AI for the Public Sector: Opportunities and challenges of cross-sector collaboration

Public sector organisations are increasingly interested in using data science and artificial intelligence capabilities to deliver policy and generate efficiencies in high uncertainty environments. The long-term success of data science and AI in the public sector relies on effectively embedding it into delivery solutions for policy implementation. However, governments cannot do this integration of AI into public service delivery on their own. The UK Government Industrial Strategy is clear that delivering on the AI grand challenge requires collaboration between universities and public and private sectors. This cross-sectoral collaborative approach is the norm in applied AI centres of excellence around the world. Despite their popularity, cross-sector collaborations entail serious management challenges that hinder their success. In this article we discuss the opportunities and challenges from AI for public sector. Finally, we propose a series of strategies to successfully manage these cross-sectoral collaborations

Analysing public service outsourcing: the value of a regulatory perspective

This article draws on findings from two longitudinal case studies of voluntary organisations engaged in delivering social care services via purchaser – provider relations with local authorities. The study focuses on changes to contractual relations, employment conditions in provider organisations and service quality. The article argues the influence of the market on these changes can only be adequately comprehended by rooting the analysis in an understanding of the way in which surrounding regulatory frameworks shape its structure and operation. In doing so, it reveals how in an era of shifting market conditions characterised by greater competition and dramatic local authority cuts, a ‘soft’ regulatory framework offers little support to partnership relations between voluntary organisations and local authorities. Instead, the regulatory environment undermines financial security among voluntary organisations, degrades employment conditions in them and raises concerns regarding their service quality

An economic evaluation of vagus nerve stimulation as an adjunctive treatment to anti-seizure medications for the treatment of drug-resistant epilepsy in England.

INTRODUCTION: Anti-seizure medications (ASMs) are commonly used to prevent recurring epileptic seizures, but around a third of people with epilepsy fail to achieve an adequate response. Vagus nerve stimulation (VNS) is clinically recommended for people with drug-resistant epilepsy (DRE) who are not suitable for surgery, but the cost-effectiveness of the intervention has not recently been evaluated. The study objective is to estimate costs and quality-adjusted life-years (QALYs) associated with using VNS as an adjunct to ongoing ASM therapy, compared to the strategy of using only ASMs in the treatment of people with DRE, from an English National Health Service perspective. METHODS: A cohort state transition model was developed in Microsoft Excel to simulate costs and QALYs of the VNS + ASM and ASM only strategies. Patients could transition between five health states, using a 3-month cycle length. Health states were defined by an expected percentage reduction in seizure frequency, derived from randomized control trial data. Costs included the VNS device as well as its installation, setup, and removal; ASM therapy; adverse events associated with VNS (dyspnea, hoarseness, and cough); and health-state costs associated with epilepsy including hospitalizations, emergency department visits, neurologist visits, and primary care visits. A range of sensitivity analyses, including probabilistic sensitivity analysis, were run to assess the impact of parameter and structural uncertainty. RESULTS: In the base case, VNS + ASM had an estimated incremental cost-effectiveness ratio (ICER) of £17,771 per QALY gained compared to ASMs alone. The cost-effective ICER was driven by relative reductions in expected seizure frequency and the differences in health care resource use associated therewith. Sensitivity analyses found that the amount of resource use per epilepsy-related health state was a key driver of the cost component. CONCLUSIONS: VNS is expected to be a cost-effective intervention in the treatment of DRE in the English National Health Service

A cost-effectiveness analysis of endoscopic eradication therapy for management of dysplasia arising in patients with Barrett's oesophagus in the United Kingdom

BACKGROUND AND AIMS: Endoscopic eradication therapy (EET) is the first line approach for treating Barrett's Esophagus (BE) related neoplasia globally. The British Society of Gastroenterology (BSG) recommend EET with combined endoscopic resection (ER) for visible dysplasia followed by endoscopic ablation in patients with both low and high grade dysplasia (LGD and HGD). The aim of this study is to perform a cost-effectiveness analysis for EET for treatment of all grades of dysplasia in BE patients. METHODS: A Markov cohort model with a lifetime time horizon was used to undertake a cost effectiveness analysis. A hypothetical cohort of United Kingdom (UK) patients diagnosed with BE entered the model. Patients in the treatment arm with LGD and HGD received EET and patients with non-dysplastic BE (NDBE) received endoscopic surveillance only. In the comparator arm, patients with LGD, HGD and NDBE received endoscopic surveillance only. A UK National Health Service (NHS) perspective was adopted and the incremental cost effectiveness ratio (ICER) was calculated. Sensitivity analysis was conducted on key input parameters. RESULTS: EET for patients with LGD and HGD arising in BE is cost-effective compared to endoscopic surveillance alone (lifetime ICER £3,006 per QALY gained). The results show that as the time horizon increases, the treatment becomes more cost-effective. The five year financial impact to the UK NHS of introducing EET is £7.1m. CONCLUSIONS: EET for patients with low and high grade BE dysplasia, following updated guidelines from the BSG has been shown to be cost-effective for patients with BE in the UK

How is the New Public Management applied in the occupational health care system? - decision-makers' and OH personnel's views in Finland

<p>Abstract</p> <p>Background</p> <p>In many countries occupational health care system is in change. Occupational health studies are mainly focused on occupational health substance and content. This study offers new perspectives on municipal OHS and its operations from management perspective.</p> <p>Aim</p> <p>The aim of this study is to analyse how New Public Management (NPM) doctrines are applied in the Finnish occupational health care system (OHS). The main focus is to describe and compare the views of decision-makers' and OH workers within the framework of NPM.</p> <p>Methods</p> <p>The data were collected by semi-structured interviews from 17 municipal decision-makers' and 26 municipal OH workers. Data was analyzed by examining coded data in a theory-driven way according to Hood's doctrine of NPM.</p> <p>Results</p> <p>The doctrines were not as compatible with the OH personnel view as with the decision-makers' view. Decision-makers and OH personnel highlighted the strict criteria required for operation evaluation. Moreover, decision-makers strongly accentuated professional management in the public sector and the reorganization of public sector units. These were not equally relevant in OH personnel views. In OH personnel views, other doctrines (more attention to performance and accomplishments, emphasizing and augmentation of the competition and better control of public expense and means test) were not similarly in evidence, only weak evidence was observed when their importance viewed as medium by decision-makers. Neither of the respondents group kept the doctrine of management models of the private sector relevant.</p> <p>Conclusions</p> <p>The NPM and Hoods doctrine fitted well with OH research. The doctrine brought out view differences and similarities between decision-makers and OH personnel. For example, policymakers highlighted more strongly the structural change by emphasizing professional management compared to OH personnel. The need for reorganization of municipal OH, regardless of different operational preconditions, was obvious for both decision-makers and OH personnel. The adaptation of more clarify management to a municipal context is not trouble-free. The municipality systemic structure, complex operational environment, and reconciliation of political and officer authority set challenges to management of municipalities.</p

POSC289 Cost-Effectiveness of Vagus Nerve Stimulation with Anti-Seizure Medication Versus Anti-Seizure Medication Alone in the Management of Drug Resistant Epilepsy in England

ObjectivesTo estimate the cost-effectiveness of vagus nerve stimulation (VNS) as an adjunctive therapy to anti-seizure medication (ASMs) when compared with a strategy of ASMs alone for the management of drug resistant epilepsy (DRE).MethodsA five health state cohort transition model was developed, with a 10-year time horizon, a 3-month cycle length and an English National Health Service perspective. Health states were defined by a percentage reduction in seizure frequency and aligned with randomised trial data informing the first cycle transition probabilities. Thereafter, non-VNS patients remained in state, while a systematic literature review informed further VNS patient transitions up to year 2, after which they remained in state (subject to death or device discontinuation). Extrapolation of registered VNS implant Kaplan-Meier data informed explantation and replacement probabilities. Health state utilities were age and gender adjusted. Published estimates, combined with trial data regarding mean seizure frequency, informed health state resource use. In addition to the base case analysis, scenarios, one-way deterministic and probabilistic sensitivity analyses were undertaken.ResultsAdjunctive VNS has an incremental cost-effectiveness ratio of £17,711 per quality-adjusted life year (QALY) when compared to a strategy of ASMs alone. Results were most sensitive to unit costs of inpatient care, with VNS expected to be dominant if the cost of a non-elective care admission exceeded £2,225. Using the UK National Institute of Health and Care Excellence threshold of £20,000 to £30,000 per QALY, VNS was cost-effective in the majority of scenarios evaluated, inclusive of varying the costs of device implantation, replacement and explantation by 15 percent.ConclusionsManagement of DRE with VNS is a cost-effective option in comparison to ASM therapy alone. This finding is driven by a reduced seizure frequency with VNS, which is consequently expected to improve a patient\u27s health-related quality of life and reduce downstream medical costs

Understanding governmental activism

This article seeks to understand an understudied phenomenon: governmental players joining forces with non-governmental players in contentious actions against policies they want to prevent or redress. This behaviour, which we call ‘governmental activism’, problematizes important assumptions in the social movement literature on state–SMO dichotomies and on seeing ‘the state’ as a homogeneous and unified actor that solely provides the context for SMO activities. Governmental activism also problematizes assumptions on cooperation and ‘new’ modes of coordination in the governance literature. To understand governmental activism, we build on the strategic interaction perspective from social movement studies and on third-phase institutionalism from political science. In our analysis, we show the particulars of governmental activism. Our arguments are illustrated by empirical material on a case of municipal amalgamation in the Netherlands

The war on street 'terror': why tackle anti-social behaviour?

This article examines the rationales of Dutch politicians for tackling the perceived pressing problem of 'anti-social behaviour' (ASB) and the question did they copy the British approach? The first part will describe in short the concept of policy transfer and the recent British fight against ASB. The focus will be on the introduction of the Anti-social Behaviour Order. The second part is an empirical study into the Dutch retreat from 'condoning' ASB, consisting of interviews with Dutch politicians focusing on their ideas for tackling ASB. Those are compared with the British's rationales. This kind of comparative elite ethnography is not common in criminology, but this article aims at providing evidence of its benefits. By answering the research question an insight into the origins of policy in the sphere of criminal justice can be obtained

Poverty levels and children's health status: study of risk factors in an urban population of low socioeconomic level

To test the hypothesis that the low socioeconomic population living is shanty towns in Porto Alegre presents different levels of poverty which are reflected on its health status, a cross-sectional study was designed involving 477 families living in Vila Grande Cruzeiro, Porto Alegre, Brazil. The poverty level of the families was measured by using an instrument specifically designed for poor urban populations. Children from families living in extreme poverty (poorest quartile) were found to have higher infant mortality rate, lower birth weights, more hospitalizations, and higher malnutrition rates, in addition to belonging to more numerous families. Thus, the shanty town population of Porto Alegre is not homogeneous, and priority should be given to the more vulnerable subgroups.Para testar a hipótese de que a população de baixo nível socioeconômico apresenta diferentes níveis de pobreza que repercutem em seu estado de saúde, foi realizado estudo transversal envolvendo 477 famílias de uma população urbana pobre residente na Vila Grande Cruzeiro, em Porto Alegre, RS, Brasil. O nível de pobreza dessas famílias foi medido por meio de um instrumento especialmente elaborado para populações urbanas pobres. Crianças oriundas de famílias vivendo em extrema pobreza (quartil inferior) apresentaram maior taxa de mortalidade infantil, menor peso de nascimento, maior número de internações hospitalares e maiores índices de desnutrição, além de pertencerem a famílias mais numerosas. A população de baixo nível socioeconômico mostrou-se heterogênea em relação a diferentes indicadores de saúde. Concluiu-se que a identificação de subgrupos mais vulneráveis numa população permite concentrar as ações de saúde entre os mais necessitados

The Stakes in Bayh-Dole: Public Values Beyond the Pace of Innovation

Evaluation studies of the Bayh-Dole Act are generally concerned with the pace of innovation or the transgressions to the independence of research. While these concerns are important, I propose here to expand the range of public values considered in assessing Bayh-Dole and formulating future reforms. To this end, I first examine the changes in the terms of the Bayh-Dole debate and the drift in its design. Neoliberal ideas have had a definitive influence on U.S. innovation policy for the last thirty years, including legislation to strengthen patent protection. Moreover, the neoliberal policy agenda is articulated and justified in the interest of “competitiveness.” Rhetorically, this agenda equates competitiveness with economic growth and this with the public interest. Against that backdrop, I use Public Value Failure criteria to show that values such as political equality, transparency, and fairness in the distribution of the benefits of innovation, are worth considering to counter the “policy drift” of Bayh-Dole