Commissioning better oral health for vulnerable older people

Public Health England | September 2018 |Commissioning better oral health for vulnerable older people

Public Health England have produced resources to support commissioners in improving the oral health of vulnerable older people.

These resources are designed to support commissioners in improving the oral health of vulnerable older people in all settings.


The toolkit gives an overview of the impact of oral diseases in vulnerable older people and presents the evidence of what works to improve oral health to inform commissioning.

The toolkit is supported by a rapid review of the evidence and a resource compendium (Source: PHE).


An evidence-informed toolkit for local authorities

Evidence review for an evidence-informed toolkit for local authorities

Commissioning better oral health for vulnerable older people: resource compendium


Social care: the Conservative Party’s 2017 General Election pledges on how individuals pay for care (England)


A new House of Commons briefing paper considers the Conservative Party’s 2017 General Election pledges to reform how individual pay for social care.  This paper sets out the proposals, comparing them to the current position and exploring their possible implications.   While the forms have yet to be implemented the government outlines plans to publish a Green Paper before the summer 2018 parliamentary recess.

Full reference: Jarrett, T. (2018) |Social care: the Conservative Party’s 2017 General Election pledges on how individuals pay for care (England) | Number 8001 | Retrieved from |
The full briefing paper can be downloaded here 

Falls prevention: cost-effective commissioning

Guidance from Public Health England (PHE) for commissioners and communities to provide cost effective falls prevention activities.  Local authorities and Clinical Commissioning Groups (CCGs) can use results from the tool to protect and improve the health of their local populations when making commissioning decisions.

The flexible Excel sheet allows for results to be tailored to the local situation based on the knowledge of the user. All interventions are aimed at those aged 65 and over. It can be accessed here 

The accompanying report, A Return on Investment Tool for the Assessment of Falls Prevention Programmes for Older People Living in the Community,  which explains how the tool was constructed and outlines the main findings, can be read here 

PHE have also produced a structured literature review which identifies which interventions are cost-effective in preventing falls in older people living in the community can be downloaded from their website.

Tackling loneliness and social isolation

Tackling loneliness and social isolation: the role of commissioners | The Social Care Institute for Excellence 


This briefing draws on discussion from a seminar held in September 2017 to explore the opportunities and barriers faced by commissioners seeking to address social isolation in older people.  It also looks at previous research and evaluations in this field.

The paper:

  • identifies the evidence that points the way to a better understanding of effective interventions
  • provides examples of practice emerging in different parts of the country
  • examines what needs to happen next in order to create a more conducive
    commissioning environment.

Full briefing: Tackling loneliness and social isolation: the role of commissioners

Additional link: SCIE press release

Economic evaluations of seasonal influenza vaccination for the elderly

The Council of the European Union (EU) has recommended that action should be taken to increase influenza vaccination in the elderly population | BMJ Open

Image source: Joe The Goat Farmer – Flickr // CC BY 2.0

Objectives: The aims were to systematically review and critically appraise economic evaluations for influenza vaccination in the elderly population in the EU.

Results: Of the 326 search results, screening identified eight relevant studies. Results varied widely, with the incremental cost-effectiveness ratio ranging from being both more effective and cheaper than no intervention to costing €4 59 350 per life-year gained. Cost-effectiveness was most sensitive to variations in influenza strain, vaccination type and strategy, population and modelling characteristics.

Conclusions: Most studies suggest that vaccination is cost-effective (seven of eight studies identified at least one cost-effective scenario). All but one study used economic models to synthesise data from different sources. The results are uncertain due to the methods used and the relevance and robustness of the data used. Sensitivity analysis to explore these aspects was limited. Integrated, controlled prospective clinical and economic evaluations and surveillance data are needed to improve the evidence base. This would allow more advanced modelling techniques to characterise the epidemiology of influenza more accurately and improve the robustness of cost-effectiveness estimates.

Full reference: Shields. G.E. et al. (2017) Systematic review of economic evaluations of seasonal influenza vaccination for the elderly population in the European Union. BMJ Open. 7:e014847


Reducing hospital admissions by improving continuity of care in general practice

This briefing summarises research that analysed data from over 230,000 anonymised patient records for older people aged 62 – 82 years | The Health Foundation

Image source: The Health Foundation
  • Continuity of care is an aspect of general practice valued by patients and GPs alike. However, it seems to be in decline in England.
  • Our analysis, published in The BMJ and summarised in this briefing, looks at the link between continuity of care and hospital admissions for older patients in England. We looked specifically at admissions for conditions that could potentially be prevented through effective treatment in primary care.
  • We found there to be fewer hospital admissions – both elective and emergency – for these conditions for patients who experience higher continuity of care (ie those who see the same GP a greater proportion of the time). Controlling for patient characteristics, we estimate that if patients saw their most frequently seen GP two more times out of every 10 consultations, this would be associated with a 6% decrease in admissions.
  • To improve continuity for patients, general practices who are not already doing so could set prompts on their booking systems and encourage receptionists to book patients to their usual GP. Patients could also be encouraged to request their usual GP.
  • Clinical commissioning groups and NHS England Area Teams could work with general practices to support quality improvement initiatives that maintain or improve continuity of care.
  • Future national initiatives should have a well developed understanding of how and why the policy will impact on continuity in a particular context.

Read the full overview here

Read the full report here

Preventing falls and fractures

Public Health England has published Falls and fracture consensus statement: supporting commissioning for prevention.


The guidance is aimed at local commissioning and strategic leads with a remit for falls, bone health and healthy ageing.  This document outlines approaches to interventions and activities helping prevent falls and fractures to improve health outcomes for older people.

The Royal College of Physicians has published Look out! Bedside vision check for falls prevention.

This guide aims to help ward staff assess a patient’s eyesight in order to help prevent them falling or tripping while in hospital.

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