Tag Archives: #health

Health Champions – “unlocking the power of communities”

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By Heather Cameron

“On the societal level, we must understand that health is not an individual outcome, but arises from social cohesion, community ties, and mutual support.” Dr Gabor Maté

Health inequalities have long been an issue in the UK and despite continuous government commitment to tackling them, they continue to persist.

It is estimated that avoidable illness costs around £60 billion and that 1 in 4 deaths are preventable with the adoption of healthier lifestyles. Calls have therefore been made for radical changes in the approach to public health by improving health and wellbeing outside of the core public health workforce.

This is just the approach of the Community Health Champion model, developed by Altogether Better, which has demonstrated not only the positive impact on health but the social value of such an approach.

What are health champions?

Health Champions are volunteers from all walks of life who are provided with accredited training and support so they can undertake health promotion activities within their communities to reduce health inequalities and improve the health of the local population.

The Community Health Champion role began as a five year Big Lottery Funded programme (Wellbeing 1) in 2008. Over 18,000 Health Champions were recruited, trained and supported between 2008 and 2012, reaching over 105,000 people.

Through a combination of their training and own personal experiences, these volunteers empower and encourage people within their families, communities and workplaces to take up healthy activities, create groups to meet local needs and can signpost people to relevant support and services.

Challenges

While Wellbeing 1 succeeded in reaching many people in need, the programme also raised two specific challenges: in almost all cases, the work being done was invisible to the NHS; and securing ongoing funding to continue the support was difficult.

Peer support was later identified as the most appropriate way of trying to connect communities with health services.

Following this recognition and the success of the original model, further lottery funding was awarded to develop the Champion model and use it to engage champions, communities and health services (Wellbeing 2).

Co-production of health and wellbeing outcomes

The model was applied to health services specifically with the aim of addressing the apparent disconnect between the NHS and community-based services. It helps connect both patients with support in their communities and professional practices with those communities.

Many citizens have volunteered in different ways and in different settings. These include:

  • Practice Health Champions working closely with their General Practice to create new ways for patients to access non-clinical support
  • Youth Health Champions where children and young people are recruited, trained and supported to help young people more actively engage with and influence their own and their community’s health
  • Pregnancy and early years Health Champions who are interested in giving children a better start
  • Health Champions working within a specialist, hospital-based NHS service
  • Senior Health Champions who engage with older people, offering a complimentary approach to more formal programmes

Community-based health improvement initiatives such as this could help to strengthen community-professional partnerships and cross-collaboration among health, social and other services. And this in turn could lead to a reduction in health inequalities.

Positive outcomes

According to a recent evaluation of the Health Champions programme, Wellbeing 2 has resulted in a range of benefits:

  • 86% of champions and 94% of participants in the programme reported increased levels of confidence and well-being;
  • 87% of champions and 94% of participants in the programme acquired significant new knowledge related to health and well-being;
  • 98% of champions and 99% of participants in the programme reported increased involvement in social activities and social groups;
  • 95% of practice staff involved with the programme would recommend it and wish to continue.

Other benefits included reduced social isolation, increased levels of exercise/healthy eating and feeling physically better. One champion reported “this has helped me more than any medication might.”

Success stories  include the work of a cycle champion who has improved her own health and wellbeing, encouraged over 70 other people to improve theirs through taking up cycling, provided cycle training to over 50 people in 6 community groups and provided specific detailed help to 5 people.

Other successes have involved volunteers setting up football training, providing support to women with mental health issues, providing advice and support to ethnic minorities and providing advice on healthy eating.

In terms of monetary value, an  analysis of the social return on investment (SROI) of a series of Altogether Better project beneficiaries found a positive SROI of between £0.79 and £112.42 for every pound invested, highlighting the potential value of these initiatives to funders.

Final thoughts

At a time of increasing demands on health services and with the relentless squeeze on public sector resources, perhaps the move towards greater community empowerment and collaboration across sectors is the right one. After all, as I’m sure we’d all agree, prevention is better than cure.

If you liked this blog post, you might also want to read Heather’s earlier post on social prescribing

Follow us on Twitter to see what developments in policy and practice are interesting our research team.

 

 

Should the UK introduce a tax on sugar?

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An assortment of liquorice allsorts sweets.

by Stacey Dingwall

Recent months have seen two enquiries to our Ask a Researcher service for evidence on sugar consumption in the UK. Namely: should this be taxed?

Sugar has become somewhat of a villain in the UK, with magazine articles, research and governments all telling us that we should be greatly reducing, or even eradicating completely, our consumption of added sugars in particular. The week beginning 30th of November even saw the first National Sugar Awareness Week, part of a campaign to encourage the government to establish a sugar reduction programme in the UK. However, is a ‘sugar tax’ really necessary?

Sugar consumption: a public health issue?

According to the Royal Society for Public Health (RSPH), absolutely. Last month, they published a review of how to tackle obesity in the UK, which included the introduction of a sugar tax. The report notes that, according to the latest forecasts, half of all adults in the UK are expected to be classed as obese by 2050. Key to reversing this trend, it is argued, is to tackle issues around diet and nutrition among children, who are now spending double the amount of time per day in front of screens than children in 1995 (something that has been shown to increase cravings for food and drink, but not for nutritionally sound items). Alongside other developed nations, the UK is also seeing an ever increasing rate of consumption of high-sugar carbonated drinks.

While the RSPH recommends placing restrictions, or ending, the use of advertising and sponsorship by junk food and drinks companies around family and sporting events, it also argues that this is not enough to tackle the country’s obesity problem. The RSPH supports the introduction of a tax on sugary drinks of 20%, or 20p per litre. Their report highlights evidence which suggests that this could prevent or delay around 200,000 cases of obesity per year, and points to the experience of Mexico, who introduced a tax of 10% at the start of 2014. During that year, sales of sugary drinks declined by 6% overall, and by 9% among those living in the most deprived areas of the country (the demographic group most likely to be obese).

What does the government think?

After a delay, the UK government published Public Health England’s (PHE) review of the evidence for action with regards to sugar reduction in October. The report:

  • agrees that too much sugar is consumed in the UK
  • favours a reduction in advertising to children
  • recommends the introduction of a tax on full sugar soft drinks of 10-20%

This, combined with a range of other measures, it is argued, could save the NHS £500 million per year. The PHE recommendation was also supported by the House of Commons Health Committee, in their recently published Childhood obesity – brave and bold action report. Having heard evidence from parties including Sustain and Jamie Oliver, a key figure in the campaign for the introduction of a sugar tax, the Committee recommended that such a levy should be introduced at 20%, in order to achieve maximum impact.

The Prime Minister, however, is still not convinced, stating that he believes there are “more effective” ways of tackling obesity. The government is due to publish a strategy on childhood obesity in the New Year.

What does the evidence say?

A number of countries have implemented a form of taxation on sugar or saturated fats. These include:

  • a tax on saturated fats in Denmark
  • Finland’s tax on sweets, ice cream and soft drinks
  • Hungary’s public health product tax
  • France’s tax on sugar- and artificially-sweetened beverages

According to a review of using price policies such as these to promote healthier diets by the World Health Organization, food pricing policies are feasible, and can influence consumption and purchasing patterns as intended, with a significant impact on important dietary and health-related behaviour. Crucially, however, the same review notes a lack of formal evaluation in this area.

A report published earlier this year by the activist group Taxpayers’ Union of New Zealand, Fizzed out: why a sugar tax won’t curb obesity,  questioned the validity of nutrition related taxes. Reviewing the experience of Mexico, they suggested that the reduction in consumption of sugary drinks following the introduction of an excise tax of one peso per litre in January 2014 had been overplayed.

It’s also the case that the Danish tax on saturated fats was repealed by the government after only one year. This was due to a number of economic impacts that quickly became apparent after the tax was implemented, and resulted in plans for similar taxes to be abandoned. In fact, fat consumption in Denmark has been on a downward trend for some time now, therefore no tax incentive was required. And according to the Danish minister of finance, “to tax food for public health reasons [is] misguided at best and may be counter‐productive at worst”.

Whether the UK Prime Minister will be swayed on this matter remains to be seen. It’s likely that a ‘sugar tax’ will continue to be deemed too politically sensitive to introduce, especially as one in five people continue to live below the poverty line.

Related reading
Child obesity: public health or child protection issue?

Our popular Ask-a-Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

Follow us on Twitter to see what developments in policy and practice are interesting our research team.

Increasing participation in sport and physical activity

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by Stacey Dingwall

Our latest member briefing focuses on increasing participation in sport and physical activity in the UK, looking at successful examples of increasing activity and ways in which policymakers are trying to overcome the barriers to participation in sport and physical exercise. You can download the briefing for free from the Knowledge Exchange publications page.

Physical activity levels in the UK

Despite the longstanding and valued position in British society of sport, getting people of all ages involved in sport and physical activity has become increasingly challenging. While current UK guidelines for aerobic activity recommend that adults aged 19 and over should spend at least 150 minutes per week in moderately intensive physical activity, the latest statistics on physical activity from the British Heart Foundation indicate that:

  • Only 67% of men in England and Scotland report meeting recommended levels of physical activity, and only 59% in Northern Ireland and 37% in Wales;
  • Women are less active than men in all UK countries, with 58% reporting meeting recommended levels in Scotland, 55% in England, and 49% in Northern Ireland and 23% in Wales;
  • Physical activity levels vary by household income; in England in 2012, 76% of men in the highest income quintile reached recommended levels, compared to 55% of men in the lowest income quintile.

The implications of inactivity

Low levels of physical activity not only have health implications, but also economic – in the UK, inactivity has been estimated to cost the NHS £1.1billion (Allender, 2007) with indirect costs to society bringing this cost to a total of £8.2billion.

Government action

Our briefing highlights the range of policies and interventions implemented by the UK and devolved governments to try and increase participation in sport and physical activity among the population. These include the Department of Education’s £150m per year Primary PE and Sport Premium Fund; and Scotland’s sport strategy for children and young people, Giving Children and Young People a Sporting Chance.

Good practice – home and abroad

In addition, the briefing profiles successful interventions at the community level, such as Let’s Get Fizzical, a physical activity programme for young people delivered by StreetGames in collaboration with Birmingham City Council. International examples of good practice are also highlighted, including the Active Healthy Kids Canada programme and the North Karelia Project in Finland.

 

The Knowledge Exchange specialises in public and social policy. To get a flavour of the commentary it offers, please explore our publications page on the Knowledge Exchange website.

To find out more on how to become a member, contact us.

Social prescribing – just what the doctor ordered?

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By Heather Cameron

It is widely acknowledged that wider social, economic and environmental factors have a significant influence on health and wellbeing. According to recent research only 20% of health outcomes are attributable to clinical care and the quality of care while socioeconomic factors account for 40%.

With increasing pressures on GPs and lengthy waiting times a real issue for many, particularly those with mental health conditions, social prescribing could represent a real way forward.

The government clearly recognised the importance of social prescribing in its new deal for GPs announced earlier this year, which made a commitment to make social prescribing a normal part of the job.

In response to a recent Ask-a-Researcher request for information on different approaches in social prescribing and evidence of what works in the UK, it was interesting to find that despite the recognition of potential value, there has been little evaluation of social prescribing schemes to date.

Much of the material found focused on specific interventions and small-scale pilots and discussion around implementation. A new review of community referral schemes published by University College London (UCL) is therefore a welcome addition to the evidence base as it provides definitions, models and notable examples of social prescribing schemes and assesses the means by which and the extent to which these schemes have been evaluated.

So what is social prescribing?

Social prescribing means linking patients with non-medical treatment, whether it is social or physical, within their community.

A number of schemes already exist and have included a variety of prescribed activities such as arts and creative activities, physical activity, learning and volunteering opportunities, self-care and support with finance, benefits, housing and employment.

Often these schemes are delivered by voluntary, community and faith sector organisations with detailed knowledge of local communities and how best to meet the needs of certain groups.

Social and economic benefits

Despite a lack of robust evidence, our investigation uncovered a number of documents looking at the social prescribing model and the outcomes it can lead to. Positive outcomes repeatedly highlighted include:

  • improved health and wellbeing;
  • reduced demand on hospital resources;
  • cost savings; and
  • reduced social isolation.

According to the UCL report, the benefits have been particularly pronounced for marginalised groups such as mental health service-users and older adults at risk of social isolation.

A recent evaluation of the social and economic impact of the Rotherham Social Prescribing Pilot found that after 3-4 months, 83% of patients had experienced positive change in at least one outcome area. These outcomes included improved mental and physical health, feeling less lonely and socially isolated, becoming more independent, and accessing a wider range of welfare benefit entitlements.

The evaluation also reported that there were reductions in patients’ use of hospital services, including reductions of up to a fifth in the number of outpatient stays, accident and emergency attendances and outpatient appointments. The return on investment for the NHS was 50 pence for each pound invested.

Similarly, the Institute for Public Policy Research (IPPR) has recently argued that empowering patients improves their health outcomes and could save money by supporting them to manage their condition themselves.

IPPR suggests that if empowering care models such as social prescribing were adopted much more widely throughout the NHS we would have a system that focused on the social determinants of health not just the symptoms, providing people with personalised and integrated care, that focused on capabilities not just needs, and that strengthened people’s relationships with one another.

Partnership working

With a continued policy focus on integrated services and increased personalisation, social prescribing would seem to make sense. In addition to providing a means to alternative support, it could also be instrumental in strengthening community-professional partnerships and cross-collaboration among health, social and other services.

The New Local Government Network (NLGN) recently examined good practice in collaboration between local authorities, housing associations and the health sector, with Doncaster Social Prescribing highlighted as an example of successful partnership working. Of the 200 referrals made through this project, only 3 were known to local authority and health and wellbeing officers, showing that the work of social prescribing identified individuals who had otherwise slipped through the net.

And with the prospect of an ageing population and the health challenges this brings, a growing number of people could benefit from community-based support.

As Chair of Arts Council England, Sir Peter Bazalgette, notes “social prescribing is an idea whose time has come”.

Follow us on Twitter to see what developments in policy and practice are interesting our research team.

Further reading: if you liked this blog post, you might also want to read Heather’s earlier post on the health and wellbeing benefits of investing in public art.

Top down ‘devolution’ or a bold new era for local government? An update on the Cities and Local Government Devolution Bill

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By Steven McGinty

On Wednesday 21st October, the Cities and Local Government Devolution Bill reached the Committee Stage for consideration by the House of Commons. The Bill, which was initially introduced in the House of Lords, provides statutory authority for the devolution of powers to local areas. The Local Government Association (LGA) has described it as an ‘enabling Bill’ – as very few of the policy areas covered in devolution agreements are mentioned.

Yet its technical nature has not deterred debate. Whitehall, local government, and a host of other interested parties have all sought to shape the Bill, and the devolution agenda.

So, what are the main elements of the Bill?  

The Bill makes a number of proposals, including that:

  • Ministers will have to make a statement demonstrating that all new domestic legislation is compatible with the principles of devolution;
  • Elected mayors can be introduced for combined authority areas, and can be given the functions of Police and Crime Commissioners (although this is not mandatory);
  • Powers can be transferred from public body functions to combined authorities;
  • There should be requirements for combined authorities to be scrutinised and audited;
  • Powers should exist to transfer public functions to certain local authorities, and to fast track changes to their government structures.

Which devolution deals have already been agreed?

The Government has received 38 bids, including four from Scotland and Wales. The first devolution deal was the Greater Manchester Agreement on the 3rd November 2014. Since then, a number of other deals have been agreed, including the Sheffield City Region Agreement on Devolution (12th December 2014), the Cornwall Devolution Deal (16 July 2015), and Tees Valley Devolution Agreement (23 October 2015).

However, a number of agreements are still under discussion. For instance, the Liverpool City Region bid is seeking power over a large range of areas, including the creation of a Land Commission and a development corporation, EU structural funds, and retention of business rates. They are also considering introducing an elected mayor.

Elected mayors

The Bill currently before the House of Commons states that elected mayors should not be a condition of further devolution. Nevertheless, the government have linked a full transfer of powers to a directly-elected mayor. In May 2015, the Chancellor, George Osborne, argued that:

“It’s right people have a single point of accountability: someone they elect, who takes the decisions and carries the can. “

However, in the same speech, the Chancellor also suggested that he would “not impose this model on anyone”.

Some, though, would argue that the Chancellor’s approach is closer to the first statement. For instance, a group of North East MPs have challenged Ministers to “just be honest” and admit that they forced the North East Combined Authority to accept an elected mayor. Interestingly, Durham County Council, a member of the North East Combined Authority, is set to allow residents to vote on the new deal. Yet, even if the public voted against the deal, the Cities and Local Government Devolution Bill provides that the Communities Secretary has the power to eject a combined authority member, and continue with the deal.

Similarly, it’s been reported that the Department for Communities and Local Government (DCLG) has explicitly told Suffolk and Norfolk that they would need a directly-elected mayor if they want major powers to be devolved.

The LGA has recently suggested that the government should look to identify alternatives to directly-elected mayors.

Health and social care devolution

During the debates, concerns have been raised over whether devolving health services would mean that health services would no longer be subject to national standards. In the House of Lords, Baroness Williams attempted to clear this up, explaining that services would still be part of the NHS and the social care system and national standards would apply.

However, this led to Lord Warner questioning how ‘devolved’ health services would really be. Chris Ham, Chief Executive of the Kings Fund, also stated that:

“The unanswered question is how much freedom public sector leaders will have to depart from national policies in taking greater control of NHS resources.”

He suggested that this issue would need to be worked on.

 Will the Bill bring devolution to English regions?

The great advantage of the Bill is that it provides flexibility for local areas to negotiate their own devolution deal. But, as we have seen from already signed agreements, combined authorities may have to agree to terms that are at odds with the local electorate. For example, in 2012 the electorate of Manchester voted against directly-elected mayors. Yet, a couple years later, they became the first combined authority to sign an agreement with the Chancellor.

Some, however, will say that genuine devolution will only be achieved through devolved finances. This has already started to happen with the Chancellor announcing that local authorities will be able to retain business rates.

Overall, though, the devolution journey has just begun. Each local council will make their own arrangements, and will be answerable to their own electorate. Ultimately, it will be for them to decide through the ballot box whether genuine devolution has been delivered.

The Bill will return for further consideration in the House of Commons on 17 November 2015.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Read our other blogs on devolution:

Public health in Scotland … problems and solutions

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scotpho logoBy Stacey Dingwall

On Friday 11 September 2015 I attended the annual seminar of the Public Health Information Network for Scotland (PHINS) at Glasgow Royal Concert Hall. Now in its 16th year, the event provides an opportunity to keep up to date with the latest developments in public health related issues and research at both the local and national level.

This year’s sessions were focused around two themes: health inequalities in Scotland, and active travel.

Health inequalities in Scotland: causes and interventions

The first speaker of the day was David Walsh of the Glasgow Centre for Population Health (GCPH). David outlined the findings of research he’s been involved in, looking at explanations for excess mortality in Scotland compared to the rest of the UK and Europe, and in Glasgow particularly. Currently, there are still 5,000 ‘extra’ deaths in Scotland than in England each year, i.e. excess mortality.

The session particularly focused on the findings of the 2013 study, Exploring potential reasons for Glasgow’s ‘excess’ mortality: results of a three-city survey of Glasgow, Liverpool and Manchester. These three cities are home to the highest levels of deprivation in the UK and consequently, the lowest life expectancies, with Glasgow being the worst of the three. David explained that over 40 potential causes for this were synthesised as part of the research, with the following identified as among the most plausible explanations:

  • The scale of urban change post World War 2 had a larger impact on Glasgow, in the form of slum clearances, the construction of poorer housing and large amounts of high rise flats, and limited investment in maintenance of this housing.
  • The ‘socially selective’ new towns programme created social divisions, with only the wealthier and higher-skilled able to move there.
  • Different responses at the local political level – Manchester and especially Liverpool vehemently resisted the Conservative policies of the time, however this was not the case in Glasgow.

The morning also saw a presentation from Jim McCormick from the Joseph Rowntree Foundation (JRF) on rising poverty levels in Scotland and the UK since the recession. Jim suggested that the increasing casual nature of work now seen in the UK is what is driving the rise of poverty. He highlighted the hourglass shaped economy we now have, due to the disappearance of mid-level semi-skilled jobs alongside a rise in higher- and lower-skilled jobs.

An analysis of whether a National Living Wage would bring different groups up to the JRF’s annual Minimum Income Standard by 2020 was also presented; according to their findings, the only group that will be close to it is single people without children.

Physical activity and active travel in Scotland and the UK

The first session after the break saw another presentation from GCPH – this time from Bruce Whyte on trends and challenges in active travel in Scotland (i.e. walking and cycling).

It was highlighted that travelling by car remains the most popular mode for people to travel to work, despite the fact that most of the journeys undertaken are short (i.e. less than two miles long). Bruce highlighted successful initiatives in this area in Glasgow, however, including the cycle hire scheme and the development of the Kelvingrove-Anderston cycling and walking route, on which GCPH published a report earlier this year. His presentation included comment from those who use the route on its health and safety benefits, and it was suggested that its success has led to impetus for similar projects in the city.

The following presentation came from Niamh Shortt of the Centre for Research on Environment, Society and Health (CRESH) at the University of Edinburgh. She looked at the findings from research into whether the physical environment has an impact on inequalities in physical activity and active travel. Tying in with the first theme of the day, this session noted the impact of health and income inequalities on physical activity rates and travel mode choices.

The morning was rounded off by Stuart Hay of Living Streets Scotland, a charity working to promote the benefits of walking and ensure that the country’s streets are fit to do so. Stuart praised the work of the Scottish Government in this area, highlighting the development of a separate walking strategy for the country. He concluded that we have the policy infrastructure in place, and it’s now time to ensure it is implemented.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Read our other recent articles on public health issues:

The Idox Information Service can give you access to a wealth of further information on health inequalities and active travel, to find out more on how to become a member, contact us.

Dementia’s impact on those who care

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By Alan Gillies

Recent research has suggested that the rate of growth in the prevalence of dementia may be levelling out as the general health of the population increases. While such findings are encouraging, commentators have pointed out that increasing rates of obesity and diabetes, as well as the fact that people are living longer, means they have to be treated with caution.

Whether we face a continuing increase, a stabilisation or a decline in dementia, for those who are affected it will continue to have a devastating impact. And this includes not just the person with dementia, but also their loved ones and those who care for them.

A recent enquiry to our Ask a Researcher service asked for our help on this very question. As a social worker needing to understand the broader impacts of the disease on the family in order to be to provide appropriate help and support, the enquirer came to us looking for the available research evidence on the impacts of dementia on those caring for them. Our researcher was able to provide a comprehensive roundup of the current literature, highlighting the variety of issues facing carers of those with dementia.

Carers’ working lives

Not all the issues covered were ones that might be immediately obvious, like the practicalities of caring and the emotional impact of seeing a loved one affected. For example, one piece of research we were able to flag up examined the impact on carers’ working lives and workplace relationships.

Over half of respondents to a survey (53%) said that their work had been negatively affected due to their caring responsibilities. The survey highlighted the pressure on those in the prime of their working life, most often women, who are combining care for an older relative, often at a distance, with a range of other family responsibilities.

Minority ethnic carers

We also highlighted research on the way dementia can affect different sectors of the population. One recent study we identified, examined how the migration experiences and life histories of Sikhs living in Wolverhampton impacted on their experiences of caring for a family member with dementia and the barriers to accessing services.

It found that, rather than cultural differences, it was migrants’ experiences and perceptions of social exclusion, their perceived and actual social position as migrants, that affected the ways in which they accessed services.

Communicating with family members who have dementia

As well as drawing together a range of research on carers’ experiences and difficulties, we were able to include examples of initiatives, such as Talking Mats, which can help to improve the experience of caring for a loved one with dementia.

Talking Mats are a simple communication tool, developed at the University of Stirling, to help people with communication difficulties to express their views. It uses a simple system of picture symbols that allow people to indicate their feelings about various options relating to a topic.

Research for the Joseph Rowntree Foundation looked at their use for people with dementia and their family carers. It found that, unexpectedly, although the people with dementia and the family carers both felt more involved in discussions using Talking Mats, the increased feeling of involvement was significantly higher for the carers. Carers repeatedly reported feeling ‘listened to’ by the person with dementia and felt that their loved one could actually ‘see’ their point of view. It found that many family carers said they often choose not to say something that is going to inflame a situation, so instead they say nothing at all. Whereas the Talking Mats tool allowed them time and space to have their say, and helped to organise and structure their conversation with the person with dementia for whom they cared.

Our response to the enquiry provided our member with a speedy and concise roundup of the currently available literature on the issues and difficulties facing those who provide vital care for people with dementia.

Our popular Ask a Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

The Licensing Act ten years on: ‘ruinous excess’ or a more civilised drinking culture?

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By Heather Cameron

‘Unbridled hedonism is precisely what [the Licensing Act] is about to unleash with all the ghastly consequences that will follow.’

This was what the Daily Mail declared in 2005 in anticipation of the relaxation of the licensing laws. Ten years on, a report by the Institute of Economic Affairs (IEA) claims that this relaxation of the laws did not have the ruinous results predicted by many at the time. On the contrary, the report’s findings suggest that the Act has actually benefited consumers and that violent crimes and other alcohol-related problems have declined.

What changed a decade ago

Introduced in 2005, the Licensing Act abolished set licensing hours in an attempt to make the system more flexible and reduce problems of drinking and disorder associated with a standard closing time, effectively allowing for ‘24-hour drinking’.

Opening hours of premises are now set locally through the conditions of individual licences. The Act gave licensing authorities new powers over licensed premises, whilst giving local people a greater say in individual licensing decisions. The aspiration was that in the longer term its provisions, together with other government initiatives, would help to create a more benign drinking culture.

Many, however, believed these reforms would lead to increased alcohol consumption, more binge-drinking, a worsening of alcohol-fuelled violence and crime, and more alcohol-related attendances to hospital A&E departments.

What actually happened

The IEA’s findings show these fears were unfounded. Key findings of the report include:

  • Alcohol consumption – the consumption of alcohol has fallen by 17% since 2005, the greatest reduction in UK drinking rates since the 1930s.
  • Binge-drinking – rates of binge-drinking have declined for every age group since 2005, with the biggest fall among 16 to 24 year olds (from 29% to 18%). Rates of teetotalism are now as high amongst 16 to 24 year olds as they are amongst pensioners.
  • Violent crime – violent crime fell in the first year following the Act and has declined in most years since. The rate of violent crime has fallen by 40% since 2004/05, incidents of crimes largely aggravated by alcohol have dropped sharply and domestic violence has declined by 28%. Although some evidence suggests that there has been a rise in violent crime between 3am and 6am, this has been offset by a larger decline at the old closing times.
  • Health outcomes – the evidence from A&E departments suggests that there was either no change or a slight decline in alcohol-related admissions after the Act was introduced. Alcohol-related hospital admissions have continued to rise, although at a slower pace than before the Act’s introduction, and there has been no rise in the rate of alcohol-related mortality. There was also a statistically significant decline in late-night traffic accidents following the Act’s enactment.

It would therefore appear that the greater flexibility afforded by the Act which has allowed for increased availability of alcohol has not coincided with a surge in intemperance as predicted.

Rather, by providing greater choice, perhaps the Act has empowered the adult population to act more responsibly. At a time when working hours and patterns vary dramatically by occupation, traditional standard opening times do not accommodate much of the population. In addition, they also do not meet the needs of the growing night-time economy, which is of considerable value to the economy overall, as highlighted in our recent blog.

Other initiatives

It is doubtful, however, that the changes to the licensing laws are the only factor effecting changes in drinking culture. The Act also encouraged other initiatives that have helped to bring about more positive outcomes.

In response to the Act, the Civic Trust’s report Night vision: town centres for all, prompted a number of innovations including a new Civic Trust NightVision design award, a series of practical pilot projects and ideas. This ultimately led to the Purple Flag accreditation scheme, a voluntary scheme to raise the standard of night-time town and city centres, providing accreditation to those places that are managing their night time experience well.

Various other initiatives include: Best Bar None, Pubwatch and Community Alcohol Partnerships. Since Doncaster introduced the Best Bar None scheme in 2006, violent crime has fallen by over 40% in the town centre in the evening.

It would be fair to say that the provisions of the Act and the way they have interacted with other initiatives appear to have had a positive result and not ‘the ghastly consequences’ previously predicted.

As Christopher Snowdon, author of the IEA report, commented:

“The doom-mongers were wrong…The biggest consequence of relaxing licensing laws has been that the public are now better able to enjoy a drink at the time and location of their choice.”

Local authorities have responsibility for over 50 licensing and registration functions. Idox is a market-leading provider of licensing and regulatory services solutions which offer councils an efficient way for monitoring and enforcement.

By streamlining business processes and workflow, the solutions also allow for effective shared services and stakeholder engagement via the online digital service, Public Access for Licensing. 

The Idox Information Service can give you access to a wealth of further information on health and social issues – to find out more on how to become a member, contact us.

Further reading

Crime reduction through regulations (violent disorder and licensed trade), IN Scottish Justice Matters, Vol 3 No 2 Jun 2015

Understanding the alcohol harm paradox in order to focus the development of interventions (2015, Alcohol Research UK)

Regional alcohol consumption and alcohol-related mortality in Great Britain: novel insights using retail sales data, IN BMC Public Health, Vol 15 No 1 2015, pp1-9

Reducing the strength: guidance for councils considering setting up a scheme (tackling street drinking) (2015) Local Government Association

Alcohol interventions, alcohol policy and intimate partner violence: a systematic review, IN BMC Public Health, Vol 14 No 881 2014

Top 5 trends for public sector technology

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The Word 'Digital' on metal

Image from Flickr user Ged Carroll via Creative Commons

By Steven McGinty

At the Idox Information Service, we like to keep up to date with the latest developments in public sector technology. Whether it’s what new digital services are on the market or which direction the government is heading in, we like to monitor everything that could potentially have an impact on our customers, as well as, of course, ourselves.

With the pace of change though, sometimes it’s a good idea to stand still and reflect. Therefore, we’ve decided to sit down, analyse the trends of the day, and produce our very own list of top 5 public sector tech trends.

Here’s what we’ve come up with:

Government as a platform

The recent election win by the Conservatives provides a certain level of continuity for the Government Digital Service (GDS). Over recent years they have been heavily involved in the implementation of ‘government as a platform’. They describe it as:

“a common core infrastructure of shared digital systems, technology and processes on which it’s easy to build brilliant, user-centric government services”.

The most high profile example of the government as a platform approach is the GOV.UK website. In 15 months the government has shifted from having over 300 government agency and arm’s length body websites to having information delivered through just one single website.

The GDS has also introduced GOV.UK Verify, a platform that allows citizens to prove who they are when using government services. At the moment, several government departments have signed up, including HM Revenue and Customs (HMRC), the Department for Environment, Food & Rural Affairs (DEFRA) and Department for Business, Innovation & Skills (BIS).

It is likely that government as a platform will continue, with new government departments and agencies moving onto GOV.UK and GOV.UK Verify. The Chancellor, George Osborne, also announced a greater role for the GDS in working with local government. The result could be a greater use of government as a platform principles in local government.

Government austerity

The issue of tackling the budget deficit was a major theme of the last election. It’s widely accepted that savings will have to be made if the government is to reach its goal of running a surplus by the end of the parliament.  The Local Government Association highlight that local authorities may be particularly affected, estimating cuts of approximately 9% next year. Although it will be interesting to see if a recent warning against further cuts, which has come from Conservative Councillors, will make a difference.

Either way, this will have an impact for technology. It could mean that councils will be looking to find technical solutions to create efficiency savings. We have also seen local authorities working more closely together and sharing services in order to drive down costs.

Data driven decisions (analytics)

The public sector has been using data collected from a variety of channels to provide more efficient and effective public services. Government services are being moved online and users are being encouraged to make this their first port of call.

For instance, Essex County Council has been using analytical and diagnostic methods from the commercial sector to map the ‘customer journey’. They applied this approach to the booking of Adult Learning courses, which requires customers to interact with a number of systems.

‘Open government’

In January, the Speaker’s Digital Democracy Commission published a report on how technology can be used to improve democracy in the UK. Some of the main proposals include:

  • Ensuring that Parliament is fully interactive and digital by 2020;
  • Introducing secure online voting for citizens by 2020;
  • Making sure that published information is freely available in formats suitable for re-use;
  • Using new technologies and social media to help explain the role of the Houses of Commons and increase public engagement.

Health and social care

Health and social care is a key area for technology. The policy of health and social care integration means that technical solutions are required to manage and share information.  Although this has been an issue for decades, the demand for greater savings has meant that this has become a real issue. It will also be necessary to meet new legislative requirements, such as the reporting requirements introduced through the Care Act.

Further Reading:

We regularly write about public sector technology, and how technology based solutions can help drive improvements in public sector service delivery. Other recent blogs include:

Care vs control: the Mental Capacity Act and deprivation of liberty

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deprivation of libertyOriginal Image by JohnHain licensed under Creative Commons

In a time where our Human Rights are being politicised and reviewed there are far reaching consequences of any changes. An example of this is its application to those who suffer mental health issues. Article 5 of the Human Rights Act states that ‘everyone has the right to liberty and security of person. No one shall be deprived of his or her liberty [unless] in accordance with a procedure prescribed in law’. But what happens if a person is a danger to themselves or others? How can society ensure we honour their human rights whilst protecting them from harm?

We recently had an enquiry from a member about the Mental Capacity Act. They wanted to understand how the act and, specifically, the deprivation of liberty safeguards would affect their service users. Taking away someone’s right to liberty is a very real dilemma facing service providers who are dealing with safeguarding decisions at the sacrifice of a human right. These safeguards have been put in place to help deal with that situation, give clear guidance and ensure that liberty is protected.

The Social Care Institute for Excellence presents the following key messages in relation to the safeguards:

  • The Deprivation of Liberty Safeguards are an amendment to the Mental Capacity Act 2005. They apply in England and Wales only.
  • The Mental Capacity Act allows restraint and restrictions to be used – but only if they are in a person’s best interests.
  • Extra safeguards are needed if the restrictions and restraint used will deprive a person of their liberty. These are called the Deprivation of Liberty Safeguards.
  • The Deprivation of Liberty Safeguards can only be used if the person will be deprived of their liberty in a care home or hospital. In other settings the Court of Protection can authorise a deprivation of liberty.
  • Care homes or hospitals must ask a local authority if they can deprive a person of their liberty. This is called requesting a standard authorisation.
  • There are six assessments which have to take place before a standard authorisation can be given.
  • If a standard authorisation is given, one key safeguard is that the person has someone appointed with legal powers to represent them. This is called the relevant person’s representative and will usually be a family member or friend.
  • Other safeguards include rights to challenge authorisations in the Court of Protection, and access to Independent Mental Capacity Advocates (IMCAs).

We found that most of the published research into the Mental Capacity Act so far has, in fact, concentrated on the impact it has had in terms of issues around capacity to consent, through the Deprivation of Liberty Safeguards introduced as part of the Act.

In March 2014 the Supreme Court identified an ‘acid test’ to understand whether people were being deprived of their liberty. This, and the quantity of research being developed around this area, highlights the difficulty in ensuring that our liberties are safeguarded: each case must be individually assessed and an informed decision made, which make the safeguards vital in the appropriate treatment of vulnerable individuals.

The results of our research for our member highlighted the use of case studies in this area, especially those which highlight best practice and the individual approach. Research looked at the impact of the MCA on service users in general terms, as well as on particular groups, including people with learning disabilities, those living in residential care, and young people. After reviewing the evidence, some of the most appropriate examples we shared with our member included:

The Idox Information Service can give you access to further information on act and provides a range of resources for social services departments, more information can be found on our website here.

To access services such as ask a researcher or find out more on how to become a member contact us here.