December 2018
Our Head of Research, Dr Stephen Boxford, contributed to a Health Foundation webinar about evaluating the use of a novel social franchising approach to support the spread and scale up of health and care interventions. You can watch a recording of the webinar here. You need to register with the Health Foundation to access it.
December 2018
This month we were struck by two reports which both set out visions to improve life expectancy rates in the UK, which have currently stalled, and also reduce health inequalities. The Department of Health and Social Care have published Prevention is better than cure: Our vision to help you live well for longer which sets out the ambition of putting prevention at the heart of the nation’s health. The report sets out why prevention matters and presents the prevention vision for those already living with a health and social care need, and how they can live well for longer.
The King’s Fund have published A vision for population health: towards a healthier future which also notes that prevention is key, but that the NHS remains primarily a treatment service. The report outlines the increasing importance of investment in prevention, public health and spending that supports population health. The challenge is where is the increased investment coming from?
As Anita Charlesworth at the Health Foundation has noted: “A funding increase of £20.5 billion per year to NHS England’s budget by 2023/24 is around 3.4%. This will help stem further decline in the health service, but it’s simply not enough to address the fundamental challenges facing the NHS, or fund essential improvements to services that are flagging.”
As 2019 approaches and the NHS turns 71, it faces increasingly complex and challenging decisions about how best to achieve its vision of delivering better services and supporting the public to achieve improved outcomes. We look forward to working with our clients in 2019, many of whom are grappling with these complex issues.
December 2018
What did we do?
One of our most interesting projects at Cordis Bright this year involved researching the needs of vulnerable households across a local authority area in Wales. To do this, we worked with 15 different agencies in the area and looked at the prevalence of different indicators of vulnerability, which are known to increase the chances of poor outcomes.
We based this research on: (a) Reaching Out: Think Family; and (b) Adverse Childhood Experiences.
Think Family identifies nine indicators that increase the chance of poor outcomes, especially if experienced in multiple combinations. The indicators are shown below.
A higher incidence of ACEs is internationally recognised as predicting negative outcomes in adulthood, such as smoking, incarceration and domestic violence. The nine ACEs we included in this exercise, and the proportion of adults in Wales affected by each one, are shown below.
Was there a link between Think Family indicators and ACEs?
The Welsh ACEs study found that people with four or more ACEs were particularly likely to experience poor outcomes in adulthood. The graph shows that households with four or more ACEs were likely to have around four to six Think Family indicators, making them especially vulnerable to poor outcomes. There weren’t any households in this cohort where parents had experienced all nine ACEs.
The relationship between ACEs and Think Family indicators is positive, but it is a weak correlation. The fact that the correlation was weak suggests the relationship between childhood experiences in the past and household disadvantage in the present is also influenced by other factors.
Was there a link between ACEs and Think Family indicators?
When we repeated this analysis the other way around – looking at the average number of ACEs experienced by parents in households with multiple Think Family indicators – the findings were similar: there appeared to be a weak correlation between the number of Think Family indicators and the average number of ACEs. This is shown in the graph below.
What does it mean?
All in all, this piece of analysis shows that there might be a relationship between people’s adverse childhood experiences (ACEs) and the level of household disadvantage they face when they are grown up and have children. This, in turn, can potentially impact on the next generation of children living in those households.
The relationship appears to be weak, and there are exceptions: there are families with high numbers of ACEs but low current disadvantage, and families with high current disadvantage but low numbers of ACEs. This illustrates the importance of other factors in determining the pathway from a childhood with multiple ACEs to a household facing disadvantage.
We think more research is needed here. In particular, we need to understand how individuals experiencing risks as children can build resilience so that their children are less likely to experience poor outcomes.
We think such research is likely to highlight the importance of putting interventions in place to reach vulnerable children as early as possible, giving them the best chance to overcome their early disadvantage and protecting them from poor health, violence, incarceration and other negative experiences in adulthood.
November 2018
The Early Intervention Foundation’s report on Realising the Potential of Early Intervention received a mixed reception. Local authorities and their partners agree on the importance of intervening early to prevent need from escalating but remain concerned about financial pressures which prevent them from investing in this space. At the National Children and Adult Social Care Conference, Department for Education colleagues suggested that further evidence was needed to prove that early intervention was making a real difference. Until then, it appears that central government is likely to continue to focus on statutory services and funding innovative projects that have the potential to reduce demand – and create cashable savings – at tier 3 and 4.
The State of Health and Social Care 2018 report written by CQC continues to describe a pattern of experience first identified in 2016 when they reported on services reaching ‘tipping point’. Nothing illustrates this more strongly than the distances from home of out of area health placements for people with serious mental health needs. CQC is a regulator and cannot therefore recommend a ‘solution’ beyond the need for greater alignment between health and social care, or highlight that the most critical impact of Brexit is the ‘domestic void’ where national strategy on health and social care should be. The green paper on adult social care is now due before the end of year (along with a 10 year plan for the NHS). It is fair to say that further delay will only increase the scale and complexity of what it must address.
November 2018
Dynamic Wrexham commissioned Cordis Bright to conduct a five-year longitudinal evaluation of A Dynamic Future. This is a project aiming to support and improve the transition process for disabled young people aged 14-25 living in Wrexham and their families. It received funding from the Big Lottery Fund for a five-year period from 2013 to 2018 and worked with 199 young people in this period.
2018 represented the final year for the evaluation. The approach included elements of gaps analysis; and a summary of the findings from this gaps analysis can be downloaded below.
The gaps analysis found that:
If you would like to receive a copy of the full report on the gaps analysis, please contact Hannah Nickson on hannahnickson@cordisbright.co.uk or 020 7330 9170.
November 2018
Dynamic Wrexham commissioned Cordis Bright to conduct a five-year longitudinal evaluation of A Dynamic Future. This is a project aiming to support and improve the transition process for disabled young people aged 14-25 living in Wrexham and their families. It received funding from the Big Lottery Fund for a five-year period from 2013 to 2018 and worked with 199 young people in this period.
The evaluation approach incorporated a range of methods, including: review of literature; collation and analysis of monitoring and outcomes data; and consultation with young people, their family members, project staff and other local organisations. Annual evaluation reports were produced each year.
The final report for the evaluation has now been produced and can be downloaded below.
It found evidence that the project:
The findings of the evaluation have informed the ongoing development of the project over the five years. They may also be of interest to those who are considering delivering, commissioning or funding similar projects with and for disabled young people.
November 2018
Cordis Bright's SEN Stress-Test features in a recent article in TES about SEND pressures. You can view the article here.
November 2018
Effective hospital discharge services are important on multiple levels: for patients, hospital staff and organisations as a whole. We reviewed evidence from pilots and research articles and good practice guidance on hospital discharge and transfers of care. Here we highlight the factors that enable effective and timely hospital discharge and provide a good practice benchmark against which current hospital discharge practices and processes can be compared. We also highlight the key barriers to effective hospital discharge.
Please get in touch with our Head of Research, Dr Stephen Boxford, for more detail or to continue the conversation.
November 2018
Cordis Bright believes that the research that we carry out is of the highest quality and matches work carried out by any academic institution. In line with our commitment to undertaking rigorous, professional and robust research we have developed this Research Governance Framework (RGF), much of which is adapted from ethical/research frameworks of professional bodies such as the NHS Health Research Authority and the British Sociological Association.
In the RGF we set out our five core principles in conducting social research. We then go on to explain how we apply these five core principles through the life of a research project. Download a copy below.
The Cordis Briefing is a subscription service for independent sector providers of adult social care and supported housing.
Learn moreAn in-depth look at some of Cordis Bright's work: best practice evidence reviews.
Learn moreThe Cordis Pulse is our monthly digest of policy, practice and research developments.
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