RESEARCH
Health and social care
Policymakers around the world need to deliver effective health and social care services with limited budgets. At the same time, technological advances and the availability of rich datasets provide opportunities for research as well as new models for the delivery of services.
Through comprehensive evidence reviews, data analysis, development of metrics, and qualitative research, we provide governments, and health and social care providers with critical insights.
Below is a selection of our work on health and social care.
Understanding the social care support needs of Scotland's prison population — Scottish Government
As a response to the increasing need for providing the Scottish prison population with social care support, the Scottish Government commissioned Alma Economics to assess the nature and prevalence of social care needs among people in custody.
Our team carried out a comprehensive review of existing evidence and interviewed Scottish Prison Service officials, Prison Governors and NHS and social care professionals to understand key drivers of social care needs and challenges in providing comprehensive support.
Following this, we developed a novel probability model to produce detailed quantitative estimates of the number of people in prison in need of social care, disaggregated by age, gender, and prisoner status.
➥ The full report is available on the Scottish Government website.
Gambling and Mental Health: Analysis of the Annual GB Treatment and Support Survey — GambleAware
Our team was commissioned by GambleAware to conduct secondary analysis on three waves (2020, 2021, 2022) of the Annual Great Britain Treatment and Support Survey to explore the relationship between mental health and gambling harms.
We carried out a desk-based review of the existing evidence on gambling harms and mental health, including that of “affected others” – i.e., people impacted by others’ gambling. Further, we performed in-depth descriptive, correlation, and regression analysis to explore the relationship between Problem Gambling Severity Index (PGSI) scores and various metrics related to mental health.
Our analysis indicates that, since 2020, the prevalence of both problem gambling and mental health diagnoses has increased. Further, our findings show that certain mental health issues like intermittent explosive disorder (a.k.a. anger disorder) and ADHD are significantly more common among individuals experiencing problem gambling (individuals with PGSI scores of 8 or higher). Individuals who identify as affected others also experience worse mental health than the general population.
The findings of our research will be used by GambleAware to inform guidance to individuals and medical practitioners about the relationship between gambling harms and mental health. It will also help guide future research and uses of the Annual Great Britain Treatment and Support Survey.
➥ The findings from this report have been published on the GambleAware website.
Evaluability Assessment of the Connected Communities Strategy — Welsh Government
Protracted loneliness or social isolation can have a major impact on people’s physical and mental wellbeing, as well as wider social and economic impacts. According to data from the National Survey for Wales (2021/22), 13% of the Welsh population perceived themselves to be lonely, with 58% “sometimes lonely”.
To address the issue, the Welsh Government has developed the Connected Communities strategy, a long-term plan to tackle loneliness and social isolation in Wales and to build stronger social connections. We were commissioned by the Welsh Government to assess the evaluability of this strategy.
In a comprehensive scoping phase, we first conducted literature reviews and interviews with government policy leads and external stakeholders. Building on these findings, we developed an integrated Logic Model and Theories of Change to outline the causal pathways through which the strategy is expected to generate its intended impacts. We evaluated the strategy against predefined criteria, reviewed potential evaluation methods, and proposed recommended indicators for future evaluators. Lastly, we provided actionable recommendations to enhance the strategy's evaluability.
Our findings will guide the Welsh Government as it determines the most appropriate evaluation activities for the Connected Communities strategy.
The UK Covid-19 Inquiry Terms of Reference: Analysis of Consultation Responses
The UK Covid-19 Inquiry asked Alma Economics to analyse responses to a consultation on the draft Terms of Reference which set out the scope for the Inquiry.
Our team carried out segmentation analysis of the closed-ended questions to show how opinions varied between different demographic groups and regions of the UK. In addition, we used Alma Economics’ proprietary software to conduct thematic analysis of over 20,000 responses to open-ended free-text field questions, identifying key ideas and issues raised by respondents. Our software uses cutting-edge Natural Language Processing (NLP) machine learning techniques to power an integrated process of manual and automated text analysis.
The analysis received wide press coverage and provided an overview of the public’s most pressing concerns regarding the Inquiry’s scope, its priorities, and the ways in which it can ensure that people’s experiences can be heard. These findings helped inform the scope of the Covid-19 Inquiry and ensure that the public’s concerns were factored into the decision-making process regarding what the Inquiry should look into, what it should investigate first, and how it should engage with stakeholders.
Our report and the Inquiry’s Terms of Reference consultation summary report can all be found here.
Selected press coverage:
BBC: https://www.bbc.com/news/health-61423500
The Guardian: https://www.theguardian.com/uk-news/2022/may/12/chair-of-uk-covid-inquiry-urges-johnson-to-broaden-its-scope
Evening Standard: https://www.standard.co.uk/news/uk/covid-inquiry-terms-of-reference-mental-health-young-people-inequality-b999630.html
Strategic Evidence Review: Serving Military Community and Veterans — GambleAware
The first survey on gambling risk factors among UK Armed Forces veterans concluded that veterans were over ten times more likely to experience gambling-related harms than non-veterans. In light of these findings, GambleAware commissioned Alma Economics to conduct a strategic review of the evidence base on gambling-related harms among the military community and veterans. This research aimed to deepen understanding of (i) what existing activity or services are being delivered to support this community to reduce gambling-related harms and (ii) what works, in what circumstances, and why in terms of prevention, early intervention, and treatment of gambling-related harms in this community.
To conduct this investigation, we employed a Rapid Evidence Assessment methodology, complemented by interviews with service providers and academics. The resulting report and evidence map offers a thorough overview of the evidence base regarding the nature of gambling within the military community, the current landscape of services, and recommendations for improving screening, prevention, and treatment of gambling-related harms among serving military personnel and veterans in Great Britain. The recommendations will inform GambleAware’s role in supporting this community going forward.
Self-help strategies for reducing gambling harms — GambleAware
Past research has indicated that only 5-12% of people experiencing harmful gambling seek formal treatment due to perceived and structural barriers. In its place, self-help strategies are a common and often preferred way for people experiencing gambling harms to reduce these harms. It has been demonstrated that such strategies can be successful in significantly reducing gambling severity in the absence of formal treatment.
In this context, Alma Economics was commissioned by GambleAware to explore the use of self-help strategies among people who are experiencing gambling-related harms. We carried out a Rapid Evidence Assessment to explore the evidence on the use and effectiveness of different types of self-help strategies. This included exploring which combinations of strategies are used, how marginalised communities engage with these strategies, and learnings from adjacent sectors (e.g. substance use, mental health).
Our resulting report and evidence map provide a comprehensive overview of the literature on self-help strategies along with key recommendations and identify knowledge gaps and areas for future research.
➥ Read our report here.
Children’s and young people’s mental well-being during the Covid-19 pandemic — Public Health Wales
Alma Economics was commissioned by Public Health Wales to carry out a review of evidence on the impact of the Covid-19 pandemic and the associated government measures on the mental well-being of babies, children, and young people. Our team conducted a systematic literature review to provide evidence-based answers on the impact of the pandemic, and an analysis of recent data capturing the changes in children's mental well-being before and during the pandemic.
Public Health Wales will use the report findings to support a Mental Well-being Impact Assessment (MWIA) of the impact of Covid-19 on children and young people, to inform policy and decision-making among stakeholders in Wales.
➥ You can read the full report here.
Consultation Analysis: New Cancer Strategy — Scottish Government
The Scottish Government commissioned Alma Economics to conduct an analysis of a written consultation which sought the public’s views on cancer prevention, management, and care.
Given the projected increase in cancer incidence, the country’s ageing population, and the challenges resulting from socioeconomic inequalities and the Covid-19 pandemic, this strategy will affect the lives of many Scottish citizens affected or at risk of cancer.
We used rigorous descriptive and thematic analysis of responses to identify the key themes put forward by the public. Respondents placed great emphasis on the need to prioritise prevention and early intervention through raising awareness, promoting healthier lifestyles, and facilitating earlier diagnoses.
Our analysis indicated that tackling unequal access to cancer care arising from socioeconomic and geographic factors was also important to respondents. There were also calls for greater support for the workforce, more investment in research and innovation, greater recognition of secondary, rare, and less survivable cancers, and a more person-centred approach, among other themes.
Our analysis will inform Scotland’s new cancer strategy.
➥ The report can be found here.
Return on investment of digital technology adoption in adult social care — Better Security, Better Care
The Better Security, Better Care programme (BSBC) commissioned Alma Economics to develop a tool that adult social care providers can use to estimate the indicative return on investment and financial savings from adopting digital technology.
To enable this, we first undertook an evidence review of existing digital technologies such as telecare, and workforce planning software. Then, we developed case studies to evidence the impacts of digital technology adoption in social care, which were subsequently checked through several interviews and a round-table discussion with BSBC stakeholders and adult social care leads. For each case study, we monetised: (i) financial savings and efficiencies; (ii) implementation costs; (iii) wider NHS efficiencies; and (iv) health and wellbeing outcomes for patients.
All results were then aggregated and collated in a user-friendly dashboard, allowing social care providers to change key assumptions such as the number of care workers and technology areas for investment, and tailor results to their setting.
Development of Composite Metrics for the Monitoring and Prioritisation of Health and Wellbeing Conditions — Rail Safety and Standards Board
Alma Economics was commissioned by the Rail Safety and Standards Board (RSSB) to develop a tool for monitoring health and wellbeing in the rail sector.
Our team conducted a thorough review of key areas in occupational health and wellbeing in the rail industry, identifying health and wellbeing monitoring frameworks already in use in the rail and other industries in the UK and abroad. This process led to the development of the Health and Wellbeing Index (HWI). HWI is a composite index that covers sickness absence, cases of diagnosed or self-reported conditions, exposure to health risks as well as mental wellbeing. Based on valuation methodologies from health economics, HWI brings these components together in a headline metric that tracks employee health and wellbeing outcomes over time.
HWI will be a useful tool for the rail industry, feeding into existing management systems to improve the health and wellbeing of workers. Our approach also has wide applicability to other sectors aiming to promote health in the workplace.
➥ The full report is available on SPARK (free access, requires registration).
➥ Read our research paper (on the wider applicability of our approach) published in Safety Science here.
Council social care support for people with lifelong disabilities — Local Government Association
The Local Government Association commissioned Alma Economics to investigate the experience of council social care support for people with lifelong disabilities. We wanted to identify ways in which this support can be improved and what barriers there are to delivering and accessing the support. We were also interested in understanding disabled people’s transition from children to adults’ services.
To get a good understanding of the topic from the perspective of service users as well as service providers, our team of researchers conducted a review of existing evidence and interviews with social care staff and parent carers of children and young people with lifelong disabilities.
Through thematic analysis, we identified several important themes that were set out in a final report and a simple English version of the report. Both reports contain quotes from service users, their families, and service providers to better illustrate the themes identified.
Findings from this project may be used to inform future LGA research and solutions on how to improve social care services for people with lifelong disabilities and their families.
Evaluability Assessment of the Healthy Weight: Healthy Wales Strategy — Welsh Government
Tackling obesity is amongst the most significant public health challenges in Wales, with around 25% of four- to five-year-olds and nearly 60% of adults currently either overweight or obese. To combat this challenge, the Welsh Government has developed the 10-year Healthy Weight: Healthy Wales (HWHW) strategy to reduce and prevent obesity in Wales.
We were commissioned by the Welsh Government to assess the evaluability of this strategy. We advised the Welsh Government on how they should approach the future evaluation of the strategy and how limited resources should be allocated to these evaluation activities. To support this, we actively engaged with Public Health Wales, the Welsh Government and other expert stakeholders in Wales, such as academics and Obesity Alliance Cymru.
Our work included assessing the feasibility of different evaluation methods in line with HM Treasury’s Magenta Book and Green Book, to develop a bespoke evaluation framework for the strategy. We then worked with stakeholders to produce a series of logic models and a Theory of Change to determine how HWHW and respective interventions will lead to the desired outcomes. This exercise was used to inform the evaluation approach and the identification of key indicators that can be used to evaluate the programme’s success. We developed a toolkit for determining which of the strategy’s policies should be evaluated and which evaluation type would be most appropriate, given constraints relating to data availability, relative and absolute cost, timeliness and robustness.
Our work will be used by the Welsh Government to determine the appropriate evaluation activities of the HWHW programme.
➥ Find our report here.
Strategic Evidence Review: Training
In order to provide and commission better training services for professionals supporting individuals experiencing or at risk of experiencing gambling harms, GambleAware commissioned Alma Economics to investigate existing training programmes. The goal was to understand what makes these programmes effective and identify the barriers faced by practitioners trying to access or deliver them.
To achieve this, our team utilised a Rapid Evidence Assessment methodology supplemented with interviews with key stakeholders. The report culminated in a set of recommendations to help GambleAware deliver and commission more effective training programmes in Great Britain.
British Sign Language (BSL) National Plan 2023-2029: Analysis of consultation responses
The British Sign Language (Scotland) Act 2015 requires the Scottish Ministers and public bodies listed in the Act to publish and consult on a draft of their British Sign Language (BSL) plan. In this context, the Scottish Government launched a written consultation between July and September 2023, seeking stakeholders’ views on the draft British Sign Language (BSL) National Plan 2023-2029. Alma Economics was commissioned by the Scottish Government to analyse the responses to that consultation.
Descriptive analysis was conducted on the closed-format questions, and thematic analysis was used to synthesise themes raised in the open-text questions and during over 40 community consultation events. The findings from our consultation analysis informed the BSL National Plan 2023-2029, published in November 2023.
➥ Our report is available here.
COVID-19 and employment changes in Wales: Promising interventions to improve health and health equity — Public Health Wales
The Covid-19 pandemic and related policy measures brought significant changes in the labour market in Wales and internationally. These changes, resulting in unemployment, income insecurity, and uncertainty, can be detrimental to physical and mental health.
Public Health Wales sought to identify interventions that could address the health impact of employment changes caused by the pandemic. For this purpose, our team developed an evidence map from the academic and grey literature. At the core of our methodology was a search protocol tailored to the specific research questions, allowing for a transparent and replicable search of the literature. The findings of this study were summarised in an interactive online tool, which gives users the opportunity to explore the evidence of interest swiftly and identify gaps in the literature by using the available filters.
For this study, we also delivered a technical report outlining our methodology, a narrative summary presenting overarching findings, and a Research Extraction Sheet (RES) providing further information on the studies included in the map.
The reports and evidence map are published on the Public Health Wales website.
Our reports and interactive evidence map:
Sustainable care commissioning rates — Royal Borough of Kingston upon Thames
Alma Economics was commissioned by the Royal Borough of Kingston upon Thames (RBK) to collect and analyse data on the costs incurred by the care home and home care providers in Kingston as part of the Market Sustainability and Fair Cost of Care (FCOC) exercise set out by the Government. The exercise is meant to inform how adult social care will be reformed by ensuring that providers are paid a fair amount and developing resilient and sustainable care markets.
Our team engaged with providers in Kingston and offered targeted support to fill in the questionnaire, including one-to-one sessions, workshops, and a follow-up exercise to increase the quality and robustness of the data. The data collected from providers were then submitted to the Department of Health and Social Care (DHSC).
As part of this project, we worked closely with RBK to form a robust assessment of sustainable commissioning rates for homecare and care homes in Kingston to ensure that the commissioning rates set out do not result in over- or underpaying for care. To assess the sustainability of the recommended commissioning rates we assessed the financial position of care providers in Kingston, analysed the price indexes that best capture cost pressures, and modelled the impact of changes in commissioning rates.
The result of the analysis informed a commissioning strategy that ensures long-term provision and value for money in Kingston.
Cost benefit analysis for pan-London implementation of the North West London radiography career framework
Alma Economics was commissioned by the North Central and East London Cancer Alliance and Health Education England (HEE) to examine a proposed solution to address retention and recruitment issues for diagnostic radiography staff.
Our methodology combined quantitative (e.g. administrative data) and qualitative elements (e.g. case studies and an online survey) to estimate the costs and benefits that are expected to flow from the rollout of a competency-based progression scheme for diagnostic radiographers in London.
To calculate the costs, we considered several data sources on hiring and administrative and supervision costs, as well as on vacancy rates, staff in post, salaries, and tenure. The key assumptions for calculating the benefits were informed by interviews and an online survey with Trusts implementing competency-based progression schemes.
To calculate the baseline, we developed a micro-simulation model to estimate staffing changes and costs month by month over a 5-year period for a range of scenarios, including full implementation and partial implementation. We also estimated how impacts of the progression scheme would vary across Trusts with different characteristics, such as differing recruitment, retention, and vacancy rates.
Our analysis included recommendations and highlighted the factors that would underpin the implementation of a successful career progression scheme.
Identifying Measures to Prevent Customer-on-Staff Work-Related Violence — Rail Safety and Standards Board
In the context of its commitment to protecting the health and wellbeing of staff in the sector, the Rail Safety and Standards Board (RSSB) commissioned Alma Economics to support the rail industry in Great Britain to establish effective policies for the prevention and management of workplace violence.
Our team produced a robust evidence base on good practice in tackling workplace violence following a systematic review of the international literature. We also carried out quantitative analysis of the causes and impact of violence in the sector, and we engaged with stakeholders to gain an in-depth understanding of the policy landscape. This research helped us explore how good practice identified in our review can be adapted to the specific needs and challenges facing the rail sector in Great Britain.
Based on key findings from this work, we arrived at a set of interventions and recommendations on improving current practices in the sector. We also produced a suite of tailored tools for policy decision-making, including a framework to enable consistent assessment of workplace violence policies and a detailed guide for putting together business cases for training for staff and line managers.
➥ You can find out more about our research and tools here.
Adult social care predictive modelling — Local Government Association
Alma Economics was commissioned by the Local Government Association (LGA) to engage with councils and other stakeholders to understand the need for a predictive modelling tool. The tool will support councils' decisions about future care provision and commissioning activity.
As part of the project, we spoke with representatives from 20 councils across England and non-government bodies, as well as staff from the Association of Directors of Adult Social Services (ADASS), the Care and Health Improvement Programme (CHIP), and other stakeholders via a series of regional workshops. During these conversations, we presented a long-term vision for a predictive model and gathered insight into the needs and concerns of councils around this tool.
The stakeholder feedback informed the development of core principles for the model as well as our proposal for a pilot.
Review of NHS winter pressures — British Thoracic Society
The British Thoracic Society (BTS) asked Alma Economics to review the available evidence on the impact of respiratory diseases on the NHS during the winter season. The BTS is dedicated to improving the care of people with respiratory and critical care conditions, bringing together healthcare professionals and other specialists in the field. Our work for the BTS informed their thinking on policy solutions to the NHS winter pressures.
The review included evidence on hospital admissions, bed days, and costs, comparing the wintertime impact of respiratory diseases with other times of the year and other disease areas. The project drew from NHS data and included the production of a data factsheet. For example, we used data from NHS Digital’s Hospital Accident and Emergency (A&E) Activity statistics to chart the evolution over time of the number of A&E attendances for the top 20 most common primary diagnoses.
Taskforce for Lung Health Evidence Review
Alma Economics played an integral role in the development of a 5-year strategy to improve lung health in the UK for the British Taskforce for Lung Health.
We systematically reviewed evidence and developed an easy reference briefing document to guide policy discussions with important stakeholders.
To assist the Taskforce in identifying key issues, we ranked vital recommendations against the assessment criteria covering impact, feasibility, value for money, and reach.