Gp public h transcript — SMP305 lecture transcript

Um Just in case you're wondering, I think there's been an issue with the timing, um, of this session, so on I it's, it should have started at 1:15, um, I think on the i Sheffield app from what I've heard, it says 1:15, but on Minerva it still says 1:30, so I'm just waiting for everyone to turn up because, um, I think there's only about half of you here, so. Heads up, apologies about that. I'm just trying to find out some more info. The session you've got after this, um, there's a 15 minute break between the two sessions. Um, so that session should have started at should be starting at 2:30300. Um, my session runs was supposed to run 1:15 till 2:15, 15 minute break, 2:300 until I think 4 o'clock. Um, so I'll, we'll, we might, I might just have to eat into a little bit of the break time, but I'll try and go through everything as quickly as I can, um. Normally this session is at 1:30, it's obviously been changed because of room bookings or whatever I'm not sure but um yeah it's obviously not gone everywhere unfortunately. Just like to keep me on my toes a little bit, you know, keep it interesting.

It says 1:15 on my Minerva now. I don't know if they've changed it. Right. OK Right, I'll um I'll get cracking. Uh, so, yeah. Apologies um for the late start or the prompt start depending on which timetable you looked at. So, um, the session was supposed to start at 1:15. I think the timing was then was changed on A Sheffield but not on Minerva, so apologies for those of you who were here at 1:15 expecting to start, um, because there was so few of you I thought it was worth waiting on till 1:30, um. So this session is supposed to be an hour, um, what I'll do is um. I'll try and whiz through some of the first section because that you you've got all the information actually on Minerva for that. I just wanted to go over it um with you all so that we can get through relatively quickly. There is a bit of um time at the end for you to do some group activity. I do still want you to do that because it's part of the assessment. Um it just might be that we don't have quite as long to do that bit of group work. Um, and I may just have to eat into the break slightly, um, which is due to be a 15 minute break, um, before you have your nap session, um. Which was due to start at well is due to start at 2:30. So I will do my best essentially. Um if anyone has any questions or if afterwards if something wasn't clear because I've had to rush it a little bit please do ask me. So um just. Introduce myself first of all, so I'm Kelly. Um, I work as a consultant in Public Health at Doncaster and Basset Law Teaching Hospitals. I do that half my time and then the other half I work as a senior clinical lecturer here at the University of Sheffield, um, teaching and research and obviously I'm here in my teaching capacity. So here's some of the learning outcomes for the session today, so um just some key practical stuff about knowing where to find the public health materials for this block. Gonna touch upon the assignment for the the public health assignment for this rotation as well. Talk about health inequalities and um get you to start thinking about the relevance to healthcare, understand need and then start talking about um evaluating um health services as well. So in terms of the public health part of this block, um, you'll have probably seen from the timetable, so we have um 3 and I'll put slash 4 talk face to face sessions. So the, the sessions that are specifically delivered by, um, the public health team I suppose as part of the university are this session right now, um, the session that you've got coming up, um, immediately after. And then the session on Thursday which is around making every contact count. Um, I have also put in brackets a session that um is officially part of the GP side of the er rotation, but it's titled Health Inequalities and Social Social Exclusion very much public health but it's delivered by um clin clinicians. um, so it's it's just I suppose evidencing that er clinical relevance of of those inequalities. You have also got two self-directed learning sessions, um, timetabled in as well which uh uh to allow you to prepare for the assignment. You will need to do more than that, um, but we wanted to give you some actual timetabled time to uh to get together in a group and and work on that. And then at the in the final week of the rotation, final Thursday, um, is, uh, your public health presentation session which we'll obviously go on to talk about in

a second. This slide is purely for information but um if you're anything like me I find Minerva a bit of a minefield, so this is just to to highlight um where to find uh the materials on Minerva. So the assignment, um, so basically this is, um, last year was the first year we, we ran this new assignment, um, so you're no longer the guinea pigs, which is good news. Um, it seemed to work really, really well last year, so obviously we're carrying it on this year, but we have made some changes. Um, originally, uh, so 2 years ago there was, uh, an essay you had to write a critical analysis, um. And um to be honest it didn't really give a real good feel for what public health is in the real world. um and I want to try and give you that experience and get you really thinking about the relevance of public health and um the sorts of things that you will be doing in your everyday practise. Um, so the idea of this new assignment is to develop a comprehensive health promotion and inequality reduction initiative for Sheffield. Um, in the, um, in-course assessment document, which again you'll find on Minerva, um, you're given some information about, uh, two different wards in Sheffield, Birth Park and Forward, and they're contrasting in many ways, um. You'll be put, I've actually put groups 6 to 7, but that was based on last year's numbers actually the, the numbers are a bit smaller this year, so it's actually 5 to 6 um in terms of the sizes, sizing of the groups. The idea is that each student contributes equally. That doesn't mean you all have to do exactly the same thing. Um, you can, you know, there's lots of different ways of contributing, um, but everyone should overall over the whole assignment have contributed reasonably equally. Um, the idea is that you identify and select a health inequality in Sheffield, basically an inequality between Firth Park and Fulwood, and then you develop something to help reduce that inequality. Um, the idea is that it's something new and novel. Now it doesn't have to be something that no one has ever thought about ever before because that would be a bit unfair and asking quite a lot. I suppose when we say new and novel, just not something that you would see in everyday practise, so not something that's kind of standard practise um at the moment. We have also this year given you a bit of a budget so we didn't last year and actually the feedback was that that made it less realistic cos you could do all sorts of things, in fact people, you know, some groups had ideas of huge buildings that they were gonna build and and all sorts of things which were amazing but fair enough, not really grounded in reality in this in this current financial climate. So we've given you a 50K budget. Now I'm not expecting you to cost the, you know, fine nitty gritties of your um of your intervention, but it's just to kind of give you a little bit of a boundary.

So building a new building is probably not going to happen within 50 km. Um, so it's just to kind of constrain you a little bit, but again that is the real world. So the final Thursday as I've said, um, each group will have 15 minutes um to present their ideas to the local community group which is basically everyone else who's observing. Um, and at the end of each presentation we'll just have a hands up as to whether you'd want to see that initiative in your local community. You will be stopped after 15 minutes, um, so do make sure you practise the presentation and and it's within time. Um, you can do your presentations in a variety of ways. Um, traditionally, um, most groups have done PowerPoint presentations, which is absolutely fine. Um, but you can be more creative if you want. You can do videos and we've had, we've had videos, we've had podcasts, we've had pre-recorded podcasts, we've had live podcasts. Um, you could do infographics, you could do a play even, you know. I'm not being prescriptive at all in that sense. um, and at the end we will have a vote for the best presentation of the of the day, uh, and that group will get a certificate and a small prize as well. So this is just a list of all the things that the presentation does need to include, um, so, uh, obviously a bit of an introduction and again this, this can be flexible depending on how, you know, how you decide to do your presentation. Bit of an introduction, um, as to why you've chosen this particular inequality, maybe what's the UK picture and what's the, the picture for the two wards which Firth Park and Forward. Um, look at what currently is being done, what currently works to help tackle that particular inequality. Describe your initiative. Discuss strategies for patient and community engagement, and also how you'll integrate into primary care as well. Um, talk a little bit about evaluating, how would you evaluate to see if this is actually gonna work. Um, and then some references at the end, but again, depending on how you do this, we can be a bit flexible with, with how that information's processed. So your group allocation is based on your ILA groups. Have you had that sent out to you already? Yeah, fab. I have got, I have got a list at the end, so, um, you will be getting into your groups, um, for the last however much longer, however much time we have at the end of the session. Um, but you will be getting into your groups at the end to, um, to start having a think about what you're gonna look at. And then in terms of assessment there's two things. So the first thing is a student declaration. So each of you individually will complete the student declaration. It's a short Google form that um that you have to submit no later than 1 o'clock on the final Thursday. Um, and essentially it's trying to understand what your contribution to this piece of work was. Um, was the work spread evenly across across the group? Um, and also because this is still a new, um, assignment, we are just asking for a little bit of feedback as well because I am really keen to keep adapting and changing things, uh, based on your feedback. So, um, like I said, the last year we didn't have a budget, but the feedback was actually it'd be more realistic to have a budget. We also set the setting was a fictional. town of Millfield. And again feedback was actually we prefer it to be a, be a real life place that we can you know think about and really picture where we'd where we'd be doing things. So again we are making changes based on your feedback so um if there if you do have any suggestions or um obviously need good feedback as well, um, then that would be uh really helpful. Um, but the student declaration is really important because if you don't complete this you will not pass phase 3A, and it would be a really silly thing to not pass phase 3A4. Um, so please do make sure you complete this, um, before the final Thursday, uh, Tuesday of the rotation. Um, and then the actual presentations on the day are going to be peer assessed by you. So, um, all the people who are observing your, your presentation, um, will be completing a short form. Um, again, it's only 2 or 3 questions, um, but essentially that feedback will then be collated and each group will receive the, the collective feedback so that you will know kind of the things you've done really well, the things you could improve on for the future. So my understanding is you don't actually do a lot of kind of group presentations and group work, um, like this, so, um, so obviously that feedback's really important because it's something you will have to do a lot of, um, as you go through your careers.

And then yeah just in terms of what you need to submit, so the student declaration is the first thing and then the second thing is the actual presentation in whatever form it's in. Um, so again that needs to be submitted and there's clear instructions um on how to do that on, um, in the information about the assessment on Minerva. Um, if it is something you're doing live or there isn't much in the way of um something to actually a physical thing to submit, um, just send me an email and let me know, and that, you know, that's fine. Um, but, uh, if there is something to submit, obviously please do that. And then finally, um we've got some smoking cessation training. So this is separate to um to the piece of group work. So this is a an online e-learning module. Um, it links really closely into the session you're gonna be, um, having on Thursday around making every contact count. Um, so it's a short e-learning session and then there are 5 MCQs to complete at the end. Um, I've done it myself. It took me no longer than half an hour. I've said no longer than 1 hour just to make sure that you know it's, it is 100% realistic but. I think it'll be a lot less than 1 hour to complete that. You can do that at any point, you can do that from today onwards, um, but again, um, you'll get a certificate once you've completed the MCQs, and that just needs to be uploaded, um, no later than the final Friday of the last week of the rotation. And again there's information there on where to upload.

Right, so I think that's all the assignment stuff. Has anyone got any quick questions about that for now, or does that all make sense? OK. So, um, I just want to, this will not be new to you, but I'm just wanting to shift your gaze now into the public health world. Um, so we are obviously at the minute very much focused on thinking about the population perspective. So we're thinking about groups, not just that patient in front of you, OK? When we talk about populations um. A population could be defined as many, many different things. It could be the population of Sheffield, it could be the population of Firth Park, it could be the number of people in Sheffield with type 2 diabetes, um. The list is endless. Um, so, and, and it, it basically depends on where your perspective, what, what is it you're interested in, in finding out about. So for a GP for example, um, they might be really interested in all the patients that are registered on their with their practise, so that's their practise population. Um, if they're a GP with a specialist interest in something, then they might be interested in all the patients registered with them that have got condition X. If you're thinking about a consultant diabetologist's perspective, um again could be many ways of cutting it, you could be thinking about all your inpatients, you could be thinking about all your inpatients and outpatients, or if you're thinking kind of really broadly about diabetes and prevention and how to improve um diabetes as as a whole, then you might want to think about all the people with diabetes in whatever city it is you're working with. And then similarly a vascular surgeon, it might be all the patients that they've seen, it might be death rates, mortality rates poster a specific procedure. So again there's loads of different ways to cut it, it's all about what you're interested in knowing about. But the idea is it's a population not an individual.

So now we're gonna touch upon health inequalities. So now we're we're in the world of public health. um, so health inequalities, um, again this shouldn't be new information for you, um, but essentially they're unfair and avoidable differences in health. So they mean that some population groups will experience poorer than average health access experience or outcomes. And obviously that's inherently unfair. Um, the diagram there is just highlighting all the different factors that contribute to our health outcomes. Um, so we've got socioeconomic factors which, um, play a, a, a large role. They, you know, they, they. Um, contribute to 40% of our health outcomes. Physical environment, 10%, lifestyle factors 30%. Healthcare only 20%, and that's quite interesting cos obviously that's not to say everything that we do in healthcare isn't very important, clearly it is really important. But there are also a whole host of other factors happening in people's lives that actually maybe aren't within our gift as clinicians to um. To directly influence, um, so I guess you know we could offer the best healthcare service in the world. It could be absolutely amazing. Um, but if all the other stuff on the outside is not good, then we're gonna be fighting a losing battle. So it's just making sure that you have that appreciation of the wider, the wider world, what's the, what's going on in this city, in this area, in, in this country, um, that might be contributing to some of these, some of the things we're seeing in hospitals or in GP. And that's essentially the wider determinants of health. So again this, this won't be new to you, but um the the ring in the green is, is kind of the key one really here. It's thinking about all those factors that have such an influence on our, on our health. Um, so where we live, where we work, whether we're. Educated or not, um, you know, even have we got access to water and sanitation, and you think in the UK, do we really need to ask those questions? Yes, we do. Um, so you know, what's our housing like? Is it full of mould? Is it in a high rise, full of, you know, with loads of pollution, um, exposure. Um, you know, these things all obviously contribute significantly to our health and we, we do need to have an understanding of, of. You know, where our patients coming from, what are their experiences, what are their circumstances. And this is just a graph and it's obviously flagging up Firth Park and forward there, but um this is a a map of Sheffield. um, and it's breaking it down by um something called the Index of Multiple deprivation. So this is a a a a piece of data that has combined loads of different factors that contribute to this idea of deprivation. Um, so it's not just kind of, um, poverty, although that. It's a huge part of it. It's things like access to healthcare services, it's things like access to schools. It's things like um are there prisons nearby, um, is there social housing? Loads of different factors um contribute to this, to this score. Um, but as you can see, Sheffield's a really interesting place, um, in that there's a real kind of east west divide. um, so I don't know if you can see my

cursor on here. Ooh, I can draw a line, not a very straight one. But um so you can see this side that Firth Parkcott is on is very red, which is your most deprived areas. And then this side where forward is, is very blue, which is your least deprived areas. This bit up here is green, um, it's a really rural part, it's kind of Peak District kind of areas. Um, so that's why it's, it's kind of so green up there, um, and also not very, er, the wards are massive up there cos the populations are small. Um, so yeah, so that you can see that contrast. So you can see that clearly knowing where someone's from and having an understanding of where they're living could actually have quite a, a significant impact of, of how you might support them and manage them. So again this probably isn't um new to you, but I think you know I I'm I'm always going over this stuff because I think it's so important. Um, so it's this difference between equality, equity and inclusion. So equality is where we treat everyone the same at the outset. So, um, the NHS is free at the point of use for UK citizens. Um, so we're treating everyone the same there, but that doesn't mean that everyone is accessing the NHS in the same way and certainly doesn't mean that everyone is getting the same outcomes at the end. Um, so as you can see there, we're giving everyone the same size box, but not everyone can see that football game that's happening. So equity is where we acknowledge that people have different experiences and and people have different challenges and therefore we treat people differently at the outset so that the outcomes at the end are the same, are equal. So you can see there we've given the smaller person there two boxes and now he can see or she can see the game just as well as everyone else. And then inclusion is kind of the holy grail really and we are nowhere near that yet. Um but it's always worth talking about because you know we've gotta aim high. Um, but this is where we don't actually need to treat anyone differently because the way all our systems and structures are set up mean that the outcomes are the same. Because we've accounted for that in the way we've set everything up initially. So I, I won't go through all of these, but um just pull out a few of these statistics which kind of highlight some of these inequalities. So, um, the average life expectancy for men who are homeless is 47 years and for women it's 43 years. Um, black women are 4 times more likely to die during pregnancy in the first year after birth compared to white counterparts.

Um, 1 in 3 children in Doncaster are living in poverty. You can see there's some Doncaster stats here and some national stats, that's obviously cos of my link to Doncaster Vassalville hospitals, um. The average reading age in Doncaster is 9 years old. Um, Sheffield I think it's about 10, so not much better, um. So you know, thinking about the way you communicate with your patients. Would a 9 year old understand the way you're communicating? Um, think about a lot of the NHS leaflets, you know, the standard ones that you can download. Um, how many of them would actually be suitable for a 9 year old? Probably not many. Um, so just really helpful to kind of have this understanding and appreciation so that you can think, right, how am I gonna communicate with this patient? How am I gonna, you know, get them to understand what's going on and, and, and support them through this. And then the ones I'll just pull out particularly, so, um, people with learning disabilities have an average life expectancy of 62 years, which obviously in and of itself is quite shocking. Um, but if you've got a learning disability and you're from an ethnic minority background, then your life expectancy is 34 years. Which is pretty horrendous. Um, and that's kind of just highlighting really this issue of intersectionality so.

You know, humans are complex beings. We aren't just one thing. We can't just be pigeonholed into 11 box. Um. And often what happens is um we have multiple disadvantages that then will layer upon each other and compound the overall outcomes. And again this is just important for you to understand and have that appreciation so that you know there are multiple levels where people can be challenged in terms of how they're accessing our services, what their experience of our services are like, um and ultimately what their outcomes are at the end. Um, so yeah, that that's this concept of intersectionality where things are. So this is just a framework and I'll not dwell too much on this because to be honest it's probably gonna change in a year or so, but um this is something called the Core 20 + 5 which is an NHS England framework for tackling healthcare inequalities. So the idea was, um, you know, NHS England are like all trusts and um integrated care boards and uh all NHS provider settings need to be thinking about how we can tackle inequalities. And everyone was like, well how do we do that then? How, how do we actually do that? So this was born from that. Um, so the idea is that you, um, need to identify target population first. So that can either be defined as your core 20 population, so that's the 20% most deprived nationally. Um, just to put that into context, in Doncaster, our 20% most deprived nationally, uh, our 20% most deprived nationally population is actually 40% of our population. Um, so it doesn't actually narrow things down very much. Um, so maybe we, we would focus on the core 10, so the 10% most deprived nationally, which would equate to 25% of our population. Um, plus groups are groups that have been identified, um, that we know experience poorer than average health access experience and outcomes. So they could be a whole host of different groups. There could be people with learning disabilities, it could be people with. Um, sensory impairments, it could be veterans, it could be people experiencing homelessness, um, asylum seekers, ethnic minority backgrounds, etc. The list goes on for that. But you could target specific kind of plus groups. And then the 5 is um 5 key clinical areas. So um essentially they did a NHS England did a big uh evidence review and they said in terms of bang for your buck if you're gonna start somewhere and you're at sort of trust level, um, then these are 5 good places to start. So paternity, severe mental illness, chronic respiratory disease, early cancer diagnosis and hypertension case finding. Um, you shouldn't be constrained by that if obviously you work in an area that doesn't cover one of those 5, that's, you know, you can still do something within your area, but from a sort of strategic point of view, these were 5 key areas. And then as a kind of bolt on I suppose, um, actually if we tackled smoking then we would hit all of those 5 key areas plus a whole host more. So actually smoking cessation is one of the biggest things we can do in terms of tackling health inequalities. This is exactly the same approach but for children and young people, um, so it's just the five key clinical areas here that are different. So for for children and young people they are asthma, diabetes, epilepsy, oral health and mental health. OK, so that was a bit of a whistle stop tour through health inequalities. You are getting a 3 hour session I think um in a few weeks on health inequalities and social exclusion, so you'll get a much deeper dive, um, into what that actually means from a clinical perspective. Um, so that's just to kind of give you that brief introduction. As I say, Catherine and Blurta will go through it in much more detail in terms of the kind of clinical relevance. So the rest of the um the presentation is kind of picking some key points that will be relevant for for the assignment. So it might feel a little bit kind of hodgepodge but actually it's it's all kind of things that are relevant for the assignment. So thinking about needs, so if we are wanting to do something to support a community or to improve health for a population, we need to understand what some of those needs are. So is there, is there an issue for a start, you know what, what, what is, what is the issue? What's the data telling us? What are the people telling us? Um, so that's where some form of needs assessment comes in. So understanding that need. Um, you then once you've got an idea of what, what the need is, where, where the gap is, then it's a case of planning like what we're gonna actually do then to address this gap. Then you, once you've decided, then you roll it out and then you need to evaluate it, so that's kind of something that you will be doing as part of your your assignment. So Why this is relevant to you, so you will obviously be um mainly concerned once you're well even now as medical students and then once you once you become qualified doctors, you will be mainly concerned about treating individual patients. That that will be your primary focus. Um, but, and you may get roped into some of this stuff, um, as medical students, but certainly as, um, foundation doctors, resident doctors, and definitely, um, as consultants or GPs, you will be involved in quality improvement stuff. Um, and it's really important that when you're thinking about quality improvement, how are we gonna make our services better? How are we gonna support more of our patients? Um, having that wider appreciation about health inequalities is clearly really important and can really help inform what you might want to do from that perspective. So basically developing services, improving services will be your world if it's not already. Um, so again it's just why this stuff's important for

you. So there's obviously various different ways of of thinking about need and I'm sure you'll be familiar with Maslow's hierarchy of need. um this idea that you know if you haven't got the basics there then you know thinking about someone who's who's homeless, who um street homeless, doesn't know where they're gonna be sleeping tonight, doesn't know if they're gonna be able to get a hot meal, doesn't know where they can use the toilet, um. But they're a smoker. If you tell them to stop smoking or suggest or say, you know, do you think it might be a good idea, would you like to think about stop smoking, it's just not even gonna be on their radar because they don't even know where they're gonna sleep. So having that understanding of of those kind of are the basic needs being met can actually then inform like how you would approach a a a clinical um encounter. Um, because not to say you wouldn't still try, but the reality is it's, it's not even gonna, it probably wouldn't even register with that person, um, because they're, they're so worried about, you know, I don't actually know where I'm gonna sleep tonight, I don't know where I'm. how they get a meal. um, so clearly those things are really really important and we need to have all those different layers before we can start thinking about maybe some of that behaviour change type stuff. And then of course there's that economic perception of need, demand and supply and demand, um, which can in itself drive need um or can completely exclude the need when you're just thinking about well there's a demand for this, we're gonna supply it and that's it. Um, it doesn't matter what the need is, there's a demand for something, so we'll just supply it anyway. Um, so it's, it's again another way of thinking about need. And there is this clear link between need and inequalities, so we, we know um Tudor Hart um said this many years ago and unfortunately it's still very, very real today. Is that the availability of good medical care tends to vary inversely with the need for it in the population served. So we know that where the greatest need is. The access is worse. um, so you know thinking about that image of Firth Park and forward it's much harder for people in Firth Park. Healthcare services um than it is for people on forward. And that's just a fact, it's just the way it is. So we have that. Need and that's why that inequality is increasing. What we need to do is try and reduce that inequality by doing some targeted work to support Firth Park. Forget about Forward, they're doing alright. Let's focus on Firth Park. Um, so that's, that's the idea of this, but sadly it is still very, very true. And again this just links back to that supply, demand and need issue um.

The, the sort of the aim really is to is to find something that's needed, we can supply it and there's a demand for it as well because if there's no demand for it then people won't necessarily seek seek it out or or be looking for it, um. And it's not easy to do that. um, so we know need is the ability to benefit from an intervention. Demand is what people want, what people ask for, and supply is what we can actually provide. And then this little line at the bottom is quite, is quite sort of messes with your mind a little bit but I quite like it. Um, we may supply what is demanded but not needed and not supply what is needed but not demanded. So we just need to think about actually, you know. There's a need for something, but if there's actually nothing we can do, you know, if there's no thing we can do to make that better, then actually we need to just pause that and think about something else that we can actually do something about, um, is essentially what that's saying. So, how are we doing? Um, so evaluating health services. So again this is part of that planning cycle and something that you need to think about as part of the, um, the assessment. So the, the last sort of section you just need to have a consideration about how you would evaluate your intervention. How do you know that what you're gonna put in, implement is actually gonna make a difference in the way you're wanting it to be. So there's a few different frameworks that you can think about. Um, so first one is Don obedient, um, so he has a three stage model um of evaluating the quality of of. Care and and these models are are useful again thinking about quality improvement work that you might well get involved with as students but also certainly um as doctors. um, you will always have to, you know, if you make a change in a service, you will always have to do some form of evaluation to understand whether or not it's, it's improved things, um. And uh this may be one of the, one of the frameworks you you would want to use to to look at that, so. Structure, process and outcome is what Don Obedience suggests that you look at. So structure is the things, the kind of the inputs, the things that you. To do this particular intervention. Um, so it might be, um, if it's doing more, er, hip replacements, it might be having the theatres, having the beds. Um, it's the, yeah, the actual physical things that you need. Um, the process is more the kind of care pathway. So thinking about how you're getting patients from A to B through a through a care pathway. Um, and you know at what points are things happening, at what points are, um, additional interventions being, um, required. Um, so you sort of map, map out what that what that pathway looks like. And then the outcome is kind of what it says on the tin really, it's the the thing at the end so what you know what's happening as a result of this. um and thinking about obviously you wanna look for the positive outcomes but you also wanna capture those unintended consequences as well of things that maybe are are a bit unexpected. So that's one way of of evaluating a um er healthcare service. Um, the other way is, is thinking more about quality. Um, so for that you can use Maxwell's dimensions of quality, so the three A's and three E's. So the three A's are acceptability, so how acceptable is the service to, um, to the people needing it, um, to the patients. So you know, example of that is, um, cervical screening. Um, it's not a very acceptable intervention. Um, most people do not enjoy that procedure. Um, it's not a nice thing to have to have done. It's all we've got at the minute, um, but because of that, actually the, the numbers of people taking up that screening programme are low. They're not as high as we would like, um. So you know thinking about how acceptable a service is to your population, to your patients, um, is clearly really important to the success of that service. Um, Accessibility, so can people access the service and that could be physical access, so you know, geographical. Can they, um, you know, do they live really rurally? Can they still get there? Is there a bus route? What, what have you, um, what's the costs like for patients as well? Can they afford to, to access the service? What are the waiting times? Um, and then appropriateness, so is the right treatment being given to the right people at the right time, um, that's key as well. Then we've got the three E's effectiveness, efficiency, and equity. So effectiveness is again kind of what it, what it does on the tin. So, um, you know, is it achieving the benefit you're wanting it to achieve? So is, is it, is it doing the thing you want it to achieve? Um, efficiency, that's thinking more about that financial resource, um. You know, are we getting value for money with this service? Obviously we've only got a finite amount of money in the health service um is this a good way of using that finite resource? And then equity, so are, are people being treated equitably? um can we, you know. Are we doing things to ensure that we are targeting those that really do need it and really do benefit from really will benefit from the from the service? And then we've got a range of different methods um to evaluate healthcare services so we've got qualitative quantitative, so qualitative is obviously that more kind of discussion based um er approach where you're sort of speaking to people, trying to find out what you know how they feel, um, has it been helpful, has it been beneficial, um, is it working? What are some of those access issues for example? Um, so you can get a really good understanding of, of some of those wider impacts on, um. On the of the service and then quantitative is obviously your your sort of more databased um type data so you're looking at you know, might be big, big numbers, big data, um, looking at routinely collected data, reviewing medical records, surveys, etc. Um, what I often say is quantitative is really helpful in understanding kind of the size of an impact or not as the case may be, um. But then the qualitative stuff is really helpful to kind of then understand why or how. um so you know why is the data showing this? Why is there a massive impact? um, why is there no impact? Why is there an impact in some groups and not others. So it's the qualitative data that can then help unlock some of those um answers. So actually using combined approach is, is often uh a really sensible way forward. And this is just a a bit of an overall framework of how you could sort of put some of those structures and frameworks together um as part of a a broader evaluation. So again something that might be helpful when thinking about the um the assignment.

Right. I'm really sorry that that's been a bit of a whistle stop tour, um. Has anyone got any questions for a start? OK, um, so what I want you to do now. I. Let me Right, so these are the groups, the ILA groups. So what I'd like you to do, so we'll probably just go into the break by about 5 minutes if that's OK. Um, you obviously can keep talking after that as well if you want, but um, I'm just mindful that you, you probably want a, a comfort break and what have you. So if you can get into your groups, so if we say, um, group 123. 4567, something like that, so if you all kind of make your way into your groups and then I'll uh explain what we're gonna do next. If you can do it as quick as you can as well, that'd be really helpful because we've not got a lot of time. Better. I see. Oh, you, it's not right. It's not right. 6. I see. Do you know I Right, are you all in your

groups? Put that. Right, if you could scan the QR code. That'll take you to the um. In-course assessment information, so it's got all the details about the assignment. So what I want you to do in your groups, once you've just had a chance to scan the information. Is you'll see there's loads of data comparing Forward and Firth Park, some stuff that's around the sort of social determinants of health and some stuff that's around health outcomes. What I'd like you to do as a group is decide on one thing that you you would like to have a go at addressing as part of your. For your presentation, um, so one inequality, it could be something around the social determinants of health, it could be something around the health outcomes, it doesn't matter. Could be a bit of an overlap, um, between the two. But I want you to try and decide on the topic theme. You don't have to think about what you're gonna do, how you're gonna do that yet, but I just want the sort of topic theme, um, and then in I'm like I'm sorry I'm only gonna give you 5 minutes to do that.