Expert roundtables discuss key issues around social sciences and health

April 4, 2014

Over the course of the Health of People project the Campaign brought together high-level stakeholders to discuss key issues around research, evidence and health.

Introduction

The Campaign for Social Science project ‘The Health of People’ aims to bring about a step change in the use of social sciences for population health. It is led by an interdisciplinary Working Group, chaired by Professor Susan Michie FAcSS, Director of the Centre for Behaviour Change at UCL. As part of the project, the Campaign convened three roundtable discussions in autumn 2016, bringing together policy makers, practitioners, and social science experts to discuss how social science research evidence can be used more in policy making and practice.

Using social and behavioural sciences to improve health service delivery

The first discussion, chaired by Sir Malcolm Grant CBE FAcSS, Chair of NHS England, focused on how research can influence healthcare delivery, what priorities there should be for research in this area, and how best to ensure this research is used.

Whilst modern healthcare is already influenced by the data, information and insights we get from the social sciences, there is a need to challenge the assumption that every condition should be treated by medication. The social and behavioural sciences offer new ways to deliver cost-effective outcomes, something that is key in times of limited resources.

Social sciences have a potential contribution to make that we have so far failed to realise, especially in healthcare.

But healthcare in the UK is highly politicised and the stress is often on easy-to-measure outcomes, performance in league tables and financial targets, and these short-term political drivers run contrary to long-term stability, investment and return. The disparity between policy development that moves at a fast pace to meet demand, and academic research that in investigating deeply inevitably moves more slowly also needs to be recognised. Researchers can adapt to the constraints of the policy-making environment, but there is much that could aid their work – for example access to data.

Social scientists have to recognise how politicised our healthcare system is and to work to those timescales. On the other hand, we need to have access to raw material to be allowed to carry out the research that our disciplines do so well.

Much social and behavioural research is project-based rather than thematic resulting in a wide array of small studies with inadequate infrastructure for implementation. If a study has indicated success, scale-up is added at the end, rather than being built into projects from the beginning as a success measure.

The opportunity for implementation is lost unless it is intrinsic to a project: implementation needs to be considered at the outset and ideally run in parallel to a project.

The role of the social and behavioural sciences in public health and prevention

Chaired by Kevin Fenton, Director of Health and Wellbeing at PHE, the second discussion focused on the role of the social sciences in achieving and maintaining behaviour change at population, community and individual level, the need for deepening and extending its scope, and the barriers to achieving this.

To reduce the need for acute interventions and for long-term care, to reduce spending; and to deliver better health outcomes, we need to build social and behavioural sciences more systematically into the way we deliver public health. Instead of investing downstream in a biomedical model of spending to treat the healthcare burden, we should invest upstream in social ways to prevent or reduce the problem.

But there is no silver bullet when it comes to successful preventive interventions. Looking at the success of smoking cessation, multiple factors operating at different levels at the same time – social and political norm changing, commercial or market mechanisms such as advertising bans and taxation etc. – is what made a difference. More system-based approaches are needed, and academics also need to work to engage deeply with target populations, practitioners and policy makers.

Since public health responsibilities shifted to local government in 2013, new policies, practices and procedures have been implemented. However, few natural trials are carried out, as there is little in place at present to facilitate local government and academia to meet.

Every time we don’t evaluate a natural experiment is a missed opportunity.

Science and practice must be better linked. Much of what drives public health does not lie within the NHS or Department of Health. There needs to be greater engagement with other sectors and other government departments, such as education, transport, and environmental health.

Capacity development for practitioners is also an important element, to ensure skills and expertise exist around behaviour change. At present, there is not enough sustained, non-project funding to allow for new capacity and relationship building with policy makers and practitioners to grow.

Use of data to improve health outcomes

A third roundtable was chaired by Jo Churchill MP, focusing on access, usage and linkage of health data by patients, researchers, health professionals, and industry, and how social science methods and expertise can improve health data quality, analysis and use for better health outcomes. The importance of data was raised in discussions at every roundtable, from collecting routine data in local authorities to researchers being able to access workforce data.

Health data holds huge untapped potential for improving patient and health service outcomes, if utilised by healthcare professionals, patients and researchers. People are often surprised when they realise that their information does not travel through the system to benefit other patients. But how do we get the right balance between trust and protection of the public and access to quality data?

Whilst safeguards such as the ‘five safes’ principle often make the process of accessing data very lengthy, it is important to ensure they are adhered to. It is also important to be clear about safeguards in the public discourse and use intelligible language to remind people that there are stringent safeguards in place.

Because of the complexity and variability of the many different, interconnected levels of data sharing it is difficult to achieve a single narrative.

One of the major problems with improving public understanding of the issue is that the argument is too abstract, the terminology too complicated, the reading too long, and there are not enough case studies to demonstrate how it works in practice. Moving on from care.data, presents an opportunity to use a new vocabulary.

It is not about being given trust, it is about showing trustworthiness.

When it comes to sharing data, people tend to trust the NHS, and see the benefit of sharing data for research. However, they are less trusting in government use of data, and even less trusting of for-profit uses of data. There are many examples of success in smaller geographical areas where benefit to clinicians has been clearly shown and the trust of the community has been won.

Patient and clinician benefit need to be at the centre of this debate, it is not ‘data sharing for data sharing’s sake’

Clinicians and healthcare professionals have a very important role to play in supporting the agenda of opening up data for research and it is important they understand its value: they will deliver better care for their patients if data is shared rather than over-protected.

Organisations that represent patients are important too, and many charities like Cancer Research UK are already playing an important role. More public engagement and champions outside of academia and government are also needed.

Further linking health and social data will also help understand the social determinants of ill health across large populations and the effectiveness of existing interventions. The lack of an appropriate model has in the past limited access to de-identified data that could lead to improvements in public health.

Participants at roundtable discussions

Health service delivery

Stephen Anderson, Executive Director, Campaign for Social Science
Eric Barratt, NHS Healthy Workforce Programme Manager, NHS England
Anda Bayliss, Research and Innovation Manager – Evidence, Royal College of Nursing
Siôn Charles, Deputy Director, Bevan Commission
Ed Day, Senior Clinical Lecturer in Addiction Psychiatry, National Addiction Centre, Institute of Psychiatry, and Consultant at Birmingham & Solihull Mental Health NHS Foundation Trust
Erik Ducker, Portfolio Developer – Communities and Knowledge, Wellcome Trust
Posy Goraya, Senior Manager, NHS RightCare, NHS England
Sir Malcolm Grant CBE FAcSS, Chair, NHS England
Laura Harper, Research Manager, Health Foundation
Paula Lorgelly, Deputy Director, Office of Health Economics
Christine McGuire, Science Research and Evidence Directorate, Department of Health
Amie McWilliam-Reynolds, Head of Research, Healthwatch
Susan Michie FAcSS, Director, Centre for Behaviour Change, University College London, and Chair of The Health of People project
Al Mulley, Managing Director, The Dartmouth Center for Health Care Delivery
Carol Propper CBE, Associate Dean of Faculty and Research and Chair in Economics, Imperial College Business School
João Rangel de Almeida, Portfolio Development Manager, Wellcome Trust
Chris Walters, Chief Economist, NHS Improvement
Tim Whitaker FAcSS, Director of Communications, Hanover Housing, and member of The Health of People Working Group
Sharon Witherspoon MBE FAcSS, Head of Policy, Campaign for Social Science

Prevention

Louise Ansari, Director of Communications, Centre for Ageing Better
Mark Baker, Director of the Centre for Guidelines, NICE
Amanda Bunten, Behavioural Insights Team, Public Health England
Tim Chadborn, Behavioural Insights Lead Researcher, Public Health England
Ed Day, Senior Clinical Lecturer in Addiction Psychiatry, King’s College London, and Consultant at Birmingham & Solihull Mental Health NHS Foundation Trust
Erik Ducker, Portfolio Developer – Communities and Knowledge, Wellcome Trust
Kevin Fenton, Director of Health and Wellbeing, Public Health England
Paul Lincoln, Chief Executive, UK Health Forum
Christine McGuire, Science Research and Evidence Directorate, Department of Health
Wendy Meredith, Director of Population Health Transformation, Greater Manchester
Susan Michie FAcSS, Director of the Centre for Behaviour Change, University College London, and Chair of The Health of People project
Laurence Moore FAcSS, Director of the MRC/CSO Social & Public Health Sciences Unit, University of Glasgow
João Rangel de Almeida, Portfolio Development Manager, Wellcome Trust
Helen Walters, Public Health Consultant Advisor, NIHR – NETSCC
Robert West, Director of Tobacco Studies, the Cancer Research UK Health Behaviour Research Centre, UCL, and member of The Health of People Working Group
Sharon Witherspoon MBE FAcSS, Head of Policy, Campaign for Social Science
Dagmar Zeuner, Director of Public Health, London Borough of Merton, and member of The Health of People Working Group

Use of health data

Jo Churchill MP, Member of Parliament for Bury St Edmunds
Tommy Denning, Information Governance Policy Manager, Department of Health
Erik Ducker, Portfolio Developer – Communities and Knowledge, Wellcome Trust
Katie Farrington, Director of Digital and Data Policy, Department of Health
Harry Hemingway, Director of the Farr Institute of Health Informatics, UCL
Susan Michie FAcSS, Director, Centre for Behaviour Change, University College London, and Chair of The Health of People project
Freda Mold, Lecturer in Integrated Care, University of Surrey
Ronan Lyons, Professor of Public Health, Swansea University and Director, CIPHER, and Co-Director of the SAIL Databank
Louise Park, Associate Director (Health), Ipsos MORI
Nicola Perrin, Head of Policy, Wellcome Trust
Andrew Roddam, ‎Vice President & Global Head Epidemiology, GSK
Shobna Vasishta, Programme Manager, SHARE
Robert West, Director of Tobacco Studies, Cancer Research UK Health Behaviour Research Centre, UCL, and member of The Health of People Working Group
Sharon Witherspoon MBE FAcSS, Head of Policy, Campaign for Social Science