An egg-cellent reason to go to A & E?

Posted by Emma Dorée, Fuse Communications Assistant, Teesside University

Easter is a time that many people look forward to, not only because we get a couple of extra days off work but because it is an excuse to over indulge in copious amounts of chocolate.

This year however, it seems that Easter has become a problem for many people, especially the NHS. South Tees Foundation Trust NHS have this weekend released an urgent statement on their social media sites, urging people who have given themselves stomach ache from eating too many Easter eggs not to attend Accident and Emergency.

Data for NHS England in January showed that 88.7% of patients attending Accident and Emergency were dealt with in four hours – the worst monthly performance since the target of 95% began in 2004. These figures show that Doctors are under a lot of time pressure but what they don’t show is why.

I did a piece of investigative journalism to unearth the most comical reasons why people attend A&E departments in the UK and need your help in deciding which reason is the most outrageous one.

Below are 10 reasons, most of which featured in the The Choose Well campaign developed by NHS North West in 2011 to urge people to go to the right place for NHS treatment after new figures revealed that one in four A&E patients could care for themselves or get treatment elsewhere. The campaign includes a number of short films depicting "inappropriate" A&E scenarios being played out by actors, which are very entertaining and might help you to make an informed choice.

We added stomach ache from eating too many Easter eggs as the ninth reason to keep the list up to date. Which one will get your vote?

Make sure to keep an eye on our Twitter page to find out the results!

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Supporting vulnerable communities in Australia and the UK: linking data through knowledge exchange

Posted by Theodora Machaira, PhD student at Teesside University

On the 8th of March we were pleased to welcome Jen Lorains, researcher from Australia, in Fuse. Jen was successful in winning a Winston Churchill fellowship and decided to visit Fuse as her main research interest is knowledge exchange and translational research.

As part of her visit, Jen delivered a Knowledge Exchange Seminar on ‘Early Childhood Data with Communities in Australia’. Her presentation focused on the Australian Early Development Census (AEDC) which is a national census which measures physical health, social skills, communication and general knowledge, language skills and emotions of 5 years old children. The AECD data is publically available and although it is not primarily used for knowledge exchange, it certainly facilitates it by enabling key stakeholders in early years to work with the data in order to improve child development outcomes.

Theodora (left) with Jen Lorains

Jen’s presentation was interesting on a number of levels but from a PhD researcher’s point of view, two things were most striking. First of all, thinking about child development assessments in diverse populations, I felt that Australia and the UK are not as different as I thought. In Australia, diversity exists mainly between indigenous and non-indigenous populations. Indigenous Australians have their own language, rituals and beliefs, which in early years and education settings can be challenging to deal with. Although, diversity in the UK is different and not as clear cut with many different cultures calling the country their home, diversity is also an issue over here and is now perhaps more prominent than ever. With that in mind, I was wondering, how fair (or accurate for that matter), is it to collect data on child development from all 5 years old children in English? Isn’t it possible that an indigenous child has good communication skills but in a different language? Of course, this cannot necessarily be taken into consideration in a national census. But surely that begs the question, are we classing children as having delayed development when perhaps we shouldn’t?

The second thing that got my attention was the issues with knowledge exchange in Australia that Jen discussed. She talked about how different professionals use the data and how challenging it is to have everyone on board when trying to develop common approaches to help children in areas where vulnerable children are identified as different professionals identify different solutions for highlighted problems. As my PhD focuses on systems change and developing a common approach between early years’ professionals, I again, thought about the similarities between Australia and the UK. Perhaps foolishly (I am only a year into my PhD!) I thought that these issues are a UK phenomenon, however, I quickly realised during Jen’s presentation that they are not.

Intrigued by these observations, I started talking to Jen after the seminar (and because Jen had an hour and a half to kill before her train) we decided to go for a drink after her seminar. Although some people might disagree, I thought that the pub was a great setting for knowledge exchange! We discussed my and her thoughts having travelled to the UK, USA, Canada and Peru, and realised that using research data with different communities in these counties requires researchers to be skilled in knowledge exchange. This will enable researchers to include these communities in interpreting the data and developing useful interventions with these communities. This might sometimes feel like fighting a lost battle but is essential to support vulnerable children identified through collected census data.

Obesity: many perspectives, no magic solution

Lorraine McSweeney, Research Associate, Newcastle University

To coincide with Nutrition and Hydration week Lorraine reports back from the Westminster Food and Nutrition Forum.

On the 9 March I attended a Westminster Food and Nutrition Forum titled: ‘Next Steps on Policy for Obesity - Prevention, Sugar Consumption and Priorities for Children’s Health’. The original purpose of the forum was to discuss the Government’s childhood obesity strategy. However, as publicised in the Guardian on the 26 February, this has been delayed; with the Department of Health calling it a ‘complicated issue’ that they want to ensure is a ‘game changing moment’. Despite the strategy delay the forum went ahead to allow ‘experts’ in the field to share ideas and possible approaches for the strategy.

Speakers and panel members were a diverse group ranging from Public Health England (PHE); School Food Plan; Southampton Health and Wellbeing Board; Children’s Food Trust; ukactive kids; Family Lives; primary care; Advertising Standard’s Authority; British Retail Consortium; Kantar World Panel; Food and Drink Federation; and London Food Board… the list goes on...

The McLympics - advertising and sponsorship

PHE stated that the average diet in the UK is poor with too much saturated fat and sugar and too little fibre, fruit and vegetables. This is having a knock-on effect on our children, with one in five primary school kids overweight or obese, by the time children leave primary school, this figure rises to one in three. Contrary to popular belief, this is not just an issue of poverty; obesity is happening in both the most and least affluent areas. We are bombarded with opportunities to eat 24 hours a day and there are many drivers to buy and eat. Advertising and sponsorship, which some people don’t associate with advertising, can have a negative impact on child health.

The Chief Executive Officer from the Children’s Food Trust argued that good food should be a part of a child’s life from day one, right through their life. Food should not be tailored to be ‘child-friendly’. Children should be encouraged to eat smaller portions of adult food and should not be targeted by the food industries. Parents need to be listened to and families should be helped to cook more.

The need to get children moving more was discussed and included comments about modern life not encouraging children to be active; and schools too scared to work with parents and tell them how to keep their children active. It was stated that only a third of children enjoy sports and other solutions need to be encouraged. The primary care representative felt that too many patients are being treated with the consequences of obesity. She believes that primary care professionals are missing opportunities to discuss weight with parents; however, GPs reported not wanting to cause offence and felt they did not have the time to deal with the issues.

An overarching theme from the ‘health’ representatives was that prevention is key and that the food industry was part of the problem and should be involved in solving the problem. We were informed that in an average supermarket consumers have 30,000 products to choose from and consumer change is very hard to drive.

The impact of volume of sales of products such as sugar and bread, which have no immediate substitute, are shown not to be affected by price rise. The introduction of a sugar tax was highly debated; some felt it would not change consumer behaviour, whilst others argued it would offer one solution. However, following the success of the reformulation of products to reduce salt and saturated fat, it was agreed that the reformulation of products containing sugar could be a way forward. However, representatives from the food and drink industries stated that sugars would be more difficult as it has a structural function in food.

In addition, if a product was made ‘healthier’ consumers may be inclined to eat more of the product but it was agreed that alongside reformulation, portion size control could be beneficial. There was much discussion of whether legislation should be enforced on food and drink companies – the representatives believed that due to diversity of companies, a voluntary approach was better. However, it was argued that ‘if consumers continued to make incorrect choices – legislation was all that was left’.

As you can see from this very brief summary, obesity continues to be a very complex issue; it was thought-provoking to hear the different perspectives from health, policy, practice and industry. However, the discussions emphasised the point that there is no magic solution; the publication of the Government’s childhood obesity strategy is eagerly awaited.

Photo attribution: flickr.com, Santo Chino, "McLympics": https://www.flickr.com/photos/santochino/2797034750

Social enterprises in health: can you make profit for the greater well-being of all?

Posted by Peter van der Graaf, AskFuse Research Manager, Teesside University

Is it ok to make money in public health? This was one of the key questions that that came out of the Quarterly Research Meeting on social enterprise and health last month, which was jointly organised by Fuse and the Institute of Local Governance (ILG), in association with the North East Social Enterprise Network (NESEP). Social enterprises are often involved in pioneering and transformational work that may help reduce pressure on public health providers within local authorities. But are we taking enough notice of their potential and is there an evidence base for such interventions? The event aimed to explore this theme, highlight best practice and identify barriers and opportunities for future work and research in this area.

The key note speakers first engaged in a bit of myth-busting: a social enterprise is not a legal form and does not mean the same as not-for-profit. They are not replacing the NHS or public health, are not promoting budget cuts and are not a form of corporate social responsibility. So what are they then? Professor Cam Donaldson from Glasgow Caledonian University offered the following definition: “organisations that trade for the common good (e.g. addressing social vulnerability) and where the profits of that trade are used for social and community benefit”.

Making profit for a good cause sounds like a good idea, particularly for cash-strapped health and voluntary and community sectors, but the discussions at the event made clear that this comes with a number of strings attached, which can have far reaching and often unintended consequences for organisations. For instance, bidding for contracts can shift organisational focus from addressing local needs. Organisations also have to be size and investment ready, with plenty of larger competitors out there going for the same contracts. And this can be a big ask, particularly for small community organisations that have no interest in developing a business strategy.

 

There is also an ethical dimension to this decision: moving health provision from the public sector to social enterprises means one less link in democratic accountability. Who governs the governors of social enterprises? Cam Donaldson referred to this as “the shadow state”. Is the market also the right model for public health and wellbeing delivery or does it cause further distortion of social priorities? One participant put it as follows: “Although commissioners understand the importance of well-being, they are unlikely to pay for it unless you can demonstrate that it will save them money”. If everything is all of a sudden an asset, where does that leave an ideology of free access to health and social care for all?

In summary, social enterprises in health leave a lot of questions unanswered but can make quite a difference, be it for better or for worse. Unsurprisingly, there was an urgent plea from participants to academics to develop more research in this area. Studies looking at social enterprises in health are rare and particularly their impact on health and the wider determinants of health is unknown.

Interestingly, participants argued for a move away from “REF impact research” and government favoured approaches, such as Social Return On Investment (SROI) analysis. They argued that economic models were less suited for capturing the wider range of health and social outcomes that social enterprises aim to deliver. Outcomes of social enterprises are often produced in co-production between commissioners, providers and service users and, therefore, needed to be measured as such. Therefore, participants advocated a more anthropological approach to impact research for social enterprises that allowed researchers to leave outcomes and their measurement more open from the start of the research to accommodate new meaning of impact along the way.

Would that perhaps be the greatest asset of social enterprises in health: turning co-production of evidence into a profitable approach?

A summary report of this QRM can now be found here.

Picture attribution: www.flickr.com, Tom Simpson, "I've always been able to turn mistakes into big profits!", https://goo.gl/ku0VRG 

Practice what you preach

Guest post by Robin Ireland, Chief Executive, Health Equalities Group and Director, Food Active

I am invited to review the morning papers on a regular basis for BBC Radio Merseyside. I mainly pick health subjects to discuss and went for air pollution last week. A recent report suggests that 40,000 premature deaths annually in the UK are attributable to outdoor air pollution. The biggest contributor is diesel engines and we obviously need national policy in place to support people to make the switch; ideally to walking, cycling and public transport but - at a stretch - to engines not kicking out toxic fumes.

I had cycled to the studio that morning, as I usually do, but mentioned I own a car as well. The DJ focused on me and said, “I bet it’s a diesel …..”

Which got me thinking about practising what we preach. Instead of constantly haranguing people to eat better, exercise more, not smoke etc., are we putting our own house in order?  Yes, this can be important on an individual level, but it is critical at a population level.

We look to Government for legislation to support our healthier lifestyles and I was disappointed to hear about the latest delay in the publication of the Childhood Obesity Strategy. Yes, I would like to see a tax on sugary drinks and yes, I would like to see more controls on the marketing of junk food and drinks to young people.

But I would also like to see more powers to local authorities in their efforts to promote healthy weight. This is in fact what the Health Select Committee on Obesity recommended back in November: “Greater powers for local authorities to tackle the environment leading to obesity”

Blackpool Council sign the Local Authority Declaration on Healthy Weight

Back in August 2014, the North West’s Healthy Weight campaign, Food Active, invited Action on Smoking and Health (ASH) to give a presentation in Manchester on their Local Authority Declaration on Tobacco Control. Could this approach also work for overweight and obesity? Essentially, can local authorities look in-house at their own polices to see how they impact on healthy weight?

Healthy Weight has proved to be a lot more complicated than Tobacco Control – I am not in any way suggesting that the latter is straightforward either – as of course we don’t have a product that is toxic in every way!

What has now become the Food Active Local Authority Declaration on Healthy Weight, has gone through many iterations and discussions. Our governance team, which includes myself and local public health practitioners and academics, considered a number of options. Should a Declaration be focused purely on sugar for example? Food Active decided not, as local authority policies on healthy weight would be much the same and could be positive (around encouraging active transport for example) as well as negative.

Of course Sugar Smart Cities, launched at the end of last year in Brighton, is an alternative equally valid approach where, given the evidence base around the amount of sugar in our diet, it has been singled out as a target.

On 20 January 2016, Blackpool Council became the first local authority in the country to pass the Local Authority Declaration on Healthy Weight. It was signed in front of cameras in February by the local Director of Public Health and the Cabinet Member for Reducing Health Inequalities.

The Declaration commits an authority to take measures (there are 12 listed) where possible to, for example: “protect residents from the commercial pressures and vested interests of the food and drink industry ….” and “consider how strategies, plans and infrastructures for regeneration and town planning positively impact on physical activity”. For the full list please visit www.foodactive.org.uk.

So Blackpool Council are practising what they preach and they are doing their best to take on a complex and challenging task. As the declaration states: “We recognise that we need to exercise our responsibility in developing and implementing policies which promote healthy weight”. It won’t be a piece of paper that lies on a shelf …..

And, no, I don’t have a diesel engine in my car.