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

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.

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.

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

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