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This case study concerns the work of Professor David Spiegelhalter as Winton Professor for the Public Understanding of Risk at the University of Cambridge. Based on his research on risk communication, he has made numerous contributions to public service, influencing the way health screening information is given to the public, and public policy on breast implants and plain packaging of cigarettes. In addition, through lectures, Twitter, radio and TV appearances he has become a popular commentator on risk issues and reached a substantial segment of the UK public. He has had a continuing impact on the way that statistics, risk and uncertainty are discussed in the UK today.
Statistical analysis and methodological development carried out by Imperial College London on data from the Bristol Royal Infirmary Inquiry and the Shipman Inquiry have led to new monitoring systems in healthcare. Using routinely collected healthcare information, we have highlighted variations in performance and safety, impacting the NHS through direct interventions and/or policy change. For example: (i) findings and recommendations arising from our research for the Bristol Inquiry were reflected in the final inquiry outputs, which highlighted the importance of routinely collected hospital data to be used to undertake the monitoring of a range of healthcare outcomes, (ii) a range of monitoring recommendations have arisen as a direct result of the research on data from the Shipman Inquiry, (iii) analytical tools based on our methodological research are used by managers and clinicians in over two thirds of NHS hospital trusts, (iv) Imperial's monthly mortality alerts to the Care Quality Commission were major triggers leading to the Healthcare Commission investigation into the Mid Staffordshire NHS Trust.
RVC's Veterinary Epidemiology, Economics and Public Health team (VEEPH) has been at the forefront of applying and evaluating new techniques for modelling disease risk, for policy and decision makers to use in surveillance and control of animal and zoonotic infections. Application of their recommendations, including European `Commission Decision' legislation, is contributing to ensuring that Europe remains free from African swine fever (ASF). The status of FAO Reference Centre in Veterinary Epidemiology, awarded by the United Nations' Food and Agriculture Organisation in 2012, recognises the RVC as a centre of excellence in this field and reinforces its role in guiding policies relating to animal health.
Research by Cathcart, McNeil (both Maxwell Institute) and Morrison (Barrie & Hibbert) during the period 2008-2012 has developed a methodology based on least squares Monte Carlo to value complex insurance liabilities and manage their risks. This methodology has been adopted by Barrie & Hibbert (B&H, part of Moody's Analytics) and has enabled the company to develop an internationally leading proposition for valuing insurance products. This has generated £2.5M in revenue since 2011, through implementation in 5 new products and use in 12 new consulting projects.
Research carried out by Cairns (Maxwell Institute), Blake (Cass Business School) and Dowd (Nottingham, now Durham) in 2006 produced the `CBD' model for predicting future life expectancy. The CBD model and its extensions developed in 2009 by Cairns and collaborators have had a major impact on pensions and life industry risk management practices: multinational financial institutions [text removed for publication] and other stakeholders have relied on the CBD model to risk assess, price and execute financial deals [text removed for publication] since 2010. CBD is also used by risk management consultants to advise clients, is embedded in both open-source and commercial software, and is used by the UK's Pension Protection Fund to measure and manage longevity risk.
Research on risk assessment and screening led by Wright at Plymouth University and including clinical participants from the Centre for Fetal Medicine at King's College Hospital and Tübingen University, has improved fetal and maternal healthcare. This research and work supporting the Fetal Anomaly Screening Program (FASP) has contributed to reductions in the number of unnecessary invasive diagnosis procedures in the UK, and has improved screening performance through the implementation of the NHS-endorsed Down's syndrome screening Quality Assurance Support Service (DQASS). The research has also contributed to the risk algorithms of the Fetal Medicine Foundation (FMF) which are used by the NHS and national and international companies that provide technologies for the clinical management of pregnancies by identifying high-risk groups for chromosomal abnormalities and preeclampsia.
The Cambridge-led Emerging Risk Factors Collaboration (ERFC) is a global consortium involving individual-participant data on 2.5 million participants from 130 cohort studies. The ERFC has helped optimise approaches to cardiovascular disease (CVD) risk assessment by: 1) quantifying the incremental predictive value provided by assessment of risk factors 2) evaluating the independence of associations between risk factors and CVD and 3) addressing uncertainties related to the implementation of screening. ERFC publications on lipids, lipoproteins, and inflammation biomarkers have been cited by 9 guidelines published since 2010, including those of the European Society of Cardiology and the American Heart Association.
UCL research on statistical methodology has underpinned important investigations by scientists at Oxford University into the relationship between exposure to the naturally occurring radioactive gas radon and lung cancer. The resulting dose-response relationships and risk estimates have informed advice given in 2008-10 to the UK government by the Health Protection Agency about the risk of radon exposure and the cost-effectiveness of radon control policies. They have also influenced the conclusions of the World Health Organization about indoor radon and lung cancer, as reported in their 2009 handbook. Furthermore, the research findings have led to proposals for changes to building regulations in the UK and elsewhere, and changes to the building code in Finland have resulted in a reduction in the average indoor radon concentration in new homes.
Onchocerciasis (river blindness) is a debilitating disease of major public health importance in the wet tropics. The African Programme for Onchocerciasis Control (APOC) seeks to control or eliminate the disease in 19 countries. Accurate mapping of Loiasis (eye-worm) was a requirement for implementation of APOC's mass-treatment prophylactic medication programme in order to mitigate against serious adverse reactions to the Onchocerciasis medication in areas also highly endemic for Loiasis. Model-based geostatistical methods developed at Lancaster were used to obtain the required maps and contributed to a change in practice of APOC in a major health programme in Africa. Our maps are used to plan the delivery of the mass-treatment programme to rural communities throughout the APOC countries, an estimated total population of 115 million.
The Variable Life-Adjusted Display (VLAD) is a graphical tool for monitoring clinical outcomes. It has been widely adopted by UK cardiac surgery centres, and has helped a shift in culture towards more open outcome assessment in adult cardiac surgery, which has been credited with reduced mortality rates. VLAD is also being used for a broad range of other clinical outcomes by regulatory bodies worldwide. For example, Queensland Health uses VLAD as a major part of its Patient Safety and Quality Improvement Service to monitor 34 outcomes across 64 public hospitals, and NHS Blood and Transplant uses VLAD to monitor early outcomes of all UK transplants.