Dear All,

Just a reminder that the next LHEG meeting at the NHS Improvement.

The papers & authors are below (we attach the abstracts at the end of this email, FYI).

1. Healthy Minds: A Randomised Controlled Trial to Evaluate PHSE Curriculum Development Impact on Health and Soft Skills, by Grace Lordan and Alistair McGuire (presenting).

2. Using Patient Level Information and Costing System (PLICS) Data to Examine the Drivers of Costs of Cancer Pathways and of Reducing Cancer Waiting Times in the NHS by Steven Paling, Dimitris Pipinis (presenting) and Tommy Weeks.

Date: Thursday 11 of April
Time: 6pm to 7:30pm
Venue: NHS Improvement, Wellington House, 133-155 Waterloo Road, London, SE1 8UG.

Afterwards, we'll go for a drink to  The Stage Door.

Looking forward to see you there!!!

All the best,
Mireia & CHEC Team

Abstracts:

1. Healthy Minds: a Randomised Controlled Trial to Evaluate PHSE Curriculum Development Impact on Health and Soft Skills
by G. Lordan and A.McGuire

Abstract
The Healthy Minds (HM) course is a comprehensive programme taught to all pupils in a class during a 113-hour universal programme delivered over the first 4 years of secondary school (Year 7 to Year 10, when pupils are aged 11 to 15 years old). Lessons either replaced the one hour-a-week of PSHE timetabled lessons, or were built in to the school week at other times, and were taught by school staff (teachers or learning support assistants, who received full training in each element). The course was made up of 14 modules, based on existing evidence or guidance on health education, covering a range of topics including: social and emotional learning, relationships and healthy living content suitable for students in UK secondary schools. Overall, the study recruited 13 participating schools in Phase 1 (2013), with 6 allocated to the (wait list) control arm and 7 to the treatment arm, and a further 21 participating schools in Phase 2 (2014), with 10 allocated to the control arm and 11 schools to the treatment arm. This gave a total of 34 schools, and 39 school-cohorts.

The primary aim of this evaluation was to establish whether the Healthy Minds (HM) course can improve teenagers’ health related quality of life (HRQoL) compared to a normal Personal, Social, Health and Economic (PHSE) lessons. 

The trial was considered an Intent-to-Treat (ITT) trial to allow for differences in adherence to the HM course. The primary outcome measure was the single scale of self-assessed general health drawn from a well validated questionnaire specifically designed for adolescents, the Child Health Questionnaire-CF87  (CHQ-CF87) (Schmidt, Garrett and Fitzpatrick, 2002) . This instrument also contains twelve other scales which are evaluated as part of this study as secondary outcomes, alongside other validated scales (these are the Short Mood and Feelings Questionnaire, the life satisfaction 0-10 ladder and the Child Anxiety Related Disorders (SCARED)). Data were gathered at baseline following recruitment (2013 and 2014), across relevant schools and 2-years later (2015 and 2016), and in a final stage at end of the study (2017 and 2018). 

The impact on the primary outcome - self-assessed general health after four years of the programme - was positive (0.25 standard deviations). This finding has moderate to high security.  The interim outcome – self assessed general health after two years of the programme – was also positive and of a similar size (0.23 standard deviation difference). The secondary measures had more variable results. Dimensions associated with physical health were generally positive. Likewise, the dimensions associated with behaviour and external relations were also positive. However, measures of internalised emotions were mainly positive and close to zero, but in some cases were negative.  


2. Title Using the Patient Level Information and Costing System (PLICS) Data to Estimate the Costs of Cancer Pathways and of Reducing Cancer Waiting Times in the NHS, by Steven Paling, Dimitris Pipinis and Tommy Weeks

Abstract
Background: Increasing the speed of diagnosis has been a major focus of the new strategy for improving cancer outcomes in the NHS. To achieve this goal the NHS is introducing new targets such as the 28 days definite diagnosis target (to ensure most patients receive a definitive diagnosis or ruling out of cancer within 28 days of referral from a GP or from screening). In addition, the NHS is experimenting with innovative diagnostic services such as Rapid Diagnostic Centres (RDCs) whose goal is to allow patients to have multiple tests within the same day. While such innovations may lead to significant improvement in outcomes they may also be associated with increased costs for the NHS, at least in the short-run. In this study we explore the key drivers of cancer pathway costs for those patients who are urgently referred for suspected cancer by their GP.

Method: We use 2017/18 PLICS data matched with Hospital Episode Statistics (HES) data from the same year. PLICS is a novel dataset, collected by the NHS, which provides actual care costs data at the patient level. By combining the PLICS and HES datasets we are able to construct estimates of both total pathway costs as well as costs of first appointment, treatment and diagnosis (inferred). We then estimate econometric models examining how pathway characteristics (e.g. one-stop shops, where patients have multiple appointments/tests within the same day) affect pathway and diagnosis costs. We control for provider/individual level characteristics as well as overall levels of provider activity.

Results: We find that the presence of one-stop shop increases cost of diagnosis, by increasing the number/type of tests a patient has. We also find that additional days waiting (for diagnosis or first appointment) lead to a small increase in cost of diagnosis and a small reduction in the cost of first appointment.

Conclusion: To the best of our knowledge, this is the first study to provide evidence on the short-term cost implications of shorter cancer pathways as well as on the cost impact of innovative diagnostic services such as one-stop shops. While, faster diagnosis and treatment will likely benefit patients in terms of clinical outcomes and experience it may also mean an increase in short-term costs for the NHS. Our study provides new evidence that can be used by policymakers and providers as they redesign services to achieve the goals of the NHS Long Term Plan.

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