15 research outputs found
Briefing: improving children and young people's mental health services: local data insights from England, Scotland and Wales.
In this briefing, we present analysis from the Networked Data Lab (NDL). Led by the Health Foundation, the NDL is a collaborative network of local analytical teams across England, Scotland and Wales. These teams analysed local, linked data sources to explore trends in mental health presentations across primary, specialist and acute services. This briefing includes: a) background on the trends in mental health disorders among children and young people and existing pressures on services, as well as an overview of the main policies in place in England, Scotland, and Wales to improve children and young people's mental health b) findings from NDL partners: we examine trends and patterns of service use, including the use of primary care, specialist mental health care and acute services, along with differences by demographic and socioeconomic characteristics c) examples of how local NDL teams used linked data to improve services in their area d) insights for national and local policymakers
New integrated care models in England associated with small reduction in hospital admissions in longer-term: a difference-in-differences analysis
Closer integration of health and social care services has become a cornerstone policy in many developed countries, but there is still debate over what population and service level is best to target. In England, the 2019 Long Term Plan for the National Health Service included a commitment to spread the integration prototypes piloted under the Vanguard `New Care Modelsâ programme. The programme, running from 2015-2018, was one of the largest pilots in English history, covering around 9% of the population. It was largely intended to design prototypes aimed at reducing hospital utilisation by moving specialist care out of hospital into the community and by fostering coordination of health, care and rehabilitation services for (i) the whole population (âpopulation-based sitesâ), or (ii) care home residents (âcare home sitesâ).
We evaluate and compare the efficacy of the population-based and care home site integrated care models in reducing hospital utilisation. We use area-level monthly counts of emergency admissions and bed-days obtained from administrative data using a quasi-experimental difference-in-differences design.
We found that Vanguard sites had higher hospital utilisation than non-participants in the pre-intervention period. In the post-intervention period, there is clear evidence of a substantial increase in emergency admissions among non-Vanguard sites. The Vanguard integrated care programme slowed the rise in emergency admissions, especially in care home sites and in the third and final year. There was no significant reduction in bed-days.
In conclusion, integrated care policies should not be relied upon to make large reductions in hospital activity in the short-run, especially for population-based models
Improving children and young peopleâs mental health services
Across the UK, the number of children and young people experiencing mental health problems is growing.
Mental health services are expanding, but not fast enough to meet rising needs, leaving many children and young people with limited or no support. Too little is known about who receives care and crucially, who doesnât.
This briefing presents analysis from the Health Foundationâs Networked Data Lab (NDL) about children and young peopleâs mental health. The analysis from local teams across England, Scotland and Wales has highlighted three key areas for urgent investigation, to help ensure children and young people get the care they need. These are:
rapid increases in mental health prescribing and support provided by GPs
the prevalence of mental health problems among adolescent girls and young women
stark socioeconomic inequalities across the UK.
To inform national policy decisions and local service planning and delivery, the quality of data collection, analysis and the linkage of datasets across services and sectors need to be improved and used more effectively
A critical review of smaller state diplomacy
In The Peloponnesian War, Thucydides (1972: 402) highlights the effects of the general, overall
weakness of smaller states vis-Ă -vis larger, more powerful ones in a key passage, where the
Athenians remind the Melians that:
â⊠since you know as well as we do that, as the world goes, right is only in question
between equals in power. Meanwhile, the strong do what they can and the weak suffer
what they must.â
Concerns about the vulnerability of small, weak, isolated states have echoed throughout history:
from Thucydides, through the review by Machiavelli (1985) of the risks of inviting great powers
to intervene in domestic affairs, through 20th century US-led contemporary political science
(Vital, 1971; Handel, 1990) and Commonwealth led scholarship (Commonwealth Secretariat,
1985). In the context of 20th century âBalkanizationâ, the small state could also prove unstable,
even hostile and uncooperative, a situation tempting enough to invite the intrusion of more
powerful neighbours: a combination, according to Brzezinski (1997: 123-124) of a power
vacuum and a corollary power suction2: in the outcome, if the small state is âabsorbedâ, it would
be its fault, and its destiny, in the grand scheme of things. In an excellent review of small states
in the context of the global politics of development, Payne (2004: 623, 634) concludes that
âvulnerabilities rather than opportunities are the most striking consequence of smallnessâ. It has
been recently claimed that, since they cannot defend or represent themselves adequately, small
states âlack real independence, which makes them suboptimal participants in the international
systemâ (Hagalin, 2005: 1).
There is however, a less notable and acknowledged but more extraordinary strand of
argumentation that considers âthe power of powerlessnessâ, and the ability of small states to
exploit their smaller size in a variety of ways in order to achieve their intended, even if unlikely,
policy outcomes. The pursuance of smaller state goals becomes paradoxically acceptable and
achievable precisely because such smaller states do not have the power to leverage disputants or
pursue their own agenda. A case in point concerns the smallest state of all, the Vatican, whose
powers are both unique and ambiguous, but certainly not insignificant (The Economist, 2007).
Smaller states have âpunched above their weightâ (e.g. Edis, 1991); and, intermittently, political scientists confront their âamazing intractabilityâ (e.g. Suhrke, 1973: 508). Henry Kissinger
(1982: 172) referred to this stance, with obvious contempt, as âthe tyranny of the weakâ3.
This paper seeks a safe passage through these two, equally reductionist, propositions. It
deliberately focuses first on a comparative case analysis of two, distinct âsmall state-big stateâ
contests drawn from the 1970s, seeking to infer and tease out the conditions that enable smaller
âLilliputianâ states (whether often or rarely) to beat their respective Goliaths. The discussion is
then taken forward to examine whether similar tactics can work in relation to contemporary
concerns with environmental vulnerability, with a focus on two other, small island states. Before
that, the semiotics of âthe small stateâ need to be explored, since they are suggestive of the
perceptions and expectations that are harboured by decision makers at home and abroad and
which tend towards the self-fulfilling prophecy.peer-reviewe
KLF1-null neonates display hydrops fetalis and a deranged erythroid transcriptome
We describe a case of severe neonatal anemia with kernicterus caused by compound heterozygosity for null mutations in KLF1, each inherited from asymptomatic parents. One of the mutations is novel. This is the first described case of a KLF1-null human. The phenotype of severe nonspherocytic hemolytic anemia, jaundice, hepatosplenomegaly, and marked erythroblastosis is more severe than that present in congenital dyserythropoietic anemia type IV as a result of dominant mutations in the second zinc-finger of KLF1. There was a very high level of HbF expression into childhood (>70%), consistent with a key role for KLF1 in human hemoglobin switching. We performed RNA-seq on circulating erythroblasts and found that human KLF1 acts like mouse Klf1 to coordinate expression of many genes required to build a red cell including those encoding globins, cytoskeletal components, AHSP, heme synthesis enzymes, cell-cycle regulators, and blood group antigens. We identify novel KLF1 target genes including KIF23 and KIF11 which are required for proper cytokinesis. We also identify new roles for KLF1 in autophagy, global transcriptional control, and RNA splicing. We suggest loss of KLF1 should be considered in otherwise unexplained cases of severe neonatal NSHA or hydrops fetalis