Health economic skills for advancing health policy: capturing effects of prevention and intervention beyond traditional health services

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Health systems around the world are lagging behind the needs of their patients. Larger, older populations with increasing numbers of long-term conditions are increasing demand on health services. Until recently, services have tried to target resources on those at highest risk of emergency care. However, this approach has not worked well. More recently, services have focused on prevention as a potential means of reducing demand. The NHS Long Term Plan advocates prevention, working beyond traditional health services (e.g. social work and social prescribing) and using policy levers such as new ways of financing and organising services. We need research to provide evidence for these new approaches, particularly for patients with multimorbidity who currently experience the worst outcomes.I will:1) Examine the relative effects of NHS/Local Authority public spending on prevention and priority outcomes; It has been proposed that only around 10% of health outcomes depend on access to traditional medical services. During austerity, the NHS budget has been relatively protected, but there have been substantial cuts in some Local Authorities. Building on work by colleagues and others, I will use publically available data on public spending and work out the relative benefits of spending in the health care system, and spending on other services that can affect health. This will help decisions about where to spend public money.2) Map Vanguard new care models using my published framework and examine what combination of interventions works to affect specific outcomes; From 2015, 50 Vanguard new care models were funded by NHS England. All had roughly the same aims, but with some variation in approach. I will use my previous multimorbidity framework to map interventions in Vanguards. I will then see if different types of interventions in a Vanguard lead to particular outcomes. This will build on work at UoM through the Vanguard National Programme Evaluation. Furthermore, while the whole of England has developed Sustainability and Transformation Plans (STPs) (2016), only 14/44 STPs have taken the additional step (in 2018) of forming an integrated care system (a.k.a accountable care organisation, ACO). These organisations will have greater financial and operational freedoms. I will examine the effects on health, experience and cost outcomes of this extra organisational integration over and above STP formation. I will use individual-level outcomes from hospital episode statistics (HES) to measure activity and costs, but also the GP Patient Survey (GPPS) which records patient quality of life and patient experience. The results will help commissioners decide what mix of interventions to provide to get defined outcomes. 3) Build a model to examine and simulate within-system effects of new policy changes Salford has been one of the first health systems in England to trial the ACO approach, and is a relative leader in integrated care policy in England. I will work with local linked data (held at UoM), the Salford integrated care record, to begin to build a microsimulation model to examine within-geographical system effects on the impact of future policy decisions, and develop the model as a tool to inform policymakers. A recent vignette commissioned by the MRC Methodology Research Programme Advisory Group highlighted the underuse of this type of modelling applied to health service delivery, primarily due to lack of stakeholder engagement. It also focused on "modelling flows and interactions between organisations and sectors within health and social care" as an area where development of methods has potential. I will aim to address these gaps. Results will inform local policy direction and roll-out. Research visits throughout the project and yearly stakeholder engagement meetings will keep the project policy and clinically relevant increasing dissemination and impact.