Services

In 2024 we were commissioned by NHS England to address one of the recommendations from the Infected blood Inquiry presented to Parliament in the same year. The Infected Blood Inquiry, reported that from 1970 onwards failings in treatment using infected blood and blood products resulted in over 30,000 people being infected with HIV and one or more types of hepatitis, with around 3,000 people dying of those infections. People with thalassaemia, a type of inherited genetic haemoglobin blood disorder, were subject to receiving infected blood during their standard treatment of regular frequent blood transfusions and suffered consequent harm from contracting infections. The Infected Blood Inquiry resulted in 12 overarching recommendations, many of which are relevant to people living thalassaemia. One recommendation specifically focused on people with thalassaemia stating that: “particular consideration be given, together with the UK Thalassaemia Society….., to how the needs of patients with thalassaemia ….. can best holistically be addressed.” NHS England, commissioned AGEM to carry out a qualitative and quantitative needs assessment of thalassaemia in England to address this recommendation. The aim of this work was to:

• identify the health needs of people with thalassaemia across England​
• report health inequalities experienced by people living with thalassaemia
• report variation in access and outcomes across England
• identify gaps in service and opportunities to improve the health of people who live with thalassaemia
• inform future policy and service development

We achieved these aims by synthesizing qualitative information from interviews and surveys with service users, patient representative organisations and professionals who provide thalasseamia care in addition to analysis of national data about treatment in different centres around the country. In addition we carried out a document review of current policies, service specifications and peer review visit reports. Read more here: SPH Thalassaemia Health Needs Assessment

In 2022, we completed a report for the UK National Screening Committee (UK NSC) exploring the clinical effectiveness and acceptability of targeted screening for lung cancer for individuals at increased risk. This involved an external review of evidence from a range of international trials against specified appraisal criteria. Following the publication of the evidence review, the UK NSC recommended that the four UK nations move towards the implementation of targeted lung cancer screening with integrated smoking cessation provision. The Targeted Lung Health Checks Programme being piloted by NHS England was identified as a feasible and effective starting point for the implementation of targeted lung cancer screening in England. In 2024, NHS England announced that the Targeted Lung Health Checks Programme has diagnosed thousands of people with early stage lung cancer while it is still treatable. Learn more here:  Lung Cancer Screening and read what the National Screening Committee said: Lung cancer - UK National Screening Committee (UK NSC) - GOV.UK

NHS England Specialised Services routinely assesses that policies relating to the use of the drugs, devices and procedures they directly commission are implemented correctly.   We were commissioned by NHS England to develop a methodology for delivering the compliance audits and to undertake audits for a selection of commissioning policies, that required updating. We reviewed the strengths and weaknesses of routinely available data sources, to select the best for each audit and were able to measure the extent to which implementation met the commissioning criteria set out in the policy.  The audits also included whether patients have received the expected benefits from the policy interventions, in line with those found in the clinical trials that underpin the policy.  Any changes to policy or implementation arising from the audits are taken forward by the multi-agency clinical reference group responsible for the supporting commissioners to develop and implement the policy. Read about it in more detail here:  SPH case study - Compliance audits for Specialised Services

A place partnership within a borough council received funding for residents living in areas of high deprivation with fuel poverty or fuel stress, with chronic health conditions exacerbated by living in a cold and/or damp home.  Eligible residents were offered home improvements including the installation of replacement gas boilers, loft insulation and/or cavity wall insulation.   We conducted an impact evaluation to identify whether the intervention was fully taken up, warmed the client's homes, improved their health and wellbeing, reduced household carbon emissions and whether it was cost-effective.  We carried out semi structured interviews with stakeholders including Council leads responsible for programme development and delivery, a GP leading on referring people to the programme and case managers involved in operational delivery.  These interviews demonstrated the scope for benefits provided by the Warm Homes programme in terms of individual health and comfort. Quantitative data identified potential benefits in terms of reducing health inequalities and contributing to a reduction in carbon emissions . Read about it in more detail here:  SPH case study_Warm Homes

As commissioning responsibility for many specialised services has been delegated from NHSE to ICBs, the Public Health team within the NHSE East of England region has been working closely with ICB colleagues to ensure that equality of access to services for all demographic groups is considered when setting ICB commissioning strategies. We were commissioned to support them in this by completing a review of current levels of access to services in the six ICBs within the East of England, highlighting any apparent differences these between geographic areas and between demographic groups. As public health specialists within Arden & GEM’s Health and Care Transformation consultancy, Solutions for Public Health worked closely with Business Intelligence colleagues to produce the requisite data and to carry out detailed analysis of these from a public health perspective. Findings described areas of apparent inequality and suggested possible reasons for these. The report has been shared by NHSE with ICB colleagues to help inform commissioning decisions. You can read more about this work here:   SPH case study - East of England Specialised Services Delegation Support

SPH carried out a Health Needs Assessment (HNA) for a local authority that was recommissioning its Healthy Child Programme (HCP). The purpose was to review whether existing provision and service configuration of the HCP was meeting the needs of children and young people in the county, and to identify gaps and potential options for improvement.   The HCP is a preventative programme including multiple teams and agencies across the local authority, including  Health Visiting and School Nursing Services, the Family Nurse Partnership (FNP) Programme, linking with childhood immunisation services, the community paediatrics team, the speech and language service, services for children with a learning disability and complex needs and child and adolescent mental health services (CAMHS), among others.    The HNA was carried out jointly by SPH and the local authority, with the epidemiological needs assessment and service description provided by the local authority. The report was compiled using a range of publicly available and locally collected epidemiological and service use data. SPH carried out a consultation of key corporate stakeholders as well as children and young people, their parents and carers. This included semi-structured interviews with key stakeholders in a range of organisations, a survey of a wider range of staff who work with children and young people and a survey of children and young people, their parents and carers which was distributed through the services.  The response to the stakeholder engagement was very good.  Rich qualitative data from this engagement complemented the quantitative data to inform the service specification for the recommissioning of these important services. 

The updated NICE-approved lipid management pathway was published in December 2021 (and has been updated again since). New NHS England service requirements for Primary Care Networks for the management of lipids and identification of familial hypercholesterolaemia came into effect, reflecting the updated NICE guidance. Eastern AHSN (Academic Health Science Network) is responsible for supporting the adoption of the updated lipid management pathway across the East of England. The AHSN commissioned SPH to carry out a survey of General Practices in the region to help understand and develop future support for practices. Alongside this, Eastern AHSN commissioned SPH to produce an evidence map identifying published evidence about the effectiveness of tools that assist in lipid management and familial hypercholesterolaemia identification. You can read the reports here:

• Evidence Map
• Survey of GP practices

We developed evidence-based case studies about programmes to reduce cardiovascular disease for Public Health England and the British Heart Foundation, by identifying successful initiatives worldwide. Programmes to identify and manage people at high risk of CVD were identified and their approach and research outcomes were assessed for relevance and applicability to a UK setting. Ten programmes were selected and a combination of methods used to collate information about the programmes including appraising published peer reviewed and grey literature and interviews with the research leads. The dynamic health systems framework was used to organise the relevant information into a case study template. SPH prepared a report, standalone case studies, presented a poster of the work at two conferences and worked with PHE to write a blog and article for dissemination. International Cardiovascular Disease Prevention case studies

SPH was commissioned by a County Council to evaluate a community organising initiative that had been operating across three electoral wards in a large local town.  The community organising project involved recruiting community leaders from local civic institutions to form a network.  The network engaged with their local communities to identify and prioritise issues impacting on health and wellbeing in the local area.  Actions to address the prioritised issues were developed and taken forward either by the network or by statutory agencies or both of these following a period of negotiation with community leaders.  The agreed actions were presented to the public at a specially convened event.  The County Council commissioned two external organisations to help establish the network and support its community organising activities. SPH completed a qualitative impact evaluation of the community organising project through a combination of face to face and telephone interviews with stakeholders and a document review.

Health Education England’s Genomics Education Programme (GEP) commissioned SPH to carry out an evaluation to understand early progress in the implementation of a competency framework. As the numbers and types of clinical staff involved in the process of offering genetic testing to patients grows, the GEP has worked to help ensure that those staff can feel confident that they have the knowledge and skills they need to fully inform patients and so help maximise the benefits of genomic medicine.  Competency areas were defined against which users could identify which areas, if any, they felt they needed to develop further knowledge or skills.   We carried out stakeholder interviews and document reviews that helped the GEP understand the effectiveness of their communications strategy, how early adopters were using the framework, any improvements suggested by these early adopters and any enablers and barriers encountered. 

We were commissioned by a CCG to evaluate a ‘Discharge to Assess’ initiative aimed at reducing the secondary care inpatient length of stay of elderly frail people who no longer have any medical needs. Discharge to Assess schemes aim to safely support the transfer of elderly people back to their home and their short-term recuperation. Once people are at home and have recovered as much as possible of their day-to-day functioning they can be assessed, if necessary, for on-going home care or transfer to residential care. The evaluation SPH undertook was based on a mixed model of quantitative and qualitative research and helped: 

• Provide a detailed understanding of all aspects of the initiative for commissioners 

• Link the original strategic objectives of the initiative with the day-today experience of people providing the service in managerial and operational roles and the challenges they face 

• Link the original strategic objectives with activity and cost of the initiative 

• Recommend improvements and a plan for future evaluation 

The evaluation informed the commissioning of the service in the longer term and identified immediate actions needed to strengthen the service in order for it to play a significant role in easing winter pressures at the local hospital NHS Trust.   The Local Government Association website signposts to national guidance and some examples of local initiatives:  Home First / discharge to assess | Local Government Association  

The Mid and South Essex stroke stewardship group wanted to better understand which of the interventions they delivered were high value and which were low value to inform decision-making on use of resources and investment. Arden & GEM’s Healthcare Solutions team provided training and support to enable the group to use the Socio-Technical Allocation of Resources (STAR) process in value based decision-making. As a result, the MSE stroke stewardship group has the insight needed to improve the allocation of their existing resources and improve outcomes for their patients. SPH were part of the project team, conducting a librarian review of economic evidence relating to cost-effectiveness of the stroke interventions to feed into the first workshop. This comprised a review of existing economic cost-effectiveness assessments (ideally by NICE as these are recognised as the guiding authority within the NHS). Where an economic assessment had not been undertaken then this was noted for further consideration. More detail here

Historically, SPH provided commissioning and public health support and advice to the commissioners of all cancer and non-cancer screening programmes across one region, including nine cancer screening programmes, two Diabetic Eye screening programmes and one Abdominal Aortic Aneurysm screening programme. SPH also supported all antenatal and new-born screening programmes in up to four NHS hospital trusts over an 11-year period.  We have retained this expertise within the SPH team. The types of activity that SPH undertook for this work included: 

• Supporting commissioners to meet the requirements and standards of national and local service specifications 

• Ensuring that all screening programme contracts are monitored regularly and action plans implemented where necessary to recover performance 

• Providing public health advice and expertise to commissioners and screening programmes about national and local policies, standards and pathways 

• Co-ordination of all relevant service providers along the screening pathway to support performance management of programmes 

• Identifying differences in access to screening programmes and developing actions to address them 

• Responding to enquiries from stakeholders 

• Participating in the investigation of serious untoward incidents and putting systems in place to ensure they are not repeated 

• Identifying and disseminating best practice 

SPH produces a number of high profile rapid evidence reviews for national clients every year assessing the effectiveness and cost-effectiveness of a wide range of treatments or potential interventions. Rapid evidence reviews for NHS England SPH has produced rapid evidence reviews for NHS England Specialised Services since 2012. These high-profile reviews consider the clinical and cost-effectiveness of treatments and interventions for a variety of conditions. The requirements of this contract include:

• Supporting development of research questions through liaison with the commissioner and senior stakeholders
• Supporting development of a PICOS table
• Liaising with a healthcare information scientist in Libraries to design the literature search
• Reviewing abstracts and selecting papers according to the agreed methodology
• Producing the review to an agreed template
• Internal quality assurance
• Consultation on the review with clinical specialists
• Producing a final report following consultation comments.

  Commissioned evidence reviews We also produce bespoke evidence reviews to assist customers address specific commissioning issues, for example:

• Reviews to inform national policy on population screening for the UK National Screening Committee
• Reviews to inform strategy design for preventing alcohol exposed pregnancies through understanding the predictors of alcohol consumption and the effectiveness of interventions for Blackpool Better Start
• A review on the development and use of early warning indicators in qualitative information for the Care Quality Commission
• A review on the contribution of community pharmacy in supporting/delivering lifestyle interventions and health protection/prevention for the Pharmacy and Public Health Forum
• A review on the impact and cost-effectiveness of self-management programmes on chronic disease management for a Public Health team.

Our work with Priorities Committees enables NHS commissioners to balance complex choices, backed up with independent evidence reviews and ethical frameworks. We provide an end-to-end service which includes the development of an ethical framework to inform the decision-making process, topic selection, evidence reviews, consultation with clinical specialists, operational support to priorities committees and drafting of clinical commissioning recommendations. We have also worked with commissioners around the country in developing and advising on setting up their own decision-making processes. We have experience of supporting commissioners in appeals against NICE guidance and in judicial reviews.

The General Pharmaceutical Council implemented a new revalidation framework after an extensive period of research, testing and consultation. SPH supported the GPhC by evaluating their pilot of the new process.  Working with GPhC we developed a logic model and conducted a mixed methods evaluation  including phone interviews, an online survey, analysis of entries made into the pilot system, a focus group and desk-based research.  From analysing and presenting the wealth of information gathered in a clear and concise way we were able to give the GPhC valuable insights to help them in their next steps. The report is available here: consultation_on_revalidation_for_pharmacy_professionals_april_2017.pdf   

The programme promoted the early detection of cancer by improving population awareness of the signs and symptoms of cancer and to remove barriers to seeking help. The programme also sought to ensure that GPs had the knowledge and skills to make the most appropriate referrals and supported pharmacists to engage with customers to increase their awareness of cancer signs and symptoms and visit their GPs if appropriate. SPH used a combination of quantitative and qualitative methods to assess the overall effectiveness of the programme. These included analysis of routinely available cancer indicators along with locally available data, reviewing data collected by the programme such as survey responses, reviewing project documentation including costings, and conducting interviews and focus groups. These were collated to form a comprehensive and insightful evaluation report, which the customer used to support future priorities setting.

SPH evaluated an education programme, targeted at staff within GP practices to improve end of life care. The evaluation included an assessment of the effectiveness and efficiency of the training visits through interviews and analysis of service data, an audit of the impact of the programme on practice, including changes in behaviour and the accuracy of end of life care registers, and an analysis of hospital admissions data. The evaluation found improvements in the skills, behaviours and competence of staff around end of life care in the period following the training programme.

SPH completed mental health needs assessments focusing variously on children and young people, working age adults and older people for a number of local authority customers. The aims of these needs assessments included identifying the prevalence of risk and protective factors for mental wellbeing, quantifying proxy measures for the burden of mental illness and benchmarking these against regional and national averages. Current service provision across the statutory and voluntary sectors was described and service providers, wider stakeholders and service users and carers participated though workshops, interviews and focus groups. Accompanying literature reviews considered prevention and early intervention for mental health conditions. The reports identified gaps and issues to inform future commissioning plans.

SPH was commissioned to review existing fertility policies across a group of Integrated Care Boards (ICBs) in order to support a collaborative approach to ICB policy making.  The work included:

• a comparison of assisted conception policies
• identification and analysis of up to date evidence regarding the effectiveness of a variety of treatment / policy options
• a discussion of the ethical considerations; collation and analysis of data on activity, outcomes, costs and inequalities
• and modelling of a range of policy scenarios

The work was completed over six months.  After an initial review of policies and a workshop with stakeholders from each ICB to confirm the project scope and key areas for consideration, we carried out the evidence enquiries and analysis of ethical considerations.  Alongside this, data sharing agreements were put in place with ICBs, NHS providers and private providers and data were obtained, collated and analysed.  Discussions with the Human Fertility and Embryology Authority allowed us to also receive up to date local data on activity and outcomes for NHS and private patients.  Based on this, a workshop was held to agree a wide range of policy scenarios for modelling.   A high level model was developed to illustrate the impact of different policy scenarios on numbers treated, outcomes, costs and cost effectiveness (for each ICB).  The assumptions used were clearly stated and the model allows changes to be made to these assumptions in future if, for example, the evidence base in relation to effectiveness, cost, uptake or drop-out rates changes.    The final reports included a short summary comparing policy scenarios and highlighting key ethical considerations and next steps, and a full report with appendices.

We have recently completed substance misuse needs assessments for local authorities which included: 

• Reviewing national and local policies for substance misuse provision 

• Identifying the local prevalence of substance misuse conditions and quantifying proxy measures for the burden of drug and alcohol misuse 

• Mapping existing substance misuse services 

• Completing a literature review on primary prevention for substance misuse 

Stakeholder engagement activities included: 

• Facilitating a workshop with commissioners, service providers and service users  

• Conducting semi-structured phone interviews with stakeholders 

We made a number of recommendations around gaps in service provision and capacity, including recommendations for specific groups of service users. 

As part of this review we:

• Modelled current and future demand
• Analysed patterns of hospital utilisation and catchment area
• Analysed of births by place of birth, age and deprivation quintile
• Reported on trends in risk factors for adverse outcomes from pregnancy and indicators of the quality of maternity services
• Reported on compliance of service providers against national standards
• Conducted interviews with local services to discuss how projected future need could be met