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Determinants Health and Social Care Health In All Policies population health Uncategorized

The flat of the curve. Do you want more health, or health care.

Spoiler alert – If you want more health spend less on heath care and more on upstream interventions. Controversial, and I’d expect grief for this one. I once wondered whether the proportion of health outcomes that are attributable to care mattered. I once thought it didn’t. I thought about it and concluded it did. Here’s […]

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Procedures of limited clinical value

It’s back This particular policy zombi was one of the issues I first cut my public health teeth on as a shiny new SpR (thanks Sohail!) I quickly saw it was pretty futile then as a method of financial savings. I’ve played the game a good few times since, my view is unchanged. 4 key […]

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Evidence Health Care Public Health Screening Value

Screening for cardiac risk in young adults – a poor way to save lives

This one has cropped up a lot over the years. See this thread from @CRY_UK inviting people between 14-35 to get free ECG heart screenings There’s a handy link to a website to get tested, with handy locations all over the uk. I mostly see the red mist at this point. I’ve also seen mass […]

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Health Care Public Health Value

innovation is NOT the same as shiny gadget or “invention”

people keep asking me to write a blog on “innovation” I recently wrote about our idolatry of gizmos. gizmos are certainly inventions, sometimes they are innovative. Sometimes they don’t add a lot (any) value thus Im mostly unconvinced they class as “innovative” I’m not sure I can summon the will to live to write more […]

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Health Care Public Health Shared decisions Value

Robotic prostatectomy. £60m capital cost on gizmo idolatry

I’ve previously had my rant about the ProtecT study. This broadly backs up earlier studies e.g. The PIVOT study suggesting radical prostatectomy doesn’t beat watchful waiting in terms of overall survival for localised prostate cancer. Surgery can do harm, watchful waiting will not. This is a development based on the hot of the press study […]

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Clinical Evidence Health Care Public Health Value

Avastin in Opthalmology, after the draft AMD guideline

Christmas is here The AMD guideline is out https://www.nice.org.uk/guidance/indevelopment/gid-cgwave0658/documents p150 odd onwards of the full guideline is the business end https://www.nice.org.uk/guidance/gid-cgwave0658/documents/draft-guideline#page155 it is largely as expected very clear (& exceptionally detailed) appraisal of the evidence base around the management of AMD. For me (and many) we were all waiting for this CG to see the […]

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Determinants Health In All Policies Social Value Uncategorized

Embedding the notion of social value in leisure contracts. 10 thoughts.

Thanks to those that helped draft and with ideas – Rob Copeland, Alex Shilcoff, Ollie Hart, Piers Simney, Kate Ardern, Emma Edwards Probably others who helped and I’ve forgotten. Everyone is doing “social value” now in commissioning. This is great, it’s a bit of a slippery concept however. I got asked for views on this […]

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Dear Generalist…changing cultures and attitudes in accountable care

Guest blog by @docant Dear Generalist…  Amongst all the talk of Accountable Care Systems within an STP environment and deconstructing the internal market and all that jazz: one of the key things that keeps getting mentioned is about changing cultures and attitudes.   We discuss it in terms of changing the ‘system’s’ view of General […]

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Redesigning a DVT pathway. Improving care, saving (a lot of) money

another story that I’ve been meaning to tell Another story that may never see the light of day in a scientific journal. another unpublished manuscript. Use your judgement in interpreting. Two of the authors (GF / MRF) have well documented DOI. Feel free to use and steal in any way you want. there’s a hell […]

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Shifting the focus upstream. Are thinking and doing going the same way. A Thought experiment

Jim Mcmannus has already blogged in this space.  https://jimmcmanus.wordpress.com/2016/01/30/are-thinking-and-doing-on-prevention-going-in-opposite-directions/  Here’s another spin of the dice – in a slightly different direction. The intention of many plans is to shift ££ upstream towards a proactive and preventive model, often predicated on greater emphasis toward social care and primary care. Of course this is good, you’d expect […]