Recent Submissions

  • 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:
  • 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.
  • Changes in Dementia Incidence, Prevalence, Severity and Mortality

    Hood, Andy (The Strategy Unit, 2017-09)
    Dementia is a key priority for NHS England and is estimated to affect around 676,000 people in the country. Our analysis is intended to help understand the need for future dementia diagnosis and treatment services in a specific area and to help commissioners to identify and prioritise interventions.
  • Health service use in the last two years of life

    Wiltshire, Justine; Battye, Fraser; Wyatt, Steven; Spilsbury, Peter (The Strategy Unit, 2020-10)
    Health and care services get just one opportunity to support people at the end of their life. When this support is compassionate and appropriate, unnecessary suffering can be avoided and grieving can be eased. When this is not the case, harm and distress can result. The difference in these experiences can be profound. Providing the best possible end of life care, within the limited resources available, is not a simple task. It requires a dispassionate assessment of the current situation; it demands detailed insight into the local population; and it needs the perspectives of professionals and the people they serve. Good care is founded on the intelligent use of this information. The Strategy Unit has produced a series of reports that describe the health services that patients use in the last 2 years of their lives. Reports are available for the Midlands region as a whole and for each of the 11 Sustainability and Transformation Partnerships (STP) or Integrated Care Systems in the region. The reports contain important insights into the services that patients use, how the patterns of service use change as patients approach death, differences in experience by ethnicity, deprivation and cause of death the costs of hospital treatment at the end of life and how this varies by STP levels of non-beneficial treatments the additional hospital capacity that may be required to accommodate the projected increase in deaths over the next decade These reports present a detailed account of ‘what is’. Moving on from this and deciding ‘what ought to be’ is a more complex undertaking. It involves professional judgement, evidence and clinical standards. But it also involves personal preference, values and cultural differences. Combining such diverse perspectives requires care, humanity, and skill.
  • Scoping the Strategic Analytical Requirements for Clinical Neurosciences in England

    Spilsbury, Peter; Cook, Jon; Wyatt, Steven (The Strategy Unit, 2017-07)
    Neurosciences encompasses a large number of services and interventions, delivered to individuals with a wide range of conditions by numerous providers in many settings. Describing the full range of patients, interventions and services will provide those who work in and support NHS commissioned neurosciences with the context required to holistically assess, plan and improve these services. This report identifies six analytical priorities for clinical neurosciences in England. We hope the report contributes to the development of a national strategy for clinical neurosciences and will provide a clear steer for those delivering analytical services in this area. The report was developed at the request of and with the involvement of Professor Adrian Williams, Chair of the Neuroscience Clinical Reference Group (CRG) and the National Neurosciences Advisory Group (NNAG)
  • Advancing the analytical capability of the NHS and its ICS partners

    Mohammed, Amin Mohammed; Spilsbury, Peter; Callaghan, David; Wyatt, Steven (https://www.strategyunitwm.nhs.uk/publications, 2021-10)
    We see all analysis as informing decisions. Producing high-functioning analytical teams able to design and produce high-quality analysis, and communicate it effectively to decision-makers, is therefore essential. The Strategy Unit were asked by the Strategy and Development Team in the Directorate of the Chief Data and Analytics Officer, NHSE/I, to make recommendations for advancing analytical capability across the health and care workforce. To do so, we consulted a wide range of colleagues on the questions: how do we advance analytical capability? What does high-quality analytics look like? What are the implications for skills, career paths and training? The report responds to each of these questions. It describes how analysts, teams, regions and national bodies can: organise themselves to deliver strategic analysis; develop their analytical skills and provide opportunities to simplify career pathways for analysts; appreciate and utilise the full range of analytical possibilities at their disposal; and connect with peers through networks. The report is part of a growing effort across health and care to get the most out of our analytical workforce, and provide opportunities and options for individual analysts. It builds on recent work to develop a competency framework for healthcare analysts by AphA, and informs the upcoming guidance and toolkit from NHSE/I and the Strategy Unit on building cross-system intelligence functions. Alongside the full report, a separate document outlines what career pathways for healthcare analysts might look like, and the resources available to them to advance their skills.
  • Mental health surge model

    Hood, Andy; Jemmett, Thomas (The Strategy Unit, 2020 Novem)
    Early in the Covid pandemic, it became clear that people’s mental health would suffer. Whether through bereavement, unemployment, social isolation, not being able to access support services – or a host of other routes – an alarming picture began to emerge and attract attention. The detail of this picture has become progressively clearer. Press reports, population surveys, stories from service users and staff; evidence has emerged and accumulated. We are gaining an increasingly refined understanding of exactly how bad the pandemic has been for the nation’s mental health. Against this background – and as part of a national analytical collaboration – the Strategy Unit has produced a model to help local services plan their response. Using this model, we estimate that: There will be around 11% more new referrals to mental health services, each year for the next three years; and Associated costs amount to an extra £1 billion a year. This is around 8% of annual NHS expenditure on mental health services. Moreover, these figures are in addition to the approximately 500,000 people that were not able to access services during the first national lockdown. These headline results are shocking. They are useful for seeing the scale of coming demand and for attracting appropriate attention.
  • Populations at risk of air quality-related ill health and wellbeing: Summary of multi-stage analysis for Lambeth and Southwark

    Hood, Andy; Lawless, Alexander (The Strategy Unit, 2021 Febru)
    Poor air quality is the largest environmental risk to public health in the UK and central London has the highest levels of particulate matter and nitrogen dioxide. The Guy’s and St. Thomas’ charity, now operating its programmes under the Impact on Urban Health banner, have committed to 10 years of funding to improve air quality-related health in the residents of South London boroughs of Lambeth and Southwark. The charity commissioned the Strategy Unit to explore the health of several key groups and the factors that most influence health alongside air quality within the area. We found that: Around 220,000 residents in three key groups were at high risk of air quality related ill health. Exposures and outcomes are worse for some ethnic minority groups. There are multiple and complex issues affecting the health and wellbeing of those also most exposed to poor air quality. Nitrogen dioxide levels could be impacting on cardiovascular health, particularly so around Southwark town. Factors such crime, poor housing and education appeared to worsen poor health in some areas in combination with lower air quality. Anna Tarkington, Data Partnership Manager said: “This project has supported the Health Effects of Air Pollution (HEAP) Programme in providing a better understanding of the population in Lambeth and Southwark who are most vulnerable to air pollution. We have used insights from the project to inform subsequent work within the HEAP programme such as idea generation, targeting and design. It has also been helpful to understand some of the limitations of available data and the complexities of linking air pollution to health outcomes.” Please contact us if you are interested in the analysis – and whether this might be useful for your area.
  • Advancing the analytical capability of the NHS and its ICS partners

    Mohammed, Amin Mohammed; Spilsbury, Peter; Callaghan, David; Wyatt, Steven (The Strategy Unit, 2021 Octob)
    We see all analysis as informing decisions. Producing high-functioning analytical teams able to design and produce high-quality analysis, and communicate it effectively to decision-makers, is therefore essential. The Strategy Unit were asked by the Strategy and Development Team in the Directorate of the Chief Data and Analytics Officer, NHSE/I, to make recommendations for advancing analytical capability across the health and care workforce. To do so, we consulted a wide range of colleagues on the questions: how do we advance analytical capability? What does high-quality analytics look like? What are the implications for skills, career paths and training? The report responds to each of these questions. It describes how analysts, teams, regions and national bodies can: organise themselves to deliver strategic analysis; develop their analytical skills and provide opportunities to simplify career pathways for analysts; appreciate and utilise the full range of analytical possibilities at their disposal; and connect with peers through networks. The report is part of a growing effort across health and care to get the most out of our analytical workforce, and provide opportunities and options for individual analysts. It builds on recent work to develop a competency framework for healthcare analysts by AphA, and informs the upcoming guidance and toolkit from NHSE/I and the Strategy Unit on building cross-system intelligence functions. Alongside the full report, a separate document outlines what career pathways for healthcare analysts might look like, and the resources available to them to advance their skills.
  • ‘To risk stratify or not risk stratify, that is the question’ (At least, it should be)

    Wyatt, Steven; Spilsbury, Peter; Mohammed, Amin Mohammed (The Strategy Unit, 2021 Octob)
    Risk prediction tools are ubiquitous in healthcare. These tools are often used to identify individuals at high risk of an adverse event and who may benefit from an upstream intervention. The assessment of risk prediction tools usually revolves around performance statistics such as sensitivity, specificity, discrimination and positive predictive value (PPV). Published risk prediction tools are usually reported to have good performance statistics but with little guidance on how to commission such tools. Despite their reported performance, there is a paucity of evidence on the extent to which risk prediction tools work in practice and save money. Whilst such studies may be challenging to undertake, we offer a simple framework for evaluating the plausibility of success at the design stage. This design stage evaluation of risk prediction tools combines the PPV with the number needed to treat (NNT) and shows that to save money, the unit cost of an intervention (I) must be less than the average cost of the adverse event (A) multiplied by the ratio of the PPV/NNT. (I
  • Socio-economic inequalities in coronary heart disease

    Wyatt, Steven; Grout, Jacqueline; Parsons, Jake (2022 Decem)
    People living in deprived areas develop coronary heart disease and die at a younger age than their counterparts living in other areas. In recent decades, significant progress has been made in reducing deaths from coronary heart disease, by lowering the prevalence of certain risk factors, such as smoking, by improving the consistency of disease management, and by introducing new diagnostic, pharmacological, and surgical interventions. Whilst these improvements have benefitted all socio-economic groups, relative differences in premature cardio-vascular mortality rates have increased. Addressing this problem is not straightforward. Part of the challenge for health systems is knowing where to target their efforts. Should it attempt to reduce these inequalities by improving access to preventative interventions, or by improving disease detection, or by improving treatments once a disease has been diagnosed? Our new tool, developed for and with the British Heart Foundation aims to help Integrated Care Boards (ICBs) with this challenge. In a single chart, ICBs can get an overview of the points on the care pathway where inequalities emerge and are amplified. The online tool brings information together from many sources and presents it in a novel, intuitive, visual format. We hope the tool proves useful and welcome feedback on how it can be improved.