many local examples of initiatives to increase vaccine uptake began to emerge. The Health Inequalities Improvement Team in partnership with the Vaccine Equalities Team at NHS England and Improvement commissioned the Strategy Unit to collect and collate some of these examples in a structured way. What we did: using social media channels and professional networks we identified and requested a half hour conversation with people involved in initiatives to increase local vaccine uptake. We spoke to people in March-April 2021, involved in 50 different initiatives across England and wrote up each of these individual accounts in a structured way. The examples we collected focused on four target groups: place of residence, ethnicity, faith communities and health status and could be grouped as two main types of intervention: information and outreach. Representative examples of each of these are included as case studies on the NHS England website, all 50 examples can be viewed below. A blog outlining the three key lessons for working with communities beyond the vaccination programme is hosted on the NHS Confederation website.
    • Making the Case for Integrating Mental and Physical Health Care - Full Report.

      Spilsbury, Peter; Wyatt, Steven; Hood, Andy; Croft, Stacey; Wiltshire, Justine (The Strategy Unit, 2017-05)
      The Strategy Unit, inspired by earlier research published by the Nuffield Trust, has created a ground breaking report for all STPs which investigates in detail the interaction between mental and physical health. The work describes and unpacks the gap between the physical health and life expectancy of those in contact with specialist mental health services and the rest of the population, and examines levels of variation in health care utilisation. ‘Making the Case for Integrating Physical and Mental Health Care’ has been designed to inform greater partnership working within local health economies to drive better health outcomes for patients and improved levels of efficiency. The Black Country STP were the pilot area for this work, and subsequently NHS England commissioned a version of the report for all 44 STPs in England. These STP reports were published via STP leads in May 2017 and have received wide-spread acclaim for their quality, depth and real-world practical relevance. We are particularly enthused by the positive reaction from the clinical community, with lots of examples where our work has helped to catalyse clinically- led service improvement initiatives The reports give STPs bespoke data and analysis, setting out the scope to improve patient care by better integrating mental and physical health services, in line with the ambition set out in the Five Year Forward View for the NHS. They also model potential benefits and opportunities for financial reinvestment from reduced pressure on acute care and elsewhere. Director of the Strategy Unit, Peter Spilsbury, said: “This report is important. Using newly linked national data and novel analysis, it can unpack for each STP area one of the biggest yet least spoken about health gaps facing our society - the gap between the physical health and life expectancy of those in contact with mental health services and the rest of the population.” "Some of the differentials in both health outcomes and health service utilisation are eye opening but we have been able to use these findings (and the summary of the evidence base provided) to begin building a broad coalition of local partners to identify and implement practical changes. I commend it enthusiastically to colleagues as a catalyst for much needed change.” According to the study, men with mental health disorders in England are estimated to live 19 years less than those without. For women this gap is around 16 years and the figures for both can vary substantially between STP localities.
    • Making a priority of mental health and wellbeing in Nottinghamshire

      Frith, David (The Strategy Unit, 2018-10)
      Nottinghamshire has been an early mover in the transition from Sustainability and Transformation Partnerships (STP) to Integrated Care Systems (ICS) within the NHS in England. As part of that transition, it made a conscious commitment to prioritise the transformation of mental health and wellbeing across the system, through a process involving the whole range of system partners – NHS organisations, Local Authorities, voluntary and community sector organisations and, above all, people with lived experience of mental ill health. We were delighted to be selected to support the STP in developing an integrated, all-age mental health strategy. It gave us a wonderful opportunity to build on the innovative analysis we had undertaken for all 44 STPs, making the case for integrating physical and mental health services. The STP told us that our bid "very much stood out in the crowd" because of its system focus and our breadth of understanding of mental health issues. In conducting the project, we provided some key inputs – baseline data packs, a summary of the relevant evidence-base and a report on stakeholder views – and facilitated a series of design workshops with up to 100 people contributing. Our work, in partnership with local stakeholders, provided the STP with a set of key strategic pillars that are designed to support the STP’s journey towards a transformed future for the mental health and wellbeing of the Nottinghamshire population.
    • Evaluation of an Integrated Mental Health Liaison Service (Rapid Assessment Interface and Discharge Service) in Northern Ireland

      Seamer, Paul (The Strategy Unit, 2018-10)
      A high proportion of patients treated for physical health conditions also have co-morbid mental health problems; and there is growing acceptance of a need to raise awareness of mental health issues in acute hospitals and improve the experience of care and treatment for this group. In response to such challenges, the Northern Health and Social Care Trust, one of five health and social care trusts in Northern Ireland, introduced a specialised multidisciplinary mental health liaison team—known as Rapid Assessment Interface and Discharge service[1]. The Rapid Assessment Interface and Discharge model involves rapid assessment of patients presenting to the ED with mental health, self-harm or substance misuse needs and those admitted to general hospital wards so that they can receive appropriate interventions for their physical and mental health, either in the community or in hospital. The Trust wanted to understand the effectiveness of the Rapid Assessment Interface and Discharge service and be sufficiently confident in the conclusions to make decisions about long-term funding for the service. We worked with the Trust to design a quantitative evaluation study capable of providing reliable inference about the effectiveness of the new service. A retrospective matched cohort study design was used to compare likelihood of admission from the emergency department and average length of stay for patients treated by 'Rapid Assessment Interface and Discharge' with a matched comparison group of similar patients treated in other acute hospitals in the region. All research into cause-and-effect relationships, faces the challenge of maximising similarity of groups being compared to ensure fairness of the comparison and unbiasedness of the findings. We applied a novel matching algorithm—genetic matching[2]— to select a group of comparison patients. Simulation studies have shown genetic matching achieves better covariate balance and produces more stable and unbiased treatment effect estimates[3]. Our study found, for patients treated by the Rapid Assessment Interface and Discharge service in the ED their average risk (or chance) of admission was 18.7% lower (95% confidence interval –9.3% to –27.3%). Average length of stay for a wider group of patients treated on general wards (including those benefitting indirectly from the presence of 'Rapid Assessment Interface and Discharge' Service) was 10.8% lower (95% confidence interval –9.2% to –12.4%). Both findings were statistically highly significant (P <0.001). The findings from our evaluation were instrumental in decisions that have led to the Rapid Assessment Interface and Discharge service in the Northern HSC Trust moving to a more sustainable footing
    • Inequities in children and young people’s mental health services

      Hood, Andy; Mulla, Abeda; Callaghan, David; Ward, Richard (The Strategy Unit, 2021-07)
      Good mental health during early years and childhood has a great bearing on health throughout life. By contrast, poor mental health can cast a long shadow. Consequences may include depression, self-harm, and poor physical health. Services recognise this. They aim to provide access to support in a timely and suitable way. A national target has been set, namely that 35% of children and young people with diagnosable needs should be able to access the necessary services. But there is some way to go. There has been an increasing focus on young people’s mental health, which appears to be poor relative to comparable nations and the recent past. So, to gain a clearer sense of need, and patterns of access to services, the Strategy Unit has undertaken specific analysis for the 11 Integrated Care Systems (ICSs) in the Midlands. This is another significant analytical project for the Midlands Decision Support Network. The ICS have further evidence to understand and address the problems in their area. Our findings 1. Services are struggling to keep pace with existing demand In the Midlands there are an estimated 350,000 children and young people with a range of mental health needs. At present, only 43,000 of these are receiving some kind of specialist support. Identifying the children and young people who most need support is difficult, with health and care professionals finding it increasingly challenging to reach those concerned. When they do, there is simply not enough support available. For example, our research found that only 2% of the estimated 160,000 children and young people in the Midlands with eating disorders are finding their way to specialist support. 2. There is wide variation in access to services in the region Even the better-performing areas are only able to provide the necessary support to 30% of those who need it. Children and young people who are Black / socially deprived / aged 18 to 24 / have learning disabilities or autism, tend to struggle more with accessing appropriate support. Health and care professionals suspect that services are not being provided equitably, but current data doesn’t provide clear enough evidence of this. 3. Access targets are a necessary focus, but there needs to be more meaningful analysis on who is, and who should be, using existing services ICSs need to measure what they are proposing to change. Without the correct data and subsequent analysis, this will prove almost impossible. 4. Routes into and through services need to be clearer Those that need support often don’t know how to access it. Health and care professionals acknowledge that those better able to navigate the complex services, for example through parental advocacy, tend to have an advantage in accessing support. 5. Children and young people should be involved in improving services There is limited involvement of young people in improving services. Mental health and care professionals also want this to happen more. Conclusions There is no single or quick fix to the problems highlighted in the research. Evidence suggests that the pandemic will have placed an even greater strain on already stretched services. Children and young people, as well as professionals, deserve these services to be given far greater priority, as well as improved resources. Especially at a time of stretched resources, ‘fixes’ on this scale are not straightforward. This is a long-term, cross-societal challenge: how much do we value young people’s mental health? This question is well outside the scope of our work. So we have focused our recommendations on more achievable improvements that are within current services’ control. They are to: Collect better data and use it Services could improve data collection around aspects of inequity and access. Greater precision is needed. Datasets in primary care, education, social care, criminal justice, and specialist services could all be linked. All data should be disaggregated by gender and ethnicity. Services could consider an investment in analysis and learning from the data, as well as needs assessments. Measure, monitor and maintain All new initiatives and interventions should be robustly evaluated, for equity as well as efficacy. It is essential that we all learn what works in what circumstances and that it is shared systematically. Establishing a serious learning system will inform the development and adaptation of promising service improvements; it will also provide evidence to stop any services that are not working and allow resources to be redirected. Co-design and co-produce Children and young people deserve to be meaningfully involved in their services, and their voices should be heard. A rollout of targeted engagement programmes would provide a way of reaching them. The detail: The full report is here. The evidence map is here. A webinar exploring findings can be viewed here. ICS level data on unmet needs and pathway inequalities are listed below:
    • Estimating the impact of the proposed reforms to the Mental Health Act on the workload of psychiatrists

      Wyatt, Steven; Hood, Andy; Moulin, Lawrence (The Strategy Unit, 2021-10)
      In January 2021, the Government published a White Paper, setting out its plans to reform the Mental Health Act. The Government invited views on the paper and in July 2021, it published a summary of the consultation responses and its plans to address the issues raised. The proposed reforms aim to ensure mental health service users have choice and autonomy wherever possible, that restrictions on service users’ freedoms are minimised and that opportunities for therapeutic benefit whilst detained are maximised. The reforms seek to deliver these objectives by altering the rights and responsibilities described in the 1983 Act or by introducing new rights and responsibilities. This analysis, conducted for the Royal College of Psychiatrists, estimates the likely impacts of Mental Health Act reforms on the workload of psychiatrists and the number of additional psychiatrists that would be required to meet these new obligations. Estimating the impact of the reforms is a prerequisite to adequately resourcing them. Failure to do so will create implementation risks and may inadvertently displace or interfere with other important aspects of a psychiatrist’s role. This issue is particularly important at present when demand for mental health services is high and rising rapidly.
    • Scoping study: the economics of caring

      Spilsbury, Peter; Battye, Fraser (The Strategy Unit, 2017-12)
      There is a clear moral case for supporting unpaid carers. They play an essential role in the lives of the people they care for; they often do so at a cost to their own wellbeing. But what is the economic case for supporting carers? And to what extent does the evidence base support this case? Where there are gaps in the evidence, how might they be filled? Carers play a vital role in the lives of the people they support. There has been a steady increase in the number of unpaid carers in the UK over recent years, from around 8.2 million in 2011 to 9 million in 2014. Given the pressures of an ageing population, the demand for carers is likely to continue increasing. It is also well known that carers often neglect their own health and wellbeing: they are twice as likely to have poorer physical and mental health compared to non-carers. These factors alone make a compelling moral case for supporting carers. But what about the economic case? From an economic perspective, what are the main arguments for supporting carers? To what extent are these arguments supported by current evidence? Where the evidence is weak, what should be done to fill analytical gaps? NHS England’s Patient Experience Team commissioned the Strategy Unit and ICF to provide a scoping review to examine these questions. The report and a one page summary are below. We are especially interested in hearing from people who are keen to advance the analytical agenda set out in the report.
    • Making the case for integrating physical and mental health services in England - National overview

      Spilsbury, Peter; Wyatt, Steven; Hood, Andy (The Strategy Unit, 2018-07)
      This is a national overview report of our Making the case for integrating physical and mental health services reporting which took place in July 2017. The original reports looked at the physical health of people who use mental health services; life expectancy, acute hospital use and opportunities to improve service quality and efficiency.
    • New care models - what's the evidence

      Turner, Alison (The Strategy Unit, 2019-02)
      As health and care economies start to plan how they will deliver against the commitments in the NHS Long Term Plan for England, it's a good time to reflect on how the thinking and learning from the Five Year Forward View might be taken forward. Notably, the New Care Models programme, which set out a series of different models of care. We've blogged previously about the evidence review we were commissioned to deliver by the National Institute for Health Research's Health Services and Delivery Research programme. Ours was one of five reviews funded - we looked specifically at the Multispecialty Community Provider model, which focused on an enhanced role for primary care. Since completing our report, we've been working closely with the project leads of the other four evidence reviews funded to collate and share our findings. We've prepared a high level summary of the five reviews, available to download here, to provide a quick view of the headline messages.
    • Primary and Community Qualitative Insights

      Mason, Paul; Mulla, Abeda (The Strategy Unit, 2020-07)
      The COVID-19 response required rapid change and innovation across health and care. As part of a wider package of evaluation support, from April to June, the Strategy Unit led some qualitative work (training and supporting CCG staff to conduct interviews) across an STP to capture learning from primary care (primarily PCN clinical leads) and community nursing leads about their experiences. The interviews explored the rapid move to total triage, video and online team communications, changes to day-to-day practices, working with care homes and their views on the backlog and unmet need. We held weekly reflective learning workshops with the CCG to both share learning and provide practical support with the delivery of the interviews. We also provided weekly rapid-cycle reporting of headline findings from an initial analysis of interview notes and recordings. Here we share the three rapid-cycle reports that were provided to the STP during the crisis period.
    • Accessibility of perinatal mental health services for women from Ethnic Minority groups

      Parsons, Jake (The Strategy Unit, 2020-09)
      Mental illness is common during pregnancy and first postnatal year (perinatal period), and up to 20% of women experience a wide range of mental health conditions. Barriers to accessing mental health care during pregnancy and the first postnatal year (perinatal period) seem to be greater for ethnic minority women. As a consequence of these barriers, mental illness during the peri-natal period frequently remains untreated. This can have a significant negative impact on the health of the mother and the health of their children, on her partner and the wider family and on the society as a whole. The Strategy Unit was commissioned to collaborate with Birmingham and Solihull Mental Health Trust and East London Foundation Trust on an NIHR funded research project “Accessibility and acceptability of perinatal mental health services for women from Ethnic Minority groups”. Our role was to provide analytical support to phase 1 of the study which aimed to explore access rates to secondary mental health services and patterns of engagement with these services for women from ethnic minority groups in the perinatal period in England. The analysis used national patient level linked inpatient and mental health datasets. Large and statistically significant differences were found in access to both community mental health services and psychiatric inpatient care. In particular Black African and Asian women (all sub-groups) had much lower rates of access to community mental health services. The study also found that higher proportions of admissions for Black African and Asian women were involuntary. The study concluded that access to community mental health services should be facilitated for these groups which may help to reduce the level of involuntary admissions. The results of this work have been published in the peer reviewed journal BMC Medicine.
    • COVID-19: breaking the cycle of deprivation and ill health

      Frith, David (The Strategy Unit, 2020-10)
      The current coronavirus pandemic has prompted a highly-charged debate in which what is good for health and what is good for the economy are unhelpfully and inaccurately set in opposition to one another. In a novel analysis for the Healthier Futures Academy in the Black Country and West Birmingham, we illustrate the effects that a COVID-driven recession could have on population health, and we frame a discussion about how the NHS, with other local organisations, can more effectively address the causes as well as the effects of ill health.