Assessing the value for money of an integrated health and wellbeing service in the UK.

Lay health workers have been utilized to deliver health promotion programmes in a variety of settings. However, few studies have sought to determine whether these programmes represent value for money, particularly in a UK context. The present study involved an economic evaluation of Wellbeing for Life, an integrated health and wellbeing service in northern England. The service combined one-to-one interventions delivered by lay health workers (known as health trainers), group wellbeing interventions, volunteering opportunities and other community development activities. Value for money was assessed using an established economic model developed with input from a panel of commissioners and providers, and the main data source was the national health trainer data collection and reporting system. Between June 2015 and January 2017, behaviour change outcomes (i.e. whether client goals in relation to diet, physical activity, smoking or other behaviours, had been achieved) were recorded for 2433 of the 3179 individuals who accessed one-to-one interventions. The level of achievement observed gave an estimated total health gain of 287.7 quality-adjusted life years (QALYs). In addition, there were 4669 health-promoting events, five asset mapping projects and 1595 occurrences of signposting to other services. Combining the value of individual behaviour change with the value of these additional activities gave an overall net cost per QALY gained of £3900 and a total estimated societal value of at least £3.45 for every £1 spent on the service. These results suggest that the Wellbeing for Life service offered good value for money. Further research is needed to systematically and comprehensively determine the societal value of similar holistic, asset-based and lay-led approaches.

Patient empowerment: Its implementation and systems within hospitals in England and Greece.

INTRODUCTION: International health policies recognise patient empowerment, resulting in diverse empowerment models and systems. Research on organisational systems for implementing patient empowerment between countries or from organisational stakeholders' perspective, however, is limited. Aims and methodology: This paper explores and compares organisational systems and structures for patient empowerment implementation in six acute public hospitals in England and Greece (three in each country), their cross-case and cross-national similarities and differences. It uses a comparative, qualitative, explanatory embedded case study design. Semi-structured interviews with a representative sample of stakeholders (n = 33) and documentary sources (n = 79) were analysed with framework. RESULTS: Two main patient empowerment themes were identified: (1) organisational leadership, systems, structures; (2) operational structures, services, mechanisms and activities. Generic organisational systems and structures for patient empowerment varied across-cases, but with common organisation of empowerment roles in England and common leadership in Greece. Operational structures, services and mechanisms supporting empowerment varied across-cases and cross-nationally, but with similarities in the main services. CONCLUSION: Implementation of patient empowerment was weaker in Greece than in England, attributable to differing approaches to strategic and operational leadership, limited development of strategies and influential organisational structures. Overall, patient empowerment is well-embedded in organisations with a highly visible patient empowerment profile; commitment to policies and strategy implementation at different levels; strategic and operational leadership investing in dedicated roles with clear authority for patient empowerment, influential empowerment structures and mechanisms.

A critical analysis of national policies, systems, and structures of patient empowerment in England and Greece.

BACKGROUND: Comparison of patient empowerment (PE) policies in European countries can provide evidence for improvement and reform across different health systems. It may also influence patient and public involvement, patient experience, preference, and adherence. OBJECTIVE: The objective of this study was to compare PE within national policies, systems, and structures in England and Greece for achieving integrated people-centered health services. METHODS: We performed a critical search and review of policy and legislation papers in English and Greek languages. This included 1) general health policy and systems papers, 2) PE, patient and/or public involvement or patients' rights policy and legislation (1990-2015), and 3) comparative or discussion papers for England and/or Greece. RESULTS: A total of 102 papers on PE policies, systems, and structures were identified initially; 80 papers were included, in which 46 were policy, legislative, and discussion papers about England, 21 were policy, legislation, and discussion papers about Greece, and 13 were comparative or discussion papers including both the countries. In England, National Health Service policies emphasized patient-centered services, involvement, and empowerment, with recent focus on patients' rights; while in Greece, they emphasized patients' rights and quality of services, with recent mentions on empowerment. The health ombudsman is a very important organization across countries; however, it may be more powerful in Greece, because of the nonexistence of local mediating bodies. Micro-structures at trusts/hospitals are comparable, but legislation gives more power to the local structures in Greece. CONCLUSION: PE policies and systems have been developed and expressed differently in these countries. However, PE similarities, comparable dimensions and mechanisms, were identified. For both the countries, comparative research and these findings could be beneficial in building connections and relationships, contributing to wider European and international developments on PE, involvement, and patients' rights and further impact on patient preferences and adherence.

Closing the gap between expectations and practice in continuity of care: can we still teach continuity of care?

An educational improvement audit of general practitioner (GP) training in continuity of patient care with special reference to patients with long-term conditions was commissioned by a postgraduate medical and dental deanery. The audit comprised interviews (n = 13) with GP trainers, trainees and GPs who had recently completed their training. These interviews were thematically analysed and the findings discussed in workshops with stakeholders in GP education. The interviews showed that trainers and trainees found considerable difficulty in reconciling the values of continuity of care with recent changes in policy and practice. It was also found that while training practices could demonstrate aspects of continuity of patient care, it was difficult to give trainees practical experience and responsibilities that could underline and reinforce this. Newly qualified GPs found it particularly difficult to maintain and apply their understanding of continuity of care in the realities of practice after moving on from their training practice and before obtaining a long-term GP post. The workshops formulated proposals for a series of measures to make continuity of care, in all its forms, more explicit in every element of training and in support for professional development. These proposals were analysed to develop a phased action programme and to assess their cost and utility. This showed great potential to improve the value of training in continuity of care for GP practices and trainees, and ultimately for patients.

Ninth Futures Forum on health systems governance and public participation: Amsterdam, the Netherlands, 10–11 October 2005

Many European countries are increasingly trying to involve citizens in collective and individual decision-making on health policy. The idea is that this will improve policy decisions, increase the public’s acceptance of them and encourage people to take more responsibility for both individual and community health decisions. Further, it is becoming clear that health care services need a fully engaged public as co-producers of health if they are to be affordable. But limited insight and evidence are available on how to ensure public participation and how it actually improves health outcomes in different countries. This Futures Forum reviews the progress European countries are making in public participation in health policy and points the way for countries to involve the public in health systems governance.