Evidence about the need for and provision of health visiting services
generated through research undertaken at King's College London (KCL) has
underpinned major changes in national policies for health visiting. Our
findings about health visitors' practice, availability and distribution of
services and effectiveness in terms of parenting/child outcomes, revealed
both shortfalls in provision and opportunities for improvement and led to
the development of a new caseload weighting tool and funding model for
service planning. The accumulated evidence from this research helped
convince the UK Government in 2010 to commit to 4,200 more health visitors
by 2015 — a workforce expansion of nearly 50% — in a time of austerity and
restraint elsewhere in the public sector.
The Department of Health seeks to distribute the NHS budget to local
commissioning organisations to achieve equal access for equal need and
reduce health inequalities. The formula upon which it bases this
distribution must be evidence-based, robust and up-to-date. We summarise
four pieces of applied econometric research undertaken at the University
of Manchester (UoM) and commissioned by the Department of Health that have
developed the methodology for setting budgets fairly and determined the
content of the formula in use in England from 2008-date. Adoption of the
findings of this research by government has led to a substantial
redistribution of NHS funding between areas.
In November 2008, Professor Sir Michael Marmot and his team at UCL were asked by the
Secretary of State for Health to chair an independent review to propose the most effective
evidence-based strategies for reducing health inequalities in England. The Marmot Review,
published in 2010, has fundamentally shifted discourse on health inequalities in the UK and
internationally. It has shaped public health services across England and around the world, guided
government and international policy, and has given rise to a new commitment from service
providers and health professionals to reducing health inequalities and addressing the social
determinants of health.
Findings from research at Newcastle on health inequalities and the basis
on which economic decisions are made have informed the recommendations
made to and adopted by the Secretary of State of Health. These
recommendations influenced two specific areas of the National Health
Service (NHS) budget allocation. Formulae developed by Wildman and his
colleagues are of key importance in determining the allocation of the
NHS's £8 billion prescribing budget and the £10.4 billion mental health
Research by the School of Pharmacy has been used by the UK Government in
their drive to improve the nation's public health. Our evidence base was
used to inform the 2008 White Paper "Pharmacy in England: Building on
Strengths — Delivering the Future". Healthy Living Pharmacies, recommended
by the White Paper, have been piloted leading to improved engagement with
local commissioners, further training for pharmacy staff, more
cost-effective delivery of public health services, and an increase in
public awareness and access to these services. In addition, the Government
backed Pharmacy and Public Health Forum is utilising our research in its
remit to develop, implement and evaluate public health practice in
The `People in Public Health' (PIPH) study and related research on health
trainers, health champions and volunteers has brought together evidence on
rationales for lay engagement, effectiveness and models of support.
Dissemination activities, supported by a Department of Health grant, have
achieved reach into various policy arenas and national networks. At the
same time there is evidence of research utilisation in public health
practice. One of the impacts has been the establishment of `Active
Citizens for Health', a national network of partner organisations to bring
together evidence and learning that has been hosted by Leeds Metropolitan
This case study highlights a body of research around health Research
Priority Setting (RPS) that assists policy makers in effectively targeting
research that has the greatest potential health benefit. Empirical
research on RPS led to organizational changes, and new policies within the
Cochrane Collaboration along with new training resources and new RPS
exercises. A research gap on inequalities in the risk of oral cancer in
the English South Asian population led to an evidence synthesis exercise
being carried out by the National Institute for Health and Care Excellence
(NICE) and the formulation of a new public health guideline.
Adults with learning disabilities (LD) often cannot adequately report
illness and there is evidence that treatable illnesses go undetected. As a
direct result of Cardiff University research on health checking adults in
primary care, the Welsh Government and the Department of Health now
provide funding for all adults with LDs across England and Wales to
receive an annual health check that employs Cardiff University methods.
Current data on take-up (N=78,000 per year) and evaluation of results show
that nearly 250,000 adults with LDs have had new health needs identified
and treatments initiated during the REF assessment period (2008-2013).
Nearly 40,000 adults per year will have new health needs identified and
treatments initiated as a result of the health checks, with approximately
3,500 of these being potentially serious conditions.
The UCL Dental Public Health Group have made a significant contribution
to oral health policy in the UK and internationally through their research
on oral health inequalities and the need for a reorientation of dental
services towards a more evidence based, integrated preventive approach
addressing common risks for oral diseases and other chronic conditions.
Our work has influenced local national oral health policies and the
development of clinical practice guidelines to reduce oral health
inequalities and provide the opportunity for dental professionals to
prevent both oral and systemic disease.
Public financing of health services in low income countries was
challenged by the World Bank's Agenda for Reform in 1987, which advocated
increased roles for private sector, private insurance and user fees. This
was followed by a wave of reforms implementing this approach. McPake
has been involved in researching the implications of this shift since this
period and has published a series of influential articles that have had a
demonstrable impact on this debate. Removal of user fees for all, or
selected, services or for selected population groups has occurred in many
countries, including 28 of 50 countries with the highest maternal and
child health mortality included in a recent survey (http://bit.ly/17FUiDM).
Witter is the lead researcher who has examined country level
experiences of removing fees and it is demonstrable that her work has been
applied in specific countries to shape the details of policy and has also
had a major influence on the global debate.