Sheffield DPH

  a repost and slight update of an old blog It’s back This particular policy zombi was one of the issues I first cut my public health teeth on as a shiny new SpR (thanks Sohail!) I quickly saw it was pretty futile then as a method of financial savings. I’ve played the game a good few times since, my view is unchanged. 4 key questions that I often ask 1. Inequality – I cant see enforcement of further rescrictions would improve equity, it would likely make it worse. Has the inequality impact assessment been robustly done. This is more than a EqIA (protected groups) 2. Clinical sign off – it IS a CLINICAL commissioning group. There’s nothing inherently wrong with NICE / SIGN etc, but remember its clincial guidance, designed to guide a clinical decision (terms used advisedly). Engagement with GPs and secondary care clinicians – in the spirit of CLINICAL commissioning – is there full clinical sign off. There may be an appreciable harm from restricting surgery. Has this been assessed

  Who wants more power   One of those occasional questions that crops up for every DPH  - “what powers would you like please”   Thoughts   1            I would like the SAME powers as national govt  …. Or something akin to the powers available to us cities. For example in NYC if National Govt isn’t going to do anything local Govt can take power in responsibility for addressing a risk to health. In U.K. the opposite is in place. Maybe THIS is the key power we need to ask for devo wise.   2             Caveats and cautions in “power” I don’t think “more power” is right (well only at any rate) way to solve the problem of health inequality.   Local power doesn’t / shouldn’t replace national. For example local powers on air quality shouldn’t be seen as a reason for no progress on tax and fiscal on fuel, diesel scrappage, DfT investment in the right kind of infrastructure, govt subsidy to fossil fuels.   The exercise of powers Worth exploring and unpacking “powers”.

  Is screening different to case finding in high risk groups  This is a repost of an old blog   The NSC provides advice to the 4 UK Governments on screening policy Often “screening” is done under the premise of “ahhh but its not population screening, its case finding in populations at high risk”. I was asked to try to define the difference between “screening” and “case finding” I failed to find much of a difference. Here is why   1             Background All screening programmes do harm; some do good as well, and, of these, some do more good than harm at reasonable cost [i] . Even when there is good evidence of a favorable benefit of a programme there is no a priori guarantee this will be seen in practice. This underscores the importance of complete implementation and ongoing quality assurance. Currently the four UK Governments ask UK NSC to provide advice on a proposal to offer population screening. Following a request, the UK NSC systematically assesses the eviden

  Screening School Lesson 1 This is a repost of an old blog   Screening school. Lesson 1 I’ve  written a lot on screening . Mainly for a technical audience. I often assume that’s there is a lot more background knowledge than people really have. I was asked by someone with little knowledge of screening to give a single key reference that summarises the field in a few sides. I found it quite difficult to find an article to summarise the whole lot simply and easily. 3 key references This  article by Muir Gray  is one of the simple standard references I often give people. Maximizing benefit and minimizing harm of screening WHO/Europe | European Observatory on Health Systems and Policies – Screening. When is it appropriate and how can we get it right? (2020) http://www.euro.who.int/en/about-us/partners/observatory/publications/policy-briefs-and-summaries/screening.-when-is-it-appropriate-and-how-can-we-get-it-right-2020 Health Knowledge pages on screening  also produce a

  Screening school. Screening 101 This is a repost of an old blog   “Screening saves lives” – trips off the tongue doesn’t it Try this – “Screening does harm, sometimes good, often huge opportunity cost” – trickier to land on a daily mail headline? And this -“screening rarely does more good than harm in the context of a programme that is both clinically and cost effective, and affordable.” …..mouthful? Tricky isn’t it. So often, we hear that screening is a marvel. Sometimes it is, often it isn’t. See here –  Why cancer screening has never been shown to “save lives”—and what we can do about it. See also this review –  Does screening for disease save lives in asymptomatic adults? Systematic review of meta-analyses and randomized trials . In my view it’s a bit crude to lump too many different screening programmes together and analyse in this way, but firstly the authors are making a very important general point and should be applauded, secondly some of the authors carry si