Devolve power to regions to boost local economies and tackle health disparities, says white paper

By Gabriel Blaazer

Greater collaboration between mayoral combined authorities and integrated care systems could be key to alleviating health inequalities between Yorkshire and Humber and the rest of England as well as boosting economic activity.

A new white paper is calling on the government to devolve meaningful investment and powers to local places and integrated care system (ICS) leadership, empowering them to set targets and direct investment according to local needs.

The white paper, Empowering local places for health and prosperity: new perspectives from Yorkshire and the Humber from Health Innovation Yorkshire & Humber, has been co-produced by Health Innovation Yorkshire & Humber, Yorkshire Universities and the NHS Confederation. It sets out a series of recommendations to improve health and economic outcomes in Yorkshire and the Humber, and nationally.

The cost of health-related economic inactivity to the UK is estimated in the report at £180bn a year, and in the North of England, health inequalities cost the UK £13.2bn a year in lost productivity. The Yorkshire and Humber region has the third-lowest life expectancy for both males and females nationally; facts the paper argues “reinforces the need for a new approach to improving health and economic wellbeing”.

*Source: Health Innovation Yorkshire & Humber*

The paper states that new ways of working are needed to tackle the burden of inequalities nationally. ICSs, which were established in July 2022, have as their “fourth purpose” the task of unlocking the social and economic potential of the NHS, however many have struggled to make progress in the face of mounting pressure on services and financial constraints.

At the core of the white paper is the assertion that reductions in health and economic disparities are best achieved through a place-led approach that responds to the specific needs and characteristics of the people within those places. For place-led policy and interventions to be effective, it argues they must be delivered by a broad coalition of regional, local and community-based partners, working in partnership towards a common goal.

The white paper sets out 10 detailed recommendations, targeted towards specific national and regional leaders and business. To government, the report recommends the devolution of meaningful health investment and decision-making powers to the region’s mayoral combined authorities, increased investment into health innovation research and development, and collaboration with universities to address the barriers preventing the realisation of the NHS Workforce Plan targets.

At the regional level, the paper recommends that mayoral combined authorities continue to leverage the scale and convening power of local ICSs and other anchor institutions to empower a broad coalition of partners to take meaningful action on health. The white paper urges businesses to take action to support the health and wellbeing of their employees, and to take advantage of available support and best practice.

Richard Stubbs, Chief Executive of Health Innovation Yorkshire & Humber and one of the white paper authors, said: “The link between healthy people and a strong economy is now well understood, yet despite efforts by partners in our region and government in recent years, health and economic inequalities across Yorkshire and Humber continue to widen. We must look urgently to new ways of working to ensure our people, our economy and our health service cannot just survive but thrive.

“Our aim through this white paper is to shape a new model for addressing health and economic inequalities that delivers better outcomes, not just in Yorkshire but nationally.”

The full report can be accessed here.

Local Government, News November 23, 2022

Local authorities call for ICBs to increase council representation and outline success measures

By David Duffy

Councils are working starting to work closer with health partners within integrated care systems (ICSs) but require more representation at system level to drive improvements, this is according to the County Council Network (CCN).

The report, The Evolving Role of County Authorities in ICSs, analyses the progress of ICSs from the perspective of councils. The study, which was commissioned by the CCN and conducted by IMPOWER, is based on a detailed survey and interviews with local authorities in county areas and senior health officials.

County leaders say councils and health partners are forging closer relationships in many ICSs across England, and evidence in the study shows that council leaders are investing significant amounts of time with health colleagues within these arrangements. However, the CCN say there are significant challenges to overcome before councils can consider ICSs a true “partnership” endeavour.

Local authorities feel there is a lack of processes in place to measure the impact of ICSs. In the report’s survey, less than one in five (18 per cent) of councils were confident that their ICS had a clear process for monitoring success against its primary objectives and national data on “integrated” issues was found to be very limited.

The report has also found that across England, just nine of 777 Integrated Care Board (ICB) members are elected councillors. It highlights that both councils and the NHS recognise that local politicians will need to be key allies if ICSs are to deliver transformative change, but that their role in systems is still unclear.

CCN’s report also suggests that council leaders feel that ICS are held back by a continued focus on mandated, top-down targets from the NHS and central government. It argues that this centralised control may hinder the success of local solutions rooted in long-term preventative measures developed within communities.

The report recommends that the government and NHS review the level of centrally imposed targets on ICSs, particularly in shared policy areas with local government, which could help induce a culture shift that gives greater prominence to prevention. ICSs themselves should ensure that funding and decision-making are devolved to the most appropriate level in order to best facilitate local joint-working.

It also calls on council and local NHS leaders to agree on a small number of specific and achievable inclusive ambitions this winter, to build partner confidence in ICSs’ ability to deliver real change.

CCN’s report comes ahead of Patricia Hewitt’s upcoming independent review of ICB oversight, which will be the first major stocktake on the role of councils in ICSs since their introduction in July of this year.

Other key findings of the report:

80 per cent of councils say they have increased their time working with health partners since the inception of ICSs, but that this is in part due to too much of focus being given to immediate NHS pressures.
Local authorities are ‘very cautious’ about pooling further resources with the NHS at a time when finances are stretched, particularly as the NHS is felt to have less focus on living within budgets than councils. Nationally, county authorities have pooled £13.43 per-head from their budgets into the Better Care Fund (BCF) this year; down from £15.56 per capita in 2017-18.
Councils recognise the need for decision-makers in ICBs to tackle immediate issues in the NHS and acknowledge they are also facing real pressures on their own services. However, there is concern that in the medium-term, it will be difficult to shift focus onto overarching, long-term system issues such as investing in preventative measures and out-of-hospital care, as envisioned in the NHS Long Term Plan.

Cllr Tim Oliver, Chairman of the County Councils Network, said: “Councils support the introduction of ICS and their aim to closer integrate health and care services and ultimately drive down costs for both the NHS and local government through preventative measures. Since their inception, evidence shows that councils have been enthusiastic about these arrangements and are spending more time with health colleagues.

“But today’s report acts as a useful barometer to find out what is happening on the ground in ICSs across England. Partly as a result of the funding challenges facing the NHS, and top-down central targets, there is a feeling from councils that there is too much focus on immediate and acute NHS pressures, such as hospital discharge and ambulance waiting times, rather than the preventative agenda.”

Sean Hanson, Chief Executive of IMPOWER said: “This report is the first to consider ICSs from the perspective of councils whose role is central to the integration agenda. It will be essential reading ahead of the Government’s upcoming review of Integrated Care Boards.

“These systems are complex and their implementation varies widely across councils but our report is clear that the desire exists across local authorities and the NHS to reduce health inequalities, boost preventative services and improve outcomes for citizens. However, there is concern that a lack of local autonomy and squeezed budgets will make it difficult to convert that desire into action.”

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An opportunity to secure sustainability

By Rusheen Bansal

Care England, the largest and most diverse representative body for independent providers of adult social care in England, has welcomed a new Care Provider Alliance publication as an opportunity for Local Authorities to recognise the pressures facing independent providers now and in the future.

The report, Provider Market Sustainability – Planning Support to Councils, produced by Care Provider Alliance (CPA), reflects a number of care providers’ thoughts on the Fair Cost of Care process and lays out their key concerns to assist local authorities in creating realistic Market Sustainability Plans ahead of the 14 October deadline.

The Fair Cost of Care (FCoC) exercise is a process of engagement between local authorities, commissioners, and providers, data collection, and analysis by means of which local authorities and care providers can arrive at a shared understanding of the local cost of providing care.

The FCoC exercise is aimed at helping local authorities identify the lower quartile, median, and upper quartile costs in the local area for a series of care categories. It is the purpose of the FCoC exercise to identify accurately the gap between what is currently paid, and what rate is sustainable for the future.

CPA was tasked by provider members to produce this report for councils to consider ahead of finalising their Market Sustainability Plans.

Professor Martin Green OBE, Chief Executive of Care England, commented: “This report evidences the significant pressures care providers are currently operating under. It is now incumbent upon Local Authorities to recognise these pressures in their Market Sustainability Plans due to be submitted to the Department of Health and Social Care on 14 October, to reflect the current and future reality of the sector to sustain the workforce and financial viability, whilst also to address the impact of rising energy and agency costs, as well as rising inflation.”

“The Fair Cost of Care exercise was engaged with by around 32 per cent of care homes, equating to 41 per cent of care homes places in England. With such a significant representation of data, Local Authorities now have the evidence they require to secure the future sustainability of the sector. There is no room for further excuses.”

Alongside Cost of Care exercises, local authorities are required to develop and submit a provisional Market Sustainability Plan, which will be followed by a final Market Sustainability Plan when local government budgets for 2023 to 2024 have been confirmed.

The key concerns for providers detailed within the CPA publication were workforce, energy, inflation, and return of operations and capital. Some key costs that local authorities should account for are:

Vacancies are up 52 per cent in the last 12 months against a 48-year low in unemployment
60 per cent of providers will need to uplift carer pay in addition to their annual pay uplift, due to the cost-of-living crisis
88 per cent of providers struggle to secure agency staff
Recruitment costs are up 127 per cent in the last 2 years
Overseas recruitment costs £3-5k per annum and in some locations, accommodation is unable to be sought
Even after the introduction of the Energy Bill Relief Scheme and the introduction of a cap, energy prices for providers are 3-4 times what it was 12 months ago
Food inflation is over 15 per cent of total costs currently for care home providers
Insurance premiums can be 400 per cent higher than pre-pandemic levels
Councils do not apply sufficient Return on Operations or Capital levels to sustain providers who need to maintain a profit/ surplus to invest in their organisations and to stay in business

According to the findings of the House of Commons Levelling Up, Housing and Communities Committee report titled Long-terms funding of adult social care, a gap of £7 billion was identified to respond to the growing problem of unmet needs and access to care. So far, £1.36 billion has been pledged as a part of the FCoC exercise to improve care systems bottom-up through strategic spending by local councils according to its local circumstances.

Paddington life sciences cluster to maximise benefits of industry partnerships

By Rusheen Bansal

Imperial College Healthcare NHS Trust recently set out its vision for a new life sciences cluster in Paddington, founded on its growing partnerships with research, industry and community organisations around St Mary’s Hospital.

The Trust unveiled its ‘Paddington Life Sciences’ vision on a new website, featuring three initiatives already underway:

A new digital collaboration space, opening in autumn 2022, located at Sheldon Square, next to St Mary’s and Paddington station. Housing the National Institute for Health and Care Research (NIHR), Imperial Biomedical Research Centre’s (BRC) expanding digital health programme team. It will provide space for lectures, training, events and meetings. It will also benefit from additional investment in Imperial College Healthcare’s trusted data environment which has already helped to produce new clinical insights.
The creation of a new centre for clinical infection, a specialist clinical and translational research facility to complement Imperial College London’s new Institute of Infection. Together they will be one of only a few facilities in the world to offer ‘end-to-end’ innovation, from initial discovery to improved patient outcomes, for the management of infectious diseases as well as antimicrobial resistance.
Paddington Life Sciences Partners will bring together NHS, academic, local authority and life sciences industry partners with a commitment to the area to help ensure the delivery of significant social, health and commercial value as quickly as possible.

For the longer term, the Trust is progressing a full redevelopment of the St Mary’s estate as part of the government’s new hospital programme. As well as delivering a new, state-of-the-art hospital, the redevelopment is intended to create an additional 1.5 million square feet of cross-functional commercial and lab space for life sciences businesses to develop and grow.

Imperial College Healthcare Chief Executive Professor Tim Orchard said: “Research and innovation are fundamental to the clinical excellence our hospitals are renowned for, from the Nobel Prize-winning discoveries of penicillin, the chemical structure of antibodies and the invention of the electrocardiogram, to pioneering robotic surgery, HIV care and the clinical use of virtual reality technology. Most recently, we have played a key role in developing an understanding of Covid-19 and trialling a range of new treatments.

“We are now entering a new era of discovery, at an even more ambitious scale, by maximising the potential of our existing work areas and joining them up with new opportunities. With Imperial College London, we run one of the largest NIHR biomedical research centres, undertaking hundreds of clinical trials and analysing data from well over a million patient contacts each year. Through the pandemic, many more patients and staff have been encouraged to get involved in research and we are confident this trend will grow as we continue to deepen our relationships with local communities and organisations. We are working together to improve not just healthcare, but also health and wellbeing, creating synergies that will boost education, skills development and employment opportunities in some of the most deprived areas of the UK.

“The regeneration of Paddington is also drawing more and more life sciences and technology businesses to the area, attracted by investment in transport infrastructure and excellent national and international travel connections. This also means strong links to other life sciences hubs, including Imperial College London’s growing campus at White City, adjacent to another of our own campuses, Hammersmith Hospital, and the knowledge quarter in King’s Cross and Euston.”

Dr Bob Klaber, Imperial College Healthcare Director of Strategy, Research and Innovation added: “British life sciences firms raised £4.5bn in 2021, up from just £261m in 2012. But London has not yet reached its full potential to attract investment and innovation in the life sciences sector – MedCity’s 2021 London Life Sciences Real Estate Demand Report identiﬁed an estimated 500,000 square feet shortfall in innovation and lab space. Imperial College Healthcare is ideally placed to help fill that gap.”

There will be a formal launch of Paddington Life Sciences, and the new digital collaboration space, later this autumn.

Government failing on social care and health inequalities

By Kari Gerstheimer

The government’s failure to reform social care funding in the Health and Care Act is compounding regional health inequalities, writes Kari Gerstheimer, CEO and Founder of Access Social Care.

Speaking before a Cabinet meeting last month Boris Johnson stated that: “With household bills and living costs rising in the face of global challenges, easing the burden on the British people and growing our economy must be a team effort across Cabinet.” He added that “we will continue to do all we can to support people without letting Government spending and debt spiral, whilst continuing to help Brits to find good jobs and earn more, no matter where they live.”

However, the Prime Minister’s own assurances on protecting the British public from rising costs were set against the Government’s actions regarding the Health and Care Act, which has just been enshrined in law.

The Prime Minister continues to make promises to help the British people with the growing cost burden, while the Health and Care Act leaves those on the lowest income exposed to spending a greater proportion of their assets on care costs, during the worst financial crisis we have seen in generations.

The Government’s own amendment to the Bill, which was subject to a fierce debate in both chambers of Parliament before ultimately being voted through, means that the local authority support people receive to help them meet their care costs, will no longer count towards the proposed £86,000 cap.

This is all the while that the PM has continued to make promises to address the decades-long social care funding crisis and widening health inequalities. The £5 billion in extra money announced for social care over the next 3 years, is of course welcome. But there is no mathematical link between the amount of money and the level of need. The Health Foundation calculates that at least £8 billion are needed per year, just to deliver what councils are legally obliged to.

Failure on “levelling-up”

Research commissioned by Access Social Care, which provides free legal advice for those with care needs, shows that poorer areas with lower council tax and business rate yields have been worse affected by the reduction in the central Government grant for social care.

This means that people living in poorer areas where social care need is often the greatest, are already getting a bad deal compared to other parts of the country, which flies in the face of the much-vaunted concept of “levelling-up.”

Rather than addressing this unfairness, the Government’s amendment is compounding it, by leaving people living in ‘red wall’ areas having to spend a greater percentage of their total assets on care.

The Health and Care Act is a clear contradiction in the PM’s assurance to focus efforts on easing the burden for British people and protecting the public from rising costs. It will instead deepen the cost of living to the poorest of our society and widen long-standing health inequalities.

Access Social Care are already seeing cases where the cost of living crisis means that people cannot afford the social care they so desperately need. The Government urgently needs to do more to ensure that everyone can get the social care they need, at a price they can afford.