The future of HIV services in England

The King’s Fund has published ‘The future of HIV services in England’. This report explores the challenges and opportunities facing HIV services in four areas in England, and makes recommendations on future development to those in national and local leadership roles.

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Care for people with HIV is now highly effective, and increasing numbers of people are living with HIV into older age with normal life expectancy. For example, in London there are now around four times as many people over the age of 50 living with HIV as there were 10 years ago. HIV services need to adapt to this changing demographic, co-ordinating more closely with the other health and care services that older people need and focusing on overall quality of life as well as clinical treatment.

England has an outstanding record of achievements in HIV prevention, treatment and care. Increasing numbers of people with HIV have normal life expectancy, so there are now more older people living with HIV who may have other care needs associated with ageing. The purpose of this research was to make recommendations to those in national and local leadership roles on how HIV services should develop over the next 5–10 years.

Models for co-ordinating long-term care already exist and some other services, such as those for cancer, have similarly evolved from providing specialised treatment to including long-term care. Local HIV services need to work out how to learn from these and adapt them as appropriate to join up care.

The King’s Fund suggests that HIV services must be designed locally to reflect the diversity of needs. But national NHS bodies should set the overall strategic direction and expectations, and ensure accountability. We recommend these should be more tightly defined. Stronger national leadership is needed to take action to reduce stigma, both in general and in non-HIV-specialist health care, and to support and co‑ordinate the roll-out of future models of HIV care and develop the HIV workforce.

Read the full report here

Health care costs in the English NHS

The Centre for Health Economics in York has published ‘Health care costs in the English NHS: reference tables for average annual NHS spend by age, sex and deprivation group’.

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This paper describes how to calculate average health care costs broken down by age, sex and neighbourhood deprivation quintile group using the distribution of health care spending by the English NHS in the financial year 2011/12.

The results can be used by cost-effectiveness analysts to populate their extrapolation models when estimating future health care costs. The results will also be of interest to the broader community of health researchers as they illustrate how NHS spending is distributed across different subgroups within the population.

The analysis presented in this report indicates that health care costs at any given age are higher for those living in more deprived neighbourhoods than those living in more affluent neighbourhoods. Research looking at the social distribution of health has found that quality of life is also lower at any given age for those living in more deprived neighbourhoods than for those living in more affluent neighbourhoods.

Read the full report here

Mental Health First Aid for the elderly

Bengt Svensson and Lars Hansson. | Mental health first aid for the elderly: A pilot study of a training program adapted for helping elderly people | Aging & Mental Health | Vol. 21 , Iss. 6, 2017

Objectives: Epidemiological studies have shown a high prevalence of mental illness among the elderly. Clinical data however indicate both insufficient detection and treatment of illnesses. Suggested barriers to treatment include conceptions that mental health symptoms belong to normal aging and lack of competence among staff in elderly care in detecting mental illness. A Mental Health First Aid (MHFA) training program for the elderly was developed and provided to staff in elderly care. The aim of this study was to investigate changes in knowledge in mental illness, confidence in helping a person, readiness to give help and attitudes towards persons with mental illness.

Results: The study group included staff in elderly care from different places in Sweden (n = 139). Significant improvements in knowledge, confidence in helping an elderly person with mental illness and attitudes towards persons with mental illness are shown. Skills acquired during the course have been practiced during the follow-up.

Conclusions: The adaption of MHFA training for staff working in elderly care gives promising results. Improvements in self-reported confidence in giving help, attitudes towards persons with mental illness and actual help given to persons with mental illness are shown. However, the study design allows no firm conclusions and a randomized controlled trail is needed to investigate the effectiveness of the program. Outcomes should include if the detection and treatment of mental illness among the elderly actually improved.

More Money in Your Pocket

Age UK has published ‘More money in your pocket: a guide to claiming benefits for people over pension age’.

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This report suggests that nearly 3 million older people struggling financially despite £3.5 billion in unclaimed benefits. Age UK is highlighting the rise in pensioner poverty and urging older people to check if they could be eligible to claim any additional benefits.

Age UK has updated its money guides and provides a free online benefits calculator to help signpost the benefits which are available. According to latest government figures, 1.9 million pensioners are now living below the poverty line. The same research found that one in 10 people over 65 would not be able to pay an unexpected expense of £200, to replace a broken washing machine for example. Age UK is urging older people who are struggling financially to check if they could be entitled to extra assistance.

The Government provides a range of benefits to help older people financially, such as Housing Benefit and Pension Credit. Pension Credit has slightly increased this month and could be a much-needed income boost to some in later life. In fact, if people who are eligible for Pension Credit make a claim, it could increase their income by an average of £42 a week – that’s £2,184 a year.

Read the report here

Tobacco packaging design for reducing tobacco use

The Cochrane Database of Systematic Reviews has published ‘Tobacco packaging design for reducing tobacco use’.

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Tobacco use is the largest single preventable cause of death and disease worldwide. Standardised tobacco packaging is an intervention intended to reduce the promotional appeal of packs and can be defined as packaging with a uniform colour (and in some cases shape and size) with no logos or branding, apart from health warnings and other government-mandated information, and the brand name in a prescribed uniform font, colour and size. Australia was the first country to implement standardised tobacco packaging between October and December 2012, France implemented standardised tobacco packaging on 1 January 2017 and several other countries are implementing, or intending to implement, standardised tobacco packaging.

The objective of the study was to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction.

The available evidence suggests that standardised packaging may reduce smoking prevalence. Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect. A reduction in smoking behaviour is supported by routinely collected data by the Australian government. Data on the effects of standardised packaging on non-behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence. As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake. The researchers did not find any evidence suggesting standardised packaging may increase tobacco use.

Read the full text here

A realist review to explore how low-income pregnant women use food vouchers

Ohly H, et al. (2017) BMJ Open. 7:e013731

Objectives: To explore how low-income pregnant women use Healthy Start food vouchers, the potential impacts of the programme, and which women might experience these impacts and why.

Conclusions: This realist review suggests that some low-income pregnant women may use Healthy Start vouchers to increase their consumption of fruits and vegetables and plain cow’s milk, whereas others may use them to reduce food expenditure and save money for other things.

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Public health ethics in practice

An overview of public health ethics for the UK Public Health Skills and Knowledge Framework (PHSKF) | PHE

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This part of the PHSKF provides an introduction to public health ethics both as a philosophical field of enquiry and as an applied area that guides practice and policy.

This is a reference document supporting the public health workforce in their practice and:

• explains public health ethics with reference to the longer-standing field of bioethics
• indicates in greater depth, the scope of public health ethics as a field of philosophical enquiry
• explains the links between that field and public health ethics as a direct source of professional norms and standards

The full report is available here

Why is Hearing Loss a Public Health Concern?

Tremblay, K. L. (2017) Hearing Journal. 70(4) pp. 14,16

‘Answer: Because hearing loss is highly prevalent, with numerous associated health risks that burden affected individuals, their family, and their community.’

When hearing loss is viewed from a public health perspective, the mission expands to include improving health and quality of life, not only through prevention and treatment of hearing loss but also through the promotion of healthy behaviors. An essential component of public health is the “collective action for sustained population-wide health improvement” (Lancet. 2004;363[9426]:2084 http://bit.ly/2lALIIj; Bull World Health Organ. 2014;92[5]:367 http://bit.ly/2lAFqIq). As such, there are many ongoing initiatives aimed at making hearing health care more accessible and affordable within and outside of the medical model (Ear Hear. 2016;37[4]:376 http://bit.ly/2lAL6SW; Ear Hear. 2010;31[1]:2 http://bit.ly/2lAIMew).

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What does improving population health really mean?

The King’s Fund has published ‘What does improving population health really mean?’

Put simply, population health means the health outcomes of a defined group of people, as well as the distribution of health outcomes within the group.

The health of a population is influenced by a wide range of factors and the interactions between them. They include the local environment – such as the conditions in which people live and work; social and economic factors – like education, income and employment; lifestyles – including what people eat and drink, whether they smoke, and how much physical activity they do; and access to health care and other public and private services. Age, sex and genes make a difference to health too, as well as social networks and the wider society in which people live.

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The NHS has an important role to play in improving population health and must work with local government and other partners to develop more co-ordinated approaches to improving population health. At a local level, this should involve developing common aims for improving health, defining how these goals will be measured, and sharing resources to achieve them. It may also involve developing more systematic ways for NHS staff to identify people’s non-medical needs and work with others in the community to address them. STPs offer an important opportunity for the NHS and its partners to work together to achieve this.

But NHS and local government leaders can only do so much. A major factor outside their control is the political decisions made by government – for example, on welfare spending or housing policy –which have a major impact on people’s health. Short-sighted cuts to local government and public health budgets at a national level will make ambitions to improve population health harder to achieve.

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Social prescribing: less rhetoric and more reality

Bickerdike, L. et al. (2017) BMJ Open. 7:e013384.

Objectives: Social prescribing is a way of linking patients in primary care with sources of support within the community to help improve their health and well-being. Social prescribing programmes are being widely promoted and adopted in the UK National Health Service and so we conducted a systematic review to assess the evidence for their effectiveness.

Conclusions: Social prescribing is being widely advocated and implemented but current evidence fails to provide sufficient detail to judge either success or value for money. If social prescribing is to realise its potential, future evaluations must be comparative by design and consider when, by whom, for whom, how well and at what cost.

Read the full article here