Shaping healthy communities: a report on the second symposium on the role of local authorities in reducing health inequalities.

Sheffield City Council achieved Beacon Status for its work on reducing health inequalities in 2007. The Council is hosting a series of three symposiums to promote more effective dialogue and action in this important area of local authority (LA) business. The first symposium - was held on 5th November 2008. This aimed to share an understanding of what works in tackling health inequalities and how, collectively, the region can develop significant and sustainable programmes of work in this area. A report of the symposium was compiled by staff of the Centre for Health and Social Care. The second symposium - was held on 20th July 2009. Its focus was LA practice in tackling health inequality: what are they doing well and where could practice be improved. This document reports from the second symposium

Delivering effective NHS services to our multiethnic population: collection and application of ethnic monitoring within primary care

Government health policy has emphasised the importance of understanding and tackling ethnic disparities in health and healthcare for at least four decades. Yorkshire & the Humber includes areas with large, well-established minority ethnic populations. In addition, most cities in the region, including those that have in the past been dominated by the White British majority, are now experiencing rapid migration. Persistent patterns of health disadvantage among established minority ethnic communities are now compounded by the differing health needs of new migrant populations. NHS organisations in Yorkshire & the Humber have begun to respond more systematically to the needs of minority ethnic groups. However, there is still progress to be made on establishing basic requirements for effective commissioning, including effective ethnic monitoring systems that provide high quality intelligence to commissioners, service managers and health professionals. While there are examples of innovation and good practice, there is significant variation across the region and a lack of sharing and learning between organisations. Here we report on a workshop that was convened by the Strategic Health Authority in June 2009 as a first step towards addressing this recognised area of need. The Workshop Chair was John Chuter, Chair of NHS Bradford & Airedale. The aims of the workshop were to: • Highlight the policy context and imperatives for ethnic monitoring. • Raise awareness of the current position with regard to ethnic monitoring and use of data in Yorkshire & the Humber. • Share emerging good practice. • Identify ways to move forward to improved ethnic monitoring across the region

Clinical trials in neonates: ethical issues

Clinical trials in neonatology often raise complex ethical problems. This paper suggests that in tackling these it is useful to identify and separate out those elements of the problem that are genuinely ethical (e.g. can I enter a child into a trial if I am not in personal equipoise?) from those that are empirical (e.g. what is the evidence for a treatment's effectiveness?) and those that are formal (e.g. what do codes or the law permit?) The genuinely ethical elements are examples of philosophical problems and must be tackled in a way appropriate to such problems. In practice this usually means some form of systematic argument. This is often frustrating to clinicians who are more used to the assuredness of empirical research. The paper next examines two ethical problems that arise frequently in neonatal trials. The first is equipoise and the related issue of recruiting parents who are not in equipoise because they strongly desire that their baby get the active treatment. We briefly defend the recruitment of such "desperate volunteers". The second is informed consent. We discuss the nature and value of informed consent and suggest that clinicians can often obtain worthwhile consent even in very difficult trials. The final section of the paper uses the example of clinical trials for brain injury to illustrate the difficulties.</p

Ethics and evidence-based practice

Evidence-based practice is roughly the use of current best evidence in making decisions about the care of patients (Sackett et al. 1996). At first it seems hard to imagine how such practice could raise ethical concerns; and yet it has. These concerns are set out in the first section of this chapter. Much of the past discussion of these problems has focused on the epistemology of evidence, with critics suggesting that EBP is based on an overly narrow definition of evidence and knowledge. This chapter tacks differently, focusing instead on the epistemology of practice; in other words, what type of evidence or knowledge is needed in deciding how to act? Using the distinction drawn by Aristotle between practical and scientific knowledge it is suggested that evidence in the form of scientific knowledge, no matter how widely defined, cannot form the basis for practice because it cannot provide the goals that action requires; for EBP these must be provided from within practice itself, for example, nursing or surgery. However, ultimately the goals are provided by wider personal and social goals, in particular, human flourishing. Once this is accepted, it is possible to resolve the ethical concerns that have been raised about EBP, drawing on Aristotle's account of reasoning in the practice areas of craft knowledge and of practical wisdom