Category: News

News

The Hewitt Review: key takeaways so far

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the Hewitt Review

The eagerly anticipated Review into integrated care systems (ICSs), led by former Health Secretary Patricia Hewitt was published today, setting prevention decentralisation and cross government co-production as key priorities. What have we learned so far?

Former Health Secretary and current Chair of Norfolk and Waveny ICS Patricia Hewitt, was commissioned by Chancellor Jeremy Hunt last year to undertake a substantial review into the accountability, governance and oversight of ICSs. The 89-page Review, published on Tuesday, covers England’s 42 ICSs and makes a series of recommendations to enhance the autonomy of ICSs.

In the forward to her report, Ms Hewitt says: “Unless we transform our model of health and care, as a nation we will not achieve the health and wellbeing we want for all our communities – or have the right care and treatment available when it is needed.”

The Hewitt Review calls for ICSs to be given the time and support to succeed. The establishment of ICSs must not simply be another superficial reorganisation – and the Review acknowledges a growing policy alignment ICSs that will “last well beyond one parliament, government or minister,” giving ICSs the time and space to embed the new model.

Shifting power from the centre

The Review also outlines how growing acceptance of the ICS model from DHSC and NHS England should come with a drive towards decentralisation wherever possible. To realise the promise of these systems, the Review states that “national and regional organisations should support ICSs in becoming ‘self improving systems’ given the time and space to lead – with national government and NHS England significantly reducing the number of national targets to no more than 10 key national priorities.”

Central to providing ICSs with greater autonomy is to reset approaches to health and care finance. Accordingly, the Review calls for greater funding flexibility for 10 of the most mature and best performing ICSs, as well as for broader funding reforms to be “multi-year and recurrent”.

Commenting on this, Sir Julian Hartley, Chief Executive of NHS Providers, said: “The emphasis on improvement over top-down performance management is essential and we hope the NHS at all levels will commit to the cultural shift necessary to bring this about.” 

However, Hartley went on to call for greater clarity on the responsibilities and accountabilities of the different system players.

“We worry that trusts and integrated care boards (ICBs) will struggle to work as equal partners while ICBs have day-to-day oversight of providers.

“We’re also concerned that some recommendations could add complexity and bureaucracy – for example, with auditing prevention spending and reframing the role of local government oversight.”

Cross-government co-production

Hewitt insists that, for ICSs to be successful, substantial reform is also required at the heart of government. Article 1.25 of the Review states that:

“Critically, all of us need to change. Local partners within every ICS need to put collaboration and cooperation at the heart of their organisations. NHS England, DHSC and CQC need to support and reflect this new model in the crucial work they do; and central government needs to change, mirroring integration within local systems with much closer collaboration between central government departments and other national bodies.”

Hewitt also calls upon the government to lead a “national mission for health improvement” to shift the national conversation around health promotion – this forms a central part of Hewitt’s drive to promote better health and wellbeing, rather than simply treating sickness. “To underline its importance, this could be led personally by the prime minister,” the Review states.

The Review also calls for the establishment of a central Health and Wellbeing Assembly with a membership that “mirrors the full range of partners within ICSs, including local government, social care providers and the VCFSE sector as well as the NHS itself.”

Shifting the dial on prevention

Hewitt makes a number of recommendations to embed prevention as an overarching principle for ICSs. This includes increasing the share of NHS budgets at the ICS level going towards prevention by 1 per cent over the next five years. While acknowledging that many systems will struggle with this adjustment, the Review insists that:

“An ambition of this kind is essential if we are to avoid simply another round of rhetorical commitment to prevention.”

The Hewitt Review also calls for a consistent national framework to monitor prevention investment by Autumn 2023, and suggests that ICSs should establish and publish their baseline investment in prevention by April 2024. Further, the Hewitt Review includes a recommendation to increase the public health grant allocation, which is central to enabling systems to drive forward their ambitions for the health of their local populations 

Commenting on the Review’s focus on prevention, Mathew Taylor, Chief Executive of the NHS Confederation, said: “The focus on prevention is crucial for long term sustainability of both the NHS and more broadly to increase health and wellbeing of the population, and something for which we have long been advocating.“

Health inequalities as the primary objective

Recent research from Public Policy Projects revealed widespread acceptance among ICS leaders that reducing health inequality is the biggest priority for integrated care. However, with ongoing immediate pressures and a seemingly endless cycle of year-on-year winter crises, many systems have been unable to develop the long term population health strategies needed to bring down health inequality.

In arguing that action on health inequalities is far more than a ‘nice to have’, the Hewitt Review echoes PPP’s position that action on health inequality is itself the primary objective of ICSs and essential for the long-term viability of the health and care system.

Hewitt said in her review that: “I heard real concern that the transformational work of ICSs and specifically the opportunity to focus on prevention, population health and health inequalities might be treated as a ‘nice to have’ that must wait until the immediate pressures upon the NHS had been addressed and NHS performance recovers. That is what has always happened before, and must not happen this time.

“Prevention, population health management and tackling health inequalities are not a distraction from the immediate priorities: indeed, they are the key to sustainable solutions to those immediate performance challenges.”

Empowering ICPs

The Hewitt Review also suggests a number of measures to give greater significance to the role of integrated care partnerships (ICPs), including the establishment of a national ICP Forum to create direct communication between ICPs and DHSC and to make the ICP the primary mechanism through which preventative health policy can be delivered.

The Review also gives due consideration to the need for cultural change within NHS, local government and provider bodies. As stated in PPP’s report, Ensuring ICSs represent a partnership of equals, it will take time for the constituent parts of ICSs to become familiar both with each other and with collaborating across organisational boundaries.

Digital skillsets

There is also welcome recognition in the Hewitt Review that the lack of digital skills at all levels of the health and care workforce is a significant barrier to the success of digital and data-driven transformation. This formed a core recommendation of PPP’s ICS Futures, which calls for mandatory digital expertise at board level and efforts to increase the digital competency of the workforce more broadly.

Expanding the role of CQC

With greater autonomy for ICSs will come a greater need for flexible accountability and as such, the role of CQC, and how it can be enhanced to provide greater system oversight, is one of the key focuses of the Hewitt Review. In accord with PPP’s Ensuring ICSs represent a partnership of equals, the Hewitt Review calls for increasing expectations of CQC to assess the level of mutual accountability between partners within a system. This will include assessments on cultural change and system integration.

Section 3.87 of the Review states that: “CQC should take into account the extent of collaboration around organisational development and quality improvement.” This, the Review states, should be led by a “Chief Inspector of Systems” who should draw upon the multiple sources of quantitative and qualitative data available to CQC.

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Health Inequality, News, Thought Leadership

Tackling rehabilitation provision must be a priority for ICBs

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By Natasha Owusu, Policy Lead (England) and Rachel Newton, Head of Policy at the Chartered Society of Physiotherapy (CSP).

Rehabilitation, long-term conditions and health inequity

It is not fair that a person’s ethnicity, socioeconomic situation, sex, age, religion, sexuality and disability can determine the level of access they have to rehabilitation services which can lead to worse health outcomes.

People in deprived communities and groups marginalised by discrimination live shorter lives and spend a greater proportion of their lives affected by long-term conditions and disabilities. The evidence of treatment outcomes for people with frailty, musculoskeletal, cardiovascular, respiratory, and neurological conditions, cancer, spinal injury, brain injury, and many more conditions, shows irrefutably that rehabilitation is as essential as medicines and surgery.

But rehab services are either unavailable, have long waiting times, or are poorly equipped to meet the needs of their communities, having been desperately under-resourced and under-staffed for decades. The impact of this is felt by those communities most in need, entrenching health inequity. Whether or not an individual accesses rehab affects not only their health but also their life chances, earning potential, likelihood of being in work, how active they are in their community, how likely they are to become socially isolated, and how happy they are.

Without rehab, people can be stuck in a downward spiral of worsening health, loss of mobility and poor mental health and multiple medication regimes. Ensuring everyone who needs rehab can access it can reverse this downward spiral, so that people cannot only survive but live healthy and active lives.

For decades rehabilitation services have been fragmented and developed in a piecemeal way. This has created a confusing system, which is hard for service users to navigate, or to know what to ask for or expect. GPs and hospital doctors are often unfamiliar with what rehabilitation is, what it can achieve, and the evidence supporting this. This means referral rates are low and when they do refer there is often poor communication with patients about what rehabilitation is and why it is an essential part of their treatment.

Rehabilitation is siloed, located in hospital department out-patients when it doesn’t need to be and there is inconsistency in what a ‘good’ level of provision and quality looks like. People who are marginalised, and those experiencing higher levels of deprivation, are more likely to be diagnosed with one or multiple long-term conditions, and this will be earlier on in their lives, with more severe conditions.

The same parts of the population with the greatest need for rehab also face the biggest barriers to access it. The sad fact set out in the CSPs 2022 report, Easing the pain: Rehabilitation, recovery, reducing health inequity, is that patients from deprived communities and marginalised groups are failed at every stage of the rehabilitation pathway.

This much we know. But there is so much we don’t know because data collection on rehabilitation needs, and provision is poor. Legally, all NHS and social care services must collect data about patients’ protected characteristics but there is a huge variation in how consistently and accurately this is done. This inconsistency is part of a wider issue of a dearth of data in community rehabilitation services.

The CSP’s Making Community Rehabilitation Data Count report, highlights the need for centralised data collection to best meet the needs of populations and to track the development of integrated rehab services.

The drive for improvement and innovation that has produced medical breakthroughs now needs to be applied to recovery and rehabilitation.

The role of integrated care systems

Rehabilitation sits at the intersections of health and social care sectors, taking place in social care, community, intermediate and acute NHS settings, and provided by multiple sectors.

The modernisation of rehabilitation can only be done by working across the whole system, rather than sector-by-sector or condition-by-condition. Through this approach, rehabilitation should be seen as a litmus test for integrated care systems.

There are many pockets of excellent rehab services for people with any long-term condition, that have designed their service to be accessible to all their communities, and take a holistic, integrated approach.

Scaling up this approach requires strategic leadership, adoption of consistent standards, the workforce to deliver and data.

The CSP has joined forces with more than 50 other professional bodies and national charities in the Community Rehabilitation Alliance (CRA) to recommend the following for ICBs:

  • Appoint Single Accountable Leads for Rehabilitation operating at a strategic level to deliver expansion, integration and redesign of services and be accountable for key performance metrics.
  • Adopt the Community Rehabilitation Best Practice Standards co-developed by the Chartered Society of Physiotherapy with our partners.
  • Expand and develop the rehabilitation workforce. This includes making use of the growth in registered physio numbers, but also the non-registered workforce, exercise professionals and other AHPs, nurses and doctors involved in rehabilitation.
  • Develop ICB data plans to show who is and isn’t accessing rehabilitation services, the consequences of this, the level of provision against population need, and performance on improvements.

CSP Member and Chair of the Birmingham and Solihull ICS AHP Council, Seema Gudivada, will be talking more about this approach at the panel discussion, Effectively addressing health inequalities in West Midlands (at the Birmingham ICS Delivery Forum on 18 April). Seema hopes delegates will be inspired after the event to action these recommendations to make equitable access a reality and improve outcomes for all patients across the West Midlands.

For further information or advice, please visit the CSP stand at the Birmingham ICS Delivery Forum on 18 April 2023 or email cre@csp.org.uk.

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News, Omnicell

Why interoperability is key to transforming the healthcare service and patient safety

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Ed Platt, UK Sales Director for Omnicell UK & Ireland, discusses digital systems and why interoperability is key to transforming the healthcare service and driving patient safety.

Within healthcare, interoperability is the integration of technology and healthcare systems to simplify the communication, delivery and digitalisation of clinical information across an organisation or system. Effective interoperability allows for improved collaboration and clinical workflows to inform crucial decision making, creating time and financial savings – all with the aim of driving better patient outcomes.

Omnicell, as a leading medication management solution provider, is paving the way for interoperable technology to become widespread in the healthcare landscape, as it is in other sectors. Omnicell’s Automated Platforms have been integrated with several leading providers of Electronic Prescribing and Medicines Administration (ePMA) and electronic patient record systems (EPR, more commonly known as EMR outside of the UK) which have led to a reduction in medication errors and better workflows for staff.

These working interfaces are with Better, Cerner, EPIC, AllScript, SystemOne, WellSky and MedChart, to name but a few. However, it is also possible for platforms to link and integrate with medication wholesalers, finance systems and many more stakeholders, with a view of delivering a patient-centric supply chain.

The global challenge

The World Health Organisation recognised the severity of medication errors and more than 5 years ago, introduced a Global Patient Safety Challenge, Medication without Harm, with the ambition of reducing avoidable medication-related harm by 50 per cent. The scale of the issue within the UK is worrying; in 2018 the EEPRU report, Prevalence and Economic Burden of Medication Errors in the NHS in England, further highlighted the sheer scale of medication errors taking place.

The shock of these findings led to a review, which set the healthcare system on the path to technological solutions with the impressive adoption of the ePMA systems. According to a National Institute for Health Research (NIHR) funded study, high-risk medication errors can be reduced by up to 50 per cent with the implementation of this technology.

The next step; interoperability

Linking and integrating ePMA and EPR systems with complementary systems such as inventory management tracking systems, electronic controlled drug solutions, robotic dispensing systems and automated medication dispensing cabinets is the next step in truly driving down medication errors. NHS Trusts are now taking digitalisation a step further by investing in integrated electronic health record (EHR) systems.

EHRs represent a step beyond the standard patient medical history found in paper-based patient medical records and include a broader view, including information from all the clinicians involved in a patient’s care. Importantly, they also share information with other healthcare providers, such as laboratories and specialists. This approach enables NHS Trusts to enhance their operational and financial efficiencies and improve the experience for staff working at multiple sites.

Interoperability with partners helps ‘close the loop’ in the medication management process; not only does it enable optimisation of medication administration, it also provide a full access to patient data records allowing for complete visibility and accountability. For patients, it means healthcare professionals have up-to-date access to all information, irrespective of the treatment venue, enabling the delivery of high-quality, coordinated and informed care. Integration also allows for additional features and shared data with Omnicell pharmacy technology automation and intelligence solutions to drive inventory optimisation, diversion management, medication usage analytics, compliance and population health services.

A collaborative partnership approach

Omnicell prides itself on being a long-term partner to hospitals as a quality, trusting relationship supports a smooth transition to new, technology-enabled ways of working – supporting full buy-in and adoption by staff. Technology solution providers should spend time on-site, understanding different workflows in various departments and proving expert guidance on how adoption can best be used to make significant time and cost savings quickly. For example, the medication needs on an intensive care unit are different to the needs of an orthopaedic ward.

But what is the optimum solution for each of those wards, and which model of interoperable technology is going to be the most effective when it comes to achieving zero errors, zero waste and zero time-consuming process for staff? The future must therefore be one of sharing, co-operation and transparency; between systems, between patients and healthcare providers, between healthcare providers and industry experts and between different healthcare disciplines – all driven by knowledge and supported by data.

Conclusion

Interoperability solutions are a great opportunity for the healthcare sector and could be a crucial factor in realising the future of our much-loved national health service by presenting the sector with cost, safety and efficiency opportunities. With the right partners, Omnicell’s solutions can transform medication management and create synergies across healthcare enterprises. Technology doesn’t stand still and, looking to the future, interoperable technology solutions, data and AI have the power to change the healthcare landscape beyond recognition.

Chesterfield Royal Hospital introduced ward based automation systems for medicines to further reduce the risk of error and increase efficiency, with the ultimate goal of improving the management of medicines in the ward environment and reducing the burden placed on nurses and pharmacy staff. Martin Shepherd, Head of Medicines Management at Chesterfield Royal Hospital NHS Foundation Trust, commented: “This is a significantly better and safer way of dealing with ward medicines. The risk to patient safety is lower as we have reduced our dependence on manual processes. It provides a safety net, reduces the risk of products being wrongly selected and near misses. Integrating the ward-based systems with PMA only strengthens that level of security. It helps us in our drive to ensure that patients receive the right medicines at the right time.”

St Mary’s hospital already had a ward level electronic prescribing system in operation for two years when they decided to take the next step in patient safety and automation by installing Omnicell automated medication dispensing cabinets in all care areas. Jackie Harry, NICU Ward, Isle of Wight NHS Trust, commented; “We have much better stock control and expiry date management, and it’s really easy to use even in an emergency. We have saved time hunting for keys and searching in cupboards – we know we have the stock and the cabinet takes us to it. Invaluable. Really time efficient and safe.”

Ed Platt, UK Sales Director, Omnicell UK & Ireland

This article was kindly sponsored by Omnicell.

To learn more about the importance of interoperability, visit Omnicell.co.uk or email:

UKMASales@Omnicell.com

Call: +44 (0)161 412 5333

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Community Care, Population Health, Thought Leadership

Can ICSs unlock the value of private business to health equity?

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population health in business

New insight from Public Policy Projects (PPP) outlines how businesses can support health equity through community engagement, why they should, and how integrated care systems (ICSs) can support them.

The findings go on to suggest that should these community engagement strategies be co-designed by ICS members involved in the setting of priorities for the public sector in a local area. Private businesses can align their strategies with public bodies and with one another, maximising the value of their role as community stakeholders.  

The insight piece outlines how businesses can impact the health of a community – such as by implementing healthy workplace policies, implementing inclusive local recruitment practices, partnering with community organisations, investing in community development, implementing local procurement strategies, and advocating for health equity. The piece goes on to make the business case for community investment, outlining how investing in communities can increase community loyalty and trust, improve employee morale and retention, enhance brand visibility, and increase innovation. 

The value of community engagement to businesses, the document suggests, can be further grown through collaboration with the public sector. This can support better knowledge sharing, as a number of NHS trusts already oversee effective community engagement strategies, and enable initiatives from both the public and private sector to better support oneanother and accelerate the improvement of health equity within a region.  

Improving health outcomes in the community provides the following recommendations to business leaders and policymakers: 

  • Businesses should be incentivised to invest in communities – through recruitment, procurement and outreach – and should be encouraged to partner with other businesses and public bodies to improve the quality of data and insight. 
  • ICSs, local authorities, central government and businesses should explore opportunities to utilise ICPs as a forum for private, public and third sector stakeholders in a local area to communicate, establish shared priorities and create plans of action. 
  • In order to develop stronger guidance for businesses to collaborate with ICPs, there should be a tailored section within the Maturity Matrix for ICSs discussing partnerships with private businesses. 
  • Businesses should communicate regularly with other local stakeholders, including Health and Wellbeing Boards. These communications should ensure businesses are supporting local health equity ambitions by responding to Joint Strategic Needs Assessments. 
  • Businesses and local authorities alike should seek to grow their investment into tools to understand the impact of community engagement and the health value of social investment. 
  • Further guidance on partnerships within the ICS framework should be issued – with a specific focus on enabling effective public-private collaboration. The Department of Health and Social Care (DHSC) should collaborate with the Department of Work and Pensions to issue this guidance. 
  • ICSs and DHSC should seek to develop guidance for businesses to support local health outcomes through recruitment, procurement and outreach. This guidance should not be overly proscriptive, but should provide a clear idea of the relationship between various social determinants of health and business practices. 

Improving health outcomes in the community is the second instalment of the Population Health in Business series, which discusses the health creation value of business and suggest to business leaders and policymakers alike how they may re-envisage their roles, collaborate and deliver better outcomes.  

The roundtable that served as the evidence-base for this report was conducted in February 2023 and chaired by Professor Donna Hall CBE, Chair of New Local, Integrated Health and Care Systems Advisor for NHS England, and a woman once described as a “public service pioneer” by Mayor of Greater Manchester, Andy Burnham.

Professor Donna Hall CBE said of the series: “The three workshops by PPP have explored the practical ways 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.”

The PHIB roundtable series has concluded, however the final insight summary and final report are still being written and will be launched in June 2023.  

Read the full insight piece here.

For further information about the report please contact eliot.gillings@publicpolicyprojects.com    

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News, Primary Care

New survey finds public awareness of pharmacy services as low as 13%

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Findings from pharmacy tech startup Charac reveals more than half of patients do not use their local pharmacies for anything more than minor illnesses.

A new study from Charac, an NHS-integrated one-stop platform for independent community pharmacies, has provided a new insight into public perception and patient usage of pharmacies. Awareness of the full scale of services is as low as 13 per cent of those surveyed, and 53 per cent are not using pharmacies for anything further than very minor ailments.

With pressure on the NHS reaching unprecedented levels, Secretary of State for Health & Social Care Steve Barclay has acknowledged the importance of a ‘pharmacy first’ policy for England. This is designed to allow pharmacies to act as another entry point into the health service, and to relieve some of the pressure from general practice. However, this is yet to be realised in policy, and Charac’s research has found that patient knowledge of pharmacy services remains worryingly low.

Knowledge of services

More than 50 per cent of patients were not aware of the majority of services pharmacies provide. Most respondents were only aware of 4 out of 15 potential services, being minor illnesses, repeat prescriptions, emergency contraception, and flu vaccination. Knowledge of services was as low as 13 per cent for chlamydia screening and treatment, for example.

Usage of services

The only pharmacy services that more than a third of respondents reported using were for minor illnesses, such as colds, flu, and low-level digestive issues (58 per cent), and for repeat prescriptions (47 per cent). In fact, these were the only two services that the majority of respondents would go to a pharmacy for instead of their GP – 57 per cent for minor illnesses and 52.5 per cent for repeat prescriptions, respectively.

Furthermore, patients on the whole are still using pharmacies for traditional services, such as ordering prescriptions (96 per cent) and disposing of old medication (80 per cent). While satisfaction with pharmacy services remains high, with almost half of respondents giving their pharmacy the highest satisfaction rating, patients evidently remain hesitant to use pharmacies as the first port of call.

Santosh Sahu, founder and CEO of Charac, said: “Though it is great to see patients largely very happy with the services provided by their pharmacies, it’s clear that patient confidence in various services other than prescriptions is low. To push a ‘pharmacy first’ policy, more must be done to provide pharmacies with better resources and increase patient confidence.

“Both funding and improved digital access can make a tangible difference in equipping pharmacies for the future. Charac’s platform is helping pharmacies improve their online presence, as well as helping them generate a steady income by digitising processes such as consultations and prescriptions.”

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News

Public satisfaction with NHS hits lowest level ever recorded

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Public satisfaction with the NHS has slumped to the lowest level ever recorded by the British Social Attitudes Survey (BSA), the annual survey of public opinion covering conducted by the National Centre for Social Research (NatCen).

Overall satisfaction with the NHS now stands at 29 per cent according to the new BSA survey – the lowest level yet recorded. A fall of 7 per cent from the previous year, this year’s report shows the fourth largest year-on-year drop in NHS satisfaction recorded. First carried out in 1983, NatCen’s BSA is seen as the gold standard barometer of public attitudes to a wide variety of social issues. The 40th iteration of the survey was conducted in September and October 2022.

According to analysis published by the Nuffield Trust and The King’s Fund, dissatisfaction with the NHS has also reached an all-time high, with 51 per cent of respondents saying that they were dissatisfied with the NHS. 69 per cent of respondents cited long waiting times for GP and hospital appointments among the reasons for their dissatisfaction.

Dissatisfaction with A&E services has jumped by 11 per cent, the biggest year-on-year increase in dissatisfaction since the question on A&E services was introduced in 1999. A record 40 per cent of survey respondents said they were dissatisfied with A&E services, and only 30 per cent reported feeling satisfied.

Other NHS services reaching record-low levels of satisfaction include general practice, dentistry and hospital in-patient services.

As with last year’s survey, public support for the NHS and its core principles remains undimmed. Nine out of 10 respondents agreed with the principle that the NHS should ‘definitely’ or probably’ be free of charge at the point of need, while eight out of 10 agreed that the NHS should be available to all and primarily funded through taxation.

The Royal College of Physicians (RCP has warned that the survey’s findings make the need for a long-term workforce plan from the government all the more urgent. Dr Sarah Clarke, President of the RCP, said: “It’s sadly unsurprising to hear that one of the main reasons for the public’s dissatisfaction with the NHS is staff shortages. NHS staff are under more pressure than ever before – often stretched far beyond the limits of their contractual working hours and responsibilities as they try to keep up with demand and do their best for patients.

“The government needs to publish the promised long-term workforce plan in full, including numbers of staff needed to meet demand in 5-, 10- and 15-years’ time, and commit to deliver the funding needed to underpin it. The plan must include an expansion of medical school places to increase the number of doctors. Lives are depending on it.”

Jessica Morris, report author and Fellow at the Nuffield Trust, commented: “Behind the political upheaval and turmoil playing out at the time of this survey, the British public was sending a message about the worsening situation for the NHS. The fact we have now recorded the lowest level of satisfaction with the NHS in the 40-year history of this gold standard survey is a warning siren. The rate of decline has slowed from the previous year, but that is barely a silver lining given the challenges and impact of the pandemic.

“The Prime Minister has made recovering the NHS one of his central promises going into the next general election. But these results show what an enormous task this will be. It is clear that the level of unhappiness amongst the British public over the way the NHS is running is going to take many years to recover.”

Dan Wellings, report author and Senior Fellow at The King’s Fund said: “It is easy to become desensitised to the relentless flow of bad news about struggling health services, but we cannot underestimate the significance of today’s unprecedented results. These stark findings should act as a wake-up call to those in power.

“Even with satisfaction dropping to its lowest ever level, support for the founding principles of the NHS remains strong. The public do not want a different model of healthcare, they just want the current model to work.”

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News, Workforce

Majority of clinicians want more training on health inequalities, says RCP report

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A recent study conducted by the Royal College of Physicians (RCP) finds that most clinicians feel they haven’t received enough training on health inequalities and would like more as part of their medical education.

The study, led by Dr Ash Birtles, RCP Clinical Fellow in health inequalities, looked at clinicians’ confidence in talking about and understanding health inequalities – avoidable, unfair and systematic differences in health between different groups of people.

Of the almost 1,000 clinicians surveyed, 67 per cent of respondents reported that they had not received any teaching or training in health inequalities within a training programme or as part of their degree. 31 per cent said they felt confident in their ability to talk to patients about the impact of inequality on their health, however only 26 per cent felt confident in their ability to reduce the impact of health inequalities in their medical practice.

In two self-selecting focus groups following the survey, all participants were keen to access further education on health inequalities, specifically in understanding how they could help to reduce them in practice. They felt that better understanding the needs and experiences of marginalised groups would help them in a healthcare setting. They were also interested in education on wider aspects of health and wellbeing, including the impact of sustainability and climate change on health.

Health inequalities have become a focal point of the health service in recent years. In 2021, NHS England launched a new approach to tackle health inequalities – Core20PLUS5. Its three components are: a focus on the 20 per cent of the population who constitute the lowest quintile of deprivation (the ‘Core20’); “an additional focus on local inequalities” (the ‘PLUS’); and the five key clinical areas of focus as defined in the NHS Long Term Plan (the ‘5’) – maternity care, severe mental illness, chronic respiratory disease, early cancer diagnosis and hypertension case finding.

Insights gathered during ICJ’s ICS Roadshow in autumn 2022 make clear that ICS leaders are broadly supportive of the Core20PLUS5 approach, specifically the clarity it provides to systems over their role in reducing health inequalities. The RCP study appears suggest that more nuanced and detailed training should now be made available to the frontline clinicians who are to deliver on the strategy.

When asked during qualitative interviews what the RCP could do to enhance practice in addressing health inequalities, more than half of respondents (55 per cent) said that e-learning resources would be helpful. The RCP has therefore committed to develop bitesize audiovisual educational resources on various aspects of health inequalities alongside an e-learning package.

The RCP will also be using insights from the survey to develop further educational tools and resources to support clinicians with practical ideas on reducing healthcare inequalities in their workplace. The survey was sponsored by Novartis Pharmaceuticals, who provided funding but had no input.

Dr Ash Birtles, RCP Clinical Fellow in health inequalities, and leader of the study, said: “This survey has allowed us to capture a snapshot of current practice in the UK and to engage clinicians in a meaningful dialogue about the education they feel is needed to help reduce health inequalities in practice.

“I was shocked at the lack of training many had received in health inequalities, but we’re now equipped with the insight needed to create useful and practical training in a way that clinicians feel is most helpful to them.”

The full report can be accessed here.

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News, Social Care

NW ADASS issues Data Security and Protection Toolkit support for commissioners

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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

Email: iris.steen@digitalsocialcare.co.uk

Tel: 07792 636 761

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Community Care, Health Inequality, Population Health, Thought Leadership

Prioritising local ‘business progression’ within ICS population health strategy

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population health in business

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.”

Read the full insight piece from roundtable one here.

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.   

Read more analysis from PPP’s Population Health in Business series. 

Recommendations from roundtable 1 

  • 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.    
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News, Thought Leadership

Are ICSs bringing the right voices together?

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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.

Download the full report here.

Recommendations from the chapter:

  • 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’.
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