What can we learn about the impact of cancelled planned operations on waiting times? A case study using the 2017/18 winter flu postponement policy in England.

Background: Cancelled operations can potentially impact both health and patient experience through their effect on waiting times. However, identifying causal relationships is challenging. One possible solution is to consider 'exogenous shocks' to the system as a type of natural experiment to quantify impacts.

Measuring the overall performance of mental healthcare providers.

To date there have been no attempts to construct composite measures of healthcare provider performance which reflect preferences for health and non-health benefits, as well as costs. Health and non-health benefits matter to patients, healthcare providers and the general public. We develop a novel provider performance measurement framework that combines health gain, non-health benefit, and cost and illustrate it with an application to 54 English mental health providers.

Social Decision-Making Analysis: A General Approach to Inform Decisions on Resources in the Public Sector.

Objectives: Public expenditure aims to achieve social objectives by improving a range of socially valuable attributes of benefit (arguments in a social welfare function). Public expenditure is typically allocated to public sector budgets, where budget holders are tasked with meeting a subset of social objectives.

Methods: Decision makers require an evidence-based assessment of whether a proposed investment is likely to be worthwhile given existing levels of public expenditure.

The impact of COVID-19 on mental health service utilisation in England.

The COVID-19 pandemic has had a significant impact on population mental health and the need for mental health services in many countries, while also disrupting critical mental health services and capacity, as a response to the pandemic. Mental health providers were asked to reconfigure wards to accommodate patients with COVID-19, thereby reducing capacity to provide mental health services. This is likely to have widened the existing mismatch between demand and supply of mental health care in the English NHS.

Need, demand, supply in health care: working definitions, and their implications for defining access.

Effective policymaking in health care systems begins with a clear typology of the terminology - need, demand, supply and access to care - and their interrelationships. However, the terms are contested and their meaning is rarely stated explicitly. This paper offers working definitions of need, demand and supply.

Impact of prevention in primary care on costs in primary and secondary care for people with serious mental illness.

A largely unexplored part of the financial incentive for physicians to participate in preventive care is the degree to which they are the residual claimant from any resulting cost savings. We examine the impact of two preventive activities for people with serious mental illness (care plans and annual reviews of physical health) by English primary care practices on costs in these practices and in secondary care. Using panel two-part models to analyze patient-level data linked across primary and secondary care, we find that these preventive activities in the previous year are associated with cost reductions in the current quarter both in primary and secondary care.

Geographic Disparities in the Availability of Mental Health Services in U.S. Public Schools.

Introduction: The purpose of this study was to examine geographic variation in the availability of and barriers to school-based mental health services.

Methods: A weighted, nationally representative sample of U.S.

Telehealth Competencies for Nursing Education and Practice: The Four P's of Telehealth.

Background: Telehealth is a rapidly growing health care delivery modality with advanced practice nurses as key providers. This growth has occurred without critical consideration of provider training. Training requires the development of competencies situated within a framework.

Palliative Care Needs and Integration of Palliative Care Support in COPD: A Qualitative Study.

Background: The provision of palliative care for severe COPD remains low, resulting in unmet needs in patients and carers.

Research Questions: What are the palliative care needs of patients living with severe COPD and their caregivers? What views of accessing and providing palliative care and factors influence these experiences. To what extent have palliative care and COPD services been integrated?

Study Design And Methods: A multicentre qualitative study was undertaken in COPD services and specialist palliative care in the United Kingdom involving patients with severe COPD, their carers, and health professionals.

Investigating the relationship between social care supply and healthcare utilization by older people in England.

Since 2010, adult social care spending in England has fallen significantly in real terms whilst demand has risen. Reductions in social care supply may also have impacted demand for NHS services, particularly for those whose care is provided at the interface of the health and care systems. We analyzed a panel dataset of 150 local authorities (councils) to test potential impacts on hospital utilization by people aged 65 and over: emergency admission rates for falls and hip fractures ("front-door" measures); and extended stays of 7 days or longer; and 21 days or longer ("back-door" measures).

Plan, recruit, retain: a framework for local healthcare organizations to achieve a stable remote rural workforce.

Background: Recruiting and retaining a skilled health workforce is a common challenge for remote and rural communities worldwide, negatively impacting access to services, and in turn peoples' health. The research literature highlights different factors facilitating or hindering recruitment and retention of healthcare workers to remote and rural areas; however, there are few practical tools to guide local healthcare organizations in their recruitment and retention struggles. The purpose of this paper is to describe the development process, the contents, and the suggested use of The Framework for Remote Rural Workforce Stability.

Evaluating integrated care for people with complex needs.

Objectives: As part of the Vanguard programme, two integrated care models were introduced in South Somerset for people with complex care needs: the Complex Care Team and Enhanced Primary Care. We assessed their impact on a range of utilization measures and mortality.

Methods: We used monthly individual-level linked primary and secondary care data from April 2014 to March 2018 to assess outcomes before and after the introduction of the care models.

Trends in and drivers of healthcare expenditure in the English NHS: a retrospective analysis.

Background: In England, rises in healthcare expenditure consistently outpace growth in both GDP and total public expenditure. To ensure the National Health Service (NHS) remains financially sustainable, relevant data on healthcare expenditure are needed to inform decisions about which services should be delivered, by whom and in which settings.

Methods: We analyse routine data on NHS expenditure in England over 9 years (2008/09 to 2016/17).

Impact of family practice continuity of care on unplanned hospital use for people with serious mental illness.

Objective: To investigate whether continuity of care in family practice reduces unplanned hospital use for people with serious mental illness (SMI).

Data Sources: Linked administrative data on family practice and hospital utilization by people with SMI in England, 2007-2014.

Study Design: This observational cohort study used discrete-time survival analysis to investigate the relationship between continuity of care in family practice and unplanned hospital use: emergency department (ED) presentations, and unplanned admissions for SMI and ambulatory care-sensitive conditions (ACSC).

Analysis of the EPR spectra of transferrin: the importance of a zero-field-splitting distribution and 4-order terms.

Multi-frequency EPR spectroscopy can provide high-level structural information on high-spin Fe sites in proteins and enzymes. Unfortunately, analysis of the EPR spectra of these spin systems is hindered by the presence of broad distributions in the zero-field-splitting (ZFS) parameters, which reflect conformational heterogeneity of the iron sites. We present the analysis of EPR spectra of high-spin Fe bound to human serum transferrin.

Association Between Antipsychotic Polypharmacy and Outcomes for People With Serious Mental Illness in England.

Objective: Although U.K. and international guidelines recommend monotherapy, antipsychotic polypharmacy among patients with serious mental illness is common in clinical practice.

Incentive schemes to increase dementia diagnoses in primary care in England: a retrospective cohort study of unintended consequences.

Background: The UK government introduced two financial incentive schemes for primary care to tackle underdiagnosis in dementia: the 3-year Directed Enhanced Service 18 (DES18) and the 6-month Dementia Identification Scheme (DIS). The schemes appear to have been effective in boosting dementia diagnosis rates, but their unintended effects are unknown.

Aim: To identify and quantify unintended consequences associated with the DES18 and DIS schemes.

Prospective payment systems and discretionary coding-Evidence from English mental health providers.

Reimbursement of English mental health hospitals is moving away from block contracts and towards activity and outcome-based payments. Under the new model, patients are categorised into 20 groups with similar levels of need, called clusters, to which prices may be assigned prospectively. Clinicians, who make clustering decisions, have substantial discretion and can, in principle, directly influence the level of reimbursement the hospital receives.

Effects of local authority expenditure on childhood obesity.

Background: Under the 2013 reforms introduced by the Health and Social Care Act (2012), public health responsibilities in England were transferred from the National Health Service to local authorities (LAs). Ring-fenced grants were introduced to support the new responsibilities. The aim of our study was to test whether the level of expenditure in 2013/14 affected the prevalence of childhood obesity in 2016/17.

Do care plans and annual reviews of physical health influence unplanned hospital utilisation for people with serious mental illness? Analysis of linked longitudinal primary and secondary healthcare records in England.

Objective: To investigate whether two primary care activities that are framed as indicators of primary care quality (comprehensive care plans and annual reviews of physical health) influence unplanned utilisation of hospital services for people with serious mental illness (SMI).

Design, Setting, Participants: Retrospective observational cohort study using linked primary care and hospital records (Hospital Episode Statistics) for 5158 patients diagnosed with SMI between April 2006 and March 2014, who attended 213 primary care practices in England that contribute to the Clinical Practice Research Datalink GOLD database.

Outcomes And Analysis: Cox survival models were used to estimate the associations between two primary care quality indicators (care plans and annual reviews of physical health) and the hazards of three types of unplanned hospital utilisation: presentation to accident and emergency departments (A&E), admission for SMI and admission for ambulatory care sensitive conditions (ACSC).

Local authority commissioning of NHS Health Checks: A regression analysis of the first three years.

In April 2013, the public health function was transferred from the NHS to local government, making local authorities (LAs) responsible for commissioning the NHS Health Check programme. The programme aims to reduce preventable mortality and morbidity in people aged 40-74. The national five-year ambition is to invite all eligible individuals and to achieve an uptake of 75%.

Investigating the impact of primary care payments on underdiagnosis in dementia: A difference-in-differences analysis.

Objective: In England, two primary care incentive schemes were introduced to increase dementia diagnosis rates to two-thirds of expected levels. This study assesses the effectiveness of these schemes.

Methods: We used a difference-in-differences framework to analyse the individual and collective impacts of the incentive schemes: (1) Directed Enhanced Service 18 (DES18: facilitating timely diagnosis of and support for dementia) and (2) the Dementia Identification Scheme (DIS).

Directors of public health as 'a protected species': qualitative study of the changing role of public health professionals in England following the 2013 reforms.

Background: The Health and Social Care Act 2012 gave councils in England responsibility for improving the health of their populations. Public health teams were transferred from the National Health Service (NHS), accompanied by a ring-fenced public health grant. This study examines the changing role of these teams within local government.