Tag Archives: NHS

Research with Impact: Economics, Mathematics and Statistics

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Through the REF 2021 rankings, we were pleased to see our impact results in Economics, Maths, and Statistics demonstrate a significant improvement from 2014, with 33% of our impact work ranked world-leading, 50% internationally excellent, and the remaining 17% internationally recognised. Discover our research case studies below. Visit the REF website for full details.

Demographic structure and economic trends: planning for Europe’s financial future

According to a 2019 OECD report, Fiscal Challenges and Inclusive Growth in Ageing Societies, ‘The number of people over 65 for each working-age person will at least double in most G20 countries by 2060′. This is important because age groups differ in their savings behaviour, productivity levels, labour input, contribution to innovation, and investment opportunities. Research by Professor Yunu Aksoy and Professor Ron Smith offered new insight into the specific nature of these differences as well as providing an innovative theoretical model for predicting future trends. Taken up by central banks around the world, this work has contributed to an increased focus on demographics amongst the global central banking community and influenced fiscal policy decisions in a number of countries.

Notably, a 2017 secondment to the Bank of Spain allowed Professor Aksoy to develop his research, to publish alongside Bank economist Henrique Basso, and to help answer the question of ‘how to adapt fiscal and social policies to demographic changes’, identified by the Bank’s head of research as ‘one of the most important issues’ that the Bank is currently facing. Basso went on to sit on a European Central Bank taskforce charged with investigating the future of pension schemes in the EU (a multi-billion-Euro question), which drew directly on Professor Aksoy and Professor Smith’s work to inform its research and recommendations. The work has also been invoked in German debates around immigration (where a recent policy change aimed to facilitate the entry of young, skilled workers to reinvigorate the country’s economy).

Making the right decisions for patients: competition, choice and inequality in publicly-funded healthcare

Successive UK governments have emphasised the importance of patient choice as a means for service users to voice and realise their preferences, and as a way to encourage competition in markets for publicly-funded healthcare. Dr Walter Beckert’s work on patient choice has challenged the assumption that increasing competition helps to improve care provision, showing that competition can reinforce existing inequalities between demographic groups and that patients often turn for guidance to primary healthcare practitioners who have competing priorities of their own.

Dr Beckert is an academic panel member for the Competition and Markets Authority (CMA) and his research has shaped the methodology used by the CMA to analyse the impact of hospital mergers, therefore influencing each of the eight hospital merger decisions made by that body since its first in 2013 (determining the allocation of at least £560 million in public money). More broadly, Dr Beckert’s work with the Health Foundation, a campaigning charity, has helped to change opinion within the sector as to the value of competition and has contributed to a strategic shift away from competition and towards a more collaborative approach to service delivery, as realised in the 2019 NHS Long-Term Plan. Health Foundation CEO Jennifer Dixon points out that ‘the reach of Walter’s work therefore potentially affects all the population in England – circa 55 million’.

New strategies for portfolio management: applying new estimates of equity yields and equity duration

Accurate estimates of expected rates of returns and investment time horizons are crucial for investment managers when it comes to assessing the risk and return characteristics of equity portfolios. Collaborative research originated by Birkbeck’s Dr David Schröder and continued in partnership with Florian Esterer, an asset management professional, proposed a new method for predicting returns and estimating risk on individual shares, using earnings forecasts created by analysts across the market. They also proposed for the first time the concept of equity duration, which sits alongside the well-established idea of bond duration (a measurement of sensitivity to interest rate changes).

Analysts and investment managers at asset management firms across the financial sector took up Schröder and Esterer’s work, featuring the research in internal research reports and in some cases inviting them in to deliver in-person explanations. Feedback from the Head of European Qualitative Research at one of these major international firms described Schröder and Esterer’s research as ‘crucial’ in reframing its approach ‘to measuring the duration of global stocks’, demonstrating direct impact on the billions of pounds of assets that this firm holds under its management. Esterer was also able to put the research into practice at his own workplace, which also manages tens of billions in equity holdings.

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The Experiences of Junior Doctors Working During the COVID-19 Pandemic

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In light of the rapid rise in Omicron cases in the UK, Dr Kevin Teoh, Senior Lecturer in Organizational Psychology, shares the latest findings from a study exploring junior doctors’ mental health.

Dr Kevin Teoh smiling, standing against a wall.

A big factor behind the increasing COVID-19 restrictions being (re)-implemented following the emergence of the Omicron variant is the pressure that our healthcare system is under. It is easy to see the healthcare system as this big organisation and not fully realise that its most important makeup is its people – who have their own thoughts, feeling and emotions.

In this study, we sought to better understand what that experience was like for individual doctors working during this pandemic. Over the past three years I have been working on a project led by Dr Ruth Riley at the University of Birmingham on working cultures, mental health and suicide among junior doctors in the National Health Service. When the COVID-19 pandemic started, we were able to capture the experience and impact of our participants working on the front lines, and in this study we focus on interviews with fifteen junior doctors drawn from a larger online survey of 456 junior doctors.

Challenges of working during the pandemic

Here we saw participants share at a personal level strong feelings of helplessness and powerlessness – especially in relation to the exposure to death and suffering. One participant shared that: “’I’d seen a whole ward just emptied out and then refilled overnight, after people had just died. It was horrendous”. There was also significant concern not only about being infected, but about potentially infecting loved ones outside of the workplace.

Unsurprisingly, the pandemic created substantial upheaval for junior doctors’ workplaces. Patients loads increased substantially while there was a distinct lack of support reported by others. The already under-staffed system was stretched even further as colleagues were infected, had to isolate or simply needed a break having exceeded their working hours.

On top of that, our junior doctors reported a new pressure in having to take on all the new information about this new virus on top of their existing heavy workloads, as this participant shared: “We were getting 20 emails a day, and every single one would have a red flag saying ‘vital, important, must read’, and you’d worry you’d missed something […] there’s so much information, it was constant, and you couldn’t switch off”.

There were changes to work practices, such as increased phone and online consultations, which not only necessitated learning new systems but also was not always conducive to the task at hand or supporting patient needs. It was also an additional source of complaint and abuse from patients who were frustrated with these new forms of consultations. Restrictions on group sizes, socialising and training also accentuated feelings that their training, support and learning needs were not being met.

Strategies of coping with the pandemic

Recognising the challenges from the pandemic, it was therefore concerning that many participants shared the inadequacy of personal coping strategies. Although these may have been useful before the pandemic, it was often felt that it was not enough during the pandemic.

Participants here shared how crying was one way of dealing with emotions. Others tried to be stoic – over time they were worn though and resigned that things were not going to get any better. This led to one participant sharing that “we’ve sort of entered a collective sort of depressive state of acceptance”.

More proactive examples had junior doctors trying to exert more control over their situation, seeking out new roles and tasks, such as getting more involved with supporting relatives which helped them feel as though were actually accomplishing something – “It wasn’t that sort of like, ‘I put lines in people and hopefully’, and then just watching them die”. Others shared about how they had to actively seek out psychological support to help them cope and prevent them from spiralling further.

Positive impact on working practices

Not all was doom, with participants also sharing positive examples of change. Crucially, some changes to work practices – such as longer rotations and working in consistent teams – led to feelings of better stability and more support. There were also examples of how less bureaucracy and more control allowed junior doctors to focus on more efficient and better ways of working with each other and for their patients.

Organisations too had to rapidly learn how to support their workers, with more access to psychological help and resources, or the provision of basic facilities being reinstated – including refreshments and rest areas. These were important given that “there were huge queues at the supermarket, and we were working 12-hour shifts, and it was unpredictable whether you could get food”.

What does this mean?

This study was an eye-opening experience into the challenges faced by junior doctors on working on the front-line at the start of the pandemic. As we enter its second year, serious questions need to be raised about how we support and retain not only junior doctors, but all workers in the healthcare system who likely have similar experiences. At the very least, a greater sense of appreciation and empathy for the work that they are doing is needed.

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Austerity – it can really drive you Wilde…

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Dr Sue Konzelmann, author of Austerity, discusses the long-term impact of a policy that places price before value.

Over the last decade, most of us have been on the receiving end of innumerable attempts to justify continued austerity in the UK, all of which have had one thing in common – they focus purely on money. There has been much talk of public deficits and debt – although at times, even our prime ministers have confused one with the other. The impression you get is that everything has a price; and when it comes to austerity, that’s all that matters. In the words of Oscar Wilde’s Lord Darlington, a cynic is “a man who knows the price of everything and the value of nothing.”

There has been a fair amount of cynicism in discussions about austerity. For example, the value of spending over £136bn in public funds bailing out the banks following the 2008 financial crisis would be questionable enough in itself, without then using it as an excuse to deprive so many tax payers of essential government support services – especially since, as described in my new book, Austerity, the case of Iceland had clearly shown that there was a viable policy alternative to austerity. But whilst it all came down to cash at Westminster, the vast majority of us were losing essential public services that we use, value and, in many cases, depend upon.

If this continues, our society will soon begin to unravel at an even more alarming rate, as we cut the ties that bind it together. Cuts to local authority spending have already had a drastic effect on the level and effectiveness of social services, whilst you hear a lot on the TV – on a daily basis – about the devastating effects of cuts to the police and emergency services.

The corrosive effects of multiple cuts, acting together, became all too clear whilst filming a video about austerity at the Euston food bank – but that’s something you hear a lot less about in the news.

Perhaps counterintuitively, the vast majority of people who have been forced to use the food bank since it was set up in 2010 are actually in work. But the government’s attempts to save money through changes in the benefit system, like Universal Credit, has meant that people claiming it would not get a payment for up to five weeks. How many of us would be comfortable about missing a month’s salary – or more? Not many, I suspect.

It also turns out that in order to avoid homelessness, many Euston food bank users are choosing to pay their rent, rather than buy food. This is probably rather less surprising, given that the average UK household income is around £28,000 – and renting a two bed flat anywhere in that part of London will cost around £2,000 a month. Cuts to social care have also resulted in rising homelessness – and another source of people reliant on food banks.

Austerity, as a single policy, is a very blunt instrument, that has focused on price, rather than value. As a result, it has critically impacted many inter-related policy areas. Undoing its damage will therefore mean not only sharply revising policies in such areas of affordable housing, employment, health, education and social services; it will also require changes in benefit structures and delivery – to ensure that they work together as seamlessly as possible.

In a world where it is, for some unknown reason, apparently impossible to integrate such obviously linked services as the NHS and social care, this vision might seem ambitious. It shouldn’t be. In the words of Oscar Wilde’s Lord Darlington once again, “we are all in the gutter, but some of us are looking at the stars.”

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