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York research has, continuously since the early 1990's, underpinned the methods by which a substantial proportion of the total NHS budget is allocated by the Department of Health to the organisations providing or arranging healthcare. Despite numerous NHS reforms, our research has produced formulae appropriate to each new system. These formulae have driven NHS policy on allocations across geographical areas and health care administrative entities in England, thereby ensuring that the population of approximately 55 million people receives a share of over £90 billion of healthcare resources that is fair and better reflects relative health care needs.
Abdominal aortic aneurysm (AAA) is a major cause of death in older men, in the UK and elsewhere. A large UK trial led by the University of Cambridge evaluated the long-term benefits of ultrasound screening for AAA in men aged 65-74 years. This provided the basis for the introduction of a UK national AAA screening programme in men aged 65; this was announced in 2008, initiated in 2009, and achieved full coverage of England in 2013. Similar screening has started in Sweden, New Zealand and in parts of Italy, and is being actively discussed in Denmark, Norway and Finland.
The decision about whether to fund new health care interventions is increasingly being informed by evidence of cost-effectiveness in terms of the cost per Quality Adjusted Life Years (QALY). The SF-6D health index is widely used internationally for calculating QALYs from patient reported health outcomes collected in clinical trials and other surveys. It contributes to health system efficiency from being used by health technology agencies around the world (including Australia, Canada, England, Scotland, Ireland and Norway) to calculate QALYs to facilitate decisions about the most efficient use of limited health care resources. The SF-6D is freely available to non-commercial bodies, including researchers and policy makers. Commercial benefits come from the licensing of the measure to pharmaceutical companies, health insurers and others to assess the cost-effectiveness of their products with 460 licenses being sold since 2008. A further 521 licenses are distributed on a non-commercial basis to academic researchers, public sector and charitable organisations.
Our research into the epidemiology of childhood visual impairment has transformed understanding of the epidemiology, outcomes and impact of childhood visual impairment in the UK. As a result, changes have been made to the Newborn and Infant Physical Examination Programme and the National Vision Screening Programme. Our work has underpinned the development of new quality standards for paediatric ophthalmology services issued by the Royal College of Ophthalmologists. Our studies on congenital cataract have improved the management of this condition nationally. We have involved visually impaired service users and patient groups directly in our research to improve quality of life measures and patient engagement.
Responding to the crisis in confidence amongst clinicians involved in child protection, Cardiff University developed the world's first research programme to provide the scientific basis for more reliable clinical assessments of child abuse and neglect. The programme, which involves 21 systematic reviews (updated annually) and related primary studies, has directly informed five national clinical guidelines, the National Child Protection training program and the first NICE guidance on child maltreatment. Through the Core-Info website, the evidence base created by the Cardiff team is accessed each year by 100,000 users. Key messages from their research have been published in a series of Core-Info leaflets which have reached more than 250,000 allied professionals nationally. The Cardiff research informs standardised national clinical practice, training and legal decisions, ultimately improving the recognition and protection of children from abuse or neglect.
Improving patient experience of health services is a policy priority worldwide. The University of Manchester (UoM) has conducted research on patient experience since 1995, leading to the development of a series of validated measures for assessing patient experience of quality of care in primary care, including access to care and the degree to which services are patient-centred. Our measures have been in routine use in the NHS since 2004, sent to samples of several million patients. The data have been used to provide incentives for the highest quality practices, and to inform policy makers about current care throughout the UK.
Research at the University of Bristol (UoB) led to the Department of Health (DH) decision in 1997 that screening for prostate cancer would not be introduced in the UK until there was evidence that benefits outweighed harms. UoB-led and collaborative research subsequently provided evidence to support informed decision-making in the NHS. A formal review by the DH in 2010 endorsed the policy and confirmed that any change would be based on evidence from the team's randomised trials. This research has ensured UK men have avoided known harms of prostate cancer screening in the context of uncertain benefits, and saved the UK economy £ billions.
University of Bristol research has led to a marked and persisting reduction in the number of cot deaths (sudden infant death syndrome or SIDS). The dramatic 67% fall from 1988 to 1992 in England and Wales resulted from the identification of risks associated with putting babies to sleep face-down (prone). Nationally, death rates have more than halved again (54% fall) between from 1992 and 2011, with an estimated additional 1025 lives saved between 2008 and 2011, after two studies conducted in 1993-6 and 2003-6 identified further contributory risk factors. Tens of thousands of SIDS deaths worldwide have been prevented thanks to the team's research, international collaboration and development of risk-reduction recommendations.
The core target in the government's national strategy for cancer control in England is to `save 5,000 lives a year by 2015'. This target was taken directly from research done by LSHTM showing that 10,000 cancer-related deaths per annum would be avoidable if five-year relative survival were as high as the highest levels observed in Europe. Current government strategy is entirely focused around `halving the gap' in avoidable premature cancer deaths identified in this research, which also forms the basis for England's National Awareness and Early Diagnosis Initiative.
The most frequent surgical procedure undertaken in the NHS is cataract surgery and it improves vision and quality of life (QoL). In the 1990's there were long waiting times for cataract surgery with rationing most frequently restricting surgery on the 2nd eye. A randomised controlled trial undertaken at the University of Bristol (UoB) demonstrated clear QoL benefits from 2nd eye cataract surgery, followed by a population study quantifying population requirements for 1st and 2nd eye surgery and the surgical backlog. Government policy, announced in `Action on Cataracts — Good Practice Guidance, 2000', advised that the volume cataract surgery, including on the 2nd eye, should be increased. This policy ensured timely access to surgery becoming routine practice in the NHS, thus improving the lives of thousands of people. Second-eye surgery rates rose from ~25% of operations to 35-40%, with overall increases in operations for patients needing surgery (e.g. in England up from 201,682 operations in 1998-1999 to 332,625 in 2009-2010) and reduced waiting times. These improvements were sustained through to the end of the 2000's. The research has become highly relevant again as the NHS enters another period of constrained expenditure.