Sick Britain: A call for mandatory Health Impact Assessments across government with the support of a dedicated ‘Health in All Policies’ support unit

Health is affected by a wide range of factors, from income, employment, and education, to pollution, access to green space and social networks. Health gaps arise through the unequal distribution of the wider determinants of health. Many of these factors are outside the direct control of the Department of Health and Social Care (DHSC). Working cross-government for health improvement is likely to lead to better designed and implemented policies which improve every aspect of society. A Health in All Policies (HiAP) approach describes how health and health equity can be improved through embedding consideration of health in multi-sector decision making. Health Impact Assessments (HIAs) are a mechanism for delivering an HiAP approach across national and local governments, creating the conditions for healthy lives

Development Education at University Level in Slovakia: Experiences and Challenges

This paper describes the context of global and development education in Slovakia through the implementation of a curriculum development project (titled ‘Capacity-building of human resource for health in Slovakia for international development aid’ (CABIS-IDA)), which was developed using innovative teaching and learning strategies. Participants in the training programme reported a high level of learning and provided important feedback on appropriate adult centred teaching methods. The project proved the necessity to include development and global education in formal education within the universities in Slovakia. The content of the programme was piloted and supported participatory teaching methods, which are new to the teaching culture of the country. The outcomes of the project show that the traditional paternalistic teaching philosophy and methods used in Slovak universities create serious obstacles to introducing global education into university teaching. Persisting cultures hamper the development of curricula that could more closely explore current global challenges to development and promote critical innovative thinking among students

Differences in the structure of outpatient diabetes care between endocrinologist- led and general physician- led services

Background: Despite a shift in diabetes care internationally from secondary to primary care, diabetes care in the Republic of Ireland remains very hospital-based. Significant variation in the facilities and resources available to hospitals providing outpatient diabetes care have been reported in the UK. The aim of this study was to ascertain the structure of outpatient diabetes care in public hospitals in the Republic of Ireland and whether differences existed in services provided across hospitals. Methods: We conducted a cross sectional observational study of the 36 public general hospitals providing adult outpatient diabetes care in the Republic of Ireland. Data relating to numbers of specialist medical, nursing and allied health professionals, waiting times for new and return patients, patterns of discharge back to primary care and engagement in quality improvement initiatives were recorded. Results: Thirty-five of the 36 eligible hospitals participated in the study. Sixty percent of these had at least one consultant endocrinologist in post, otherwise care delivery was led by a general physician. Waiting times for newly diagnosed patients exceeded six months in 30% of hospitals and this was higher where an endocrinologist was in place (47% V 7%, p = 0.013). Endocrinologists were more likely to have developed subspecialty clinics, access to allied health professionals and engage more in quality improvement initiatives but less likely to discharge patients back to primary care than general physicians (76 v 29%, p = 0.005). Conclusions: Variations exist in the structure and provision of diabetes care in Irish hospitals. Endocrinology-led services have more developed subspecialty structures and access to specialist allied health professionals and engage more in quality improvement initiatives. Nonetheless, waiting times are longer and discharge rates to primary care are lower than for non-specialty led services. Further studies to determine the extent to which case-mix variation accounts for these observations are warranted. Aspects of hospital-based outpatient care could be developed further to ensure equitable services are provided nationally. At a time when the delivery of diabetes services in primary care is being promoted, further research is warranted on the factors influencing the successful transition to primary care

Differences in the structure of outpatient diabetes care between endocrinologist- led and general physician- led services

Background: Despite a shift in diabetes care internationally from secondary to primary care, diabetes care in the Republic of Ireland remains very hospital-based. Significant variation in the facilities and resources available to hospitals providing outpatient diabetes care have been reported in the UK. The aim of this study was to ascertain the structure of outpatient diabetes care in public hospitals in the Republic of Ireland and whether differences existed in services provided across hospitals. Methods: We conducted a cross sectional observational study of the 36 public general hospitals providing adult outpatient diabetes care in the Republic of Ireland. Data relating to numbers of specialist medical, nursing and allied health professionals, waiting times for new and return patients, patterns of discharge back to primary care and engagement in quality improvement initiatives were recorded. Results: Thirty-five of the 36 eligible hospitals participated in the study. Sixty percent of these had at least one consultant endocrinologist in post, otherwise care delivery was led by a general physician. Waiting times for newly diagnosed patients exceeded six months in 30% of hospitals and this was higher where an endocrinologist was in place (47% V 7%, p = 0.013). Endocrinologists were more likely to have developed subspecialty clinics, access to allied health professionals and engage more in quality improvement initiatives but less likely to discharge patients back to primary care than general physicians (76 v 29%, p = 0.005). Conclusions: Variations exist in the structure and provision of diabetes care in Irish hospitals. Endocrinology-led services have more developed subspecialty structures and access to specialist allied health professionals and engage more in quality improvement initiatives. Nonetheless, waiting times are longer and discharge rates to primary care are lower than for non-specialty led services. Further studies to determine the extent to which case-mix variation accounts for these observations are warranted. Aspects of hospital-based outpatient care could be developed further to ensure equitable services are provided nationally. At a time when the delivery of diabetes services in primary care is being promoted, further research is warranted on the factors influencing the successful transition to primary care