Professor Stephen Peckham BSc (Hons), MA (Econ), HMFPH
Director & Professor of Health Policy
- 01227 827645
I am also currently Director of the Department of Health funded Policy Research Unit in Commissioning and the Healthcare System (PRUComm) a collaborative research unit with the London School of Hygiene and Tropical Medicine and the University of Manchester. PRUComm is undertaking research on the development of Clinical Commissioning Groups, contracting, competition and the development of the new Public Health System in England. I am undertaking research on healthcare commissioning and patient and public involvement.
I was recently appointed Associate Professor in the Institute of Health Policy, Management and Evaluation (IHPME) at the University of Toronto.
I have over 20 years of policy analysis and health services research experience. I have particular interests in the way services are organized and delivered and examining the development and implementation of health policy. I am also interested in the use of evidence in policy and public health and ethical implications of public health policies.
Much of my research has focused on the organization of primary care and its role in commissioning healthcare. I have substantial experience of undertaking qualitative and mixed methods research. I have been the principal investigator on large multi-centre programme grants and am involved in international projects examining models of primary care and primary care accountability.
I joined CHSS in July 2012 from the London School of Hygiene and Tropical Medicine where I had worked for seven years. Previously I held posts at Oxford Brookes University, the University of the West of England and the University of Southampton. Before that I worked for several years in the voluntary sector and before going to University in 1982, I worked for nine years in local government.
I completed my BSc in Social Sciences at the University of Southampton in 1985 and a Masters in Public Policy Analysis at the University of Manchester in 1988.
I am a member of the Social Policy Association, the Canadian Association of Health Services Policy and Research and an honorary member of the Faculty of Public Health.
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Also view these in the Kent Academic Repository
In November 2012, the Centre for Health Services Studies at the University of Kent was commissioned by NHS Kent and Medway to conduct a rapid (23 day) appraisal of the SHREWD system and the way it was currently operating across Kent and Medway. SHREWD - Single Health Resilience Early Warning Database - is an “online, real-time early warning and decision support tool”, developed by Transforming Systems (a human systems focused software development company) in collaboration with NHS Kent and Medway, partners within the Medway health system, and the University of Greenwich, with financial support from the South East Coast Strategic Health Authority. It is a system designed to be accessed and updated by partners within a local health system in order to share ‘system critical’ information. Start date: 01/11/2012 End date: Funder: NHS Kent and Medway Publication: A rapid evaluation of SHREWD: the Single Health Resilience Early Warning Database - technical report (pdf)
Commission for long term conditions: hearing the voice of and engaging users (EVOC)
The government has been encouraging the development of choice for people with Long-Term Conditions (LTC), but there are questions about whether they have a voice and are able to engage in the commissioning process. There is little evidence about what processes and mechanisms patients and the public use to make their voice heard. CHSS Director Stephen Peckham is currently leading a four year NIHR funded project assessing how commissioners can best support and engage with people with LTC to develop the most responsive local services. Working with patient groups, voluntary organisations, commissioners and service providers, the team are undertaking case studies of different approaches NHS organisations take in funding services, and how three LTC patient groups (diabetes, rheumatoid arthritis and neurological disorders) engage with health and social care agencies. Stephen Peckham said ‘We are working closely with local NHS staff organisations to explore the key problems in developing services that patients can make choices about, tracking developments over two years to help identify the true impact of patient involvement on service design and patients. We will develop guidance for funders highlighting the most effective approaches to supporting, enabling or regulating involvement across health and social care funders and providers to ensure the best patient outcomes’. The project, a collaboration between the University of Hertfordshire and the London School of Hygiene and Tropical Medicine, will report its findings later this year. NIHR website link Start date: 17/07/2012 End date: 31/07/2013 Funder: Department of Health Funding: £14,158 Publication: Commissioning for long-term conditions: hearing the voice of and engaging users - a qualitative multiple case study
Embedding research into Encompass, an NHS England Five Year Forward, New Models of Care, Vanguard site
Published in 2014, the NHS England’s Five Year Forward View saw the beginning of an ambitious programme to develop new models of care. The result has been the establishment of new ways to organise health services being piloted in a number of ‘Vanguard’ sites around the country. The Encompass Vanguard sits within the Canterbury and Coastal Clinical Commissioning Group (CCG) and involves general practices in Whitstable, Faversham, Canterbury and surrounding areas including Ash and Sandwich. Serving a population of 170,000 people, Encompass is formed into a new model of integrated care known as a Multispecialty Community Provider and is focussed on moving specialist care from hospitals to the community and in particular emphasising on integrated care for older people – a key element within the Five Year Forward View. The new models of care aim to address longstanding problems in the UK health system. Integration of health and social care services will ultimately meet patients’, service users’ and carers’ needs more effectively. Whilst shifting services from hospital to community settings, and closer health and social care service integration are far from new concepts, developing effective new ways of community working to address health and social care demands remains a challenge. A research office has been established as a joint partnership between the Encompass Vanguard and CHSS. The office supports research undertaken within the 16 practices that make up the Encompass group and also conducts and supports research and evaluation of aspects of Encompass’ activities. The research function ensures delivery of high quality national portfolio studies working in collaboration with the NIHR Clinical Research Network and generates and facilitates research activity within all the member practices. The aim is to make research part of the normal everyday activity of the practices and use the knowledge generated by new research to improve care quality. The research will ultimately contribute to the development of the new model of care, provide educational and development opportunities for practice staff and improve staff recruitment and retention. Start date: 01/02/2016 End date: 31/03/2018 Funder: Encompass Vanguard Funding: £164,000
How general practice team composition and climate relate to quality, effectiveness and human resource costs: a mixed methods study in England
General Practice is central to the NHS, and is where people first seek non-emergency health advice. GPs deal with a wide range of health and social care issues for local people. They have traditionally employed a staff team of e.g. nurses, care assistants, receptionists, managers and liaise with community services such as midwives and health visitors. Many GPs are retiring or leaving the NHS. More newly-trained doctors work in hospitals and there is a shortage of GP practice nurses. NHS general practice is under pressure. At the same time, more people with long-term conditions need regular care from GP teams. Tasks formerly done in hospital are being transferred to general practice. It is vital that GPs organise teams efficiently to treat as many patients as possible. General Practices’ staffing arrangements vary widely. Practices have tended to become larger over time, and include a wider range of staff (e.g. physiotherapists, pharmacists). Some GPs have combined into ‘super-practices’. There is little evidence to show GPs and service commissioners what size or structure of practice, or professional staff mix, works best for patients. This NIHR Health Services & Delivery Research-funded project aims to provide such evidence, exploring how the composition of GP teams and team relationships (‘climate’) affects quality of care and health outcomes for patients, and practice costs. Professor Stephen Peckham leads the project team, who will: Survey the literature to learn about skill mix in countries with healthcare systems resembling our NHS. Analyse existing big data sets and use statistical methods to investigate the relationship between differences in the organisation and skill mix of practices in England and quality of care and effectiveness. Quality measures will be based on inspection data. Effectiveness will be measured using number of patients hospitalised for conditions that should be general practice managed. Conduct a staff survey in a nationwide sample of practices to explore how workforce issues affect staff wellbeing and job satisfaction Observe/interview staff to investigate how team climate affects daily working and patient experience. Work with GPs and commissioners to review project findings and create guidelines for all practices on optimum professional staff mix and good team working. Find novel ways to publicise research results to GPs, NHS managers, government organisations, academics and the public. Patient and public opinion provided valuable input to the research application and a service user group will contribute at all stages of the project. Start date: 01/10/2018 End date: 30/09/21 Funder: NIHR Funding: £404,316
Mindfulness and Weight Management
This funding supports a research collaboration between CHSS and Kent Community NHS Trust Weight Management Service, in order to co-develop a research bid to NIHR around mindfulness and weight management/maintenance. The collaboration will also facilitate the development of future studies and research proposals. Weight management team staff will provide input towards the design of the intervention and the evaluation framework. Funding for Dr Sarah Hotham's time at CHSS for one day a week during Feb-March 2016 will enable her to lead on the deliverable, the written research proposal detailing the co-developed intervention, how impact and processes will be evaluated, and next steps. Start date: 01/02/2016 End date: 31/05/2016 Funder: Kent Community Health NHS Foundation Trust Funding £4,702
Tackling Obesity in Medway
Public Health Collaboration. CHSS has been commissioned to conduct an external evaluation of Medway Public Health Department’s weight management projects. This collaborative project will assess how Medway’s initiatives and programmes could be built on and improved. In 2014 Medway Council hosted an Obesity Summit attended by private, public and voluntary sector partners, to help develop a framework for tackling obesity. Medway Council’s dedicated ‘Supporting Healthy Weight’ team (SHW) works with adults, families, children and young people to help them in achieving healthy weight. Within the National Child Measurement Programme (NCMP) classification, 23.3% of 4-5 year olds and 32.7% of 10-11 year olds in Medway are overweight or obese. The SHW team provide and commission a diverse range of interventions across Medway to help prevent and manage overweight. These include four MEND programmes (2-4, 5-7, 7-13 and Graduates) and Fit Fix, a programme for 13 – 17 year olds. The team work across the Council to maximise opportunities to support obesity prevention in all aspects of the Council’s work, and in the revised Medway Local Plan. The evaluation will also focus on raising awareness of the SHW portfolio and developing its media profile to get the message out to a wide audience about obesity and public health initiatives in Medway. Start date: 15/01/2015 End date: 14/01/2017 Funder: Medway Council Funding: £67,187 Poster presentation: Evaluability assessments as part of a ‘whole systems approach’ to evaluating Medway Council’s interventions to tackle obesity.
Adoption and Large Scale Spread of QLPQuic: Improving outcomes after emergency laparotomy.
Emergency laparotomy, a high-risk procedure involving incision to access the abdominal cavity 30 day patient mortality is reported at 14.9%, rising to 24.4% for those over 80 years old. Patients surviving may face post-operative complications and long hospital stays. Reports have shown widely varying care standards. In collaboration with Royal Surrey County Hospital and the Academic Health Services Network (AHSN), CHSS has been awarded a two-year Health Foundation scaling-up grant. The project will roll out a programme to improve patient outcomes in emergency laparotomy; adopting an evidenced-based quality improvement care bundle known as the Emergency Laparotomy Quality Care pathway (QLPQulC).Twenty hospitals are involved spanning three AHSN areas including Kent, Surrey and Sussex. The care bundle was developed and introduced at the Royal Surrey and three other hospitals. Results have shown improvements in care standards, with 30 day mortality reduced by 25% and risk adjusted hospital mortality by 42%. The current programme aims to deliver similar reductions in mortality across at least 20 hospitals. CHSS will undertake an evaluation, examining the process of rolling out the programme, uptake in the 20 hospitals, and whether it delivers expected levels of patient benefit. Start date: 01/03/2015 End date: 31/08/2017 Funder: The Health Foundation Funding: £142,675
Effectiveness of public health system in combating severe population health crisis in Ukraine
This is a joint project with the Kyiv Economics Institute at the Kyiv School of Economics www.kse.org.ua It is a 12-month development study to assess the feasibility of implementing a full-scale evaluation of the Public Health programmes and policies in Ukraine over the period 1990-2014. Ukraine has long faced a significant health crisis exacerbated by growing health inequalities. It is one of five countries in the World Health Organisation European region with life expectancy 11 years lower than EU average and a 10 year gap between males and females. Since independence in 1992 Ukraine’s health care and public health systems have become inadequate to deal with growing epidemics of non-communicable diseases and TB/HIV/AIDs. The Ukraine government has stated its commitment to reform and to evidence-based decision-making. However, the dire state of population health and economic and political difficulties make it likely to opt instead for rapid implementation of ready-made examples from other countries. This allows for no fundamental analysis of what does/did and does not/did not work in the Ukrainian context. This 12-month development study funded by the Medical Research Council will examine how Ukraine’s national public health programmes and policies evolved from 1990-2014, mapping their implementation across regions and over time. Professor of Health Economics, Olena Nizalova leads the CHSS team which also includes Prof Stephen Peckham and Dr Erica Gadsby. Start date: 15/06/2015 End date: 31/12/2016 Funder: Medical Research Council Funding: £100,590 Project Publications: Working Paper 1: Importance of Process and Impact Evaluation of Public Health Programmes/Policies Overall and Especially in Financially Deprived Settings (David J Hunter, Stephen Peckham, Erica W Gadsby) This paper sets the scene for subsequent papers by discussing the importance of research evidence in public health policy and practice, and the role it plays, alongside other influences, in decision-making processes. The paper outlines the meaning and challenges of ‘evidence-informed public health’, and discusses the role of governments (and others) in developing public health policies and programmes based on good evidence. It then explores the UK experience of supporting evidence for public health policy, and looks at the way in which public health research has developed there, before discussing the need for greater commitment to, and investment in, research and knowledge exchange in Ukraine. Working Paper 2: Current Population Health Needs and Their Regional Distribution in Ukraine (Olena Nizalova,Nataliia Shapoval, Olga Nikolaieva) This working paper describes briefly the situation in Ukraine in terms of population health over the past decade, starting from the analysis of the national level data on mortality and comparison of its levels and the last decade’s dynamics to that in the UK, Estonia, and Russia. Further comparison is made between avoidable/non-avoidable mortality as a more appropriate measure of the effectiveness of the Public Health system. To complete the description of the situation with population health, we analyse the available information on morbidity across various conditions linked to high mortality. Working Paper 3: Public health programmes and policies in Ukraine: development, design and implementation (Erica Gadsby, Stephen Peckham, Anna Kvit, Kateryna Ruskykh) This working paper describes our analysis of the evaluability (in principle) of public health programmes/policies in Ukraine. To do this, we analysed programme and policy documents, and our telephone survey and in-depth interviews, to explore the logic models of programmes/policies and to describe their (intended and actual) implementation. We sought to identify and explain programme aims, objectives, outcomes/targets and mechanisms by which outcomes are expected to be achieved. The following sections include some general conclusions resulting from our analysis of a range of programmes/policies, and give explicit examples of specific programmes/policies where relevant. Working Paper 4: Existing Elements of Public Health System in Ukraine: Current State and Historical Developments (Erica Gadsby, Olena Nizalova, Olga Nikolaieva, Nataliia Shapoval, Oleksandra Betliy, Anastasiya Salnykova) This working paper describes the historical developments and current state of the various elements that might together make up the public health function in Ukraine. To do this, we have drawn on the structure used by the European Observatory on Health Systems and Policies in their analyses of health systems in Europe (Rechel and McKee 2014), and the World Health Organization’s self-assessment tool for the evaluation of the essential public health operations in the WHO European region (WHO, 2015). We focus on a number of essential public health operations, as identified by the WHO Regional Office for Europe that guide our assessment of public health capacities and services. They are key issues for health policy-making, and look across the whole political and administrative spectrum, rather than focusing on the activities of specific institutions. For each key issue described in this working paper, we define the issue, briefly discuss the international context, and describe the situation in Ukraine, with reference to policies and regulations, organization and infrastructure, and operations and activities specific to the issue. The first key issue we address relates to the surveillance of population health and wellbeing. We then go on to explore issues of health protection, including emergency response, occupational health, environmental health and food safety. Next, we explore disease prevention and early detection of disease by examining screening in Ukraine. We then examine health promotion in the Ukrainian context, including action to address non-communicable diseases and social determinants of health. Finally, we look at the organization and financing of public health, and the state of the public health workforce in Ukraine.
Evaluating the new Public Health System in England (PHOENIX)
PHOENIX: Public Health and Obesity in England – the New Infrastructure eXamined English Public Health has undergone substantial reorganisation with a wholesale transfer of responsibilities from local NHS organisations to local authorities and Public Health England. At the same time, health service leadership and commissioning have been transformed through the creation of NHS England and clinical commissioning groups. These structural changes have enormous implications for the way in which the public health function is approached, organised and delivered. PRUComm are conducting the PHOENIX project on behalf of the Department of Health. It involves academics and professionals at CHSS, LSHTM, and the Universities of Manchester and Durham. The research examines the impact of structural changes to the health and care system in England on the functioning of the public health system. A key focus is to explore the impacts of structural changes at national, regional and local levels on the planning, organisation, commissioning and delivery of health improvement services. Taking obesity as a focal issue, PHOENIX examines local public health systems’ response to obesity and overweight. The project aims to identify the extent to which, how and why key opportunities within the new system are being realised; key challenges are being overcome; and key concerns are addressed. The scoping review stage involved detailed analysis of documents and qualitative interviews with key informants at national, regional and local levels. This informed the next phase of the research, involving two annual national surveys of key agents within local public health systems, and five in-depth geographical case studies in order to capture different organisational arrangements in local government and the NHS. For more information contact Erica Gadsby. Start date: April 2013 End date: 31/12/2017 Funder: Department of Health via London School of Hygiene and Tropical Medicine Publication: PHOENIX: Public Health and Obesity in England – the New Infrastructure eXamined First interim report: the scoping review.
How to strengthen leadership and the workforce through the re-design and implementation of a pay for performance program in primary health care in Brazil
This BA Newton Advanced Fellowship award-funded study focuses around primary care in Brazil. The research will yield new evidence on PMAQ, the Brazilian National Programme for Access and Quality Improvement in Primary Care. Academics from Brazilian universities, governmental and other organisations are collaborating with the project. The researchers will conduct a rapid review, interview policymakers, implementers and front-line staff in Goiás and Pernambuco, and examine related documentation. Data analysis will take into account relevant themes from Public Policy, the politics of performance and Health System literature. The UK/Brazil partnership will involve research collaboration, reciprocal visits and knowledge transfer. Professor Peckham will give two special open lectures at UFG in partnership with Dr Fabiana da Cunha Saddi, post-doc researcher at the Faculty of Social Sciences, Federal University of Goias in Brazil. They will teach on a policy analysis module for the University’s Political Science Masters Course. Fabiana will spend time in England at CHSS over the next two years. Read more on the UFG website > Start date: 01/03/18 End date: 28/02/20 Funding: British Academy (Newton Fellowship) £53,941
Postgraduate taught programmes for Health Leaders
In collaboration with Kent Business School, CHSS is developing the following bespoke Postgraduate taught programmes in International Healthcare Leadership and Management, for Managers working within European and Canadian health systems. Masters (MSc) in International Healthcare Leadership and Management Postgraduate Diploma International Healthcare Leadership and Management Postgraduate Certificate in International Healthcare Leadership and Management Global pharmaceutical company Abbvie are funding the set-up and development of the course programmes through their European Office in Paris. Kent Business School are providing expertise in management, leadership and marketing. CHSS will deliver the student-funded courses to run next year and beyond 2016, through flexible learning with time spent on Kent University’s Canterbury campus. The programmes address new approaches to health care management within and across NHS, EU and other global health systems. They will meet an identified need for learning focused on skills for health leaders to effectively manage a changing health environment and ever-increasing demands on health systems. Developed countries are facing the challenge of adapting to approaches to health care that focus on how services are organised and managed. Organisations are tending to become smaller with flatter structures and as they cope with more complex delivery settings, they must adopt collaborative, integrated working. Learning from the modules will be immediately transferable to the workplace. The programmes complement and develop recent CHSS work supporting healthcare managers in adapting to structural changes and shifts in health care delivery. CHSS Research Fellows Ferhana Hashem and Rowena Merritt are leading on module development and learning objectives, supported by Research Assistant Catherine Marchand. Start date: 01/08/2015 End date: ongoing Funder: AbbVie Biopharmaceuticals Funding: £41,711