Oct 28 2014

Taking qualitative research to its logical conclusion

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by Ann Richardson, Visiting Fellow, PSSRU

I have been doing qualitative research most of my working life and I enjoy it immensely. There is something very satisfying about capturing people’s views about a topic – often an issue of some importance to them – in their own words. Most of my paid work has focused on experiences of the health service, such as patients’ views about their treatment and care for coronary heart disease, cancer, diabetes and so forth. Some has concerned experiences of social care, such as parents’ views about the appropriate future care of their adult sons or daughters with learning disabilities. Such research may not answer statistical questions, but it gets to the heart of how people feel.

The writing-up of qualitative research traditionally involves some explication of the issues by the researcher and some quotations from those interviewed, to show how they expressed themselves in their own words. Over the years, I became interested in exploring whether one could omit the researcher almost entirely and allow those interviewed to tell their stories – and explain the issues – themselves. Much too often, it was their words which were most alive or moving and the researcher simply paraphrased them for explanation, but without a great gain in understanding. My reports became increasingly quotation-based, with some tentative analysis offered by myself. Whether this was a style that was seen to be better or worse than a more traditional one I never knew.

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Oct 23 2014

The NHS England Five Years Forward View and the missing £30 billion

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by Mireia Jofre-Bonet and Alistair McGuire

The NHS England Five Years Forward View was released on 23/10/2014 and highlights that the current NHS is facing a crisis. There has been a fall in real terms expenditure, as, regardless of what the current government states, the productivity gains that were necessary to maintain NHS expenditure in real terms have not been achieved. The King’s Fund productivity report (2014) indicates that spending on health care went from 5.5% of GDP in the mid 1990s to 8% in 2009 and then stayed around that level. The King’s Fund report adds that it could fall to 6% of GDP by 2021 under a flat cash scenario for the NHS and moderate GDP growth, meaning that the resources for the NHS could be reduced by about 25%.

Recently, any productivity gains that may have been achieved in the NHS have tended to come through wage restraints and volume changes on the input side of the productivity equation. Since productivity is the rate of change in outputs as inputs change; if output grows faster than inputs, productivity increases; if inputs grow slower than outputs, productivity also increases. Currently input growth is behind output increase and that explains any productivity gains. To maintain real health-care expenditure at 2010 levels, the King’s Fund report estimates that productivity gains would have to be around 4% per annum. This has not been achieved. More recently productivity has been running at 2% per annum, but this has probably been driven by people working harder as inputs get cut. Continue reading

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Oct 21 2014

Does industry sponsorship bias research findings?

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A new study reveals that the findings obtained from industry sponsored studies for widely prescribed cholesterol drugs are similar in magnitude as those in non-industry sources. Huseyin Naci, LSE Health research fellow and co-author of the study (pictured), explains further.

There is concern that the vast majority of published medical research findings may be biased. An important source of potential bias relates to the influence of pharmaceutical industry sponsorship of clinical studies. A growing share of biomedical research is sponsored by industry and the findings from industry-sponsored research are often the most influential.

There are clear financial and non-financial conflicts of interest with such research. Of greatest concern, pharmaceutical companies have a long history of delaying the publication of unfavourable clinical study reports, withholding data from patients and regulators, and cherry-picking the publication of favourable findings.

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Oct 10 2014

Investing in crisis care for people with schizophrenia makes moral and economic sense.

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Valentina Iemmi, Martin Knapp, David McDaid

“When someone has a mental health crisis, it is distressing and frightening for them as well as the people around them. Urgent and compassionate care in a safe place is essential – a police cell should never need to be used because mental health services are not available. For me, crisis care is the most stark example of the lack of equality between mental and physical health.” (The Rt Hon Norman Lamb MP, Care and Support Minister)

There is a strong moral and economic case for investing in innovative approaches that support people with schizophrenia to live independently in the community. Crisis resolution and home treatment teams and crisis houses can help reduce the need for expensive hospital admissions with some studies suggesting that the costs of care can be reduced by up to 30% through these service models. There is a clear potential for Clinical Commissioning Groups to make better use of their resources by investing in home treatment teams and crisis houses as approaches to crisis resolution.

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Oct 6 2014

Culturally-sensitive maternity care services: A systematic global mapping of interventions

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Differences between the cultures of health care services and service users have been recognised as a major issue in service delivery, particularly in the delivery of maternity care services. In systematically mapping the literature on interventions implemented to address cultural factors that affect the use of maternity care services, Ernestina Coast, Eleri Jones, Annie Portela (WHO), and Samantha R. Lattof find that formulating and implementing culturally-sensitive programmes remain challenging despite the availability of good practices and success stories.

Scaling up women’s use of skilled maternity care is an important component of global strategies to improve maternal and newborn health, but the availability and provision of skilled care does not necessarily lead to increased utilization of maternity care services.  A recent systematic mapping conducted at the LSE indicates a growing global awareness of the need to design culturally-appropriate maternity care services in order to improve service utilization and thus maternal and newborn health outcomes.

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Sep 24 2014

Using hospital complaints to improve patient safety

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LSE colleagues from the Department of Social Psychology consider the untapped reserve of data that could be used to improve hospital patient safety: hospital complaints. Guest bloggers Dr Tom Reader and Dr Alex Gillespie explain how the analysis of this untapped data could inform future learning.

Improving patient safety in the NHS is a key priority for health policy specialists. To achieve this, the development of a ‘learning culture’, whereby hospitals learn from adverse events (e.g. medical errors), has been identified as crucial. Our research suggests that one way in which further learning might be achieved is through the rigorous and systematic analysis of hospital complaints.

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Sep 14 2014

Margaret Dangoor on her involvement in PSSRU’s MODEM project

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Margaret Dangoor joined the Personal Social Services Research Unit at LSE earlier in the year as Research Involvement Manager for a major new study on the costs and outcomes of dementia (MODEM). Here she talks about the MODEM project, how she came to be involved and her role, as well as her experiences as a carer.

Last December, the G8 countries held a Dementia Summit in London. Following the summit, on 13 May 2014 MODEM, a major dementia research project, was launched at an event held in the House of Lords and chaired by Baroness Greengross OBE on behalf of the International Longevity Centre UK. MODEM is one of six dementia projects being funded under a major new Economic and Social Research Council (ESCR) and National Institute for Health Research (NIHR) programme.

The MODEM project

MODEM will take a comprehensive approach to modelling outcome and cost impacts of interventions for dementia to 2040; it is a ground-breaking, unique 4-year study. The team of researchers is led by Professor Martin Knapp and team members from the PSSRU at the LSE will work in partnership with Newcastle University, the Universities of Southampton and Sussex and the International Longevity Centre UK.

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Sep 12 2014

How unpaid carers “pay” the costs of dementia

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by Adelina Comas-Herrera

Our recent “Dementia UK” 2014 report for the Alzheimer’s Society, in collaboration with King’s College London suggests that two-thirds of our estimated £26.3 billion cost of dementia in the UK is shouldered by carers and people with dementia. These results, which are also discussed in Martin Knapp’s recent blog post have been reported widely in the media as a “dementia tax”, and contrasted with the fact that most of the care needed by people diagnosed with conditions such as cancer is funded publicly through the NHS.

Of the estimated £17.8 billion that people with dementia and their families bear themselves, £11.6 billion is accounted for by provision of 1,340 billion of hours of “unpaid care”. These figures may seem large, yet we know that caring for a person with dementia involves very long hours, some spent assisting with basic activities of daily living (such as getting dressed, feeding, toileting), some on household tasks (such as cooking), and many ensuring that the person with dementia is safe and comfortable. The fact that people with dementia require this “supervision” element of caring means that they tend to need care for much longer hours than people with other types of care needs.

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Sep 11 2014

Dr Mike Clark on Sporting Memories and Dementia Care

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As we slip in to autumn, a super summer of sports draws to a close. How much did you enjoy the Test cricket series? Glasgow hosted the Commonwealth Games and Wimbledon delivered its annual festival of tennis. Yorkshire played host to the Grand Départ of the 2014 Tour de France with Cambridge and London hosting stages 2 and 3 respectively. And will you ever forget the shock result of the World Cup semi-final between Brazil and Germany?

Perhaps you aren’t especially interested in sports and none of these events really lit up your summer, but I bet you recall something from the 2012 London Olympics. Or perhaps you have memories of sports at school, or during childhood holidays, or of members of your family who were keen sports fans.

Sport is such an integral part of our culture and history that it is difficult for anyone to not have some powerful memories associated with it. This is where the Sporting Memories Network (SMN) is working to draw together the power of sports memories to help in the care and support of older people, especially those living with dementia. SMN’s projects have included delivering training to staff in care homes, community groups, and specialist dementia care units on using sporting memories as reminiscence therapy – a way of engaging in conversation and social contact with older people, especially men who may so often feel excluded from things.

Sitting in a training session with a group of staff from community groups and care homes provided the opportunity to see the potential power of sporting memories. People who didn’t really know each other before the session were quickly exchanging stories of their sports memories, of school, communities and families – experiences that people hadn’t thought about for a long time were suddenly rekindled by the reminiscences of others, and a huge amount of social history was recalled and retold. Another example of the power of unlocking sporting memories can be seen in the short film, Bill’s Story.

I have been evaluating this work and collating the learning in this approach, and what I have found so far from my examination of the SMN’s work is:

  • staff in all of the settings readily take to sporting-memories work, even those who had no interest in sports or who were apprehensive about doing it before the training;
  • staff report that they have engaged many older people who were not very engaged in the community group or care home;
  • staff have felt a sense of satisfaction from engaging in sporting-memories work, helping with their motivation;
  • some families visiting relatives in care homes have found the sporting-memories materials helpful to engage with their loved one who is living with dementia;
  • the approach is very versatile and can be used in many different ways and in a variety of settings.

The SMN is now exploring the potential of sporting-memories work to also:

  • open links between communities, older people and local sports clubs;
  • break down some of the metaphorical walls between care homes and communities;
  • develop intergenerational contacts and connections between people.

The SMN has been covered in the national media (for example, Soundcloud, The Guardian and The Daily Telegraph), has now attracted the support and sports stories of many sports people and other celebrities, has won a national Dementia Friends award, and has been recognised for its work by the Department of Health and the Prime Minister. Most recently, in September 2014 the SMN was named by The Observer newspaper and Nesta (a charity promoting innovation) among their 50 New Radicals.

I’ll be continuing work with the SMN to learn about the impact of sporting memories in helping people to connect with their memories and each other through sports reminiscence and keep you updated with news of this work as it develops.

For me the summer included making some new sports memories with my son Noah. My super innings against him at beach cricket (it is a sport now) and watching him learn to ride his bike will live long in our family memory. Sporting memories go deeper in us than you might at first think—collect and treasure them: you may want to use them in later life.

About the author: Dr Michael Clark is the Research Programme Manager for the NIHR School for Social Care Research and is based at the London School of Economics and Political Science.

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Jul 7 2014

Improving the relationship between social care providers and service users

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Guest blog by Chris Fennell, Head of Outreach, Kent Social Care Professionals Limited

For several years now there has been much political debate about the quality of care and service provided by health institutions and organisations. In times of widespread economic hardship it is becoming more and more important to remember that the people matter in these issues more than the bottom line.

The National Health Service (NHS) has faced increasing challenges over the past few years as budget cuts have applied pressure while demand for care services has increased. So how exactly are healthcare organisations and social care providers supposed to make time to hear the thoughts of patients, public and service users?

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