Risk adjustment for hospital use using social security data: cross sectional small area analysis

Objectives: To identify demographic and socioeconomic determinants of need for acute hospital treatment at small area level. To establish whether there is a relation between poverty and use of inpatient services. To devise a risk adjustment formula for distributing public funds for hospital services using, as far as possible, variables that can be updated between censuses. Design: Cross sectional analysis. Spatial interactive modelling was used to quantify the proximity of the population to health service facilities. Two stage weighted least squares regression was used to model use against supply of hospital and community services and a wide range of potential needs drivers including health, socioeconomic census variables, uptake of income support and family credit, and religious denomination. Setting: Northern Ireland. Main outcome measure: Intensity of use of inpatient services. Results: After endogeneity of supply and use was taken into account, a statistical model was produced that predicted use based on five variables: income support, family credit, elderly people living alone, all ages standardised mortality ratio, and low birth weight. The main effect of the formula produced is to move resources from urban to rural areas. Conclusions: This work has produced a population risk adjustment formula for acute hospital treatment in which four of the five variables can be updated annually rather than relying on census derived data. Inclusion of the social security data makes a substantial difference to the model and to the results produced by the formula.

Belfast Soundwalks

The Belfast Soundwalks project, led by Professor Pedro Rebelo and co-ordinated by Dr Sarah Bass (Sonic Arts Research Centre) in collaboration with Belfast City Council (BCC), aims to use sonic art to engage the public through the development of a locative mobile phone app. Targeting both tourists and citizens of the city, this project aims to sonically enhance the experience of a number of areas of the city, including destinations that may not traditionally be accessed as attractions by visitors and/or disregarded or undervalued by local residents. The project will bring together a number of sonic artists/composers who will create approximately ten soundwalks around the city, while liaising with BCC to distribute the resulting app to the public in line with their tourism and cultural strategy. The project is centred on the development of smart phone apps which provide unique listening experiences associated with key places in the city. The user’s location in the city is tracked through GPS which triggers sound materials ranging from speech to environmental sound and abstract imagined sound worlds. Additionally, local community groups will be consulted in order to evaluate and reflect upon the effectiveness of the soundwalks.

The project builds on the success of the Literary Belfast app and aims to further strengthen links between Queen’s University Belfast and Belfast City Council through facilitating the dissemination of an art form not widely experienced by the general public. Through the newly created Institute for Collaborative Research in the Humanities, directed by Professor John Thompson we are articulating this project with Queen’s consortium partners, Newcastle University and Durham University.

“The Arts and Humanities Research Council (AHRC) funds world-class, independent researchers in a wide range of subjects: ancient history, modern dance, archaeology, digital content, philosophy, English literature, design, the creative and performing arts, and much more. This financial year the AHRC will spend approximately £98m to fund research and postgraduate training in collaboration with a number of partners. The quality and range of research supported by this investment of public funds not only provides social and cultural benefits but also contributes to the economic success of the UK. For further information on the AHRC, please go to: www.ahrc.ac.uk”.

Does the UK Local Finance Improvement Trust (Lift) Initiative Improve Risk Management in Public-Private Procurement?

The UK government introduced the Private Finance Initiative (PFI) and, latterly, the Local Improvement Finance Trust (LIFT) in an attempt to improve public service provision. As a variant of PFI, LIFT seeks to create a framework for the effective provision of primary care facilities. Like conventional PFI procurement, LIFT projects involve long-term contracts, complex multi-party interactions and thus create various risks to public sector clients. This paper investigates the advantages and disadvantages of LIFT with a focus on how this approach facilitates or impedes risk management from the public sector client perspective. Our paper concludes that LIFT has a potential for creating additional problems, including the further reduction of public sector control, conflicts of interest, the inappropriate use of enabling funds, and higher than market rental costs affecting the uptake of space in the buildings by local health care providers. However, there is also evidence that LIFT has facilitated new investment and that Primary Care Trusts (PCTs) have themselves started addressing some of the weaknesses of this procurement format through the bundling of projects and other forms of regional co-operation.