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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Jun 20 2014

Eurohealth Volume 20, issue 2: Health behaviours and incentives

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Sherry Merkur, Anna Maresso and David McDaid

The last decade has seen an increasing interest in some countries of the potential of using behavioural science to inform our understanding and influence policy design. The Eurohealth Observer section kicks off with a look at the fashionable area of applying the principles of behavioural science to nudge populations towards better health and wellbeing. It discusses the growth in popularity of these health nudges and questions the evidence base on their effectiveness and cost effectiveness. It goes on to suggest where these principles may have a role to play in enhancing elements of health promotion and public health policy.

The latest issue of Eurohealth (volume 20, issue 2), which has just been published by the European Observatory on Health Systems and Policies (in which LSE Health is a partner), looks at some recent developments in this area.

In an effort to set out the broad context on why health behaviours matter, Mackenbach discusses their role within the persistence and widening of health inequalities in modern welfare states. With observed disparities in smoking and alcohol consumption, the uptake of exercise and healthy diet linked to socio-economic status, it becomes apparent that tackling these risk factors with effective interventions could have an impact on the inequalities in population health status. Whether or not incentives to change health behaviours are desirable or ethical depends on a complex mix of factors. The article by Schmidt attempts to disentangle the salient issues by identifying four goals and ten key dimensions of incentive programmes. The tool kit provided is a first step to systematically analysing different types of incentives, and could supply the basis for comparing incentive programmes of similar design.

Prainsack and Buyx contribute to this debate by bringing in a unique perspective – that of solidarity. They argue that by focusing on what people have in common rather than what sets them apart, solidarity is particularly relevant and compatible with ‘nudging’ practices because it can foster sensitivity to social inequalities and safeguard against inappropriate stigmatisation of target groups. Providing us with a national perspective, ten Have and Willems discuss the current debate in the Netherlands on using incentives to influence lifestyle and promote better health, and whether or not health insurance premiums should be differentiated to take into account people’s unhealthy lifestyle choices.

In the Eurohealth International section, Greer and Lillvis look at the difficulties of establishing intersectoral governance for Health in All Policies. They go on to suggest potential solutions for how policy-makers can create good functioning and enduring intersectoral governance to promote public health strategies.

Both of the articles in the Eurohealth Systems and Policies section reflect reforms to address budgetary pressures posed by the recent difficult economic climate. Kwong and colleagues discuss additional challenges faced by the health care payers in Poland and Hungary and how they have been confronted through pharmaceutical cost containment strategies. They also present the potential for risk-sharing schemes for medicines in the face of financial and performance uncertainty. Voncina and Sagan report on the newly implemented joint hospital procurement programme in Croatia. They describe the details of this decentralised approach and reflect on success in terms of the quality and the cost of procured goods.

Eurohealth Monitor features a new book on health professional mobility, which presents practical tools and policy responses in a changing Europe. Also featured is a new book on regulating long-term care quality that provides country-specific case studies to highlight policy options. As usual, the News section brings you a selection of national and international developments in the health sector. We hope you enjoy the Summer Issue.

Read the full issue

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Jun 19 2014

Have your say on the treatment gap in global mental health

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by Victoria de Menil and Valentina Iemmi

Lord Crisp chairing the APPG on global mental health (c) Victoria De Menil

Lord Crisp chairing the APPG on global mental health
(c) Victoria de Menil

An historic first took place in Portcullis House on 10 June. The UK All Party Parliamentary Groups (APPGs) on global health and mental health convened a joint hearing to discuss global mental health. The event, chaired by Lord Nigel Crisp together with James Morris MP, was the first of two oral evidence sessions to address the question of whether the UK government should be “doing more or doing differently” to address the treatment gap in global mental health. Three additional Parliamentarians, Meg Hillier MP, Vicount Eccles and Peter Bottomley MP, were also in attendance.

The session opened with evidence from three speakers: Professor Vikram Patel of the London School of Hygiene and Tropical Medicine, Professor Graham Thornicroft of the Institute of Psychiatry, and Dr Gary Belkin, director of New York University’s Global Mental Health Programme. Their task was to answer two questions: how significant a problem is mental illness in low- and middle-income countries; and what evidence is there for cost-effective ways to address mental health needs in low- and middle-income countries?

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Jun 16 2014

Informing and improving policy and practice for carers through research and evaluation

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Carers Week took place last week to raise awareness and improve the lives of carers and the people they care for. Much has been said about the need for a robust evidence base to support this aim. Last year a seminar series funded by the Economic and Social Care Research Council explored some of the evidence and next steps; and there is a growing body of studies exploring different aspects of carers’ lives. Here PSSRU at LSE colleagues Valentina Zigante, Nicola Brimblecombe, and Derek King reflect on a joint workshop by the Social Services Research Group and the NIHR School for Social Care Research on how research and evaluation could inform and improve policy and practice in relation to informal carers.

The day offered ample opportunity to reflect on issues ranging from the legal framework to the day-to-day reality of carers’ lives and the future of carers’ research.

Helena Herklots, Chief Executive of Carers UK chaired the event which brought together a mixed audience of carers, practitioners, researchers and stakeholders.

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May 22 2014

Reflecting on Professor John Bolton’s LSEHSC seminar: Policy, practice and austerity

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by Michael Griffiths

We recently held a seminar by Professor John Bolton*, JRFB Ltd and visiting Professor at the Institute of Public Care at Oxford Brookes, as part of the LSE Health and Social Care Formal Seminar Series. Professor Bolton’s presentation on Policy, Practice and Austerity focused on two themes: why social care’s current policy isn’t affordable; and, the examination of an emerging care model in the UK that has its roots in practice rather than academia or policy.

The policy

According to Professor Bolton, the big challenge faced is this: can we manage demand in social care at a time of increasing demographic pressures and decreasing resources?

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May 12 2014

A 20-year follow-up of childhood hyperactivity and conduct problems: Service use and public expenditure costs in adulthood

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by Francesco D’Amico, Martin Knapp, Jennifer Beecham, Seija Sandberg, Eric Taylor and Kapil Sayal

High levels of early childhood conduct problems are associated with increased health, social care and criminal justice costs in adulthood. There is a two-to-threefold increase in early adulthood costs for children with conduct disorders. These results are particularly important as little is known about the effect of hyperactivity and conduct problems in childhood on service provision or public expenditure. These findings come from a study by researchers from the Personal Social Services Research Unit at LSE and Nottingham University using a 20-year follow-up survey to quantify the impact that behavioural problems in children can have when they reach adulthood. Continue reading

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May 6 2014

Is more better? The effects of private health insurance on mental health care in a Kenyan mental hospital

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by Victoria de Menil, Martin Knapp, David McDaid and Frank Njenga

Art therapy at Chiromo Lane Medical Center © Victoria de Menil

Art therapy at Chiromo Lane Medical Center
© Victoria de Menil

In 2004, Kenya’s parliament passed a promising bill to create a National Social Health Insurance Fund to pay for outpatient and hospital care for all Kenyans, but the bill was not signed into law out of concerns over financing. Today, Kenya’s only social insurance is the National Hospital Insurance Fund (NHIF), which is under investigation by the Ethics and Anti-Corruption Commission. Private health insurance (PHI) remains one alternative to out-of-pocket payments for financing healthcare, including mental healthcare, among those who can afford it. In Kenya, PHI is used by 2% of the population and accounts for 4% of health expenditure. Critics of PHI argue that it leads to spiralling use and costs of services, while proponents suggest that it increases early access to services and improves financial protection.

Our paper looks in detail at one private psychiatric facility, Chiromo Lane Medical Center, a 30-bed hospital with the motto “recovery in dignity”. Chiromo Lane is part of a five-facility hospital group that is one of the largest providers of private psychiatric care in East Africa. In the course of a year, 455 individuals were seen at Chiromo Lane, half of them for schizophrenia or bipolar disorder, a third for substance use, and the remainder for a mix of other disorders. They were mostly men (66%), and they came from Kenya and a range of East African countries. Our paper examines the effects of private insurance on the amount of mental health services received, the price of services, and whether more care means better care.

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