NW ADASS issues Data Security and Protection Toolkit support for commissioners
By Integrated Care Journal
The North West Association of Directors of Adult Social Services (NW ADASS) has published guidance to support Adult Social Care (ASC) Commissioners in increasing the implementation of the Data Security and Protection Toolkit (DSPT) across the ASC market.
The DSPT is an annual self-assessment that shows care providers what they need to do to keep people’s paper or digital information safe and protect their business from the risk of a data breach or a cyber-attack. It reassures everyone they work with, as well as their clients and families, that they are taking data security seriously and supports them in running a care service that people can trust.
The initiative is supported by Better Security, Better Care, a national and local support programme that assists adult social care providers to store and share information safely and raise awareness among providers of the importance of data and cyber security. It is led by a programme board whose members include, NHS Digital, NHS England and Improvement, the Local Government Association, the Association of Directors of Adult Social Services and Digital Social Care, which acts on behalf of care providers.
The new guidance provides:
Example wording of DSPT requirements for councils to adopt and adapt as ASC contracts are revised or renewed.
Guidance on monitoring provider adherence to DSPT requirements within contracts as part of the Better Security, Better Care programme.
Michelle Corrigan, Programme Director of Better Security, Better Care, the official programme of support that helps adult social care providers store and share information safely, said: “We are delighted that NW ADASS is providing this support to commissioners. The guide will help councils encourage adult social care providers to evaluate and improve their data security, whether they be digital or paper-based, by completing their DSPT. This is one of many ways local authorities can support implementation of the DSPT among adult social care providers.”
The document is available here and has been developed with input from colleagues at Wakefield, Tameside, Lancashire, and Blackburn with Darwen Councils.
For more information, contact:
Iris Steen, Communications Lead (Better Security, Better Care), Digital Social Care
Prioritising local ‘business progression’ within ICS population health strategy
By David Duffy
PPP’s Population Health in Business series examines the impact of businesses on health outcomes. The first roundtable examined the impact of the employee-employer relationship on health equity within a given region.
Integrated care systems should prioritise the development of local ‘business progression frameworks’ within population health strategy. This is according to a new recommendation from Public Policy Projects (PPP).
Business progression frameworks, developed by ICS leaders and local authorities, can provide local businesses with clear guidance regarding how their employee health and wellbeing strategies can impact local health, thereby driving accountability.
Employment can greatly impact an individual’s health, though this impact varies depending on the nature of the work and workplace environment. Variations in these health implications are significant contributors to health inequalities in the UK and can have a major effect on the impact of ICS population health strategy.
Health inequalities have been found to exist within individual businesses, with poorer health outcomes typically experienced by those at lower occupational grades
The insights were uncovered during a roundtable of PPP’s Population Health in Business series, which convenes key experts, including ICS leaders, to examine the impact that businesses, and employment more broadly, have on health outcomes. The series makes practical recommendations for ICS and business leaders to collaborate to inform population health strategies and improve health outcomes at a community level.
The series is chaired by Professor Donna Hall CBE, Integration and Transformation Advisor to NHS England. Commenting on the insights gathered so far, Professor Hall said: These sessions explore the practical ways in which businesses can support health and wellness in their local communities. We have had engagement from a wide range of businesses, public health experts and academics which has been a rich and diverse discussion. The report provides helpful support and advice to local health and care system leaders, businesses and communities on making the most of private employers as a key part of the local infrastructure to support breed health and wellness for all.”
PPP has found that good employee health and wellbeing strategies and a positive workplace culture are associated with increased productivity and better staff retention – meaning that the quality of a business’s approach to employee health directly impacts their strength as an organisation. A positive workplace culture is one that fosters clear and open communication and strong co-working bonds. PPP also believes that businesses can influence the health and wellbeing of their employees through better pay, flexibility in location and working hours, and increased control over tasks and responsibilities.
Health inequalities have been found to exist within individual businesses, with poorer health outcomes typically experienced by those at lower occupational grades. Businesses that incorporate health into every level of their corporate decision-making, and seek to prioritise those in greatest need, are more easily able to impact health equity than businesses that do not.
How a progression framework is improving health outcomes in Leeds
Leeds City Council’s ‘Business Anchor Progression Framework’ provides an example of what such a framework could look like. Broken down into four sections (employment; procurement; environment and assets; and corporate and community) the framework is “designed for businesses with a large or influential local presence who want to play a full anchor role locally and is a wide-ranging tool that considers the breadth of a company’s activities.”
Anchor institutions can be defined as large organisations whose sustainability is connected to the populations they serve and who seek to utilise their assets and resources to support improvements in health equity and the overall quality of life within their local area. The framework used in Leeds poses questions to businesses such as “to what extent do you encourage the mental and physical health and wellbeing of staff through facilities, policy, culture and support?”
The framework is primarily aimed at private sector businesses that have generally yet to be incorporated into UK anchor networks. The framework also asks businesses to grade their present status and their organisation’s ambitions on a scale of one to four and is intended to provide businesses with clarity on their responsibilities as community anchors and support them in identifying key areas of improvement.
ICSs should craft ‘business progression’ strategies to chart the progress of private businesses within their local system. These frameworks should share some universal objectives and metrics but must also be tailored to the specific needs of the system in question.
Businesses should identify the key health conditions and inequities within their business and should share findings with their local ICS.
Businesses should be further encouraged to submit case studies documenting their approaches to employee health and wellbeing, and their perceived success, to the DWP and their local ICBs.
The DWP should support ICSs in developing ‘business progression’ frameworks by developing a more robust Voluntary Reporting Framework.
Health equity considerations should be incorporated into corporate decision making at every level.
An employee health and wellbeing strategy should include objectives for improving communication between employees, particularly between different seniority levels. Strategies should also view socialisation and the development of workplace ‘rituals’ as key to developing a healthy culture.
Employee health and wellbeing strategies should target those at higher risk of health inequalities, particularly those at lower occupational grades. Strategies should prioritise interventions that help employees easily access support linked to improved social determinants of health and should be extended to contracted employees where possible.
ICSs should encourage employers to re-evaluate their Employee Assistance Programmes (EAPs) to ensure support programmes are easy to use and deliver a clear benefit to employees.
Part one of the ICS Roadshow report recommends that the government should consider broadening the statutory composition of integrated care partnerships to ensure a minimum level of representation to tackle the social determinants of health.
Integrated care system (ICS) leaders have called for the formal inclusion of a broad spectrum of partners in integrated care partnerships, in a report released by PPP. The report, Ensuring ICSs represent a partnership of equals, also recommends that the statutory inclusion of provider collaboratives on ICPs will be essential if ICSs are to effectively make meaningful gains on health inequalities and population health.
These insights and recommendations were gathered from last year’s ICS Roadshow series, which saw ICS leaders and health and care stakeholders debate national and regional integrated care policy in Leeds, London, Birmingham, Bristol and Manchester.
ICS leaders were broadly optimistic that the collaborative and partnership-driven ethos of ICSs has real potential to enable the broad representation of stakeholders who have a positive role to play in population health. However, this is not a given; in its statutory framework for ICSs, the government has taken a ‘minimalist approach’, intended to ensure that the composition of integrated care partnerships (ICPs) is not overly prescriptive, and is flexible enough to reflect the particular needs of local populations.
However, this creates the potential for glaring omissions in the composition of ICBs across the country; for example, it was noted by Dr Justin Varney, Director of Public Health at Birmingham City Council, that “in the creation of ICSs, there was a requirement to have the representation of an NHS provider collaborative”, but no such obligation exists for the social care sector.
“A proper partnership going forward has to have a more structural framework.”
Professor Vic Rayner OBE, Chief Executive, National Care Forum
Pearse Butler, Chair of the South Yorkshire Integrated Care Board, stated a widely-shared opinion at the Roadshow in Leeds, saying “I don’t think an ICB can be remotely successful unless there’s really good partnership arrangements with its local authority and its voluntary sector.”
Chair of the Bristol, North Somerset and South Gloucester ICB, Dr Jeff Farrar, explained how his ICS had worked to achieve real partnership through “inclusive structures” that ensure that as many parts of the system as possible are represented at the top level; “We’ve got a large integrated care board, and we’ve also got a large integrated care partnership”, said Dr Farrar, who added: “we are trying to incorporate VCSEs at all levels.”
L-R: Stephen Dorrell, Executive Chair, Public Policy Projects; Helen Hughes, Chief Executive, Patient Safety Learning; Frances O’Callaghan, Chief Executive, North Central London ICS; Catherine Skilton, Partner, Deloitte
Professor Vic Rayner OBE, Chief Executive of the National Care Forum, argued that this inclusion must extend to citizens – the actual service users themselves. Rayner said that “a proper partnership going forward has to have a more structural framework that requires both the voice of the people who are providing services, and indeed, the voice of people who are receiving those services.”
To address this point, the report, therefore, recommends that the government consider broadening the statutory composition of ICPs to ensure a minimum level of representation to tackle the wider social determinants of health.
“Create a voice [that] represents not your organisation, but your profession.”
Yousaf Ahmed, Chief Pharmacist and Director of Medicines Optimisation, Frimley Integrated Care Board
It was acknowledged by most attendees that following such a seismic reform of the health system, it will take time for the different parts of ICSs to become acquainted with one another and adjust to differences in process and culture. Dr Tracey Vell, Associate Lead for Primary and Community Care at Greater Manchester ICS, argued that instituting formal, cross-sector leadership training would “make people around the boardroom understand what [other sectors] are and what they can do, and the restrictions” on them, facilitating better decision making and resource allocation across each ICS.
Accordingly, the report makes the recommendation that ICSs should consider implementing formal, cross-sector leadership training, to ensure that all parts of the system are aware of the capabilities and limitations of the others.
As participants grappled with the question of how to include different partners at the top level of ICSs, the principle emerged that if population health is to be effectively addressed, the default primacy of one sector over the others must be eschewed in favour of creating a ‘partnership of equals’.
Most notably, participants observed that GPs function as the de-facto point of entry into the health system for the vast majority of those in need of healthcare. This dynamic has led to immense pressure on general practice, and could be remedied if ICSs can leverage the full range of assets at their disposal, particularly the VCSE sector.
“The voluntary sector in Greater Manchester has organised itself.”
Sir Richard Leese, Chair, NHS Greater Manchester Integrated Care.
To this end, leaders overwhelmingly agreed that provider sectors and VCSE organisations must organise themselves, creating a unified voice with which they can influence meaningful change at the top levels. Yousaf Ahmed, Chief Pharmacist and Director of Medicines Optimisation at Frimley Integrated Care Board said that this means creating a “voice [that] represents not your organisation, but your profession.”
In his keynote speech in Manchester, Sir Richard Leese, Chair of NHS Manchester Integrated Care, emphasised that “the voluntary sector in Greater Manchester has organised itself. It has a leadership group that went through a competitive appointment process to appoint the partner member on the board of the ICB.”
While the representation of provider collaboratives on ICPs is not obligatory, the report considers this representation essential. As such it recommends that the government consider mandating the formation of provider collaboratives who can provide an elected chair to sit on ICPs, to guarantee the inclusion of providers from a broad spectrum, if only indirectly.
Government should consider broadening the statutory framework of ICPs to ensure a minimum level of representation to tackle the wider social determinants of health.
ICSs should consider the implementation of formal, cross-sector leadership training, to ensure that all parts of the system are aware of the capabilities and limitations of the others.
Government should consider mandating the formation of provider collaboratives who can provide an elected chair to sit on ICPs.
The upcoming Hewitt review should examine CQC’s ability and capacity to regulate cultural changes, as well as encourage greater scrutiny of how ICSs ability to represent a ‘partnership of equals’.
How Starmer is laying the foundations for a Labour life science vision
By David Duffy
Former Director of Communications for Keir Starmer and current Senior Counsel for Lexington Communications, Ben Nunn, speaks with David Duffy about Labour’s five-pillar strategy, the potential of UK life sciences and the future of the NHS.
If there has been a constant within government rhetoric in recent years, it is the ambition of turning the UK into a ‘life science superpower’. With huge untapped potential to revolutionise health and care delivery and generate significant investment, the life science sector has rightly been identified as a key pillar of Britain’s future economic growth.
“What we have now is the intellectual framework through which Labour will govern”
Recognising this potential, Labour Leader Keir Starmer has placed science innovation, and in particular, life science innovation, central to his vision for government, to give Britain its “confidence, hope and future and to build an “NHS fit for the future”. Last month, the Labour Leader unveiled his vision in the form of a five-pillar strategy – with life science innovation playing a central role.
The party has been careful to avoid potential criticism in the initial run up to the election, protecting what is still an enormous lead – currently hovering around 20 points in the polls. However, Nunn argues that this vision is “not just about winning the next election, it is about ensuring there is a programme of government in place.”
Pushing back on claims Starmer’s party has been light on policy detail so far, Nunn stresses that “this is an iterative process,” and that “what we have now is the intellectual framework through which Labour will govern.” Nunn argues that “being out of power for 14 years, Labour will inherit some of the most challenging circumstances of any incoming government. The public won’t expect Labour to learn on the job, and so they shouldn’t – they will expect an effective government that can start immediately addressing the issues.”
Unlocking industry potential
That Starmer has placed central importance on maximising life science innovation is down to the UK’s untapped potential in the sector. Britain has one of the strongest cases for becoming a superpower in life sciences, with a globally renowned research base and enviable educational institutions boosting its global credentials. This potential has not been lost on Labour, who are seeking to position themselves as the government-in-waiting that will finally capitalise on the nation’s potential.
“The public now view the sector in a more human way than before – it literally saved our lives”
“We have a strong story to tell for UK life sciences,” insists Nunn, “with considerable investment and research potential.” Nunn points to the transformative impact that the Covid-19 pandemic had upon the ways in which people viewed life sciences; “the public now view the sector in a more human way than before – it literally saved our lives.” Nunn does suggest that the current government deserves credit for opening the door to UK life sciences during the pandemic. “For all the many mistakes that were made,” he says, “the government did successfully bring these companies to the table in a meaningful way.”
Looking at the current multifaceted crisis facing the NHS, Nunn insists that Labour understands that the UK will not navigate through these challenges without further developing its relationships with the life sciences industry; “we were not going to get out of that situation [Covid-19] unless industry could step up and provide some of the solutions and the same goes for our current set of challenges,” he reflects.
As it did during its rise to government in the late 90s, Labour is again seeking to position itself as the party of competence, innovation and economic growth. With the momentum currently being garnered, Nunn sees it as “business crucial” for the life sciences sector to engage with Labour. “Ultimately, they should be planning for a change in government. ‘Complacency’ is the dirtiest word in the Labour party at the moment – no one can predict politics – that is a fools’ game, but they should be listening and reading what Labour is saying.”
While the vision is there, the devil will be in the detail, and it remains to be seen exactly how Labour would look to boost the UK market in life sciences. The UK’s share of R&D expenditure has been in steady decline over the last decade. Recent attempts to rectify this trend have come in the form of a new UK life science investment position outlined by the Department of International Trade last year, designed to bring global companies to the UK market. The latest effort to spark new growth UK life science came from Chancellor Jeremy Hunt’s Spring Budget, which revealed new regulatory reductions for simplified rapid drug approvals by the MHRA, as well as tax credit incentives for UK R&D.
“This is an area he has talked about consistently throughout his career”
If these efforts to boost sector growth are not successful, the UK risks being caught in the cold. The passing of the Inflation Reduction Act last year leaves the UK in an isolated position with regard to life science investment, potentially stuck between a rejuvenated US investment environment and further exposed following its exit from the European single market.
Having worked under Starmer while Shadow Brexit Secretary, Nunn insists the Labour Leader is prepared to grapple with what is a profoundly challenging economic environment and is confident that Labour would develop the right engagement techniques with business. He points to Rachel Reeves’ ambitious plan for UK economic growth more broadly, combined with Starmer’s long-held admiration for the life sciences sector as clear indicators of Labour’s intent. “This is an area he has talked about consistently throughout his career,” Nunn emphasises.
A vision for government?
On wider health policy, Nunn insists that Labour “would be loathe” to pursue another series of reforms, suggesting that Starmer will look to work with England’s nascent 42 integrated care systems. “We cannot lose more years to a reform agenda while there are so many urgent system priorities,” he argues. What we may expect to hear from Labour, Nunn suggests, are firm commitments to preventative health policies, an agenda which is vital to the success of integrated care and of the NHS. “Keir sees the value in prevention from his time as Director of Public Prosecutions,” says Nunn, where the impact of a disconnected approach to health, care and wider public services has been repeatedly laid bare.
“It’s about developing sound, high-level ambitions and turning that into retail, election winning arguments”
While Starmer’s outreach to the life science sector is fundamentally about creating a framework for government, there is still an election to be won and, Nunn urges Labour to avoid complacency. The former party comms guru stresses that Labour must remain grounded and develop a message that will offer tangible benefits to people’s lives. “It’s about developing sound, high-level ambitions and turning that into retail, election winning arguments,” Nunn explains
“Keir has long spoken about his desire to move past what he refers to as ‘sticking plaster politics’ – short-term efforts to obtain daily headline coverage.” This, Nunn argues, is where the UK has been trapped in its politics for some time; “this isn’t because of the Tories, it is the way our politics operates.”
Ben Nunn is Senior Counsel for Lexington Communications and former Director of Communications for Labour Leader Keir Starmer.
Registration for Health Plus Care has now gone live
By Integrated Care Journal
CloserStill Media, organisers of Health Plus Care, taking place at ExCeL London on 26-27 April, are thrilled to announce that registration is now live. As part of Health Plus Care, there are three co-branded shows: The Healthcare Show, Digital Healthcare Show and The Residential & Home Care Show.
The Health Plus Care show is the most significant and innovative UK event for healthcare professionals looking to revolutionise the healthcare and social care sectors. The Health Plus Care show is the ideal platform for you to talk about your successes, promote best practice and be a part of key discussions with the UK’s most senior healthcare leaders.
Your team will be meeting senior policy makers from NHS providers, integrated care systems, local authorities and primary care. The event offers the opportunity to generate new leads and have a unique opportunity to meet top decision makers face to face across two days at the show.
With only the most up to date content exploring the latest developments across healthcare and social care, the three shows will educate across various different streams, with a carefully curated and thought-provoking agenda.
Health Plus Care in 2022
The whole of Health Plus Care is free to attend and fully CPD certified to meet your educational needs. This is a topical and timely event, where you’re able to meet your peers in person and come away refreshed with ideas and examples you can implement in your organisation.
FREE tickets for all healthcare and care professionals are available to book here.
The organisers, CloserStill Media, specialise in global professional events within the healthcare and technology markets. The healthcare portfolio includes some of the UK’s fastest growing and award-winning events, such as The Clinical Pharmacy Congress, The Dentistry Show, The Pharmacy Show, Best Practice and Acute & General Medicine.
It is a market leading innovator. With its teams and international events, it has won multiple awards, including Best Marketer – five times in succession – Best Trade Exhibition, Best Launch Exhibition, and Sunday Times Top 100 Companies to Work For – four years in series – among others.
CloserStill Media delivers unparalleled quality and relevant audiences for all its exhibitions, delivering NHS and private sector healthcare professionals from across occupational therapy, pharmacy, dentistry, primary and secondary care with more than £16m worth of free training.
Health inequality high on the agenda at Rewired 2023
By Gabriel Blaazer
ICJ attended Digital Health Rewired 2023 this week, where combatting health inequalities received much of the focus.
“1.5 million homes do not have internet access and approximately 10 million people lack basic digital skills,” announced Richard Stubbs, Vice Chair of the Academic Health Science Network, in his keynote address at Digital Health Rewired 2023. The panel, Using Digital to Address Health Inequalities, saw Stubbs join Christopher El Badaoui, CEO of LVNDR Health and Catherine McClennan, Programme Director for Women’s Health and Maternity Services at Cheshire and Merseyside Health and Care Partnership, to discuss the use of digital as a means of addressing health inequalities.
“85 per cent of primary care practices use online triage,” Stubbs continued, “while more than 99 per cent of primary care practices use digital consulting platforms.” These facts, he argued, create an intrinsic problem; how can patients be expected to use these services if they remain out of reach, hidden behind a digital barrier?
“The pandemic digital transition was too quick to allow for real co-production.”
Layla McCay, Director of Policy, NHS Confederation
Stubbs pointed to a report from PPP, The Digital Divide: Reducing inequalities for better health, authored by Mary Brown, and stressed that government should consider digital access and skills as key measures to assess deprivation. He reiterated the importance of the report’s recommendation that “digital-by-default must operate in the context of the digital divide”, and that healthcare systems must be responsible for providing support for those who wish to access digital pathways.
L-R: Christopher El Badaoui, CEO, LVNDR Health; Catherine McClennan, Programme Director for Women’s Health and Maternity Services, Cheshire and Merseyside Health and Care Partnership; Richard Stubbs, Vice Chair, Academic Health Science Network
This view was shared by, Layla McCay, Director of Policy at the NHS Confederation. In her address to the National Policy on the Table session, McCay explained that “the pandemic digital transition was too quick to allow for real co-production.” As such, digital services that have since been deployed do not mirror the digital competence of many of their intended users, particularly those without ready access to the internet, or those with complex and long-term health conditions, minority communities and the elderly.
“Digital does not just mean ‘apps’.”
Tony Browne, Head of Innovation Digital Care Models, NHSE
Elsewhere, at Rewired’s Integrated Care Stage, Head of Innovation Digital Care Models at NHSE, Tony Browne, discussed the value of interdisciplinary teams when designing new models of care. Himself a former product designer, Browne argued that “product design is needed for digital pathways to be accessible and viable,” and that the current solutions on offer tend to be limited in their value by poor usability and a lack of co-production in their initial design.
“Digital does not just mean ‘apps’,” Brown contended. Rather, it should be closely aligned with Public Digital’s definition of the term; “applying the culture, processes, business models and technologies of the internet era to respond to people’s raised expectations.” Browne detailed the process behind NHSE’s digital cardiac pathway,” which included hundreds of hours of interviews with patients, carers, and NHS staff, as well as undertaking surveys and frontline observations. This “user-centred, data-informed approach” should be the basis for future digital pathways, Browne concluded, and will be key to reducing disparities in access to healthcare.
The Deputy Chief Executive of NHS Providers, Saffron Cordery, used her address at the Integrated Care Stage to discuss the organisation’s work to “build understanding of the potential and implications” of digital solutions at board level to “to increase the confidence and capability of boards to harness digital opportunities”. Building this digital knowledge at the top tier will be essential if health systems are to maximise the benefits of technology, Cordery argued, while ensuring that new solutions do not widen existing inequalities. Cordery referenced the Board Development Sessions run by NHS Providers, which have been delivered to more than 100 healthcare boards to date.
“These tools are built for patients and clinicians and it is so important that they are included throughout the process.”
Christopher El Badaoui, CEO, LVNDR Health
Discussing how healthcare systems can become more inclusive of LGBTQ+ individuals was LAVNDR Health CEO, Christopher El Badaoui. He argued that industry can play a vital role in improving access to underserved groups by creating parallel digital corridors into the health system. Describing how LGBTQ+ individuals often feel marginalised by traditional models of healthcare, El Badaoui emphasised the importance of co-creation and co-development of services.
He detailed the six-month period of consultation and interviews LVNDR Health undertook with members of the LGBTQ+ community, local authorities and health systems when designing their service. “These tools are built for patients and clinicians,” he explained, “and it is so important that they are included throughout the process”. El Badaoui added that during this process, “service users said it was the first time their voices were heard and respected – this is especially important to bridge trust.”
Across the stages ICJ visited, the topic of health inequalities was a recurring theme, and it became clear that most, if not all, attendees agreed that current and future reforms of the health system will have limited impact if they do not address disparities in access and outcomes. It was also clear that while digital solutions will have a substantial role to play in this area, they are not inherently a panacea to health inequalities; new ways of thinking are needed to ensure that digital solutions do not further widen the digital divide.
If health systems and policymakers can get this balance right, it could transform healthcare delivery for good.
The Hewitt Review is a unique chance to commit to the ICS agenda
By David Duffy
Barely six months in and ICSs are already subject to their first independent review – but Patricia Hewitt’s re-evaluation of integration represents a genuine attempt to finally empower ICSs, not another deck chair reorganisation.
Unless you were plugged into the health and care sector, you could be forgiven for not even realising that the NHS had only just undergone its biggest reorganisation in a decade. As we emerge from the toughest winter health and care services have ever faced, images of patients waiting on trolleys for emergency care and of people waiting years for life-altering elective treatment are now etched into the public psyche. The situation has, unsurprisingly, led to calls for fundamental reform in our system of health and care.
But while honest conversations about the state of UK health and care are essential, so too are accurate depictions of the current state of reform – as well as clear and realistic expectations of what these reforms can be expected to achieve.
“It is welcome, therefore, that rather than announce more ‘deckchair reorganisation’, the government has this time opted for a more considered re-evaluation as to the role of ICSs.”
Integrated care systems (ICSs) took up statutory footing in July 2022 with a mandate to deliver joined-up services along a place-based approach, using population health management techniques to bring down health inequalities across the country. Achieving improved health outcomes through these means cannot be accurately assessed in six months’ time, but that hasn’t stopped many commentators from calling for further wholesale reform of the NHS. No major corporation would expect instantaneous results following a merger or acquisition, so why are such patently unrealistic achievements persistently expected from the largest employer in Europe?
The answer, of course, is that our health matters to all of us, and that the government has consistently mismanaged the health service over the course of 13 years. However, the ‘holy grail’ of any health system in the world is a locally responsive integrated care system (or whatever name is used for it) and ICSs do represent a step in the right direction. What they require is time and support to harness their still new statutory position and achieve their goals.
It is welcome, therefore, that rather than announce more ‘deckchair reorganisation’, the government has this time opted for a more considered re-evaluation as to the role of ICSs. The ongoing review of ICS autonomy and accountability, led by former Health Secretary Patricia Hewitt and commissioned by former Health and Care Secretary Jeremy Hunt, amounts to a recognition of two key points: 1) that ICSs are here to stay 2) that if they are to work at a truly local level, central NHS and Whitehall must finally learn to let go.
Hewitt’s combined experience as a former Health Secretary and current ICB chair of Norfolk and Waveney ICS makes her more than well suited to conducting such a timely review. That a Tory Chancellor has asked a former Labour cabinet minister to review the government’s flagship health reform could be seen as something of an olive branch to a Labour Party that will likely inherit England’s nascent 42 ICSs. Any government would be loath to commit to another reform agenda and more legislative upheaval would neglect the significant impact ICSs have already had.
“ICSs have finallly started to build bridges between NHS providers, who are finally taking system-wide views to finance and care strategy based on joint working.”
What ICSs have been able to do so far is address tensions between commissioners (CCGs) and NHS trusts – a dynamic deliberately designed to spark competition and innovation across health and care. Many NHS regions were plagued by tense relationships as NHS trusts competed with each other for funding and CCGs sought to avoid giving said funding. This collaborative, joined-up approach has already promted system-wide approaches to financial decision-making and better adoption of digital innovation.
Hewitt will look to build on this momentum – and first among her six priorities for the review is collaboration.
The issue of collaboration versus competition in the NHS has long been debated, with proponents of the latter arguing that it promotes innovation, while those favouring the former stress that collaboration can reduce risk, expedite information sharing and facilitate scaled innovation. Evidence suggests that, given the choice, most NHS leaders prefer collaborating over competing.
Despite moving towards a collaborative model, it is the age-old shortcomings of centralisation, and an ‘NHS first’ approach to health and care, that continue to hamper the progress of integrated care in England.
Fundamentally, Hewitt is examining the overly centralised, target-driven environment in which health and care operate. Central support and direction for ICSs cannot be overly proscriptive, as the delivery of a truly integrated system is reliant on developing collaborative frameworks that respond to the differences in size, stakeholders and priorities that characterise each ICS region.
“The Hewitt Review must help empower ICSs to cut through these tensions and develop locally responsive and locally reflective service delivery.”
Despite ICSs’ remit for locally managed healthcare with a new brief to connect with local authorities and wider community services, the 2022 Health and Care Act saw Whitehall assume more central power to outline targets, creating fundamental contradictions within the current reforms. At times, ICSs across the country feel squeezed by NHS England and DHSC at a national level, and by individual providers locally.
This tension has come into sharp focus as ICSs have sought to merge the NHS with local government. If ICSs have shown us anything so far, it is that the NHS is not yet ready to marry its own accountability frameworks to those from local government. The NHS is not democratically accountable to its citizens like local authorities are, but is subject to scrutiny from central NHS, DHSC and the Care Quality Commission (CQC) – the latter of which does of course regulate social care, but this is only one part of the community service offering from local government. The Hewitt Review must help empower ICSs to cut through these tensions and develop locally responsive and locally reflective service delivery.
“The absence of an all encompassing metric is not an admission of failure, but rather an acceptance that collaborative models for health delivery are inherently complex and unique to individual localities.”
It will be fascinating to see how Hewitt will seek to reimagine the role of the CQC, which has made repeated efforts to shift its inspection regime to evaluate the progress of integration and wider system working. However, without a comprehensive remit and authority to evaluate whole systems, their impact has been limited.
Assessing the impact of such a model is extremely complicated. Globally, few have been able to produce measurement frameworks or metrics to accurately assess the impact of integrated care. Even the government’s own impact assessment of the 2022 Health and Care Act stated that “there is mixed evidence on whether collaboration can provide cost savings in the delivery of services”.
The absence of an all encompassing metric is not an admission of failure, but rather an acceptance that collaborative models for health delivery are inherently complex and unique to individual localities. Ultimately, the introduction of the Hewitt review is a recognition that successful collaboration is as dependent on culture, management, and resources as it is on rules and structures.
So, before ICSs are consigned to the scrap heap of failed health reforms, Whitehall must finally let go and provide these still young organisations with the autonomy, accountability and cultural freedom to demonstrate what they can do.
David Duffy is Head of Content for Public Policy Projects.
New report looks into the trends and innovations driving change and influencing the facilities management and cleaning industries.
On 22nd February, organisers of The Cleaning Show, which took place at ExCeL, London on 14-16 March, revealed its 2023 Trends Report, exploring where the cleaning and hygiene industries are heading, the latest innovations and trends, as well as the challenges affecting the cleaning and FM industries.
With insights from leading experts representing industry bodies, suppliers and operators, the report identifies five trends that will drive and disrupt the industry in 2023. The report offers a deep dive into how challenges in recruitment and resources, as well as technology and sustainability, will influence the industry, and what businesses need to do to respond to existing and new challenges.
The 2023 Trends Report
Unpacking the recruitment challenge, Delia Cannings, Director, Environmental Excellence Training & Development Ltd, highlights two notable shifts in the workforce during the pandemic. The first saw an influx of new, untrained entrants looking for work, while simultaneously seeing a mass exodus of trained, experienced staff. The impact of this, as confirmed by Jim Melvin, Chairman of the British Cleaning Council (BCC), is that business owners are faced with the challenge of having more jobs vacant than there are people looking for them.
Lorcan Mekitarian, Chairman of the Cleaning & Hygiene Suppliers Association (CHSA), suggests that the lack of cleaning and hygiene operators has been one of the biggest challenges to emerge in 2022 and was a clear “carryover from Brexit and COVID”. Meanwhile, one of the ramifications of the labour shortage has been a bigger focus on automated cleaning systems and robotics.
The collaborative role of technology was put under the spotlight by Kim Phillips MBE, Head of Catering & Facilities Services at Rotherham Metropolitan Borough Council, who explains that the pandemic had resulted in a “growing recognition of cleaning activities as professional services”, resulting in “an emerging sector assisted by technology”. Meanwhile, Paul Ashton, Chairman of the Cleaning & Support Services Association, agrees that technology was having a profound impact on the industry, and if the industry could embrace there would be an “immense opportunity to support front-line teams with effective automation”.
With additional input from Hamid Ghadry, Facilities Services Manager, Estates & Campus Services, University of Northampton; Dominic Ponniah, CEO of Cleanology; and Yvonne Taylor, Global Head of Cleaning at OCS Group UK; the report offers a diversity in perspectives helping to create a rounded look at current and future trends.
Paul Sweeney, Event Director, The Cleaning Show, said: “Over the past three years, the cleaning sector has experienced meaningful change. It was thrown into the spotlight, which served to demonstrate the industry’s frontline role in safeguarding and protecting the public. Today, while the pandemic has taken a backseat, new challenges are emerging.
“The Cleaning Show 2023 Trends Report recognises this transition and the emerging challenges that business owners and operators will face in the coming months. It acts as a important sneak preview of some of the trends we can’t expect to see and hear more about at this year’s show. We’re excited to return to ExCeL, London to explore how these challenges are driving innovation and chance within what is an exciting and highly valuable industry.”
Integrated Care Journal recently spoke to Dr Ashton Harper, Head of Medical Affairs (UK & Ireland) at Roche Diagnostics, to examine the heart failure diagnostic pathway and identify where the biggest opportunities in NHS diagnostics exist.
In the midst of its most challenging period of pressure, diagnostics have a significant role to play in helping to alleviate patient backlogs and free up vital resources across the sector – and nowhere is this more critical than with heart failure.
The health challenge that heart failure, a serious and chronic disease that prevents the heart from pumping blood through the body, poses to the NHS is both immense and relentless. An estimated one million people live with heart failure in the UK, with approximately 200,000 developing the condition every year, creating a profound and multifaceted set of health challenges for the NHS.
Writing in a recently published report by PPP for Roche Diagnostics UK & Ireland, Professor Sir Mike Richards described diagnostics as a “Cinderella” service within the NHS. Yet the UK’s capacity to diagnose heart failure has been consistently hampered by broader capacity challenges in NHS diagnostic service provision, as well as the lack of uptake of, and access to, innovation. A combination of workforce shortages and outdated facilities have historically contributed to late diagnosis and poorer health outcomes. This realisation directly informed Professor Richard’s 2019 report, which led to the introduction of community diagnostic centres (CDCs).
A ‘silent epidemic’
Heart failure is notoriously difficult to diagnose, in part because its key symptoms – breathlessness, exhaustion and ankle swelling – can be caused by a number of other conditions. As a result, late diagnosis of heart failure is unfortunately common, often only occurring once a patient has presented in secondary care following the onset of severe symptoms.
“If heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better”
“Current estimates are that 80 per cent of patients are diagnosed [with heart failure] after a hospital admission,” explains Dr Harper, “and a significant proportion of those will be emergency cases, and so these patients are at the late stage, requiring more intense and complex treatment.” This matters because heart failure patients who require hospitalisation account for “somewhere in the region of a million inpatient days every year, which is about 2 per cent of total NHS annual bed days”. It is also estimated that between 2-4 per cent of the total annual NHS budget is spent managing patients with heart failure (up to £6 billion in 2022/23) and according to Dr Harper, “the majority of this burden is due to hospitalisation – and hospital admissions for heart failure have increased by 50 per cent in the last decade alone”.
“Somewhere in the region of 70 per cent of the total annual cost [of managing heart failure] is actually utilised by the management of stage four patients alone,” says Dr Harper, “but if heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better; they have a better quality of life; and significantly reduced requirements of both primary and secondary care services ongoing.”
Diagnostic reform
“The NHS must look to adopt innovative diagnostic tools at a faster rate”
As was made clear in Professor Richards’ report, the NHS must conduct a wholesale rethink of diagnostic service provision. “Early diagnosis is key to effective management and better outcomes for these patients”, explains Dr Harper, “but while the use of medicines which are deemed to be beneficial and cost effective is mandated in the UK, diagnostics aren’t. It can often take 10 or more years for a diagnostic test to be widely adopted across the NHS.” As such, the NHS must look to adopt innovative diagnostic tools at a faster rate.
NT-proBNP tests are fast, cost-effective, non-invasive and recommended by NICE for the diagnosis of heart failure. Recently updated NICE Quality Standards, recommend that this test be conducted on all patients presenting to primary care with a possible heart failure diagnosis, but this guidance is not universally followed with recent data showing that only 18.3 per cent of heart failure patients had an NT-proBNP test recorded.
“Following the NICE guidance for NT-proBNP testing can reduce unnecessary referrals and allow GPs to better identify patients that do need more urgent referrals for echocardiograms”, Dr Harper notes, which is important because “we’ve got massive echocardiogram backlogs, with patients waiting months”, many of whom may not need one at all. The ability to preclude a heart failure diagnosis early would reduce the echocardiogram bottleneck, meaning those who really need one can access one sooner. “I think mandated funding for NT-proBNP would go a long way,” says Dr Harper. “This approach could help to potentially flip the site of primary diagnosis from 80 per cent in hospital to 80 per cent in the community, and therefore reduce pressure on the NHS.”
Reprioritising and reframing the issue of heart failure
Dr Harper believes that “there’s a strong case for heart failure to be prioritised by NHS England in the upcoming NHS Long Term plan refresh with clearly defined targets, such as exist for stroke and cardiac arrest.” Accordingly, “there needs to be increased collaboration between the NHS, industry and patient organisations to tackle inequalities in the diagnosis and management of patients.”
Much of this comes down to a need to educate and raise awareness of heart failure and its symptoms. “It has been described as a ‘silent epidemic’ because it hasn’t received as much attention as other pressing healthcare issues,” Dr Harper remarks. This lack of awareness has produced some alarming disparities, particularly around gender and misdiagnosis.
“Clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list”
“There is an historical presumption that heart failure is a more male-dominated disease rather than female,” he explains, “when actually it’s about a 50/50 split.” Despite this, women are more likely to be misdiagnosed than men or to wait for much longer than men for their diagnosis. Dr Harper continued, “clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list.”
Echoing recommendation three of Breaking the cycle, Dr Harper also encourages widespread adoption of the Pumping Marvellous Foundation’s BEAT symptom tracker. If shared with the wider public, this checklist – Breathlessness, Exhaustion, Ankle Swelling, Time for a simple blood test – could increase heart failure symptom awareness and ensure that more cases are identified sooner and treated more effectively.
Conclusion
“Ensuring primary and secondary care professionals share a common goal is key”
A coherent and system-wide approach will be needed if capacity is to be increased across all diagnostic modalities, but especially in heart failure. “Ensuring primary and secondary care professionals share a common goal is key,” Dr Harper says, “[and] the introduction of integrated care systems is a great opportunity to foster this collaboration.”
“By increasing diagnostic capacity in the community, we might be able to reduce the pressure on hospital admissions and NHS bed days,” and the use of NT-proBNP tests to confirm or rule out suspected cases of heart failure will be crucial. Taking the present opportunity to radically overhaul the heart failure diagnosis pathway will help to decrease the societal burden of the disease, create extra capacity for the NHS and, most importantly, help heart failure patients lead longer, healthier lives.
Breaking the cycle: Tackling late heart failure diagnosis in the UK, finds that late diagnosis of heart failure is a significant hindrance to the effective management of heart failure. It makes a series of recommendations to NHS England, Health Education England, and integrated care systems, as well as patient groups and industry to come together to improve heart failure diagnosis across the entire healthcare system.
Driving change in 2023: The Cleaning Show unites industry experts to discuss latest trends
By Integrated Care Journal
Recruitment, training and sustainability are among the notable trends set to be discussed at The Cleaning Show 2023, which returns to the ExCeL, London, from 14-16 March 2023.
Recruitment, training and sustainability are among the notable trends set to be discussed at The Cleaning Show 2023, which returns to the ExCeL, London, from 14-16 March 2023.
Under the banner ‘The Cleaning Sector in 2023 – Driving Change’, the full line-up of this year’s conference programme is now available online, highlighting the topics and speakers set to encourage learning, discussion and debate around the key topics facing a modern cleaning and hygiene sector, buoyed by greater public and political recognition earned during the Covid-19 crisis.
Expert speakers from across the sector – including members of leading trade associations and industry organisations – will take a deep dive into a range of topics including recruitment pressures post-Brexit, training and education, sustainability and climate change, employee wellbeing, technology and more. Attendees can also join keynote sessions presented by representatives from Dettol Pro Solutions and highlights from the CSSA’s ‘Innovation Showcase’ programme.
Looking to the future
To kick start the conference programme, Jim Melvin, Chairman of the British Cleaning Council (BCC), will review the BCC’s stated aims in his session The Cleaning Sector Post-Pandemic – Progress, Obstacles and the Future (14 March, 11:00). Here, Jim will review the successes and failures of the past 12 months, the key priorities moving forward.
Also discussing the future of the industry, Paul Ashton, Chairman of the CSSA, will be joined by representatives from Infogrid, Softbank and ICE to discuss The future of cleaning – The role of data in driving positive change (14 March, 12:00). This session will help attendees understand the significance of data, the key benefits and how to overcome related challenges.
Paul Ashton will return on day two with representatives from Birkin, Bunzl and OCS to delve into The future of cleaning – How technology is creating career opportunities (15 March, 12:00). Here, the panel will answer questions such as, ‘why did they choose to work in the industry?’, ‘How do they see the industry changing because of technology?’, ‘What technology do they feel will have the biggest impact?’ and more.
Meanwhile, a new panel discussion for this year’s event will honour Hygiene innovation for the future (15 March, 14:00). It will be moderated by Louisa Moore, communications and sustainability leader, Kimberly-Clark Professional EMEA who will guide panellists through the trends – good and bad – that have emerged, along with the biggest challenges now facing the industry.
Closing the Conference Theatre on day one, three CSSA Innovation Showcase finalists will take to the stage for the CSSA Innovation Showcase Presentations – The future of cleaning (14 March, 15:00), to provide an overview of their innovation and explain how it is relevant to the future of the industry, including the key benefits.
Addressing emerging trends
Sustainability and climate change in the cleaning sector remains top of the agenda for many businesses and brands, as well as rising in consumer expectations. Other trends making an impact on the industry up for discussion during this year’s programme include recruitment pressures post-Brexit, obstacles within training and education and employee wellbeing.
From The Cleaning Show 2022
Nina Wyers, marketing and brand director, The Floorbrite Group will address the issue of climate change and the role of the cleaning sector in reducing its impact during her session, Cleaning for climate change (15 March, 10:30). Elsewhere, Delia Cannings, Director at Environmental Excellence Training Development Ltd., and deputy chair of the British Cleaning Council (BCC), will stress the importance of training for cleaning and hygiene operatives to reduce risk factors whilst creating safer spaces. During her presentation. Education opportunities for the cleaning industry (15 March, 11:00), she will provide visitors with an understanding of the value of training, designed to assist with succession planning for the future.
Also urging the value of employees and the significance of front line workers in the cleaning sector, Kelsey Hargreaves, BICSc youth ambassador, will address the difficulties in recruiting and retaining staff in her session, Youth employment: Less talking, more action (14 March, 14:00). Kelsey will explore how and why the industry fails to attract a new generation of cleaning professionals, exploring the ways in which the sector can combat issues with youth employment.
Facing the truth
Other highlights of the programme will see a technical presentation led by Peter Thistlethwaite, technical projects manager at MSL Solution Providers, who will inform attendees on two of the most popular techniques of decontaminating cleanrooms: ultraviolet light systems and automated chemical misting (airborne automated disinfection systems). With recent changes to regulations concerning both of these decontamination systems, visitors are invited to join Peter in his session, Whole-room disinfection – the impact of changes to regulations, on 16 March, 10:30 to learn more.
Meanwhile, Elise Craig, programme manager of the Living Wage Foundation and Dominic Ponniah, CEO at Cleanology will discuss the living wage in Paying a wage based on the cost of living – why it’s the right thing to do for your staff and for your business (16 March, 11:00), while Fiona Bowman, Managing Director for Dysart 57 Ltd. will return to the stage following her 2022 session, Hidden in plain sight (16 March, 11:00). She will offer advice on how to support staff experiencing domestic abuse.
Neil Nixon, conference director for the Cleaning Show 2023, said: “Knowledge and learning are at the heart of the modern cleaning and hygiene sectors – learning from experience gained during the pandemic, learning from each other, and learning from mistakes made. The cleaning sector has been re-energised by its role during the pandemic, and the agenda continues to be driven by a strong and determined British Cleaning Council.
“This conference will promote discussion and debate on what has been achieved, what needs to be done, and what resources are available in meeting the objectives of a critical sector providing an essential service at a time of limited budgets and recruitment challenges. This year more than ever engagement is key to ensuring that the cleaning sector continues its current upwards trajectory.”
Paul Sweeney, Event Director, The Cleaning Show, added: “The cleaning industry is at a crucial turning point, with many suppliers and manufacturers tackling the ongoing issues of the cost-of-living crisis amongst other global problems. We are thrilled to welcome the industry’s experts to the Conference Theatre in March to hear about the latest trends and challenges.
“I am confident visitors will leave with a greater understanding of the efforts being made to adapt to the new challenges faced, embracing the tools and strategies to overcome them with a fresh outlook on what is achievable. The cleaning and hygiene sectors are filled with so many new and exciting opportunities. We’re excited to see people reconnect at the show and immerse themselves in the future of this highly valuable and exciting industry.”
Registration for The Cleaning Show 2023 is now open. To register for your free pass to attend and to find out more about this year’s event, visit https://cleaningshow.co.uk/london/.
