Opportunity costs and local health service spending decisions:a qualitative study from Wales

Background: All health care systems face the need to find the resources to meet new demands such as a new, cost-increasing health technology. In England and Wales, when a health technology is recommended by the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS) is mandated to provide the funding to accommodate it within three months of publication of the recommendation. Identifying what, in practice, is foregone when new cost-increasing technologies are introduced is important for understanding the effects of health technology assessment (HTA) decisions on the NHS or any other health care system. Our objective was to investigate how in practice local NHS commissioners in Wales accommodated financial �shocks� arising from technology appraisals (TAs) issued by NICE and from other cost pressures

Economies of scale and scope in publicly funded biomedical and health research: evidence from the literature

BACKGROUND: Publicly funded biomedical and health research is expected to achieve the best return possible for taxpayers and for society generally. It is therefore important to know whether such research is more productive if concentrated into a small number of ‘research groups’ or dispersed across many. METHODS: We undertook a systematic rapid evidence assessment focused on the research question: do economies of scale and scope exist in biomedical and health research? In other words, is that research more productive per unit of cost if more of it, or a wider variety of it, is done in one location? We reviewed English language literature without date restriction to the end of 2014. To help us to classify and understand that literature, we first undertook a review of econometric literature discussing models for analysing economies of scale and/or scope in research generally (not limited to biomedical and health research). RESULTS: We found a large and disparate literature. We reviewed 60 empirical studies of (dis-)economies of scale and/or scope in biomedical and health research, or in categories of research including or overlapping with biomedical and health research. This literature is varied in methods and findings. At the level of universities or research institutes, studies more often point to positive economies of scale than to diseconomies of scale or constant returns to scale in biomedical and health research. However, all three findings exist in the literature, along with inverse U-shaped relationships. At the level of individual research units, laboratories or projects, the numbers of studies are smaller and evidence is mixed. Concerning economies of scope, the literature more often suggests positive economies of scope than diseconomies, but the picture is again mixed. The effect of varying the scope of activities by a research group was less often reported than the effect of scale and the results were more mixed. CONCLUSIONS: The absence of predominant findings for or against the existence of economies of scale or scope implies a continuing need for case by case decisions when distributing research funding, rather than a general policy either to concentrate funding in a few centres or to disperse it across many

An evaluation of a short course in mindfulness for Health Visitor Practice Teachers

Practice Teachers (PTs) participated in an 8 week course, Mindfulness Based Cognitive for well-being and resilience. The evaluation was undertaken using three (3) evidenced based questionnaires: Perceived stress(PSS) (Cohen et al 1983), Self-Compassion Score SCS (Neff 2003) and Five Facet Mindfulness Questionnaire (FFMQ) (Baer et al 2006) to identify outcomes for the mindfulness training. Findings indicate the impact on personal wellbeing and professional practice with recommendations for retention of students & Health Visitor (HV) workforce. Summary Mindfulness skills to support top performance and good mental health were offered in eight two-hour sessions to 18 Practice Teachers from September- December 2014 and was evaluated. The course drew on the approach of Mindfulness Based Cognitive Therapy, where participants learn to focus their attention and develop the possibility of creating the space for reflection and response rather than reacting to life’s difficulties. Participants had the opportunity to develop self–care and self-compassion in the sessions as well as in between sessions and which research has shown can have a positive effect on others. Compassion is a contemporary theme in the CNO’s strategy to return to the fundamentals of nursing; mindfulness enables the foundation of practising compassion on self and ultimately to practice compassion with others we work and care for. The attendees were encouraged to review and refresh their practice through with the ultimate planned outcome, to reduce student attrition and prevent breakdown of the practice placement. However, this is a the complex area of adult learning and the nature of student attrition from courses as well as from the workforce cannot necessarily be reduced to one factor. The practice of mindfulness can have an influential effect on health, well-being and resilience, as shown by scientific and medical evidence. This experiential course was neither therapy nor religious instruction but an effective means of helping to alleviate stress and promoting well-being, resilience and flourishing. The course was delivered at a time when practitioners, including PTs were experiencing an increase of student numbers and service delivery changes with associated imperative data collection. The perception of practitioners about the declared increase in the HV workforce (DH 2011) to support and implement these changes was not evident and the evaluation indicates the need for self-care and resilience in the workforce which includes students and practitioners. The project outcomes make recommendations based on the impact of this mindfulness training with PTs to inform future developments within the programme and practice education as well as the HV workforce where a number of interventions call for 'mindfulness' with infants, children and families

Exploring the interdependencies of research funders in the UK

Investment in medical research is vital to the continuing improvement of the UK's health and wealth. It is through research that we expand our understanding of disease and develop new treatments for patients. Medical research charities currently contribute over £1 billion annually to medical research in the UK, of which over £350 million is provided by Cancer Research UK. Many charities, including Cancer Research UK, receive no government funding for their research activity. Cancer Research UK is engaged in a programme of work in order to better understand the medical research funding environment and demonstrate the importance of sustained investment. A key part of that is the Office of Health Economics‟ (OHE) 2011 report “Exploring the interdependency between public and charitable medical research”. This study found that there are substantial benefits, both financial and qualitative, from the existence of a variety of funders and that reductions in the level of government financial support for medical research are likely to have broader negative effects. This contributed to other evidence which found that the activities and funding of the charity, public and private sectors respectively are complementary, i.e. mutually reinforcing, rather than duplicative or merely substituting for one another. “Exploring the interdependencies of research funders in the UK” by the Office of Health Economics (OHE) and SPRU: Science and Technology Policy Research at the University of Sussex, represents a continued effort to build the evidence base around the funding of medical research. This report uncovers the extent to which funders of cancer research are interdependent, nationally and internationally. Key figures show that two thirds of publications acknowledging external support have relied on multiple funders, while just under half benefited from overseas funding, and almost a fifth are also supported by industry. In addition the analysis shows that the general public would not want tax funding of cancer research to be reduced, but would not donate enough to charities to compensate for any such reduction

Rapid evaluation of service innovations in health and social care: key considerations

Background: The Children and Young People’s Mental Health Trailblazer programme is funding the creation of new mental health support teams to work in schools and further education colleges. Mental health support teams directly support children and young people with ‘mild to moderate’ mental health problems and work with school and college staff to promote well-being for all. A new workforce of education mental health practitioners is being trained for the teams. / Objective(s): The National Institute for Health and Care Research Birmingham, RAND and Cambridge Evaluation Rapid Evaluation Centre and Policy Innovation and Evaluation Research Unit undertook an early evaluation of the Trailblazer programme to examine the development, implementation and early progress of mental health support teams in the programme’s first 25 ‘Trailblazer’ sites. / Design: A mixed-methods evaluation, comprising three work packages: 1. Establishing the baseline and understanding the development and early impacts of the Trailblazer sites, including two rounds of surveys with key informants and participating education settings in all 25 sites. 2. More detailed research in five purposively selected Trailblazer sites, including interviews with a range of stakeholders and focus groups with children and young people. 3. Scoping and developing options for a longer-term assessment of the programme’s outcomes and impacts. Fieldwork was undertaken between November 2020 and February 2022. The University of Birmingham Institute for Mental Health Youth Advisory Group was involved throughout the study, including co-producing the focus groups with children and young people. / Results: Substantial progress had been made implementing the programme, in challenging circumstances, and there was optimism about what it had the potential to achieve. The education mental health practitioner role had proven popular, but sites reported challenges in retaining education mental health practitioners, and turnover left mental health support teams short-staffed and needing to re-recruit. Education settings welcomed additional mental health support and reported positive early outcomes, including staff feeling more confident and having faster access to advice about mental health issues. At the same time, there were concerns about children who had mental health problems that were more serious than ‘mild to moderate’ but not serious enough to be accepted for specialist help, and that the interventions offered were not working well for some young people. Mental health support teams were generally spending more time supporting children with mental health problems than working with education settings to develop ‘whole school’ approaches to mental health and well-being, and service models in some sites appeared to be more clinically oriented, with a strong focus on mental health support teams’ therapeutic functions. / Limitations: Despite efforts to maximise participation, survey response rates were relatively low and some groups were less well represented than others. We were not able to gather sufficiently detailed data to develop a typology of Trailblazer sites, as was planned. / Conclusions: Key lessons for future programme implementation include: – Whether mental health support teams should expand support to children and young people with more complex and serious mental health problems. – How to keep the twin aims of prevention and early intervention in balance. – How to retain education mental health practitioners once trained. / Future work: The findings have important implications for the design of a longer-term impact evaluation of the programme, which is due to commence in summer 2023. / Study registration: Ethical approval from the University of Birmingham (ERN_19-1400 – RG_19-190) and London School of Hygiene and Tropical Medicine (Ref: 18040) and Health Research Authority approval (IRAS 270760). / Funding: The Birmingham, RAND and Cambridge Evaluation Rapid Evaluation Centre is funded by the National Institute for Health and Care Research Health Services and Delivery Research programme (HSDR 16/138/31). The Policy Innovation and Evaluation Research Unit is funded by the NIHR Policy Research Programme (PR-PRU-1217-20602)

Capital Flows to developing countries: does the emperor have clothes?

This paper begins by examining the pattern of capital flows first to low-income countries, and then to emerging economies. In both cases, we see a dramatic collapse in the last several years. The evolving determinants of these trends in FDI flows (the principal category of private flows to low-income countries) and other capital flows are analysed. The behaviour of flows to emerging economies heavily influences both present and potential future flows to low-income countries. The paper concludes with the policy implications at both source countries and low-income recipient countries.

Implementing & evaluating a community of practice for health visiting - final report

This report presents the context, approach and findings arising from implementing and evaluating a Community of Practice (CoP) for Health Visitors across Kent and Medway funded by Health Education England (Kent, Surrey and Sussex) and built on the launch of the Communities of Practice concept in Kent and Medway (Keen et al 2013). The intention of the CoP, with its focus on health visiting practice, was to support a Health Visitor from each locality across Kent and Medway to: •develop their skills in practice development and clinical leadership •create effective learning cultures within which students and practitioners can flourish •explore how the effectiveness of health visiting can be demonstrated Two interrelated methodologies, action research and practice development were selected because they both focus on practical action in the workplace that is systematically implemented and evaluated through collaborative, inclusive and participative approaches. Three overarching processes (methods) were used to support the health visitor clinical leaders included active learning (Dewing 2008), action learning (McGill & Beaty 2001) and critical companionship - a helping relationship that focuses on helping a practitioner to learn (Titchen 2000). Within the lifetime of the project 18 co-researchers across two cohorts were recruited to the action learning sets; recruitment of co-researchers was undertaken in partnership with service managers. Four powerful influences emerged that impacted on the co-researchers’ participation in the project and also the potential for sustainability of the CoP project. Understanding the factors and strategies that influence the successful implementation of Communities of Practice is important to others who may be involved in similar initiatives. The limitations of the project are explored with recommendations for a range of organisations. Resources and outputs are shared and promoted widely to help others develop effective workplace cultures that use the workplace as the main resource for learning

Speech Communication

Contains research objectives and three research projects.U. S. Air Force (Electronic Systems Division) under Contract AF 19(604)-6102National Science Foundation (Grant G-16526)National Institutes of Health (Grant MH-04737-02

Type-II micro-comb generation in a filter-driven four wave mixing laser [Invited]

We experimentally demonstrate the generation of highly coherent Type-II micro-combs based on a microresonator nested in a fiber cavity loop, known as the filter-driven four wave mixing (FD-FWM) laser scheme. In this system, the frequency spacing of the comb can be adjusted to integer multiples of the free-spectral range (FSR) of the nested micro-resonator by properly tuning the fiber cavity length. Sub-comb lines with single FSR spacing around the primary comb lines can be generated. Such a spectral emission is known as a “Type-II comb.” Our system achieves a fully coherent output. This behavior is verified by numerical simulations. This study represents an important step forward in controlling and manipulating the dynamics of an FD-FWM laser