How budget cuts have affected England’s alcohol and drug treatment services

By Suzie Roscoe

A bit about me: I am in my final year of my PhD at ScHARR, which is funded by a University scholarship I won in 2017. Prior to this, I had been working in the public sector for over 15 years leading commissioning and strategy for community safety, alcohol and drugs; a job I left to complete this PhD. Why? There are two main reasons. First is my passion for the subject. My study focusses on the impact of budget cuts from alcohol and drug treatment services and due to my professional experiences, I wanted to help better understand the effects to support treatment policy. Second, after completing my Masters part-time alongside a demanding job, I decided complete my PhD on a full-time basis. When I’m not studying, you can usually find me walking my rescue dogs or running in the hills.

A bit of background to my study: In England, an estimated 900,000 adults need specialist treatment for alcohol or drug dependence. Whilst this is only about 2% of the adult population, the associated harms are substantial and far-reaching. Alcohol and drug dependence can negatively affect an individual’s physical and mental health, their wellbeing, working lives, and local communities. It can affect their relationships, quality of life and life expectancy and create pressure on publicly funded services, including hospitals, social care and the police. Specialist treatment forms an important part of national policy to reduce this harm as it is evidenced to improve health and social outcomes for individuals, their families and broader society. Local authorities are responsible for funding and monitoring treatment services in England; with most of the funding being made available by the Public Health Grant. This is money given to local authorities by national Government to fund public health services, including alcohol and drug treatment. Since 2013/14, there have been reports of substantial budget cuts to Public Health Grant funding and the money allocated to alcohol and drug treatment. Whist there have been no declines in the estimated number of people who would benefit from treatment, there have been reductions in the number of people engaging in treatment but we do not know if this is connected to the budget cuts. Fewer people engaging in treatment may contribute to increased health and social harms and, in recent years, there have been increases in related hospital admissions and deaths.

Study design: This blog focuses on the results from phase one (of three) of a mixed method study (Figure 1); designed after completing a systematic review of the available evidence. Phase one matched routine quantitative data from the Ministry of Housing and Local Government, the National Health Service, the Office for National Statistics and the National Drug Treatment Monitoring System. Phases two and three build upon this by interviewing, and then surveying, people responsible for funding treatment services to understand their views and experiences of the effects of budget cuts.

Figure 1: Diagrammatic overview of my PhD multimethod study design

What did I do? In phase one, I matched readily available data from administrative reports on each local authority. I then looked at whether local authorities that had experienced larger changes in public health grant spending had also experienced larger changes in the following outcomes: treatment engagement, successful completions, alcohol-specific hospital admissions, alcohol-specific mortality, and drug-related deaths.

What did I find? Treatment services in England have lost more than £212.21 million (-27%) of Public Health Grant funding between 2013/14 and 2018/19. By 2018/19, 34,000 fewer (-11%) people were engaging in treatment and 44,000 fewer were successfully completing (-21%) alcohol and drug treatment despite overall increases in the estimated number of people who would benefit from treatment. During the same time period, there were increases in alcohol-specific hospital admissions (+9%), alcohol-specific mortality (+4%) and drug-related deaths (+24%). Areas that had experienced bigger cuts in treatment spending saw fewer people accessing and successfully completing treatment. However, areas that had experienced bigger cuts did not experience bigger increases in admissions or deaths. In my published paper, I encourage caution in interpreting these results for several reasons. For example, most people who would benefit from alcohol or drug treatment do not access treatment, so any relationships may be more identifiable by matching patient data. Also, the study focuses on a six-year period but it may take much longer for the full effects to be seen.

Figure 2: Dual axis chart showing trends in mean local authority public health grant investment in treatment and mean treatment access and successful completion numbers

These results might help policy makers make decisions about treatment funding. Fewer people engaging in, and successfully completing, treatment might increase relating harm and increase cost pressures elsewhere, including health and social care and criminal justice services.

Where can you find out more? If you are interested, you can read the full paper in Drug and Alcohol Review.

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2021 Sheffield World Health Assembly Simulation (#SheffWHO2021) – Building Back Better: Strengthening Health Systems

The Sheffield World Health Assembly Simulation, or #SheffWHO is a student-led annual conference simulating the process of the annual World Health Assembly, the World Health Organization’s supreme governing body. During this immersive simulation, participants role play with specific roles such as Member State representatives or Non-State Actors such as NGOs, pharmaceutical companies or media organisations. Delegates then debate throughout the three-day event, drafting resolution papers to propose innovative solutions to major health challenges. Keynote speakers, including senior representatives from WHO and academics from around the world, are also invited to help stimulate discussion and advance real-world learning.

Attending the conference is a unique experiential learning opportunity and highly recommended for anyone interested in Public Health or Global Health.In its fourth year running, #SheffWHO2021 was held virtually from 19 to 21 March 2021. This year, over 100 participants joined from 34 countries around the world, including Europe, Africa, Australasia and the Americas.

Prior to the event, delegates submit position papers highlighting the views of the country they represent, on the conference theme, which this year was “Building Back Better: Strengthening Health Systems”. Ms. Magali Collonnaz participated as the delegate of Germany and won the ‘Best position paper’ award. Her paper is published below.

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Introduction

We are living in extraordinary times: 2021 brings the COVID-19 mortality to >2 million deaths worldwide (1) and to >70,000 deaths in Germany (2). The COVID-19 pandemic has been exerting enormous pressure on health systems around the world, highlighting the sub-optimal resilience of health systems, even those renowned for their high performance (3). Building back after the COVID-19 pandemic is intrinsically linked to health systems strenthening. Health systems strengthening is key to limit the adverse consequences of epidemics, and to treat cases while maintaining essential health and non-health services (4). Moreover, access to affordable and quality healthcare is a fundamental human right and a prerequisite for sustainable social and economic development (5). The question now is what can we do to strengthen health systems?

Germany : Country profile & health system

In 1883, Germany was the first country in the world to establish a nationwide Social Health Insurance (SHI)(6). The German health system has a complex governance structure:  Germany is a federal republic and decision-making powers are shared between national and state levels (7). Governance of the German health system relies strongly on self-governing structures and there is limited state control. Health insurance is mandatory in Germany since 2009 and coverage by the SHI is nearly universal, with 88% of the population covered by the SHI in 2017 (7–9). Private health insurances (PHI) cover 10% of the population, while the last 2% are covered by special schemes (7–9). Employees earning less than 54 900€ per year are automatically insured by SHI. Other people can opt for PHI or stay in SHI on a voluntary basis (6,8). Everyone has an equal right to health care regardless of their income (9).

Healthcare is mostly financed with the premiums paid by employees and employers (9). These premiums are based on income. SHI revenues are pooled together with some tax subsidies in the central health fund and reallocated to sickness funds. Physicians are paid fee-for-service, and hospital care is reimbursed through diagnosis-related group based payment (6,8). Germany invests a substantial amount of its resources on healthcare, with 3 996€ per capita spent in 2015, the second highest amount in the EU (6). A total of 84.5% of health spending is publicly funded (the highest share in the EU ) and out-of-pocket spending only amounts to 12.5%, which is below most EU countries (6).

Life expectancy at birth in Germany was 80.7 years in 2015, slightly above the EU average of 80.6 (6). Access to health in Germany is good, with very few citizens reporting unmet needs for medical care (0.5% of the population reported having forgone needed care in 2015). However, unmet need is higher in lower income groups of the population (6).

Health system strengthening: Germany’s current response

Germany is strongly committed to strengthening its health system through actions on the six health system building blocks identified by the WHO (5,10). Germany has a strong and resilient health system, resulting in relatively good health for the population. This is the result of several measures taken by the government over the past few years. First, the Institute for Quality Assurance and Transparency in Health Care (IQTiG) was founded in 2015 to develop quality indicators and make medical care quality more transparent for patients (6). Second, several reforms have addressed the shortage of physicians, in rural areas. For example, the 2015 Healthcare Strengthening Act promoted the establishment of integrated care programs, enabled municipalities to set up health centres and allowed hospitals in rural areas to provide outpatient care (11). In addition, physicians working in rural areas now receive financial incentives (6). Third, the recent Long-Term Care Strengthening Acts have considerably expanded the benefits package. This was coupled with an increase in insurance contribution rates by 0.5%. Part of this increase is used to create a long-term care precaution fund (6). Lastly, Germany has a very large hospital inpatient sector, with 813 beds per 100 000 inhabitants, which is the highest ratio in the EU and 58% above the EU average (6). Bed capacity has only been reduced by 11% since 2000, whereas some European countries have reduced capacity by more than 40% over the same period. Germany also has high numbers of physicians and nurses, with per population rates above the EU average (6).This is partly explaining why Germany’s health system was so successful in managing the Covid-19 pandemic.

However, the health system still has room for efficiency improvement: Given the high number of hospital beds, the physician to bed ratio is relatively low, and the nurse to bed ratio is one of the lowest in the EU. Moreover, amenable mortality in Germany is below the EU average, but 10% of all deaths were still considered to be avoidable through higher quality and more timely care in 2014.

Health systems strengthening: the solutions

Germany strongly believes that health systems strengthening must be a priority if we want to achieve the sustainable development goals by 2030 (12) and avoid service disruption during future outbreaks. Several actions at the national and international level must urgently be considered.

At the national level

  1. Ensuring access to healthcare for all through universal health coverage is one of the key strategies to

strengthen health systems, as well as to achieve the Sustainable Developing Goal 3. In addition, out-of-pocket payment must be reduced to a strict minimum.

  • Vulnerable and isolated groups of the population must be ensured access to healthcare, and measures must be taken to remove any barriers jeopardising access to healthcare for these groups.
  • All countries should increase the healthcare workforce and number of hospital beds, including beds in intensive care units. This is essential to increase health systems resilience. In addition, the mental health needs of the health workforce must be protected and they should be offered fairer wages.
  • Public health services must be strengthened in order to ensure a timely detection and notification of epidemics or other health-related threats. This includes investing more money into public health services, developing reliable monitoring systems and drafting clear frameworks for emergency public health response.

At the international level

  1. As planetary, animal and human health are intrinsically aligned, one health must be given a high priority in the WHO’s agenda to ensure a better preparedness to emerging infectious diseases outbreaks.
  • We need to use the appropriate metrics in evaluating health systems. Standardized methods for data collection are required to allow for cross-country comparison of the burden of disease caused by an outbreak. We also need internationally comparable measures of precariousness that go beyond GNP and life expectancy to highlight health inequalities.
  • We need to emphasise global solidarity: high income countries must support low-and-middle income countries in post-Covid recovery. Global and national health should be considered together, and there should not be any disparity between countries’ local and global response to tackling a global health treat.

References

1.    WHO Coronavirus Disease (COVID-19) Dashboard [Internet]. [cited 2021 Feb 19]. Available from: https://covid19.who.int

2.    Germany: WHO Coronavirus Disease (COVID-19) Dashboard [Internet]. [cited 2021 Mar 9]. Available from: https://covid19.who.int

3.    El Bcheraoui C, Weishaar H, Pozo-Martin F, Hanefeld J. Assessing COVID-19 through the lens of health systems’ preparedness: time for a change. Glob Health. 2020 Nov 19;16(1):112.

4.    Strengthening the health system response to COVID-19 – Recommendations for the WHO European Region: policy brief, 1 April 2020 (produced by WHO/Europe) [Internet]. [cited 2021 Mar 11]. Available from: https://www.euro.who.int/en/health-topics/Health-systems/pages/strengthening-the-health-system-response-to-covid-19/strengthening-the-health-system-response-to-covid-19-policy-brief/strengthening-the-health-system-response-to-covid-19-recommendations-for-the-who-european-region-policy-brief,-1-april-2020-produced-by-whoeurope

5.    Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ). Health systems strengthening [Internet]. GIZ. [cited 2021 Mar 9]. Available from: https://www.giz.de/en/worldwide/40525.html

6.    State of Health in the EU Germany Country Health Profile 2017 [Internet]. 2017. Available from: https://www.euro.who.int/__data/assets/pdf_file/0004/355981/Health-Profile-Germany-Eng.pdf

7.    Germany: health system review [Internet]. WHO Regional Office for Europe; 2014 [cited 2021 Mar 9]. Available from: https://apps.who.int/iris/handle/10665/130246

8.    Düllings J. Overview of the German Healthcare System. HealthManagement [Internet]. 2010 [cited 2021 Mar 9]; Available from: https://healthmanagement.org/c/imgfr/issuearticle/overview-of-the-german-healthcare-system

9.    Health care in Germany: The German health care system [Internet]. Institute for Quality and Efficiency in Health Care (IQWiG); 2018 Feb [cited 2021 Mar 9]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK298834/

10. Strengthening health systems to improve health outcomes : WHO’s framework for action [Internet]. World Health Organization; 2007 [cited 2021 Mar 13]. Available from: https://www.who.int/healthsystems/strategy/everybodys_business.pdf?ua=1

11. Munir K, Worm I. Health systems strengthening in German development cooperation: making the case for a comprehensive strategy. Glob Health. 2016 Dec 3;12(1):81.

12. THE 17 GOALS | Sustainable Development [Internet]. United Nations. [cited 2021 Mar 13]. Available from: https://sdgs.un.org/goals

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Discussing ‘Tricky Topics’ with Young People at a Distance: the Challenges of Exploring Sensitive Subjects in Virtual Focus Groups

Covid Realities is a research project looking into the experiences of parents and carers on low incomes during the pandemic. Dr Nick Woodrow, Research Associate in ScHARR has written a blog which features on their site. https://covidrealities.org/researching-poverty/tricky-topics-young-people

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The Practice and Research Collaborative (PaRC) Yorkshire Humber: Two years on

In June 2021, the Practice and Research Collaborative (PaRC) Yorkshire Humber will celebrate its second anniversary (https://youtu.be/yQs6uMRvENc). PaRC is led by Professor Liddy Goyder and managed by Dr Annette Haywood (ScHARR) and is a conduit for public health research and knowledge exchange across the Yorkshire and Humber Region. Its mission is to integrate public health research and practice by building on existing national and regional public health structures. PaRC is a way of bridging the research into practice gap and linking academic institutions with local authority based public health practitioners to enable collaboration on research that can translate into the provision of improved public health practice through evidence based interventions.

We have established a successful management group comprising representatives from our academic partners, research interested colleagues within local authorities, public health registrars, Public Health England, and the NIHR Clinical Research Network. PaRC is funded from a number of sources including legacy funding CLAHRC (South Yorkshire and Yorkshire Humber); CRN and PHE. We are able to showcase a variety of activities from our inception in June 2019, including successful funding applications, supporting applications from our local authority partners, developing networks (e.g. Yorkshire Obesity Research Alliance; YORA – https://www.parc-hub.co.uk/links-and-resources/yorkshire-and-humber-obesity-research-alliance-yora/), forging partnerships with our academic institutions, supporting fellowships (https://www.sheffield.ac.uk/scharr/people/staff/alexis-foster) and ensuring close linkages with existing infrastructure, including NIHR Public Health Research Applications and Design Advice – PHRADA (https://www.rds-yh.nihr.ac.uk/wp-content/uploads/2020/09/RDS-PHRADA-what-we-do.pdf). We are also supporting a number of workshops across the region which aim to develop the skills of the public health workforce.

Contact details:

Dr Annette Haywood, Manager Public Health Practice and Research Collaborative (PaRC) YH, School of Health and Related Research
Email: a.haywood@sheffield.ac.uk

Follow us on Twitter! @ScHARRPubHealth @annettehaywood @PaRC_YH

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An Undergrad’s experience of the Think Ahead SURE Scheme

This summer I was lucky enough to take part in the Think Ahead SURE scheme, a summer research programme lasting for 6-8 weeks at the University of Sheffield based in the Faculties of Medicine, Dentistry and Health or Science. Prior to application, prospective applicants are able to review the wide variety of projects available to work on and apply to several simultaneously. Each project is designed and headed by a PhD student who supervises the undergraduate, providing a unique opportunity for peer learning and research. The application process is competitive requiring the submission of a CV and covering letter followed by a panel interview headed by the project leaders.

The Project and its context

change4life-4The Project I worked on was offered by a PhD student in ScHARR and aimed to map out the Behavioural Change Techniques (BCTs) of the Change4Life Food Scanner app. Behavioural Change Techniques are the ‘active ingredients’ of evidenced-based behavioural strategies. These include things like social support, prompts and ques and feedback on behaviour to name a few. The app itself was developed by Public Health England as part of a wider public health campaign aimed at families to target obesity. The app works by allowing the user to scan the barcode of food products and then provides the nutritional content of the item presented in several ways.  Evidence suggests that interventions with a theoretical grounding tend to be more successful in achieving their intended outcome, however it was unclear whether the Change4Life Food Scanner app was designed with theory in mind. BCT mapping was therefore required to identify the presence of BCTs, and their combinations, in order to provide a basis for evaluation of the intervention. The project mapped an updated and outdated version of the app finding that both encompassed BCTs which have previously been found to be effective in similar settings.

My Experience

Undertaking this project has helped me develop both academically and personally.

One of my preparatory tasks was to prepare a grant application to fund the research project. Having prepared the application along with my supervisor, we were about to submit when we were informed that the organisation we were applying to were cancelling funding due to Covid-19. Further bad news followed when we were informed by the University that due to the impending Lockdown and the Covid-19 pandemic, the SURE scheme would be cancelled this year. This was devastating; however, both my supervisor and I were determined not to lose the opportunity. Together we negotiated with the organisers of the scheme to allow us to continue with the project. This meant that we had no funding, we would be working from home on a voluntary basis and I would be undertaking the project part-time while working a part-time job. This taught me determination, perseverance and time management skills. The project allowed me to experience the inner workings of academic research from literature searches and presenting results to preparing a manuscript for publication which has ignited a desire to pursue further research activities and has equipped me with invaluable experience which I hope to apply in my future study and career. At present, our manuscript is being reviewed for publication and should it be accepted, would mean that I will be a second author on a published piece of research as an undergraduate – something which I never would have imagined happening!

A Call for ScHARR Students

While the SURE scheme is open to PhD students and early career researchers from the Faculties of Medicine, Dentistry and Health or Science, there are very few projects offered by ScHARR. I would therefore encourage any PhD students and early career researchers from ScHARR to get involved with the SURE scheme, providing a greater variety of projects for the undergraduate students to get involved with. The SURE scheme is a fantastic opportunity for PhD students and researchers to gain supervisor experience and help an undergraduate flourish in their own research experience. 

Emily Michalik-Denny 

emichalik-denny1@sheffield.ac.uk

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Organising virtual conferences during the COVID-19 pandemic

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This year, I was on the organising committee for the Early Career Alcohol Research Symposium (ECARS) and the Society for the Study of Addiction (SSA) PhD Symposium. Both would initially take place in-person, but it quickly became clear that this was not possible this year. We thought it was important to try to organise online replacements, as conferences are great opportunities for early career researchers (ECR) and PhD students to present their work and network. In this blog, I will reflect on my experience organising and participating in these virtual conferences and I hope this will helpful for those who are planning virtual conferences in the future.

Accessibility
The main advantage of running our events online was increased accessibility. Both ECARS and the SSA PhD Symposium would have been able to accommodate a maximum of 40 delegates in person. However, more than 80 delegates registered for both events and we could accommodate them all online. Many of them would not have been able to attend face-to-face as they were from outside the UK, had other obligations, or did not receive funding for conference travel. Delegate feedback for both events showed that these delegates especially valued the opportunity to present their work and/or network with their peers.

The same benefits applied to external speakers. Both of our events included a career advice panel. Because speakers did not have to travel all over the country for a one-hour session, we could invite a wide range of panel members, including people from outside academia and someone who was on maternity leave at that time. Their perspectives were very useful for delegates and it would have been more challenging to arrange this face to face.

Finally, as a conference attendee myself, I noticed that the online format appeared to encourage ECRs to ask more questions and get more involved in the discussion than in previous conferences.

Logistics
We used Blackboard Collaborate for ECARS and Zoom for the SSA PhD Symposium, because we had institutional licenses for these. Technical difficulties were our biggest concern, as there is little you can do when speakers have weak internet connections or are unable to log in. Luckily, at both events we only had technical problems for one or two speakers, and everyone else was able to do their presentation without trouble.
Blackboard and Zoom had their advantages and disadvantages. Blackboard allowed us to upload the presentations to the meeting in advance, so we didn’t need to rely on speakers to share their own screen (which may be difficult for speakers with poor internet connections). However, that also meant speakers couldn’t use transitions or animations in their PowerPoint slides. In Zoom, speakers had to share their own screen in order to give their presentation. This wasn’t possible for some speakers, which meant that the chair had to share the presentation on their own screen instead. Most delegates were already familiar with Zoom and everyone was able to join, whereas some delegates were not able to access the Blackboard meeting due to it being blocked by their firewall. Zoom also allows you to see multiple videos at once, which was great for socialising during breaks, whereas on blackboard you can only see 6 videos at once. On the other hand, Blackboard has a built-in “raise hand” functionality, which made chairing Q&As much easier, which was lacking on Zoom. For future events, it is worth investigating different conference platforms to find one that matches your requirements.

Socialising
Networking and socialising are important reasons to attend conferences for many people. This was one of the most challenging things to try to implement online. We encouraged delegates to turn on their audio and video during breaks to get to know each other and/or use the chat function to socialise. However, it is hard to hold a conversation online with large groups. At ECARS, we scheduled breakout discussions at the end of each session, which allowed delegates to get to know each other in smaller groups. However, connecting to breakout groups in Blackboard takes quite a long time and this caused some delegates to drop out of the session. At both events, we organised a social event (game/quiz) in the evening to try to replace the conference dinner. Whilst delegates told us they wanted more opportunity to connect with each other, very few attended the evening event. It seems that after a day of online sessions, delegates do not want to spend their evening online too. Future online conferences may want to consider opening a “socialising room” where delegates can drop in and out at different points in the conference to meet others.

Overall, there are many benefits to running an online conference and organisers can choose a platform that suits their needs. Given that we all need to reduce our carbon footprint and that online conferences are accessible to a wider audience, it would worth considering online options for future events even after the pandemic is over.

Dr Inge Kersbergen
SSA Research Fellow, School of Health and Related Research

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Learning from a School Streets pilot in Sheffield: Creating healthy community spaces in a time of COVID-19? – Dr Amy Barnes

Sheffield Schools Carterknowle Junior and Holt House Infants released a community-led evaluation report on 8th October 2020 (Clean Air Day!) about their week-long ‘School Streets’ pilot in late 2019, which involved closing part of Bannerdale Road in the city. I worked with the school community on the pilot and we have learned a lot together.

‘School Streets’ have been trialled across the country. They involve restricting car access near schools during drop-off and pick-up to make streets healthier and safer for children. They often involve other local action too: encouraging active travel, ‘citizen science’ activities to get people involved in monitoring air quality or traffic flows, and organising events so that the community can celebrate and enjoy the space created. 

During the closure, we found that 4 out of 5 families opted for active travel, by walking, cycling or scooting to get to school. The report looks at changes in air quality and traffic volumes during the road closure. It also explores the views of parents, children and local residents.

By working together, we learned that School Streets can create a new local space for children and families: to play, interact, feel safe, be active and be independent. As a local resident, quoted in the report, said:

“There were some teething problems on the first day but once people who use the road were aware of the closure, there was a real difference around the peak hours. The road was not only quieter, but it also felt more open and calmer.”

Our report shows that there is a lot of support locally for more action to create School Streets. The pilot was not without its issues and these are also discussed in our report. For example, the impact of closing the road displaced some of the remaining commuter traffic onto nearby roads, increasing congestion there.

In terms of air quality, we worked with Dr Maria Val Martin, an atmospheric scientist at the University, who was involved with monitoring air quality during the closure. As Maria explained:

The results from the air quality sensors during the plot week were inconclusive. We’d need a much longer period of time to show if there’s a sustained impact on air pollution reductions. However, we know from NO2 readings during the 2020 lockdown that the reduced traffic resulted in consistently lower NO2 levels compared to the averages from 2016-19.”

In the midst of this global COVID-19 pandemic, perhaps now more than ever people need cleaner air to breathe and safer outdoor community spaces to help with physical distancing. ‘School Streets’ schemes could have a vital role to play here. We want all Sheffield and city communities to have the resources to take action to create safe and healthy School Streets as we deal with COVID-19. This will require bold city leadership but we are confident that Sheffield and other cities can seize the opportunity to make ‘School Streets’ schemes a reality.

If you agree, lets start a conversation about it…

Dr Amy Barnes, Lecturer in Public Health (Policy)

Email: a.barnes@sheffield.a.uk

Dr Maria Val Martin, University of Sheffield

Nikki Rees, Co-opted School Governor

For more information about the pilot, you can also Jenny Johnson, Parent Governor, Holt House & Carterknowle Schools Federation.

Email: jjohnson@holthouse.sheffield.sch.uk    

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Supporting ScHARR’s teaching for 2020-21

After the emergency responses needed for the continued delivery and assessment across our programmes since late March, responding to the COVID-19 pandemic lockdown, we are now busy preparing for the start of the 2020-21 academic year with some significant challenges and opportunities to keep us on our toes. We are all sad to see the departure of Rosalyn Ferguson, whose skilful leadership has shaped ScHARR’s vision for consolidation and redevelopment of our Masters-level courses in response to the University’s Programme Level Approach (PLA) initiative. A significant challenge will be to maintain momentum for our PLA developments and it is helpful that UEB has revised the PLA roadmap to allow more time for consideration of how better to embed employability, inclusivity and sustainability in our programmes at a time when we are all focusing on adapting our delivery of teaching and assessment for next semester. In the past few weeks, we have seen a number of changes in module leadership and a strong response from all quarters of ScHARR – academic, research, professional services and administrative staff alike. To ensure that we are well placed to respond flexibly to either a need for tighter restrictions on or more open access to campus-based teaching, essential for good student experience. While there is still some uncertainty about how our teaching will look across the semester, to help prepare for 2020 Luke Miller, Rosalyn Ferguson and Peter Grabowski are delivering a series of three ‘Bytesize’ sessions. Focusing on considerations for developing alternative assessments to replace timed invigilated exams, resources available for engaging students actively in synchronous and asynchronous delivery of learning outcomes, improving the accessibility of learning resources for students in line with recent changes in legislation, and keeping PLA priorities in mind as we go forward.

Learning and Teaching Publication

Rosario E, Grabowski P, Evans M. (2020). How do spaces for learning and teaching impact upon the achievement of small group learning outcomes? A student perspective at the University of Sheffield, UK. Student Engagement in Higher Education Journal. 3(1):157-166

In this project, funded by the Student Engagement team at the University of Sheffield, a group of six Student Ambassadors for Learning and Teaching (SALT), drawn from across the Faculty of Medicine Dentistry and Health, developed a questionnaire to assess student views of the appropriateness of current teaching and learning spaces for achieving target learning outcomes across small group learning activities. In follow-up focus groups, they further explored how a range of teaching spaces might impact upon the achievement of learning outcomes. Drawing also from the literature, they looked beyond environmental factors (lighting, heating, noise etc) to identify three key recommendations that could be easily adopted, for Faculty to consider when planning the reconfiguration of learning spaces; easily configurable rooms for the flexibility to work in different group sizes, multiple visual aids to encourage better engagement and more innovative spaces with dynamic layouts that help regulate the power balances among teachers and learners and that encourage participation. Impacting beyond the Faculty, the University’s central Learning, Infrastructure and Space Management Group endorsed the SALT recommendations, agreed that they should inform the University’s current refurbishment programme for learning and teaching spaces and agreed that student views should be included in refurbishment planning going forward. The paper includes reflections on the project from the SALT Lead (ER), the academic supervisor (PG) and the L&T Professional Services supervisor (ME) and it demonstrates effective empowerment of students’ voice across the Faculty.

(Peter Grabowski is a Senior University Teacher in ScHARR and is Programme Lead for the MSc in Human Nutrition. He collaboratively developed the above project during a secondment as a Faculty Officer for Learning and Teaching.)

M.Ed. Graduation

In January, Emma Hock graduated from the School of Education with an MEd in Teaching and Learning in Higher education. For her dissertation, she examined the impact of a new problem-based learning (PBL) module on the integration of teaching and research in a research-led department at a research-based institution, through interviews with staff and students on the module. Her findings revealed that the module gave students an insight into the research undertaken in the department, and further steps could be taken to make research-teaching integration more complete. In broad terms, participants highlighted a need to make research-teaching integration integral to both teaching and research, potentially involving a ‘win-win’ solution that respects the workloads of staff while also getting students more involved. She has presented her findings at the Learning and Teaching Scholarship Showcase at the University of Sheffield in November 2019 and June 2020.

(Emma Hock is a Senior Research Fellow in ScHARR. She leads on two MPH modules and is Deputy Programme Lead for the MSc International Health Technology Assessment, Pricing and Reimbursement.)

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Public Health Practice and Research Collaborative (PaRC) – Dr Annette Haywood, School of Health and Related Research (ScHARR)

A HaywoodDr Annette Haywood, Manager for the Public Health Practice and Research Collaborative (PaRC) (Yorkshire & Humber) recently blogged about her journey to becoming PaRC Manager.

You can read more here:

From CLAHRC to PaRC my journey so far

See our short animation here:

https://youtu.be/yQs6uMRvENc

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Experiencing MD Viva during lock-down and thinking about racism by Alicia Vedio

I am a postgraduate research student for a Doctorate of Medicine in Public Health, and a physician in the NHS. I started part time PGR studies in 2014 in the School of Health and Related Research (ScHARR) at The University of Sheffield, studying the role that healthcare practitioners have in access to healthcare and submitted my thesis early in January 2020.

My viva was initially planned for March 2020, but the university workers’ strikes, and later COVID 19, delayed this. It was finally arranged for the end of April during the lockdown in the UK. Having a viva during lockdown meant this had to be online and I did not know how would this affect the experience. I had a mock viva using Blackboard Collaborate with both my supervisors that was really useful but I noticed my connection was not strong due to being far from the modem at home. I made sure that on the day of the viva I was in my dining room where the modem is and asked everyone at home to find something to do so, as not to be interrupted – not an easy task during lock-down but it worked well, and I felt more relaxed!

It was a relief that the experience was enjoyable mainly because both my examiners were as interested in the subject of inequalities in access to health care as I am and I was pleased to receive some useful and also complimentary feedback. But of course, it was not all positive. Before the viva, I knew there was a significant gap in my thesis and I wanted to draw attention to it by naming it here. The gap was a lack of discussion of racism theory. I had been made aware of this and had been expecting to receive comments about this in the viva feedback. I did. It was not easy to realise that I had such a serious blind spot and that perhaps I, even if unwittingly, had avoided entering into a deeper analysis and discussion of the subject of racialisation and racism within health care. I really hope and expect that my experience will resonate with other researchers. The many discussions and meetings I attended that reflected the work of the Health Equity and Inclusion theme team made it easier to direct the work I needed to do.

Since my viva, I have learnt a lot about racism theory, and not only about academic work in relation to health care related to my viva feedback. A month after my viva, George Floyd was brutally murdered in the US because he was black – one of a long line of shocking murders of people of colour that has been happening for centuries – and that it was made globally public due to being shared widely within social networks. It sparked a strong worldwide response and has also highlighted some really important resources on the work white people need to do to build a society that is fair to people of colour by dismantling racism. Systemic and structural/organisational racism are useful concepts that help to research and discuss barriers of access to health care services. Understanding structural racism is important but I (we) also need to work on our own blind spots to generate real changes in our lives and where we work. Most importantly, personal realisations are hard to confront. Knowing that I grew up in a white-dominated society with racist structures, organisations, and daily messages and education makes clear why I failed to name such an important issue but is deeply uncomfortable. My only consolation is that I am one of millions of white people in this society with the same problem to tackle. Intent and impact comes to mind, and impact is what we need to focus on. These two concepts refer to how we need to look at the effects of our actions and of the society structures. Intent may be positive but this is not relevant to the detrimental impact it has.

In conclusion, I have learnt that we can only work towards anti-racism and, for me, incorporating this in my thesis is only one of many steps. However, seeing racism and naming racism, is essential for in-depth change and this is why I wanted to tell my story here. Like everyone, my identity is an important part of my life. I am white, despite being of mixed indigenous, Black and Jewish descent, but I am mostly from white-mixed European descent, and I am myself a migrant descending from migrants. My own life experience and that of my ancestors impacted who I am today.

I now realise that the deconstruction required to eliminate racism is life-long work regardless of age and it is essential. In my study and work I look into addressing the role practitioners have in facilitating or hindering access to healthcare for a particular population. I explored the impact myself and other practitioners have, approaching it with an inequalities lens trying to address the imbalance of power between practitioner and individuals. My work now is to link societal, structural and personal racism to understand its role in creating barriers, in influencing personal development and in impacting the work of the NHS.

I also wanted to share some of the excellent resources I have encountered in my search for understanding.

The Great Unlearn” and “Do the Work” by Rachel Cargle provides many examples of how white supremacy and white privilege work and gives frameworks that help examine how organisations can respond to this problem.

Me and White Supremacy” by Layla Saad names many of the barriers to dismantling racism and these are well structured and clearly explained. You can also find her in YouTube describing her book in four steps.

I particularly found “Mindful of Race” a book by Ruth King (2018) helpful- this is a journey through an understanding of racism with a mindfulness framework and helps understand this oppression more clearly. Ruth King uses Buddhist concepts and shares her own experiences in helping organisations become more inclusive, diverse and anti-racist.

There are many more anti-racist resources available; these are some of the ones that have helped me greatly. I would encourage you to explore these or other resources to ensure that, together, we have a collective impact on dismantling societal and structural racism.

Alicia Vedio

Infectious Diseases Physician, Postgraduate Researcher Public Health, School of Health and Related Research, The University of Sheffield – abvedio1@sheffield.ac.uk

Publications:

https://onlinelibrary.wiley.com/doi/full/10.1111/jvh.12673

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017- 4796-4

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