Cost of living hits social care staff as vacancies soar

By Gabriel Blaazer

As a Health Foundation report finds care home staff are more likely to be living in poverty than other health workers, figures from Skills for Care show the social care vacancy rate has risen to a record-high.

Skills for Care’s annual social care workforce report has shown a drop in the number of care workers in England for the first time in 10 years. It follows a new report from the Health Foundation which finds that care home staff are far more likely to be living in poverty than other health workers, with one in five living in poverty before the latest cost-of-living crisis, compared to one in eight of all workers.

The findings have raised fresh concerns over the viability of a career in care. Despite a stream of pleas for the government to raise the status and pay of care workers, Skills for Care’s report also shows that 80 per cent of jobs in the economy pay more than the average job in social care.

Estimates within Skills for Care’s report show a three per cent fall in the number of posts filled in 2021-22 (amounting to 50,000 posts), the first time a drop has been recorded in 10 years. As such, the vacancy rate in adult social care has risen to 10.7 per cent, the highest rate since figures began in 2012-13. However, the number of vacancies in adult social care also increased by 52 per cent over the last year, up 55,000, and now stands at 165,000 vacant posts.

Furthermore, the starter rate for carers fell from 37.3 per cent in 2018-19 to 30.8 per cent in 2021-22, while staff turnover rates remained at a similar level (29 per cent in 2021/22), meaning that a similar proportion left their roles with fewer staff to replace them.

Taken together, the figures suggest that longstanding difficulties in recruiting and retraining staff are behind the fall in overall workforce numbers, rather than a decrease in demand.

Speaking about Skills for Care’s report, Professor Martin Green, Chief Executive of Care England, said: “This report illustrates the impossible challenge currently facing independent care sector providers. A growing number of people are living with increasingly complex conditions but are being supported through an insufficient government funding pot.

“A lack of government action has had a significant consequence on providers’ ability to recruit and retain staff, with staff being lost faster than they can be replaced. The writing is on the wall and immediate help is urgently required to secure the future sustainability of the sector.”

In-work poverty increasing among social care workforce

Using national survey data from April 2017 to April 2020, the Health Foundation found that around one in 10 residential care workers experienced food insecurity during this time, with 13 per cent of residential care workers’ children living in material deprivation – unable to afford essentials like fresh fruit and vegetables or a warm winter coat. Among the children of all working families, this figure stood at 5 per cent.

Care home staff were also found to be twice as likely to be in receipt of in-work benefits compared to all workers, with around 20 per cent of residential care home workforce drawing on universal credit and other legacy benefits from 2017 to 2020, compared with 10 per cent of all workers.

Given that these figures account for the period before the latest cost of living crisis and Covid-19, the Health Foundation suggests that the picture has likely worsened since 2020; food costs rose by 13 per cent in August 2022 and the annual rate for clothing and footwear was 7.6 per cent in the year to August 2022, up from 6.6 per cent the previous month.

Commenting on the Health Foundation’s report, Hugh Alderwick, Director of Policy at the Health Foundation, said: “Social care workers – who are mostly women – play a vital role in society but are among the lowest paid workers in the UK, and experience shocking levels of poverty and deprivation. Many cannot afford enough food, shelter, clothing and other essentials, putting their health at risk.”

With inflation topping 10 per cent following the Chancellor’s disastrous September ‘mini-budget’, and showing no signs of dropping, there are real fears for the ability of the social care workforce to function under the current circumstances.

Many criticised the absence of a workforce plan in Health and Social Care Secretary Thérèse Coffey’s announcement to the House of Commons in September. The latest reports have prompted renewed calls for the government to issue a comprehensive and fully-funded workforce plan for social care in England, as well as broader measures that tackle the root causes of poverty.

The Health Foundation accuses the government of prioritising the needs of the wealthy over the needs of average workers, although considerable funding has recently been made available to provide support with energy bills. However, they argue that “despite [the government’s] 45p tax rate U-turn, its plan for growth will mostly benefit the richest households.”

“£15 an hour – it’s the least they deserve”

Hugh Alderwick added: “Sustained underfunding of social care has contributed to unacceptable pay and conditions for staff and major workforce shortages, with vacancies in England rising by 52 per cent last year. This reflects political choices. If government values people using and providing social care, it must act to tackle low pay and insecure employment conditions in the sector.

“People on low incomes are most likely to struggle through the current cost-of-living crisis, and poverty in the UK is set to increase. Yet government’s plan for growth prioritises tax cuts over investment in public services – with a further squeeze on public spending likely to follow.”

GMB, the general workers’ union, is citing the report in it calls for social care workers to receive £15 per hour. Rachel Harrison, GMB Nation Officer, said: “Care workers are an immensely skilled, compassionate workforce who do an incredible difficult job. Instead of being properly rewarded, they are expected to survive on a whisker above the minimum wage.

“Essential care is delivered by underpaid and mostly women workers. And without the dedication of our care workers the whole house of cards will come tumbling down. GMB is campaigning for care workers to be paid no less than £15 an hour – it’s the least they deserve.”

Redefining place-based care: facilitating system change

By Graham Brown

Graham Brown, UK&I Marketing Director at Tunstall Healthcare, discusses what the future holds in regards to service transformation and place-based care, and how technology can facilitate access to care and reduce health inequalities.

In order to redefine care and achieve preventative services that reduce health inequalities, it’s important to approach healthcare services both holistically and through targeted resolutions to specific areas of care provision.

By starting with place-based care and the role of technology, it is possible to approach issues around prevention and proactivity and the tailoring of care to individual people and communities. This in turn will help care providers to combat health inequalities and improve access to health, social care and housing.

Defining place-based care

Place-based care presents multiple opportunities, as well as some intrinsic challenges. In order to capitalise on the opportunities that are presented, we must first define ‘the place’ and what this means to the people both providing and receiving health and social care services.

When defining place-based care it’s important to consider the different demographic regions across the UK. There are disparities in the health and wellness of communities with different population characteristics, with affluent areas tending to be more well and living longer than those in poorer areas. Any attempts to tackle these inequalities must therefore be able to target different demographics, by taking into account disparities in access to technology, health and wellbeing, and life expectancy.

The local nature of ICSs will mean that the professionals involved are better placed to understand the needs of different populations and the communities in which they are based. This will then enable better collaborations so that place-based care can be defined, which will in turn support more tailored care that plays a key role in reducing health disparities between communities.

The majority of the population moves between different places, such as the workplace and home, on a daily basis, and this impacts our ability to deliver place-based services across a range of sectors. However, this presents significant challenges when it comes to health and care delivery. Consideration of how to adapt where and when care is provided to each individual that needs it is very important if services are to become proactive and preventative.

A key question is how to ensure that the right objectives, targets and outcomes to manage this are in place. For place-based care to integrate technology and be truly effective, it has to be mobile.

Person-centred and community care

Achieving personalised care will support the transition beyond a holistic approach to one where it is possible to deliver place-based care that targets specific areas, particularly those that require transformation.

Only by making person-centred care a reality can healthcare services be transformed to become flexible and have a place-based approach at their core. To look after a population as a whole in the right places, we need to look after individuals first, particularly through individualised health and care records.

Timings and the evolution of service provision will need to flex for different areas, and the skillset of the workforce will have to change accordingly. By bringing equilibrium to the living standards and available opportunities of our population, we will see an immediate and sustained benefit on health and wellbeing and a reduction in the need for severe elective activities.

Funding streams and ICSs

Changes in funding streams could precipitate a real system change that removes the silos that are currently placing barriers on delivering the most effective services with their own outcomes. However, it is first necessary to take a step back and define these outcomes, to keep the population healthy and deliver real change.

Considering single accountability and each step of an individual’s care journey will empower Tunstall to support ICSs in their role. For example, providing winter funding to social care services first, rather than straight to the acute trust, could have the potential to cut the numerous problems and pressures that the colder weather places on healthcare services and reduce the number of people requiring hospitalisation and other complex care services.

This will be further supported by real collaboration and integration across the system, with a particular focus on enabling data sharing. If issues and demand are addressed earlier, budgets and funding streams can be allocated to the specific areas that need them, and professionals will have peace of mind that there will be fewer significant hospitalisations of vulnerable people.

Falls protection is a particular point that places significant pressures on the health and care spectrum. For example, unaddressed fall hazards in the home are estimated to cost the NHS in England £435 million.1 If the right funding streams, people and technology are put in place, we can build on preventative and proactive approaches to reduce the number of people experiencing falls and the complex and often severe elective activities that can occur. This will in turn lead to a significant pressure being removed from the system.

The impact of technology

Technology’s role as an enabler can move the prevention agenda forward, however it is only valuable if it drives sustainable system change. In order to integrate technology effectively, we must bring the right skill sets into our services to ensure they can deploy digital solutions successfully.

Technology can have a significant impact on the citizen, particularly with the advancement of wearable technology. The ongoing progress that’s been made around data privacy is likely to continue, particularly as the next generation grows up in a digital-first landscape. This will lead to citizens being more comfortable with health and care technology and their data being fed directly into their health and care records.

Technology can provide a longitudinal profile of an individual instantaneously, which is particularly important for personalised care provision, and for making citizens feel more in control and responsible for their own health, wellbeing and care. The more that technology is integrated into care provision, the more empowered the population will become.

However, technology can also initially make people feel less empowered which has contributed to the uptake challenge. Providing education to citizens and care providers can help them to understand how and why they should use technology, which is ultimately to help people live freely and independently in a place of their choice.

Facilitating system change

Tunstall can facilitate system change by integrating technology into our services and considering big data, trends analysis and early indicators. Preventative services will develop effectively when individuals are willing and open to engage with technology and allow the right people to have access to their data. If this engagement is not driven forward, it’ll be more challenging to generate system change and the generational improvement that is needed.

The need to address short term pressures is one of the fundamental challenges within our services. Immediate pressures can become overwhelming and all-=encompassing, which then make it challenging to get to the root causes and tackle them in a systemic way. This is where technology can help, by increasing the bandwidth of the people who can make these changes happen. By giving them access to the right information in the right way they will have the ability to make the right changes at a place based and population level.

As a leading provider of technology, Tunstall is working closely with ICSs to understand the challenges that are faced by our health and care services and how these can be solved collectively. Technology leaders should be focused on breaking down barriers between organisations to help ICSs have the desired impact. Communication through the system, partnerships and problem solving will drive a central vision that ensures shared outcomes.

For more information, please visit www.tunstall.co.uk.

This article was kindly sponsored by Tunstall Healthcare.

Ethicon showcases product portfolio in UK & Ireland hospital tour

By Ethicon

Ethicon, the Surgical Technologies Company of Johnson & Johnson MedTech, has launched its first-ever roadshow across the UK & Ireland, including a showcase that demonstrates the role of digital innovation in supporting the NHS to tackle the backlog of patients waiting for treatment.

Ethicon is committed in its mission to support healthcare systems to treat more patients and provide better experiences and outcomes, especially as recent announcements from the Department for Health and Social Care show how important digital transformation of the healthcare system is, with £2 billion earmarked from the spending review to help digitise the NHS and social care sector.

The Ethicon roadshow began in September and runs until early December. It is a unique opportunity for clinical and non-clinical healthcare professionals to speak to representatives and industry experts about how driving digital transformation is pivotal in this mission, outlining the importance of Ethicon’s Surgical Simulation Strategy and Services & Solutions offering which gives surgeons additional information to support their clinical decision-making.

The products being showcased on the tour bus cover specialties including Colorectal, Gynaecology, Thoracic, and Bariatric. Ethicon’s digital offering has the potential to drive the next surgical revolution, bringing together the value of Next Generation Robotics and Instrumentation, Advanced Imaging, and AI-powered Digital Solutions.

Learn more about Ethicon and its product portfolio here.

“We’re focused on creating a differentiated digital ecosystem including working in partnership with our dedicated account management team to support a successful implementation, data insights, and best practice sharing,” said Jenny Nagy, Ethicon’s General Manager in Great Britain. She continued to highlight the value the company sees in this collaboration:

“Our Ethicon roadshow will give customers the opportunity to discuss innovation in healthcare and witness our innovations first-hand with our product demos hosted on the bus. Our mission may have been accelerated by the pandemic, but we’re keen to connect with our customers in-person to demonstrate the value we place on working together to advance the use of technology in tackling the biggest healthcare challenges.”

The Ethicon tour bus is also hosting:

Science of Energy Training
Surgical Simulation Suite
Product Training Innovation Workshops
New Product Innovations

Clinical and non-clinical healthcare professionals can register their interest in attending and booking a slot at their chosen hospital location here.

This is a sponsored article.

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.

NHS community pharmacies sound alarm as inflation bites

By Gabriel Blaazer

The National Pharmacy Association (NPA) has raised concerns about the future of the community pharmacy sector, with a new report highlighting the impacts of inflationary pressures

The NPA commissioned the investigation into the implications of inflation on community pharmacy commissioned in June 2022 following large spikes in inflationary pressures this year. Professors David Taylor of University College London and Panos Kanavos from the London School of Economics and Political Science were asked to investigate the capability of community pharmacy across the UK to purchase and dispense NHS and other medicines and to become more focused on the provision of clinical services.

The report, Protecting the UK Public Interests in NHS Community Pharmacy, was published in September 2022 and warns of several thousand community pharmacies in the UK having to close thanks to rising costs and ‘flat’ NHS pharmacy funding.

The overall number of community pharmacies in England has fallen by 600 since 2018, about 5 per cent of the total. This number was likely kept artificially low thanks to temporary additional payments that were made to pharmacies during the Covid-19 pandemic, while many pharmacies that remain open have only done so by accepting reduced incomes and incurring more debt.

Many have also reduced the services they offer, cutting loss-making discretionary services and reducing opening hours. A FOI request has revealed that between December 2020 and July 2022, 1600 pharmacies in England reduced their opening times by an average of six hours per week in a bid to cut costs.

Many of the pharmacies that remain under threat are located in more deprived areas, where further closures of pharmacies risks widening existing health inequalities. The report warns that serious damage could be done to the NHS’ medicine supply without urgent government action to help community pharmacies remain as viable going concerns.

However, the picture looks less grim outside of England, with initiatives in Scotland and Wales producing a more stable outlook for community pharmacies there. In Wales, shifts in the balance of NHS pharmacy fees towards providing clinical services, as opposed to dispensing medicines, are being introduced, while in Scotland, prescribing pharmacists are now able to diagnose and treat a variety of conditions that previously would have required GP intervention thanks to the Pharmacy First Plus scheme.

Inflation, inflation, inflation

The report comes after Ernst & Young (EY) were commissioned by the NPA to conduct a study of the funding, policy and economic environment for independent community pharmacies in England. This study was concluded in September 2020 and predicted a deficit of £500 million in community pharmacy funding by 2024. It also asserted that the current financial framework for the NHS pharmacy network was unsustainable.

According to figures from the NPA, the inflation adjusted value of NHS community pharmacy ‘global renumeration sum’ fell by 10 per cent between 2015 and 2017 (see Figure 1 below). It has remained at £2,592 million since then, with no annual allowance for inflation. As things stand, the proportion of English NHS funding allocated to pharmacies will have fallen in real terms by over one third in the period 2015-2024, falling from 2.4 per cent to 1.6 per cent. However, higher inflation rates and increased NHS outlays mean that the drop is likely to be larger.

Figure 1 (click to enlarge): The Community Pharmacy Global Sum in England to (projected) 2024 in current prices and at 2015 prices, CPI adjusted. Source: Professor David Taylor, Professor Panos Kanavos. Authors’ estimates based on ONS and NHS data.

The current Community Pharmacy Contract Framework for England was agreed upon for the period 2019-2024, before the pandemic and the recent inflation crisis. It would have been appropriate to expect a 2 per cent annual inflation rate when the ‘flat NHS funding’ contract sum was agreed upon. However, with inflation sitting at over 10 per cent, and expected to remain there for potentially one or two years, community pharmacies in England are now facing up to net funding shortfalls of 15 per cent in 2023 and 20-25 per cent in 2024, against what could have reasonably been expected in 2019.

Following the steep rise in inflationary pressures in 2022, the new report, Protecting the UK Public Interests in NHS Community Pharmacy, was commissioned by the NPA. It urges the new government to intervene to prevent further pharmacy closures and ensure the viability of the sector throughout the current period of economic turbulence.

The report does, however, point to some signs for long-term optimism, notably the fact that all new pharmacy graduates will qualify as prescribers by 2026. The government has recently announced its ambition for community pharmacy to assume some of the clinical services burden, thus relieving pressures on GP practices and A&E departments.

Such measures were also recommended by a recent Public Policy Projects report, ICS Futures, and the NPA say that that under the new integrated care systems, a transformation of community pharmacy’s role can be achieved, “given sufficient political, managerial and professional will to pursue the public’s best interests.”

Intelligent Healthcare: the tech transforming the NHS

By Gavin Wheeldon

Manchester-based technology company, Purple, is playing a vital role in the digitalisation of the NHS with its innovative ‘Intelligent Healthcare’ solution. Gavin Wheeldon, Chief Executive Officer, discusses the future of the healthcare sector and the vital tech required to drive this digital transformation.

This is a sponsored article.

As the world continues to recover from the crisis that is the Coronavirus pandemic, the healthcare industry is under immense pressure to catch up and keep up. With patient numbers reaching an all-time peak and 6.5m people on the waiting list for hospital treatment, healthcare providers are searching for solutions to stop the backlog growing even further.

Many are understandably resorting to people power to help solve the problem. As a result, a number of hospitals and facilities are continually inundated with waves of new, temporary and student staff. Staggering statistics show that hospitals in England spent more than £1.7billion on agency staff in the first three quarters of 2020-21 alone.

But what the healthcare sector needs are viable ways in which it can innovate, speed up and revolutionise its service to make things much more efficient – to ease the pressure on this growing employee base and to support the overall patient experience. The NHS 2022-23 business plan highlights an absolute dedication to “transforming care through harnessing information and technology”, with the overall strategy focussed on a “care […] to digitalise services, connect them to support greater integration and, with these foundations, enable service transformation.”

Driving the change

Purple are at the forefront of this digital transformation. Thanks to their ‘Intelligent Healthcare’ platform, Purple are able to help hospitals revolutionise for the long term. Their vital technology offers healthcare facilities large and small a range of different tech-led solutions; from real-time location of employees and wayfinding for patients to the launch of Purple’s innovative asset tracking technology.

Purple’s ‘Intelligent Healthcare’ platform

The latter was recently launched by the Purple team in order to provide staff with the ability to keep track of hospital assets such as drugs and apparatus in real time, through their phones. As an interactive ‘indoor Google map’, the platform’s integrated wayfinding hardware then enables them to navigate towards those assets in the hospital as required.

Speedy solutions and wayfinding tech

It is estimated that nurses spend at least one hour of every shift searching for critical pieces of equipment and medication, with only 31 per cent of their total time being spent with patients due to this admin.

As an asset tracking and navigation tool, Purple’s new digital capability will help increase efficiency, reduce costs and improve patient experience for healthcare organisations up and down the country, as well as in the US.

Not only will staff be able to closely monitor and reach their materials more quickly and efficiently, but hospital visitors and patients will also be able to find their way around the hospital much more swiftly, alleviating unnecessary stress and allowing them to focus on the priority of health.

Creating efficiencies

Using Purple’s technology, pharmacies and healthcare providers also have the option to track their medicines on site using mini tags which can help better manage their prescription services. By attaching a mini tag to either a medication bag or an individual vial, applying a BLE tag to a medication cart or by using individual badge tags on delivery personnel, medical providers can better understand where the medication, cart or personnel is located using a mobile device or portal. Upon arrival on site, pharmacies will be notified that medication has arrived by using Purple’s Geo Fences, which initiate notifications.

Purple’s asset tracking solution, combined with the wider intelligent healthcare package, has the potential to help the NHS address the £300m in lost medicine reported every year – money that could pay for more than 11,000 community nurses or almost 20,000 more drug treatment courses for breast cancer.

A trusted provider

With 60 per cent of British employees now using apps on their mobile phones to perform their duties to a higher standard, this shift to tech-first will be a key driver in the digitalisation and future of the healthcare sector.

Purple already provide Wi-Fi to a number of healthcare providers in the UK, including Croydon University Hospital and Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust. As well as providing connectivity for patients, staff and visitors, Purple’s service it goes beyond the limits of everyday Wi-Fi, allowing for real time alerts and information sharing.

In partnership with VCU Health, their team were able to harness its wayfinding solution to create a personalised navigation app for all eight buildings and the VCU Medical Centre as well as its corresponding parking decks. Vitally, Purple’s resource here offers patients a downloadable route which can take them from their front door right to their appointment.

Their app gives a turn-by-turn direction to the exact unit or clinic location allowing patients to arrive on time and anxiety-free. Patients are also equipped with the ability to manually search for facilities such as food and dining and shops on site – and even return to their car or other saved locations.

The future of the sector

Without doubt, the increasing support required by the NHS and wider healthcare community is staggering. Fortunately there is a straightforward solution at hand. These technological advances will serve to alleviate nurses’ valuable time, reducing unnecessary admin and relieving some of the additional stress encountered in the workplace.

If Purple’s Intelligent Healthcare platform can go even part-way to bridging the gap in staff shortages and waiting times, it will have succeeded in its aim. Equipping healthcare professionals with the tools they need, will allow them to focus on delivering vital care, transforming the patient experience for the better.

Gavin Wheeldon, Chief Executive Officer, Purple

Health Inequality, Population Health, Primary Care, Thought Leadership September 30, 2022

Has the government given up on its health ambitions?

By David Duffy

David Duffy analyses Theresa's Coffey's start as health secretary.

Despite the already catastrophic impact of the government’s mini-budget, the first casualty of the government’s short-termist approach to governing was health and care.

Amid the ongoing response to the government’s remarkably misguided mini-budget, recent announcements from DHSC have flown somewhat under the radar of national media. But last Friday’s postponement of the health inequalities white paper is a reflection of a 12-year-old government who have become devoid of long-term strategic thinking in health and care.

Much like how Mr Kwarteng’s budget is being criticised for seeking a short-term growth boost while sacrificing economic stability, Ms Coffey’s health announcements so far seem to be aimed at garnering public support in the short term, and fail to into account the long-term causes of ill health and the enduring challenges facing the sector. Our Plan for Patients, Thérèse Coffey’s first stab at a plan for health and care, is receiving as much attention for what it misses as what it includes, with glaring omissions around workforce strategy and health inequality.

Last week it was reported that new Health and Care Secretary intends to postpone, and potentially scrap, the publication of the long-awaited government health inequalities white paper. It is estimated that health inequalities cost the UK £31 billion to £33 billion per annum before Covid-19 and the paper was a key part of Boris Johnson’s leveling up initiative. When first announced by then Health Secretary Sajid Javid back in February, the intention was to set out “bold action” to deal with disparities in health outcomes based on race, gender and income.

In response, over 155 members of the Inequalities in Health Alliance (IHA) last week wrote to Coffey urging her to maintain the commitment to publishing a Health Disparities White Paper (HDWP) by the end of this year.

The Alliance said: “The DHSC and NHS will be left in the ultimately unsustainable position of trying to treat illness created by the environments people live in”.

The IHA have urged for the government to restate its commitment to health inequalities, warning that “focusing on individual behaviors and access to services alone will not be enough to close the almost 20-year gap in healthy life expectancy that exists in England between those from the least and most deprived communities.”

“that the Secretary of State has so far chosen to ignore the issue almost entirely poses ominous signs for the future health of the nation”

Whether or not you agreed that Johnson’s levelling up initiative was ever truly going to become a reality, it did help kickstart hugely beneficial discourse around health inequality, further prompted by the uneven impact of Covid-19. It was clear from recent Public Policy Projects meetings between system leaders that there is a growing consensus that tackling health inequality is the central objective of integrated care systems (ICSs). With ICS leaders in agreement on the need for action, what has happened to the government’s desire for “bold action” on health inequality?

The obvious answer is that while the economy is rapidly deteriorating and every government department is being asked to find ‘efficiency savings’, long term social and economic rejuvenation is taking a back seat. But in the context of a deepening cost of living crisis, the fact that the new Secretary of State has so far chosen to ignore the issue almost entirely poses ominous signs for the future health of the nation.

Cost of living

Recent polling from the Roya College of Physicians has found that even by May 2022, 55 per cent of people felt their health had been negatively affected by the rising cost of living, with the increasing costs of heating (84 per cent), food (78 per cent) and transport (46 per cent) reported as the top three factors.

Rising costs are creating environments for preventable ill health to manifest in deprived areas across the nation, ultimately impacting health services – but of course, the crisis directly impacts health providers, as well as those delivering care.

NHS Providers have published a shocking new survey from its membership, revealing that some staff are electing to not eat during work hours in order to provide for their children, with some quitting altogether to find better paid work in pubs and bars. Other key findings from the survey include:

71 per cent of trust leaders reported that many staff are struggling to afford to travel to work;
69 per cent said the cost of living is having a ‘significant or severe’ impact on their ability to recruit lower-paid roles such as porters and healthcare assistants;
61 per cent reported a rise in mental health sickness absence;
81 per cent are ‘moderately or extremely’ concerned about staff’s physical health;
95 per cent said that cost of living increases had significantly or severely worsened local health inequalities;
72 per cent said they have seen more people coming to mental health services due to stress, debt and poverty;
51 per cent said they have seen an increase in safeguarding concerns as a result of people’s living conditions.

The health and care community is united in its concern for the wellbeing of its staff and for their capability to respond to the underlying causes of the nation’s health challenges. Unfortunately, the government is failing to match this concern with sound, long-term policy – this epitomised by Our Plan for Patients.

In some ways, it can hardly be a shock that the government is losing its desire to implement long-term health policy; Coffey is the country’s fifth Secretary of State for Health in as many years and must also balance this role with the position of Deputy Prime Minister. Even still, much of the sector has been taken back by some of Our Plan for Patients’ glaring omissions, as well as questioning some of the key commitments within it.

In setting out her key priorities as Health Secretary, the threadbare document published last week attempts to establish Coffey as a “champion” for patients. So far, the plan has achieved little more than alienating much of the health and care community, while simultaneously discrediting the last 12 years of government health policy.

Primary care

“Ministers are quick use the pandemic to excuse ominous backlogs in elective care, yet they do not offer the same leeway for the primary care sector”

One of the central aims of Our Plan for Patients is the expectation for all patients to receive a GP appointment within two weeks of request. In setting this wholly unrealistic, arbitrary national target, without providing additional support for GPs to achieve it, Coffey is seeking to create a doctors vs patients dynamic.

It’s a cheap tactic, designed to pick up votes, and the right wing press immediately came out in support of it. The Daily Mail blamed ‘soulless megapractices’ for ‘Glastonbury style 8am ticket rushes’ – the simple and highly flawed suggestion is that GPs must ‘do more’ and ‘care more’ to improve access to services.

“Targets don’t create doctors,” said Helen Buckingham from the Nuffield Trust, one of many organisations and figures who criticised the target. Former Health Secretary Jeremy Hunt insisted in the Commons that “adding a 73rd national” target for GPs would not address the challenges in the sector. Matthew Taylor Chief Executive of the NHS Confederation simply said the plans “do not go far enough”.

Fundamentally, the UK has a rapidly ageing population with increasingly complex conditions and comorbidities to manage – and it does not have the staff to deal with it. The Health Foundation recently revealed a shortage of full-time 4,200 GPs, with that number projected to rise to about 8,900 by 2030/31. Further, there are 132,000 vacant posts across the NHS. This number includes 47,000 nurses and more than 10,000 doctors.

In the face of these challenges, primary care teams continue to perform remarkably. The latest figures show that GPs carried out 26.6 million appointments in August, up from the previous month and over three million more than in August 2019 – before the pandemic. Nearly half of appointments in August took place on the same day that they were booked and over 80 per cent within two weeks of booking. Almost 70 per cent of these appointments were delivered face-to-face.

Ministers are quick use the pandemic to excuse ominous backlogs in elective care (despite the fact that there were already four million people on waiting lists before Covid-19 hit), and yet they do not offer the same leeway for the primary care sector and continuously fail to acknowledge its achievements.

Primary care was at the centre of the UK’s highly successful Covid vaccine rollout, one of the few genuine achievements of Boris Johnson’s government. All the while the sector maintained impressive rates of service delivery in other areas and managed to rapidly adapt to digital consultations, ensuring that as many patients as possible received care with little to no infection risk.

Rather than support and celebrate a sector that delivered when we most needed it, the government has decided to point the finger at primary care – demanding more from GPs without providing them with the means to deliver.

Unfortunately, initial noises from the current ‘government in waiting’ will have done little to reassure primary care professionals. Shadow Health Secretary Wes Streeting has not only reaffirmed the gas lighting of GPs but has gone a step further, promising same day face-to-face GP appointments to anyone who wants them if Labour were to win power – an announcement already dismissed by the British Medical Association as “not being grounded in reality”.

Even in a political sense, this seems a needless promise to make while the Tories continue to haemorrhage support in all policy areas. A recent YouGov poll suggests that Labour are four times more trusted by the public to manage healthcare – the party should use this political capital to outline long-term health policy that addresses fundamental workforce shortages.

We need our leaders to be realistic and honest with the public about what is possible, and not automatically assume “meeting public expectations” is best for primary care without seeking to manage those expectations.

In the absence of a bona fide, long-term workforce strategy from Westminster, perhaps it is time that we had a government that faced a hard truth: that not every patient should get to see their GP upon request. Patients and end-users should be better engaged with system reform so that they are more aware of the options available to them within health and care and not resort to using GPs for every request – there are simply not enough doctors to see everyone.

Where is the integration agenda?

“This is ‘sugar rush’ politics at its worst. A short-termist approach to governing that is designed to garner a quick dose of public support while the long-term needs of the sector go ignored.”

Political leaders must reaffirm the aims and objectives in the NHS Long Term Plan and indeed the recent Health and Care Bill. In integrated care, there is a principle for care delivery which is designed to segment patients to different parts of the system – delivering them the care that most appropriately addresses their needs while protecting the precious capacity of seriously understaffed and under-resourced parts of the sector.

It is concerning that supporting the development of ICSs, and their focus on addressing health inequality through population health strategies relevant to specific regions, received so little attention in last week’s announcements. If properly supported, ICSs can act as conveners of public services beyond health and care, and so have a huge role to play in revitalising communities and addressing broader inequalities.

The term ‘ICS’ does not appear once in Our Plan for Patients, and the only references to ‘integrated care’ are made in the context of describing integrated care boards as ‘local NHS services’. The whole point of integrated care, i.e., the heart of the government’s flagship health legislation only published two months ago, is to unite a disparate health and care system under a common purpose to improve health outcomes. This of course includes providers within the NHS, but it also includes social care, primary care and wider local government and community care.

As Richard Vize outlined recently in the British Medical Journal, the government has repeated the age-old trope of essentially treating social care as a discharge service for NHS hospitals. Yes, it is true that that a healthy social care sector would alleviate pressure on the NHS, but social care should be so much more than a pressure valve for hospitals.

For many with serious and lifelong conditions, social care is the lifeline that enables them to interact with the world and live with dignity and independence. Politicians who treat social care as a mere afterthought would do well to remember this.

As well as this, the care sector harbours unique insight and intelligence into local health challenges and could provide a hugely meaningful career option for thousands of new recruits. The government should be looking to professionalise the social care sector while helping ICSs to harness the expertise that already exists within it to improve population health outcomes.

There should always be a dual purpose to health reform: addressing immediate challenges while moving towards common, long-term objectives. Immediate problem solving is essential – patients deserve the best possible care that the system is able to give them and right now they are having to wait too long to get it or not receiving it at all. But in purely focusing on the immediate, more visible issues, such as GP waiting times, the government fails to address the root of the problems. The sector needs more staff, better equipment and more resource.

To make matters worse, there are already worrying rumours that the government plans to scrap its obesity targets. Alongside smoking, obesity is one the largest preventable causes of ill health and contributes significantly to cancer rates. Scrapping targets before they have barely had a chance to have an impact makes the promise in this plan to “support people to live healthier lives” ring rather hollow.

This is ‘sugar rush’ politics at its worst. A short-termist approach to governing that is designed to garner a quick dose of public support while the long-term needs of the sector (and ultimately the public) go ignored. It seems that finally the Conservatives have now stopped pretending they have any intention of fixing this very broken health and care system.

It will be of little reassurance that DHSC has already begun rolling back some of these expectations, with the two-week GP appointment target pushed back to the Spring of 2023. The damage has been done, Coffey has drawn her ‘battle lines’, and seeds for a crisis winter like no other for health and care have already been sown. Compounding this is the fact that the government seems incapable or unwilling to provide light at the end of the tunnel in the form of a long-term plan for health and care.

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35,000 patients diverted from primary care through social prescribing hubs

By Rusheen Bansal

NHS Property Services announces the successful delivery of more than 50 buildings and outdoor spaces converted into social prescribing hubs to ease burden on primary care ahead of a winter crisis.

NHS Property Services (NHSPS) has announced the successful delivery of more than 50 buildings and outdoor spaces being used as social prescribing hubs by members of local communities across the country.

The government-owned company has helped local communities up and down the UK over the last three years by identifying, converting, and handing over 54 tailor-made hubs where people can access non-clinical services such as outdoor gyms, sensory gardens, suicide prevention counselling, breastfeeding advisory sessions and ‘toy libraries’ for families to engage in social interaction.

Patients are encouraged to take greater control of their own health and improve their wellbeing in a bid to help reduce mounting pressures on clinical and acute services. Rhea Horlock, Head of Corporate and Social Responsibility for NHSPS comments: “Passing the 50-hub milestone is important progress in our efforts to support NHSE in meeting its targets for 900,000 people to be referred to social prescribing by 2023/24. We are committed to continue to grow our social prescribing programme to bring this valuable support to more local communities”.

It is estimated that about 35,000 people have been able to access services and spaces located at the converted sites since the project began in 2019. This includes patients experiencing a range of physical and mental health issues, including people with special educational needs/learning difficulties and disabilities, people with physical and mental health issues, young carers, asylum seekers and refugees, expectant parents, and adult offenders

This supports NHS England’s announcement earlier this summer to recruit 2,000 link workers to ease the demand on primary care this winter. Hubs like the ones successfully delivered by NHSPS will be a vital component in ensuring the NHS remains resilient as winter pressures are expected to be the worst to date.

One example of this kind of space delivered by NHSPS is The Listening Space in London, set up to provide ongoing face-to-face support available for many people with chronic suicidal feelings, given by well trained and professionally supervised volunteers.

CEO Sarah Anderson CBE shared: “Although The Listening Place was only established five and a half years ago, with a second full time premises opened in partnership with NHSP, and even more Volunteers trained, we are now receiving and responding to more than 500 referrals a month.”

With the NHS Long Term Plan expecting to be refreshed over the coming months, non-clinical interventions such as social prescribing are expected to feature as a core focus for innovation given their proven results to reduce the pressures on primary and acute care. NHS Property Services will continue to support the development of hubs across the NHS estate to support this growing ambition.

Labour’s 45p tax rate pledge welcomed as workforce crisis set to deepen

By Gabriel Blaazer

With nearly one in five NHS and social care workers planning to leave for better pay, the RCP welcomes Labour’s plans to double the number of doctors by restoring the 45p tax rate.

New research has revealed that 43 per cent of health and care workers are considering a job change due to the pressures of their current job, with nearly a fifth (16 per cent) planning to leave the industry completely.

The findings come after Labour pledged to reinstate the 45p tax rate, abolished by Chancellor of the Exchequer, Kwasi Kwarteng, to fund the doubling of medical training places for doctors and nurses.

The announcement from Labour’s Shadow Chancellor, Rachel Reeves, has been welcomed by groups representing the doctors and the NHS, with the RCP President, Dr Sarah Clarke, saying: “We have long called for a doubling of medical school places and were pleased that on Monday the Shadow Chancellor set out Labour’s pledge to do just that.”

Labour have also committed to adding an extra 10,000 nursing and midwifery clinical placements every year, as the NHS and social care battle unprecedented workforce crises which went largely unaddressed in Thérèse Coffey’s first major policy announcement as Health and Social Care Secretary last week.

Addressing a workforce in crisis

Labour have also pledged to recruit 8,500 mental health workers, a move which was welcomed by NHS Providers’ Director of Policy and Strategy, Miriam Deakin, who said: “It is good too to hear a focus on mental health, tackling health inequalities, investing in expanding the workforce and boosting prevention in the community.”

Summarising the effects that more than a decade of cuts and underinvestment have created, Shadow Health and Social Care Secretary, Wes Streeting, said: “Because people can’t see a GP they end up in A&E, which is worse for them and more expensive for the taxpayer.

“Because people can’t get the mental health support they need, they reach a crisis point, which is worse for them and more expensive for the taxpayer. Because people can’t get the social care they need, they’re left stuck in hospital, which is worse for them and more expensive for the taxpayer.”

Responding to Wes Streeting’s speech, Dr Clarke added: “Training more doctors is essential to addressing the challenges that we know the healthcare system will face in the future, such as the rising demand that will come with an ageing population.

“The Shadow Secretary of State’s speech also recognised that a lack of social care leads to people staying in hospital for longer than they need to. A long-term funding settlement for social care is vital to speeding up discharges from hospital and preventing admissions in the first place by enabling more people to live fulfilling, independent lives.”

Responses to Labour’s policy pledges differ sharply to those recently announced by the Conservative Government. Professor Martin Marshall, Chair of The Royal College of GPs, said of the latter’s plans that: “Lumbering a struggling service with more expectations, without a plan as to how to deliver them, will only serve to add to the intense workload and workforce pressures GPs and our teams are facing, whilst having minimal impact on the care our patients receive.”

Underlining the scale of the challenge, Miriam Deakin added that: “With a staggering 132,000 vacancies across trusts and many more in primary and social care, we need a long-term national workforce plan to help the NHS and social care recruit and retain the staff they need. Without this, efforts to improve patients’ access to care will be challenging.

However, Labour has received criticism from some quarters, after Wes Streeting announced at the Labour Party Conference that Labour would require all GPs to offer face-to-face appointments to anyone who wants one. The British Medical Association said the plan was “not grounded in reality”, and suggested that GPs are simply “not trying hard enough”.

“The lack of support on the ground is leading to mass burnout”

The survey of more than 1,000 health and care professionals in England was conducted by Florence, a technology platform providing health and social care workers access to available shifts, and paints a damning picture of how low morale and burnout are impacting an already stretched workforce.

It finds that almost a third of healthcare workers (28 per cent) admit to feeling overwhelmed at least once a week, with 17 per cent feeling burnt-out every day. Meanwhile, 97 per cent stated that the cost-of-living crisis has caused further stress or burnout among healthcare professionals.

It comes after more than half of healthcare workers (56 per cent) admit to working more than 2-3 times a week over their contracted hours, with 7 per cent working overtime every day. Not having enough staff is causing the most pressure in their role (50 per cent), followed by low pay (39 per cent) and high workload (35 per cent).

Fiona Millington, Chief Nurse at Florence, who has long argued that vacancy rates are a big problem within the sector, commented on the NHS’s current situation, saying: “The biggest challenge for the industry at the moment is, without a doubt, staffing. There are more nurses leaving the industry than joining, at a time when the demand for nurses is increasing. The number of vacancies still sits above 105,000 and remains much higher than the overall unemployment rate.

“The lack of support on the ground is leading to mass burnout across the workforce, leading many to question their futures in the profession. The NHS is plugging vacancies with resources from other countries and areas but it has become just a constant cycle of crisis management, without developing long term solutions to the problem.”

World Pharmacists Day: UK pharmacists join the celebration of modern pharmacy to create healthier futures

By Rusheen Bansal

Pharmacists from across the globe have shared their thoughts on the changing role of pharmacy as part of celebrations to mark International Federation of Pharmacists’ (FIP) World Pharmacists Day 2022.

27 pharmacists from across the globe and the AmerisourceBergen family, a pharmaceutical distributor, have contributed to a digital book of celebration, which aims to highlight the changing role of pharmacists and how they can create healthier futures.

Pharmacists are no longer just ‘chemists’ – some pharmacists are now able to diagnose, treat and prescribe for patients who traditionally may have needed to see a doctor or GP, and the government now plans to give more of a role to community pharmacy to alleviate the pressure on GPs. Others are guardians of their local community – keeping an eye on vulnerable patients who may not have regular contact with other healthcare professionals.

Raj Rohilla of Midhurst Pharmacy (West Sussex)/Goys Pharmacy (Battersea)/ Hamlins Pharmacy (Shepherds Bush) noted: “We need doors to open and mindsets to change so that all healthcare professionals can work collaboratively to improve the health and wellbeing of people.”

During the COVID-19 pandemic they stepped up to support stretched healthcare systems, with many taking a leading role in the world-wide response. This has evolved further with more and more pharmacists offering vaccination services for COVID-19, as well as flu, chicken pox and ‘holiday’ vaccinations.

This changing role of pharmacists is helping the health and care workforce to unite to create healthier futures for their local communities.