The role of care home fees in the public costs and distributional effects of potential reforms to care home funding for older people in England

In England, Local Authorities (LAs) contribute to the care home fees of two-thirds of care home residents aged 65+ who pass a means test. LAs typically pay fees below those faced by residents excluded from state support. Most proposals for reform of the means test would increase the proportion of residents entitled to state support. If care homes receive the LA fee for more residents, they might increase fees for any remaining self-funders. Alternatively, the LA fee might have to rise. We use two linked simulation models to examine how alternative assumptions on post-reform fees affect projected public costs and financial gains to residents of three potential reforms to the means test. Raising the LA fee rate to maintain income per resident would increase the projected public cost of the reforms by between 22% and 72% in the base year. It would reduce the average gain to care home residents by between 8% and 12%. Raising post-reform fees for remaining self-funders or requiring pre-reform self-funders to meet the difference between the LA and self-funder fees, reduces the gains to residents by 28-37%. For one reform, residents in the highest income quintile would face losses if the self-funder fee rises

Wanless social care review: securing good care for older people, taking a long-term view

More than one million older people (aged 65 and over) use publicly funded social care services in England. In light of criticism and controversy about the funding of these services, The King’s Fund commissioned Sir Derek Wanless to undertake a review of social care. The review sought to determine how much should be spent on social care for older people in England over the next 20 years and what funding arrangements need to be in place to ensure that this money is available and will produce high-quality outcomes. This report of their findings will make a significant contribution to the debate on the future of social care

A major increase in snake pipefish (Entelurus aequoreus) in northern European seas since 2003: potential implications for seabird breeding success

Since the early 2000s routine fish surveys have recorded increasing numbers of snake pipefish, Entelurus aequoreus, in the northeast Atlantic. Fishermen and divers have also commented on this increase and pipefish have started to appear in the diet of seabirds and other marine predators. This paper collates information from these diverse sources and assesses the current status of snake pipefish. We found compelling evidence of a dramatic increase in the abundance of snake pipefish starting around 2003 and continuing up to the present (2006) and a range expansion northwards to Spitzbergen and the Barents Sea. Since 2004 snake pipefish have been increasingly recorded in the diet of many species of seabird breeding in colonies around the coast of the UK, and in Norway, Iceland and the Faeroe Islands. Information on the nutrient value of snake pipefish is currently lacking but their rigid, bony structure makes them difficult for young seabirds to swallow and there are numerous records of chicks choking to death. Thus, in the case of avian predators during the breeding season, it appears unlikely that increased abundance of snake pipefish will provide a useful alternative prey. The reason for the rapid and dramatic increase in numbers of snake pipefish is currently unclear but such events are characteristic of marine ecosystems and will almost certainly have an effect on food web dynamics

The Well London program--a cluster randomized trial of community engagement for improving health behaviors and mental wellbeing: baseline survey results.

BACKGROUND: The Well London program used community engagement, complemented by changes to the physical and social neighborhood environment, to improve physical activity levels, healthy eating, and mental wellbeing in the most deprived communities in London. The effectiveness of Well London is being evaluated in a pair-matched cluster randomized trial (CRT). The baseline survey data are reported here. METHODS: The CRT involved 20 matched pairs of intervention and control communities (defined as UK census lower super output areas (LSOAs); ranked in the 11% most deprived LSOAs in London by the English Indices of Multiple Deprivation) across 20 London boroughs. The primary trial outcomes, sociodemographic information, and environmental neighbourhood characteristics were assessed in three quantitative components within the Well London CRT at baseline: a cross-sectional, interviewer-administered adult household survey; a self-completed, school-based adolescent questionnaire; a fieldworker completed neighborhood environmental audit. Baseline data collection occurred in 2008. Physical activity, healthy eating, and mental wellbeing were assessed using standardized, validated questionnaire tools. Multiple imputation was used to account for missing data in the outcomes and other variables in the adult and adolescent surveys. RESULTS: There were 4,107 adults and 1,214 adolescent respondents in the baseline surveys. The intervention and control areas were broadly comparable with respect to the primary outcomes and key sociodemographic characteristics. The environmental characteristics of the intervention and control neighborhoods were broadly similar. There was greater between-cluster variation in the primary outcomes in the adult population compared to the adolescent population. Levels of healthy eating, smoking, and self-reported anxiety/depression were similar in the Well London adult population and the national Health Survey for England. Levels of physical activity were higher in the Well London adult population but this is likely to be due to the different measurement tools used in the two surveys. CONCLUSIONS: Randomization of social interventions such as Well London is acceptable and feasible and in this study the intervention and control arms are well-balanced with respect to the primary outcomes and key sociodemographic characteristics. The matched design has improved the statistical efficiency of the study amongst adults but less so amongst adolescents. Follow-up data collection will be completed 2012

Responses to changes in sprat abundance of common tern breeding numbers at 12 colonies in the Firth of Forth, east Scotland

Breeding numbers collected in 12 common tern Sterna hirundo colonies in the Firth of Forth, Scotland, along with sprat landings data for the area, were used to investigate how the dynamics of a shared prey resource may affect different colonies in a region. Between 1969 and 2010, breeding numbers fluctuated much more at individual colonies than across the region as a whole, with the largest colonies showing opposite trends, suggesting relocation by birds. This indicates that data from individual colonies may be less useful than regional numbers when using seabirds as indicators. Tern breeding numbers in the region were reduced when the sprat stock (Sprattus sprattus) collapsed in the early 1980s after targeted fishing, but recovered during recent decades when the stock was unfished. This should be considered for reopening the Firth of Forth sprat fishery, as well as in the management of other shared prey stocks

Formulating eHealth utilizing an ecological understanding

Current evaluation and impact of health care on health outcomes via the Internet is limited in its scope in terms of feedback and interaction between the Web, health-care providers, and patients. A Health Web Observatory underpinned by the academic disciplines of Health Web Science and Medicine 2.0. may provide the infrastructure to address these limitations. Furthermore, a formula is described to consider the effect of digital interventions from the perspective of either the citizen, health professional/policy maker or at the population level. This chapter develops these concepts with exemplars and challenge the Web Science and Medicine 2.0 communities to develop new tools to enable the triangulation of data to understand end-user interaction with the Web and thus identify new integrated strategies for preferable health outcomes