A survey of 172 leaders of the National Health Service (NHS) in England found that there is strong support for delivering a high quality, environmentally sustainable NHS; a firm belief that sustainability is part of delivering corporate goals; and a more general awareness of current NHS policies and practices on sustainability. However, 55% of leaders see organisational culture as a barrier to improving sustainability, with 83% of leaders agreeing that incentives and local diversity are necessary to progress more rapidly towards a sustainable NHS.
Between 15 and 20 percent of hospital emergency readmissions may be avoidable, according to research by RAND Europe and the University of Cambridge. The work, which aimed to inform the NHS Outcomes Framework, however warns that setting a rigid benchmark may be problematic. If rates are to be used for comparison, it will be important to risk-adjust for differences in case-mix between hospitals or departments.
Developed as part of the "Science of Science" programme for the UK’s Department of Health, this short paper examines the use of prizes to support the objectives of the Department’s Research and Development Directorate. It reviews the use of performance measures and incentives and concludes that prizes should play a more significant role in the UK health R&D system than they have to date. It is not suggested, though, that they should replace existing systems.
Normally, technology transfer involves developed countries forging ahead with innovation while others adopt technologies in their wake. This is an exploratory study of health technologies explicitly developed for developing countries being transferred from South to North. While it concludes that many of the factors key to successful transfer are highly contextual, it will be of interest to policymakers who find their concerns beginning to overlap (such as in relation to cost).
Germany's National Association of Statutory Health Insurance Physicians is looking to develop a unified reimbursement framework that accounts for regional prices and incorporates quality indicators. RAND Europe has informed the development of a resource allocation framework by providing an overview of quality indicators and approaches currently used for 'high stakes' assessment — that is, public reporting, transparency and accountability — in high-income countries globally.
The availability of low-price, high-strength alcohol is strongly associated with crime, disorder, and antisocial behaviour. Before proposing the ban on selling alcohol below the rate of duty plus VAT, the British Home Office considered a set of alcohol pricing policy options, which RAND Europe evaluated to determine their likely effects on the economy. This report provides findings on a range of potential impacts for each policy option on producers, on- and off-licenses, and consumers.
The European Commission is considering revising its Tobacco Products Directive and commissioned RAND Europe to help assess the key health, social, and economic impacts of five policy options under consideration. The study used a variety of qualitative and quantitative methods, including rapid evidence reviews and econometric and health-economic modelling techniques, to assess the economic and health effects of future regulation.
The policy of offering patients a choice in where they receive hospital treatment was intended to create competition among providers and to improve quality of care, but it has not succeeded. Patients say they value aspects of quality when choosing a hospital, but few actually consult published performance information and instead opt to be treated by their local provider. Moreover, the 'threat' of patient choice has led few hospitals to try to improve their reputation.
Many countries have invested in quality information systems that share data about healthcare provider performance as a means to improving healthcare quality, transparency and accountability. Reviewing the experience in seven countries, a collaborative project has identified a number of design considerations for the English NHS, such as the clear definition of objectives, ensuring user accessibility and stakeholder involvement, and the need to provide valid, reliable and consistent data.
Structured approaches to manage chronic conditions are widely seen as a means to improve the quality and reduce the cost of care for those with chronic disease, but evidence such approaches achieve these ends remains uncertain. To help advance the methodological basis for disease management evaluation, RAND Europe has reviewed the academic and grey literature on evaluation methods and metrics to identify key challenges and possible solutions to assess the effects of complex health interventions.
Healthcare planning enables decision makers to influence and direct the provision of health services, but its relevance is highly contextual. Researchers have developed a framework to assess, improve and enhance healthcare planning, and have conducted a case-study analysis of the framework to identify the common challenges faced by Germany, Austria, Canada and New Zealand as well as the differences in each setting.
Public involvement in healthcare policy has been advocated as a means to enhance the responsiveness of healthcare systems. However, the concept, rationale, objectives, and effectiveness of public involvement are poorly defined and difficult to ascertain. A comprehensive review of published literature, supplemented by observations of several public involvement initiatives, provides conceptual and empirical evidence for the benefits of public involvement in healthcare policy.
Several differences exist in the use of medicines for diseases such as osteoporosis, dementia, and rheumatoid arthritis across a range of countries, not least because of reimbursement schemes, access to specialists, and clinical practices. The "On-Call Facility" for International Healthcare Comparisons, a joint project of RAND Europe and the London School of Hygiene and Tropical Medicine, examined these variations through a review of published and specialised "grey" literature.
Social care is an increasing important public service, but little is known about its impact and how effective or efficient different care interventions are. To help remedy this situation, RAND Europe has undertaken research for the Office of National Statistics and the Personal Social Services Research Unit that quantifies the value placed on different aspects of social care related quality of life. This research forms part of the new Adult Social Care Outcomes Toolkit (ASCOT), which provides a tool for commissioners, service providers and regulators to quantify the outcomes of care interventions and help prioritise expenditure in areas which offer the greatest return to service users.
Researchers, including those in the mental health field, seek to secure more resources by identifying new scientific opportunities to fund. RAND Europe is undertaking a parallel effort to better understand the mechanisms and potential opportunities for spending those funds by developing evidence on the kind of research that leads to effective treatments and cures and exploring how this evidence could inform decisions in the future. A major multinational study that takes a long-term look at research and advances in mental health is the latest project to be funded as part of this initiative.
Interest in international benchmarking of healthcare quality is growing, and a considerable body of data exists for cross-national comparisons in selected areas of care, but drawing valid interpretations can be difficult. For example, the UK's National Health Service measures quality via effectiveness of care, patient safety, and patient experience, but an additional factor in many countries is healthcare access. Comparing quality across countries is thus only a first step in comparing—and improving—health outcomes.
The use of radio frequency identification in the healthcare setting holds the potential for improved patient safety and reduced costs. RAND Europe studied individual cases to identify the potential and real costs and benefits of RFID deployment in European healthcare, as well as the critical success and failure factors of RFID implementation programmes in practice. An initial set of reports provide a framework for conducting cost-benefit analyses in the future and to stimulate the effective monitoring and capturing of cost-benefit data in care delivery settings. A final report presents three scenarios for 2020, to describe futures in which the technology and health care sectors develop in different ways.
To discuss and take voluntary actions toward reducing alcohol-related harm, a multi-stakeholder European Alcohol and Health Forum was launched in June 2007. Monitoring of the Forum is key to achieving its objectives and creating trust in the activities undertaken by its members. To this end, the EC commissioned RAND Europe to carry out a quality assessment of all monitoring reports submitted by Forum members. These contributions can help to evaluate how successful the Forum has been as an alternative mechanism for change and action, compared to previous policy and enforcement mechanisms.
RAND Europe explored the impact of the Department of Health's Biomedical Research Units (BRUs) scheme on the translational research landscape in England. BRUs are collaborations between the National Health Service and academic partners, and share a common goal to undertake translational research and contribute to innovation in areas of high disease burden and clinical need. More specifically, the report investigates how institutional relationships between clinical and academic partners, industry and other health research system players are changing; how the scheme is helping build critical mass for research and innovation in priority disease areas; and the effects of any changes on efforts to deliver the broader goals set out in the Department of Health's R&D strategy, Best Research for Best Health.
Initiatives aimed at influencing the behaviour of citizens to improve individual and societal outcomes have been systematically used by governments (as well as by non-governmental bodies) for decades in many fields including transport, education, crime and health. Behaviour change programmes are very common in the UK and elsewhere, and significant financial resources are spent on them. The UK National Audit Office has commissioned a study to examine the use of behaviour change programmes campaigns in today's Department of Health. The study aims to improve understanding of their importance, nature and impact.
A recent European Court of Auditors report on the European Union Public Health Programme drew heavily on RAND Europe's interim evaluation of the PHP. The ECA offered a wide critique of how the PHP was run. In this way, RAND Europe's evaluation work is contributing to strengthening accountability and oversight in European Union institutions.
More than 95 percent of the £2 billion of public funding for medical research each year in the UK is allocated by peer review. Long viewed as a respected process of quality assurance for research, grant peer review has lately been criticised by a growing number of people as inefficient and structuraly flawed. This report presents the findings of a wide-ranging literature review to evaluate these criticisms and a short discussion of simple modifications that might help to address some of them.
This review is tasked with developing an evidence base for potential action to improve the health and wellbeing of NHS staff; as well as making practical recommendations for improvements. The review was initiated by the Department of Health and is headed by Dr Steve Boorman. Working in partnership with The Work Foundation and Aston Business School, RAND Europe led on the literature review, staff perception survey, the call for evidence, and the identification of supporting international good practice work.
This report assess the expected health, economic, social and environmental impacts of five policy options that the European Commission Directorate-General for Public Health and Consumer Protection (DG SANCO) is considering for achieving smoke-free environments in the European Union (EU-27). The EU initiative would aim to assist Member States in implementing comprehensive smoke-free laws in line with their obligations under the World Health Organization (WHO) Framework Convention on Tobacco Control.
This study was commissioned by the UK General Medical Council (GMC) to provide an evidence base on the systems of medical regulation in place in the countries of origin of the ten largest groups of non-UK qualified doctors registered in the UK. As the core regulator of doctors in the UK, the GMC seeks to compare UK regulations with the regulation of medical professionals in other countries and whether any differences could potentially affect quality of care and patient safety.
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