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It is over 20 years since the publication of the Wanless Report, “Securing our Future Health: Taking a Long-Term View”. The Wanless Report argued that the National Health Service (NHS) would survive in its current form only if the population became “fully engaged” with it.

In this discussion paper, the authors explored what “fully engaged” meant to Wanless, what it might mean now (allowing for the impact of the anti-vaxxer movement) and what policymakers could do to enhance public engagement.

Although the Wanless Report neatly fitted into other long-term thinking about the NHS, it was unique in that it built economic models to predict the costs and impact of different patterns of NHS performance. Wanless predicted that people’s poor levels of health would put considerable pressure on the NHS. This pressure could swamp efforts to meet healthcare targets and improve health outcomes, despite its sizeable investment of money. Wanless set out three possible scenarios for public engagement with the NHS: solid progress, slow uptake and fully engaged.

The authors pose questions for policymakers and practitioners. Would a reboot of the Wanless approach be worth the effort for policymakers? If yes, how would it differ from the original? The NHS faces the whole of society; could it be the vehicle for engaging the anti-vaxxer public with the truthfulness of medical science, and will it be this, that is, Wanless' enduring legacy?

The exploration of the Wanless Report is complicated (at least for the time being) by the rise of the anti-vaxxer movement’s resistance to health promotion and mistrust of part of the NHS.

The purpose of this paper is to explore the current interest in leadership within the National Health Service (NHS), especially within medicine, as a solution to the slow rate of integration of health and social care services.

This paper is a conceptual analysis of policy documents and professional statements about leadership.

Leadership is a new common sense, promoted despite the limited evidence that it actually delivers. Leaders take risks, develop organisational vision and involve others in change using influence rather than hierarchic authority. They work together in ad hoc local networks, and, because leaders experience the work first hand, they are trusted by fellow professionals and bring to the organisation of work a flexible, immediate, policy-oriented dynamism and pragmatic adaptability.

This paper argues that the leadership movement represents a historic compromise between professionals (mostly medical) who want to shape decision making about service reconfiguration, and managers and politicians seeking ways to integrate health and social care services.

To the authors’ knowledge this conceptual analysis is the first to be applied to leadership within the NHS.

The purpose of this paper is to consider the potential of public health perspectives to “come to the aid” of dementia research and practice.

This paper draws on research and policy papers.

This paper outlines some potential preventive interventions, focussing particularly on life-course phenomena like child poverty, diet and pollution, on the biological mechanisms that enable psychosocial interventions, and on the status of dementia as a syndemic disorder.

This paper presents the opinions of the authors alone. It is based on recent research evidence and the authors’ experiences of dementia research, education and services. The implications for social scientists and for dementia research funders are contained in discussion of the need for research on prevention and social support for people with dementia and their families. While the evidence to guide primary prevention using psychosocial methods is less secure, the paper outlines a large secondary prevention research agenda in dementia.

Methodological approaches that facilitate harmonisation, pooling and comparison of data, are needed. In practical terms the paper argues that there is a need to know if and how psychosocial interventions work, and improve quality of life or even influence harder outcomes.

Few papers have considered the implications of a public health approach to dementia other than taking an epidemiological approach and focusing on the problems of dementia and rising numbers. This paper argues that a wider view of public health may be of particular relevance to dementia syndrome.

The purpose of this paper is to discuss the different meanings of integration as expressed in dementia care practice and service organisation in England. Dementia is frequently complicated by concurrent illnesses or long-term conditions at the end of life.

This is a policy discussion.

The paper describes three forms of integration: linkage, co-ordination of care, and full integration. Each form or level is related to dementia as a progressive neurological disorder with multiple symptoms, which also overlaps with other long-term conditions, making each individual’s dementia unique. Linkage means being able to identify appropriate resources to meet the needs of the individual and their family. Co-ordination usually means multi-disciplinary working at least with general practice and often wider practitioner input. Full integration is best expressed by the work of care homes, which co-ordinate care and often draws on diverse funding streams.

Greater specificity of the meaning of integration may be helpful to policy makers and practitioners. The care and treatment of people with dementia may be optimised if practitioners think about work styles and engagement with other sectors, agencies and professionals rather than pursuing all-encompassing organisational integration. Care homes may have much to teach other practice settings about full integration.

Integration is often seen uncritically as the solution to all problems; this paper explores the varieties of integration and explores their implications for practitioners and policy makers supporting people with dementia and their carers.

The boundaries between what is a healthy response to stress and anxiety and what is abnormal are often difficult to determine, especially in primary care. Even symptoms of conditions such as psychoses and dementia can present as relatively normal behaviour. This paper considers depression in late life as an example of this tension. On the one hand, depressive symptoms may be viewed as an ‘understandable’ response to bereavement or physical illness, while, on the other, it can be a serious, disabling and life‐threatening condition if left untreated. Primary care has a key role to play in supporting depressed older people, through improved pattern recognition and diagnosis, by tailoring effective treatments to fit the individual, and by providing or signposting the older person to information and advice. This is a pivotal role that primary care plays in relation to other mental health problems that older people experience.

Successive policy documents concerning older people's health and well‐being have aimed to improve their care, by raising standards and promoting independence. These policies also emphasise the need for research to prevent disability, and reduce admission to hospitals and long‐term care settings. This paper reports an evaluation in progress of a health technology approach designed to achieve these objectives. An ‘expert system’ is described that is intended to improve older people's access to health and social care information, to enable service providers to review the health and social care needs of older people, and to allow planners to assess the needs of whole populations. The paper ends by inviting discussion and responses from readers of this journal.

The National Dementia Strategy is a challenge to commissioners of health and local government services to knit a thick pullover out of thin wool. The thick pullover is necessary because dementia is a progressive neurodegenerative disorder that erodes the capacity of those affected by it, and absorbs increasing resources as it progresses. The thin wool is the limited evidence that investment in new kinds of services will produce benefits for people with dementia and their carers, while being affordable. This paper reviews the scale of the problem of dementia and its likely impact on services in the near future. It discusses some of the key recommendations of the National Dementia Strategy and explores debates about dementia advisors, economic modelling of innovative dementia services and the need for widespread training in the recognition of and response to dementia. Finally, it offers an approach to changing professional practice that is based on adult learning principles and workplace‐based reflective practice.

At a time of increasing interest in mental health in later life, the role of public health approaches is potentially heightened. This paper draws on interview data with older people living in London to consider the interplay between personal and public approaches to health and well‐being. The interviews were under taken as part of the midpoint review of the UK government's 10‐year strategy for older people (Healthcare Commission et al, 2006) and the social characteristics of London are considered.

There have been few economic evaluations of joint working between social and health care. This paper focuses on collaboration between professionals providing care for people aged 75 and over, and examines the economic costs of contacts made by social workers with community nurses, GPs and older people or their carers. Two areas were studied, one where social care and primary care services were co‐located, and the other with social work teams located separately from local health services. The two forms of social care location had an impact on contacts and costs but overall it was fairly small. Contact costs made up only a small amount of the overall costs of care These findings suggest that altering the organisational arrangements for care delivery may improve the process of care delivery, but result in only minor changes to the proportion of overall resources directed to older service users.