NHS leaders offered free access to resource to help address air pollution across England

By Gabriel Blaazer

A new resource is to be offered to every NHS Integrated Care System (ICS) to support their development as ‘Clean Air Champions’.

Data confirms that everyone in the UK is exposed to the threat of air pollution, with more than 97 per cent of postcodes in breach of at least one World Health Organisation (WHO) limit for toxic pollutants.¹

This includes vulnerable environments such as healthcare settings, including the one million people who attend GP appointments every day in the UK and the approximately 16 million people who travel to major A&E departments in England every year.²

In the UK, 36,000 premature deaths per year are caused by air pollution, one in five of all premature deaths, and tackling air pollution will be a vital strand of integrated care systems’ (ICS) efforts to address and reduce environmental determinants of poor health.^3,4

Launched at the NHS ConfedExpo, the ICS Clean Air Framework is a practical tool that empowers healthcare leaders to take action on cleaner air and has been developed to support every ICS in England to become a ‘Clean Air Champion’. Joining forces to drive the initiative forward are the environmental change charity Global Action Plan, Newcastle Hospitals and Boehringer Ingelheim. The Framework is freely available to all 42 ICSs nationally to aid the development of an action plan to improve air quality around all healthcare access points in England.

The Framework links to the mandated requirements of Green Plans, the NHS Standard Contract, the Delivering a greener NHS report and the UN’s Sustainable Development Goals. The tool supports the newly established ICS healthcare leaders to incorporate air quality improvement measures around hospitals and health hubs as part of their broader commitment to address environmental challenges.

The Framework launch coincides with Clean Air Day on June 16th, which this year reveals how air pollution impacts almost every organ in the body. Professor Sir Stephen Holgate, Special Advisor on air quality to the Royal College of Physicians and UKRI’s Clean Air Champion, explains “Air pollution is an invisible killer and plays a role in many of today’s major health challenges. The ICS Clean Air Framework is a ground-breaking resource to support the NHS in implementing air quality improvement initiatives that will ultimately protect the health, wellbeing and economic sustainability of today’s communities and future generations.”

The Framework is being pioneered by Newcastle Hospitals, who are first to drive the development of an action plan in their region. James Dixon, Associate Director of Sustainability at Newcastle Hospitals, explains “The NHS has an opportunity to lead by example and set the benchmark for clean air and safe workplaces. Through the creation of an action plan guided by the ICS Clean Air Framework, here at Newcastle Hospitals, we are already making progress and seeing direct benefits to our communities.”

Larissa Lockwood, Director of Clean Air, Global Action Plan, explains how the ICS Clean Air Framework can support healthcare leaders in taking action: “Air pollution kills seven million people globally each year, which is more than malaria, HIV/AIDS and obesity combined.^5,6,7 It is a public health crisis that needs immediate action from the health sector. It also cannot be right that our most vulnerable are exposed to it in our places of care – is it fair that a baby must take its first breath in a polluted environment? By developing this framework and working at the Integrated Care System level, we have the opportunity to tackle some of those area-wide issues, empowering healthcare leaders to pursue action on air pollution to secure a healthier future for their region.”

Uday Bose, Managing Director at Boehringer Ingelheim UK & Ireland, explains the impact of the project both now and for future generations, “People who are already suffering with poor health are most at risk of the detrimental effects of air pollution, so this initiative plays an important role in addressing health inequalities. Our commitment to transforming lives goes beyond the provision of medicines, as this initiative clearly illustrates. It also demonstrates the power of partnerships and delivers a real opportunity to create a healthier future for families, the NHS and the planet.”

The ICS Clean Air Framework aims to provide healthcare leaders with a platform to drive positive change and support the implementation of initiatives to improve air quality, without adding to the administrative burden. The NHS net zero targets are as ambitious as possible and are supported by the need for immediate action and commitment to continuous monitoring, evaluation and innovation. It is therefore critical that key stakeholders and local authorities work collectively to turn ambition into action.

More information regarding the Integrated Care for Cleaner Air initiative and the ICS Clean Air Framework is available from today at www.actionforcleanair.org.uk/health/ics-framework.

¹ addresspollution.org. 2022. Providing the public with the most accurate air pollution data available. [online] Available at: <https://www.addresspollution.org/> [Accessed 26 May 2022].

_{2</sup)The Kings Fund. 2019. Key facts and figures about the NHS. [online] Available at: <https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs#what-does-the-average-day-in-the-nhs-look-like> [Accessed 12 May 2022].}

³GOV.UK. 2019. Public Health England publishes air pollution evidence review. [online] Available at: <https://www.gov.uk/government/news/public-health-england-publishes-air-pollution-evidence-review#:~:text=Air%20pollution%20is%20the%20biggest,lung%20cancer%2C%20and%20exacerbates%20asthma.> [Accessed 26 May 2022].

⁴Who.int. n.d. Air pollution. [online] Available at: <https://www.who.int/health-topics/air-pollution#tab=tab_2> [Accessed 25 May 2022].

⁵Who.int. 2022. Fact sheet about malaria. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/malaria> [Accessed 25 May 2022].

⁶Who.int. 2021. Obesity. [online] Available at: <https://www.who.int/news-room/facts-in-pictures/detail/6-facts-on-obesity> [Accessed 25 May 2022].

⁷Who.int. 2021. HIV/AIDS. [online] Available at: <https://www.who.int/data/gho/data/themes/hiv-aids> [Accessed 25 May 2022].

Report reveals 229% rise in social care needs assessment enquiries

By Integrated Care Journal

The number of social care needs assessment enquiries increased by 229 per cent in the year 2021/2022 compared to 2019/2020, according to Access Social Care’s annual State of the Nation report.

The report, released yesterday, paints a desperate picture of the English social care system, with a significant rise in advice demand far outstripping available resources.

Access Social Care is a nationwide charity providing free legal advice for people with social care needs. Its second annual State of the Nation report is based on a data collaboration project in partnership with Royal Mencap Society, Age UK, Carers UK and Independent Age.

With the use of 74,000 separate data points, the report outlines the key challenges facing people who need social care and looks at the extent to which advice demand and provision has changed.

The nationwide data in this year’s report also shows an increase in enquiries that were identified as needing specialist legal advice in the year 2021/22, compared to 2019/20.

The report also reveals that the number of enquiries regarding concerns about existing social care and support rose by 43 per cent in the year 2021/22 compared to 2019/20.

The wellbeing of both care users and care providers has continued to spiral downwards. According to Access Social Care, pressure on capacity has meant that helplines have been required to take on additional staff and expand opening hours to cope with the increased demand on their services.

Charging has also become an increasingly pressing issue, accounting for 25 per cent of the dataset. Local authorities have been pushed into further unsustainable cost efficiencies, increasing charges for social care to meet budget targets and causing further demand for advice on charging.

Kari Gerstheimer, Chief Executive of Access Social Care said: “Whether we are self-funders or in receipt of state funded care, we will all need social care at some point either for ourselves or for a loved one.

“The Government claims to have fixed social care and continues its promises to help ease the cost-of-living crisis, but the sums don’t add up. Millions of people are feeling the effects of an underfunded system.

“We want a social care system that is properly financed, readily available and fairly distributed. Currently, vital services are overstretched, and people are going without the necessary social care they so desperately need – something needs to change.”

Caroline Abrahams CBE, Charity Director of Age UK said: “The findings in this report provide clear evidence of a system under severe duress.

“Councils are struggling to discharge their responsibilities to people in need of care and support and are having to adopt explicit prioritisation measures to deal with the overwhelming demands they face.

“In these difficult circumstances navigating the always complex social care system is a real challenge. It makes the role of charities who provide information and advice about social care more important than ever, both for the people in need of help and by shining a light on what’s really going on in care services across the country.”

Access Social Care provides expert legal advice to disabled people, elderly people, and their family carers to ensure their social care needs are met.

Report finds white nurses twice as likely as black and Asian colleagues to be promoted

By Niamh Macdonald

White nurses are twice as likely to be promoted as Black and Asian staff in the NHS, new survey results from the Royal College of Nursing (RCN) show.

According to the RCN, the survey results demonstrate that racism is ‘endemic in health and care’. The UK-wide survey of almost 10,000 nursing staff found that across all age groups, White respondents and those of mixed ethnic background were more likely than Black and Asian colleagues to have received at least one promotion since the start of their career.

The survey, which was published at the annual RCN congress in Glasgow, showed the difference is most stark between those aged 35 to 44. While 66 per cent of White and 64 per cent of respondents from mixed ethnic backgrounds in this age group said they had been promoted, this fell to just 38 per cent of Asian and 35 per cent of Black respondents.

The RCN also said that their biennial employment survey showed structural racism is having a ‘devasting impact’ on minority ethnic nursing staff in other ways.

The survey found that Black respondents working in hospital (39 per cent) and community (32 per cent) settings are more likely to report having experienced physical abuse than respondents of other ethnic backgrounds.

The RCN is calling on the UK government to ‘seize the opportunity of its planned reform of human rights legislation’ to ensure that health and care organisations, regulatory bodies and inspectorates are required by law to tackle racism, including in the workplace.

According to the RCN this could include a legal requirement to eliminate disparities in recruitment, retention and career progression, or a greater responsibility for employers to protect minority ethnic groups.

RCN Diversity and Equalities Co-ordinator Bruno Daniel said: “The pandemic has shone a spotlight on structural racism in health and care services and we must seize this opportunity to stamp out this vile behaviour once and for all.

“The UK government and devolved administrations must properly acknowledge and address this problem and the devastating impact it has on Black and minority ethnic staff and patients.”

Responding to the Royal College of Nursing’s (RCN’s) research, the interim chief executive of NHS Providers, Saffron Cordery said: “As the largest employer of Black, Asian and minority ethnic people in the country, the NHS must recognise and confront the structural racism and discrimination that still exists within its ranks.

“These important findings are the latest in a long string of evidence highlighting the unacceptable presence of structural racism within our health and care system.

“Time after time we see similar findings that show ethnic minority staff face higher levels of discrimination, and are more likely to face bullying, harassment or abuse from patients or colleagues.

“It is only by recognising these facts and having an honest conversation about racism, its structural roots and its impact, that change can be achieved.

Fuller Stocktake: Time for a radical overhaul of primary care

By Niamh Macdonald

The Next steps for integrating primary care: Fuller stocktake report was published yesterday, outlining a vision for transforming primary care led by integrated neighbourhood teams.

The review was carried out by Dr Claire Fuller, CEO (Designate) of Surrey Heartlands ICS, commissioned by NHS England and NHS Improvement.

With weeks to go until integrated care systems (ICS) are granted statutory footing, the report emphasises this opportunity to radically overhaul the way health and social care services are designed are delivered.

According to Dr Fuller, ‘Primary care must be at the heart of each of our new systems – all of which face different challenges and will require the freedom and support to find different solutions.’

Support, enablement and respect are three key themes of the reviews findings. The report states that these sentiments are important to set the right tone and accelerate the change that needs to be delivered in primary care.

To improve access, experience and outcomes in primary care across all communities, the report outlines three key offers:

Streamlining access to care and advice for people who get ill but only use health services infrequently: providing them with much more choice about how they access care and ensuring care is always available in their community when they need it
Providing more proactive, personalised care with support from a multidisciplinary team of professionals to people with more complex needs, including, but not limited to, those with multiple long-term conditions
Helping people to stay well for longer as part of a more ambitious and joined-up approach to prevention.

Matthew Taylor, chief executive of the NHS Confederation, said: “This review must be a watershed moment for establishing primary care as an integral part of local systems, working across boundaries to deliver population-based care, and a demonstration of the benefits of the integration agenda.

“Our members – from primary care leaders through to ICSs – agree that investing in local relationships, developing and supporting frontline workers, and maintaining stability in general practice are the key components to achieving fully integrated primary care.

If we are to get serious about ramping up prevention, improving patient outcomes including by tackling health inequalities, and providing more personalised care, primary care’s deep-rooted connection to its local communities cannot be overstated.”

Responding to Dr Fuller’s stocktake, interim chief executive of NHS Providers Saffron Cordery said: “Trust leaders will welcome the findings of the Fuller ‘stocktake’ which sets out how primary care can work with partners across health and care to best meet the needs of their local communities.

“The welcome focus in the stocktake on creating neighbourhood health teams to offer continuity of care and support those with complex, ongoing health needs is essential and will help to tackle the health inequalities which have been exacerbated by the Covid-19 pandemic.

“But with just over a month to go before integrated care systems become statutory bodies on July 1st, we now face the challenge of making this vision a reality.

“First and foremost, Dr Fuller’s stocktake underlines the need to tackle the serious challenges facing those who need to access same day, urgent care. This is no small undertaking and will require collaboration across mental health, community services, primary care and secondary care if it is to succeed.”

Featured, News, Social Care May 26, 2022

The social care workforce: Overworked, undervalued and poorly paid

By Mary Brown

On 27 April 2022, Public Policy Projects (PPP) hosted a roundtable entitled The Social Care Workforce: Averting a Crisis as part of its report series The Future of Social Care. The PPP Social Care Network, made up of senior cross-sector stakeholders in social care and a Lived Experience Panel, sought to find practical solutions to the challenges relating to the workforce.

The crisis facing social care is fundamentally a workforce one, and low pay and poor working conditions are impacting the experience of staff and end users alike.

One Network member described the long journey they have had with trying to find carers for their son, and how “the problems with the social care workforce have now caused [their] son to receive inadequate care”. For the Network member, it was evident that poor conditions for workers make it difficult to consistently provide high levels of care.

Social care: A fulfilling and worthwhile career

The Network members emphasised that social care can be a fulfilling and worthwhile career. However, one member expressed that “Nobody talks about it.”

“Nobody talks about the difference they’ve made to somebody’s life, somebody who lived at home and couldn’t manage independently anymore, and their friends and family were under enormous pressure,” they explained.

A social care career is a skilled and challenging career route, but tends not to be publicly regarded as one. Social care must become a more attractive and respected career path for students.

Network members with experience working in universities noted that very few students harbour ambitions to go into social care, with greater ambition being shown towards childcare, social work, the NHS or physiotherapy. Put simply by one network member, “there is simply no ambition to be an adult social care worker”.

Improved advertising campaigns offer one solution. One network member shared a heart-warming TikTok showing the day-to-day life of a carer supporting a disabled adult, showing that his profession was not simply that of a support worker, but a “gym buddy”, a “swim coach”, a “karaoke performer”, a “culinary professor”, and a “Lego architect”.

The video showcased the bond he has with the individual he cares for and the varied tasks in his working day, demonstrating the positive aspects of a career in social care. The Network member suggested that it “might inform recruitment campaigns” for social care in England.

A clear career trajectory

Network members were in general agreement that social care requires a clearer career trajectory. If there was a visible route for progression within the system, the sector would be more attractive to young, bright school leavers and university graduates. It was suggested that cross sector career paths should be formed.

“No one in any career expects to progress without spending time in different departments; we need to do the same in social care and for its providers”, said one member.

To attract more people to the sector, there needs to be greater clarity of the differentiation in provision. Not every member of the caring profession does the same job there are a variety of roles, areas of expertise, and levels of seniority which people should be made aware of.

We must make caring into a proud profession in its own right, not something that is ancillary to nursing.

Recognising social care qualifications

A career in social care may be more attractive if it were formally recognised. One Network member criticized the care certificate as it is not an accredited qualification. The only way that the care certificate would be accredited through the QCF would be through the employer hiring a qualified assessor “and the cost of that for the employer is astronomical, so most employers don’t do that”. This makes the care certificate “almost redundant and it certainly doesn’t attract young people to the sector to see it as a long-term career”.

One network member mentioned that Florence Nightingale is generally crediting with “professionalising” the role of nurses, and that the Royal College of Nursing was later founded at a time when, arguably, nurses were performing many of the hands-on caring jobs performed today by care assistants.

The network member added “as far as I can ascertain, They Royal College of Nursing does currently admit some care assistants, but only those working in roles directly supervised by nurses .This excludes most care workers. We must make caring into a proud profession in its own right, not something that is ancillary to nursing”. The network member added that there is perhaps a case to be made for the establishment of a College of Care Assistants or workers.

Care workers should be paid fairly for the value of their work, and the level of skill and expertise required.

Better pay for care staff

Across the Network, there has been a consistent consensus that carers must receive better pay, and the latest meeting showed no change of course on this point.

It was described as “scandalous” that professions such as retail work and cleaning are paid more than social care, despite being less technically and emotionally demanding. One Network member, as a provider of care, expressed outrage that “[they] get to pay £10 an hour in a town where you can get £15 for dog walking, how can this be conducive to successful recruitment and retention?”

While there was widespread agreement on the fact that carers are underpaid, some Network members warned against the idea of increasing pay to be a cure all to the current workforce crisis.

“There is an unnerving conflation between the rate at which staff should be paid for their skills, and whether that will attract them to work in the sector. These two things are being confused. Care workers should be paid fairly for the value of their work, and the level of skill and expertise required, which is not the same as raising pay in the hope that the system would receive an influx of workers.”

This point serves to emphasize that any changes to the workforce must start with a fundamental change in attitudes toward social care work, and “this will then lead to a conversation about what we pay our professional staff”.

Support and collaboration

The latest MHA care workforce report showed a 23 per cent disparity exists in pay between the NHS and comparable roles in social care. “A big part of that gap is salary, but a significant portion comes from disparities around sick pay, payment for additional hours worked, and pensions, which are all benefits that social care providers cannot hold a candle to.”

It was broadly agreed that the social care system should mirror the NHS Agenda for Change pay scale. If the NHS and social care are to work more closely within integrated care systems (ICSs), then staff must undoubtedly be paid the same for equivalent roles.

One network member highlighted that this would facilitate the better collaboration of multidisciplinary teams, ultimately enabling better care. They also promoted the concept of new “cross-sector roles”, working across different departments in health and social care, which would help to facilitate easier patient flow throughout the system.

Without the right support structures in place, the social care workforce will continue to face a struggle in providing quality of care. In order to successfully implement meaningful changes, the PPP Social Care Network could all agree that a fundamental change in attitude to value the social care workforce is necessary.

The roundtable concluded with a sentiment shared by the Network, “Carers need to be paid more money, they need to be supported and valued more highly by society so that they can lead full and active lives”.

For more information on PPP’s work on social care, please contact policy analyst Mary Brown at Mary.brown@publicpolicyprojects.com

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