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Cardiff, United Kingdom

Evans B.A.,University of Swansea | Snooks H.,University of Swansea | Howson H.,Welsh Assembly Government | Davies M.,Bangor University
Implementation Science | Year: 2013

Background: Although an evidence-based approach is the ideal model for planning and delivering healthcare, barriers exist to using research evidence to implement and evaluate service change. This paper aims to inform policy implementation and evaluation by understanding the role of research evidence at the local level through implementation of a national chronic conditions management policy.Methods: We conducted a national email survey of health service commissioners at the most devolved level of decision-making in Wales (Local Health Boards - LHBs) followed by in-depth interviews with representatives of LHBs, purposively selecting five to reflect geographic and economic characteristics. Survey data were analysed descriptively; we used thematic analysis for interview data.Results: All LHBs (n = 22) completed questionnaires. All reported they routinely assessed the research literature before implementing interventions, but free-text answers revealed wide variation in approach. Most commonly reported information sources included personal contacts, needs assessments, information or research databases. No consistent approach to evaluation was reported. Frequently reported challenges were: insufficient staff capacity (17/22); limited skills, cost, limited time, competing priorities (16/22); availability and quality of routine data (15/22). Respondents reported they would value central guidance on evaluation.Five interviews were held with managers from the five LHBs contacted. Service delivery decisions were informed by Welsh Government initiatives and priorities, budgets, perceived good practice, personal knowledge, and local needs, but did not include formal research evidence, they reported. Decision making was a collaborative process including clinical staff, patient representatives, and partner organization managers with varying levels of research experience. Robust evaluation data were required, but they were constrained by a lack of skills, time, and resources. They viewed evaluation as a means of demonstrating that targets had been met.Conclusions: There is a gap between evidence-based aims of national health policy and how health services are commissioned, implemented, and evaluated at local level. Commissioners and managers are unable to routinely incorporate research evidence. If health services research is to identify most effective ways to implement high quality care, it should be incorporated into commissioning and service delivery. Local commissioners and managers need to build the critical use of research evidence and evaluation into health policy implementation at local level in order to provide consistent and effective healthcare services. © 2013 Evans et al.; licensee BioMed Central Ltd.

Evans H.F.,Welsh Assembly Government
New Zealand Journal of Forestry Science | Year: 2010

Pest risk analysis is central to determining both country risks from potential biotic threats and identifying the nature and scale of measures the country puts in place to address the identified threat. International Plant Protection Convention procedures, described in International Standards for Phytosanitary Measures No. 11, are the basis for pest risk analysis and recognise three elements; initiation, pest risk assessment and pest risk management. Among the components of the initiation phase, the decision on whether to base the pest risk analysis on a pest or a pathway for movement of a pest is fundamental. However, it must be recognised that the two are inextricably linked, although the tendency to concentrate on the pest is dominant. A pest-based approach has the advantage of focus on a named organism but, increasingly, there is recognition that other pest organisms that might be associated with the same pathway will tend to be missed. Such a 'list-based' approach has been valuable in raising awareness and in tackling recognised threats, but it is probably true to state that most pest-based pest risk analyses have been retrospective and only initiated when a pest has actually been found in a new geographic area. It is, therefore, important to recognise that a range of organisms in addition to those on a phytosanitary list can move along a given pathway. This suggests the need for a more generic approach to risk mitigation of high-risk pathways so that organisms not on current phytosanitary lists are accounted for. In this context, live plants for planting pose the greatest threats and the greatest challenge in development of effective phytosanitary measures. In attempting to manage multiple threats on a given pathway, a philosophy of "manage once remove many" needs to be developed as a component of pest risk analysis aimed at maximum pest risk reduction. © 2010 New Zealand Forest Research Institute Limited, trading as Scion.

Ryan B.,University of Cardiff | Ryan B.,Welsh Assembly Government
Clinical and Experimental Optometry | Year: 2014

Over the last 50 years, the concept of a low vision service has changed considerably. It has moved away from just the optometrist or optician dispensing magnifiers, to having a large team working across the health and social/ community care sectors, with voluntary organisations often playing an important role. This paper reviews how low vision rehabilitation services have evolved and what models of low vision care are currently available. It goes on to consider the effectiveness and accessibility of low vision care. Finally it explores what the future might hold for low vision services, to be better prepared for the increase in the number of people with low vision and their evolving needs and what role(s) an optometrist might have within these anticipated developments. © 2014 Optometrists Association Australia.

Greenhalgh T.,Global Health Policy and Innovation Unit | Morris L.,Hermitage Medical Practices | Wyatt J.C.,University of Leeds | Thomas G.,Welsh Assembly Government | Gunning K.,Performance Management and Service Improvement
International Journal of Medical Informatics | Year: 2013

Aim: To compare the experience of the four UK countries in introducing nationally accessible electronic summaries of patients' key medical details, intended for use in emergency and unscheduled care episodes, and generate transferable lessons for other countries. Method: Secondary analysis of data collected previously on all four schemes; cross-case comparison using a framework derived from diffusion of innovations theory. Main findings: Whilst all four programmes shared a similar vision, they differed widely in their strategy, budget, implementation plan, approach to clinical and public engagement and approach to evaluation and learning. They also differed, for various reasons, in stakeholder alignments, the nature and extent of resistance to the programme and the rate at which records were created. A nationally shared, widely accessible electronic record has powerful symbolic meaning; it may or may not be perceived as improving the quality and safety of care or (alternatively) as threatening patient confidentiality or the traditional role of the doctor or nurse. 'Hard' project management oriented to achieving specific milestones and deadlines sometimes appeared counterproductive when it cut across the 'softer' aspects of the programmes. Conclusion: When designing and implementing complex technologies with pervasive implications, policymakers must consider not only technical issues but also the personal, social and organisational aspects of the programme. A judicious blend of 'hard' and 'soft' management appears key to managing such programmes. © 2013 Elsevier Ireland Ltd.

Burnley S.,Open University Milton Keynes | Phillips R.,Welsh Assembly Government | Coleman T.,Environmental Resources Management Ltd
International Journal of Life Cycle Assessment | Year: 2012

Purpose: The aim of this research was to determine the optimum way of recovering energy from the biodegradable fractions of municipal waste. A part-life cycle study was carried out on the following wastes: paper, food waste, garden waste, wood, non-recyclable mixed municipal waste and refuse-derived fuel. The energy recovery processes considered were incineration, gasification, combustion in dedicated plant, anaerobic digestion and combustion in a cement kiln. Methods: The life cycle assessment (LCA) was carried out using WRATE, an LCA tool designed specifically for waste management studies. Additional information on waste composition, waste collection and the performance of the energy recovery processes was obtained from a number of UK-based sources. The results take account of the energy displaced by the waste to energy processes and also the benefits obtained by the associated recycling of digestates, metals and aggregates as appropriate. Results and discussion: For all the waste types considered the maximum benefits in terms of climate change and non-renewable resource depletion would be achieved by using the waste in a cement kiln as a substitute fuel for coal. When considering the impacts in terms of human toxicity, aquatic ecotoxicity, acidification and eutrophication, direct combustion with energy recovery was the best option. The results were found to be highly sensitive to the efficiency of the energy recovery process and the conventional fuel displaced by the recovered energy. Conclusions and recommendations: This study has demonstrated that LCA can be used to determine the benefits and burdens associated with recovering energy from municipal waste fractions. However, the findings were restricted by the lack of reliable data on the performance of waste gasification and anaerobic digestion systems and on the burdens arising from collecting the wastes. It is recommended that further work is carried out to address these data gaps. © 2012 Springer-Verlag.

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