Case study: Improving diabetes care in Norfolk and Waveney

By Integrated Care Journal

How collaboration between DUET diabetes and Norfolk and Waveney ICB is helping to upskill healthcare professionals involved in conducting primary care diabetes reviews.

DUET diabetes was founded to improve the understanding and knowledge of those looking after adults with diabetes. The service offered is designed to improve the skills and confidence of professionals working in health and social care roles and the standards of diabetes care they provide; ultimately benefiting the people (adults) they look after.

DUET has been working with Norfolk and Waveney integrated care board (ICB) to develop a face-to-face workshop programme as part of their creation of a Diabetes Training Academy. Through the creation of a central diabetes training hub, the ICB aimed to:

Drive excellence in diabetes care, ensuring healthcare professionals (HCPs) had the competencies they require to improve the management of diabetes.
Reduce potential complications that arise from more uncontrolled diabetes.

The workshop programme was designed for HCPs involved with conducting diabetes reviews within primary care practices. The content focussed on laying the foundations of understanding diabetes and its management and then built upon these to include the ‘eight key care processes’ and the importance of a ‘holistic diabetes review’. A key aspect was to ensure that learners could confidently and competently undertake a diabetic foot screening examination and be aware of the local footcare pathways.

Representatives of the ICB involved with driving this initiative also attended the workshops to further understand the challenges taking place in primary care (looking specifically at local issues) as well as better understand the inconsistencies.

The workshops have been attended by 55 HCPs (additional funding is being sought to roll out further training), with overwhelmingly positive results:

100 per cent of learners recommended the workshops.
100 per cent also felt their knowledge and skills had improved because of the training.
More than 80 per cent of learners indicated a preference for learning in small groups that are interactive and led by a professional.
Fewer than 2 per cent indicated a preference for E-learning.

*HCP knowledge satisfaction scores pre-training*

*HCP knowledge satisfaction scores post-training*

The training has helped HCPs to understand how to be more person-centred by understanding the impact diabetes can have; such as the importance of pre-conceptual care and availability of additional local services. Being better educated, knowing when and where to refer concerns, providing a person-centred, safe and responsive service enables HCPs to provide appropriate support (and education) to people living with diabetes in a caring and effective manner. The ultimate beneficiaries are the people living with diabetes.

“Very happy with this course! One of the best courses in healthcare I have done. I have learnt so much, and gained lots of confidence in diabetic reviews and foot checks.” Tiffany Ellis Healthcare Assistant, Primary Care

“It was a lovely small group and we all engaged in the activities, as well as ask and answer questions.” Sam Chapman Healthcare Assistant, Primary Care

For more information about DUET diabetes, click here.

Unpacking cancer disparities in England

By Rachel Millar

Despite major gains in diagnosis and treatment, England continues to experience high disparities in cancer outcomes, with social and financial deprivation major drivers.

In December 2023, The Lancet Oncology published a landmark paper highlighting the “astounding inequality” in the risk of dying from cancer in England. Researchers from Imperial College London looked at the 10 most deadly cancer types in England and analysed the risk of dying from these across England’s 314 districts from 2002 to 2019.

Although the overall risk of dying from cancer before the age of 80 had declined over that time period, their analysis shows huge inequalities in risk depending on where in the country someone lives. For women, the risk of dying from cancer was one in 10 in Westminster, while for women in Manchester the risk was one in six. Meanwhile, the picture for men ranged from one in eight in London’s Harrow to one in five in Manchester. The study found that lung cancer had one of the highest inequalities in risk across areas with those at greatest risk areas having triple the risk of dying from lung cancer compared with those in lowest risk regions.

The concept of health inequalities is now well established in the UK and beyond. The publication of the DHSC Black Report in 1980 demonstrated that, although there had been a general improvement in public health since the introduction of the welfare state, there were widespread health inequalities across the country. It found that the primary cause for these inequalities was deprivation. Over four decades later, there is now a vast body of evidence examining health inequalities and the evidence suggests that despite new treatments and technologies, overall health is deteriorating, and the inequalities are widening.

Social determinants still a major influence

Research has shown that for cancer, the social determinants of health impact both prevalence and prognosis. The Health Foundation describes the social determinants of health as the “social, cultural, political, economic, commercial and environmental factors that shape the conditions in which people are born, grow, live, work and age”.

A 2020 report demonstrated that more than 30,000 extra cases of cancer in the UK each year can be attributed to social and financial deprivation, while survival was found to be worse among the most deprived groups. Many of the risk factors for cancer are influenced by the social determinants of health. For example, individuals residing in areas with higher levels of deprivation are 2.5 times as likely to smoke compared to those in the least deprived areas, and they find it harder to quit.

Diet inequality is also an issue that affects the most deprived in society. Research has shown that people in deprivation have poorer diets, and consumer higher levels of poor quality, ultra processed, high calorie food than those in the least deprived areas. This population also suffers from much higher rates of obesity. As a result of such social determinants of health, those that grow up and live in deprivation are more likely to get cancer, but the story doesn’t stop there.

Variations in diagnosis

There is huge variation across the UK in cancer diagnosis. There are currently three UK screening programmes: for bowel, breast and cervical cancers. In theory these screenings are open to everyone eligible, however, in reality there are various barriers to screening that disproportionately affect certain populations, and this leads to inequalities in diagnosis.

Barriers to screening are an active area of research but there are several factors that have been identified to contribute. Stigma is one factor, with research showing that cancer stigma is linked to lower screening uptake, and this tends to be more prevalent among people from ethnic minority backgrounds.

Another barrier recognised is the practicality of attending a screening. For example, other responsibilities such as work or caring may make it difficult to get to an appointment. There are ways to overcome these barriers and increasingly NHS services are implementing changes to make screening more accessible to everyone. For instance, research suggests language barriers hamper screening uptake and therefore translation services can help overcome this. Also, offering greater flexibility on appointment times and re-invitations for those that haven’t responded have been found to positively impact uptake in underserved populations.

Overall, there are clearly gross inequalities across both the risk of developing cancer and the prognosis once it has developed. However, as researchers gain deeper insights into these inequalities and the mechanisms that contribute to them, NHS and public health services can implement best practices in order to try and level the playing field for cancer care. In April, Public Policy Projects will be hosting a round table event looking at regional inequalities in prostate cancer, so look out for the report later this year.

News March 11, 2024

Improving the lives of people in our places through place-based procurement

By Stuart Watkins

Place-based procurement is a strategic approach that provides benefits for healthcare systems, value for the taxpayer and serves as a catalyst for economic development. Stuart Watkins, Health Business Manager at Crown Commercial Service explains the importance of place-based procurement and offers key considerations for developing successful policies.

Providing a good quality and healthy life for people that live in the communities that make up our places is at the centre of public service provision.

Place-based procurement is about understanding the issues, interconnections and relationships in a place and coordinating commercial action and investment to improve the quality of life for people.

Beyond health outcomes, place-based procurement has the power to shape the broader landscape by encompassing social value, carbon neutrality, interoperability and sustainable economic benefits.

All the places that make up our diverse communities across the United Kingdom will have different health and social care models to meet their specific local needs. This gives rise to both Integrated Care System (ICS) place-based procurement challenges and opportunities.

The benefits of place-based procurement

There are several benefits that can be achieved through strategic place-based procurement, including:

Efficiency and cost savings: standardisation and place-based Cost Improvement Programmes (CIPs) of clinical pathways ensure the best possible outcomes for patients, place-based partnerships and the taxpayer.
Patient and community centred care: investing in place-based digital health services ensures the provision of accessible, patient-centred care at home or in other community settings.
Tackling health inequalities head-on: place-based procurement strategies directly address disparities by aggregating social value and sustainability requirements and helping ICSs improve access, outcomes and experiences.
Economic development through pricurement: the intentional support of local businesses and the aggregation of sustainability requirements not only support economic growth but also contribute to the overall well-being of the community.

Five considerations for your integrated care boards’s place-based procurement policy

While each region will have different strategies based on its unique goals and circumstances, the following place-based procurement strategies are helpful approaches for all ICSs to consider.

Choosing national procurement aggregation initiatives: A simple way for ICSs to save costs and improve procurement efficiency is through collective buying. When ICSs combine their own buying needs with those of other organisations across the public sector, they can tap into savings not possible when buying individually. CCS runs ongoing aggregation programmes for goods and services including IT hardware, mobile services, software licences and utilities. Joining an aggregation enables ICSs and place committees to combine local requirements with other ICSs nationally, ensuring economic value and favourable terms.

Regional collaboration through purchasing and innovation: Working together with regional NHS trusts, schools, science networks and universities helps develop and procure innovation. These contracts allow a lead group, or authority, to source goods and services for everyone within the ICS. This means that economies of scale can be achieved. 

Engaging communities / co-designing strategic projects: Place committees and integrated care boards regularly connect with local communities and interest groups. This makes it straightforward to turn these localised stakeholder engagements into strategic procurement projects that have a positive influence on places, like establishing a new acute hospital.

Harnessing data-led procurement: ICSs are investing in data analytics to inform procurement decisions and enable them to secure sustainable procurement value. 

We understand that this is a critical area for the NHS. It is the foundation of developing an efficient, effective and economic commercial strategy, both nationally and locally. In this context, CCS has provided £12.8 million of funding over three financial years to support the rollout of the Atamis e-commerce system. 69 per cent of NHS organisations are already signed up, with a target of 90 per cent by 2025. 

Empowering local small and medium enterprises: Prioritising local SMEs aligns with ICS goals, supporting community growth. This creates business opportunities and supports local development, as well as reducing environmental effects from distant supply chains.

How CCS can help

At CCS, we’re committed to collaborating with our colleagues across the public sector to revolutionise health and social care, and improve the lives of UK citizens.

As the largest public procurement organisation in the UK, our scale allows us to access multiple savings and provide real benefits for customers.

Think of CCS as a collaborative partner. Our experts can help you successfully navigate the complexities of place-based procurement and achieve transformative healthcare outcomes.

Download our full white paper

Our latest white paper, ‘Place-based procurement strategies for Integrated Care Systems’, aims to enable ICSs to optimise every pound spent, address their communities’ unique needs and maximise the health and wealth of the regions they serve. You can download the guide from the CCS website.

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

By Gabriel Blaazer

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

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

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

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

*Source: Health Innovation Yorkshire & Humber*

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

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

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

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

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

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

The full report can be accessed here.

Extra Early Support Hubs funding welcome, but more needed, warns Royal College of Nursing

By Gabriel Blaazer

The government is providing an extra £3 million to expand the number of Early Support Hubs across the country and reduce pressure on NHS services.

The Royal College of Nursing (RCN) has cautiously welcomed an extra £3 million of funding to expand access to Early Support Hubs for children and young people in England.

The 24 drop-in hubs will provide psychological therapies and specialist advice to children and young people, on issues such as mental health, sexual health, employment, drugs and alcohol and financial worries.

Following the government’s initial investment of £4.2 million in October 2023 to support 10 Early support hubs, the additional funding will see a further 14 hubs increase their service offering to children and young people. A network of 70 Early Support Hubs already operates across the country, run by a combination of volunteer organisations, NHS trusts and local authorities.

However, while welcoming the additional investment, the RCN has warned that the government needs to go further in supporting the mental health of young people and is urging the government to make similar commitments to improving workforce recruitment and retention.

The RCN’s Head of Nursing Practice and Professional Lead for Mental Health, Stephen Jones, said: “The RCN has repeatedly pushed the government to invest in early mental health intervention and we’re pleased to see these calls recognised with additional funding for early support hubs. But as demand continues to rise, this must be one step of many.

“Across England’s NHS mental health services, there are over 13,000 unfilled nursing posts, accounting for nearly 1-in-3 of all nurse vacancies. Shortages like this have real-world consequences, leaving staff unable to meet the needs of all patients suffering a mental health crisis.” Jones urged government ministers “not to become complacent and invest in the nursing workforce which delivers these vital interventions.”

The Deputy Chief Executive of NHS Providers, Saffron Cordery, has likewise urged the government to go further, saying: “Too many children and young people and their families face long waits for mental health and community health services vital for their wellbeing and development.

“We need a more joined-up, cross-government approach with equal national focus on community and mental health services to support children and young people as early as possible.”

The government says that it has increased spending on NHS mental health services from almost £11 billion annually in 2015/16 to almost £16 billion in 2022/23. It has pledged an additional £2.3 billion of funding a year but March 2024, aiming to extend mental health support to a further 345,000 children and young people, “regardless of [their] background or location”.

UK cancer patients waiting longer for treatment than comparable countries, research finds

By Integrated Care Journal

The research compares access to radiotherapy and chemotherapy across four countries and eight cancer types.

New research by University College London reveals that cancer patients in the UK wait longer for treatment compared to several other nations. In a first-of-its-kind study, researchers analysed data from two studied published in the Lancet Oncology, covering more than 780,000 patients diagnosed with eight different types of cancer between 2012 and 2017 in the UK, Australia, Canada, and Norway. The cancer types were oesophageal, stomach, colon, rectal, liver, pancreatic, lung and ovarian cancer.

The study found that UK patients had the longest average waiting times for both chemotherapy and radiotherapy across all four countries. The average wait for chemotherapy in the UK ranged from 48 days in England to 65 days in Scotland, while Northern Ireland and Wales fell in between. Norway had the shortest average wait at 39 days.

For radiotherapy, the wait times were even longer in the UK, ranging from 53 days in Northern Ireland to 81 days in Wales. Newfoundland, Canada, had the shortest average wait at 42 days, followed by Northern Ireland (11 days longer), England (three weeks longer), and Scotland and Wales (seven weeks longer).

The study also highlighted that a lower proportion of UK patients with certain cancers received chemotherapy and radiotherapy compared to the other countries. For example, only 59 per cent of ovarian cancer patients in the UK received chemotherapy, compared to 73 per cent in Australia, 72 per cent in Norway and 67 per cent in Canada.

Similar disparities were observed for pancreatic cancer patients, with UK pancreatic cancer patients the least likely to receive chemotherapy or radiotherapy (27 per cent), compared with Canada (41 per cent), Norway (44 per cent) and Australia (47 per cent).

While not all patients require these treatments, chemotherapy and radiotherapy are key treatment options for cancer. The research suggests that countries with better cancer survival rates tend to have shorter waiting times and more frequent use of chemotherapy and radiotherapy. Cancer Research UK, which partly funded both studies, attributed the delays in treatment to a lack of long-term planning for cancer care in the UK compared to countries with strong cancer strategies and allocated funding.

This research offers valuable insights into the current state of cancer treatment in the UK and raises important questions about potential improvements to benefit patients.

Michelle Mitchell, Chief Executive of Cancer Research UK, attributed part of the UK’s poor performance on cancer treatment to the NHS’s longstanding workforce challenges, saying: “When it comes to treating cancer, timing really matters. We can learn a great deal from other countries who have stepped up and substantially improved cancer services. With a general election on the horizon, the UK government has a real opportunity to buck the trends we see in this research and do better for people affected by cancer.”

Cancer surgeon and Clinical Lead for the International Cancer Benchmarking Partnership, Dr John Butler, said: “Lower use of chemotherapy and radiotherapy in the UK could impact people’s chances of survival, especially for older patients. This study captures missed opportunities for patients in the UK to receive life-prolonging treatment.”

The Department of Health and Social Care said it has invested substantial sums into cancer care since the period covered by the research, citing £162m invested into radiotherapy equipment and £2.3bn invested into community diagnostic centres.

New BMA report highlights ‘broken’ mental health system

By Integrated Care Journal

Persistent lack of funds and trained staff, combined with soaring demand, are placing unprecedented strain on NHS mental health services, new report finds.

A new BMA report, based on first-hand accounts from doctors working across the NHS, reveals the state of England’s ‘broken’ mental health services.

The current annual economic cost of poor mental health has been conservatively estimated at more than £100 billion in England alone, and £117.9 billion across the whole UK. The report from the BMA, “It’s broken.” Doctors’ experiences on the frontline of a failing mental healthcare system, identifies that a compound of funding, staffing, infrastructure and systemic challenges have led to the “dysfunctional” and “shocking” deterioration of NHS mental health services.

Without concerted efforts from central government to resource mental healthcare according to demand, which continues to outstrip NHS capacity, as well as societal change, the report argues that the future is bleak for those suffering from poor mental health, especially children and those with neurodevelopmental disorders.

Despite there being a greater focus on mental health from successive recent governments, the report finds that words have rarely translated into action, and that there has been no overall improvement to services in the last decade.

This is partly attributed to a lack of adequate resources within the system, but also to the impact of wider social determinants, such as housing, unemployment or financial concerns. It accuses the government of failing to grasp “the significance of the issue and how failing to tackle these wider societal issues is increasing demand for NHS mental healthcare.

Among its recommendations, the BMA report calls on the Department for Health and Social Care to “plan for and incentivise the expansion of the professionally trained workforce, including within psychiatry and general practice,” as well as to “embed mental health social care within the NHS, for example through in-house social workers.”

It also makes argues that attempting to quantify how much extra funding and staff levels are needed is incredibly difficult due to a lack of consistent data on the prevalence of mental illness, and echoes recommendations from Healthwatch that NHS England collect and publish national data on referrals and waiting times.

The BMA carried out in-depth interviews with doctors across the mental health system, including those working in psychiatry, general practice, emergency medicine, and public health. “[Support for people with mental health conditions] is shocking,” said a practicing psychiatrist quoted in the report. “We would not accept this in any other area of medicine.”

Quotes in the report:

“Mental healthcare in this country is dysfunctional. It’s broken.” – GP, Nottingham

“Patients always know that they can come into the emergency department…between spring this year and spring 2022 there was a doubling of Mental Health Act assessments in the emergency department. Which I think is fairly indicative of more systemic issues and obviously it impacts on our workload.” – Consultant psychiatrist working in A&E, Oxford

“Everybody wants to do the right thing. Everybody’s trying really hard, but we’re just not putting our money where our mouth is when it comes to saying we need to invest in prevention and early intervention.” – Public health consultant, West Yorkshire

Dr Andrew Molodynski, a consultant psychiatrist in Oxfordshire and the mental health lead at the British Medical Association, said: “As doctors struggling to provide mental health care, we know only too well that the system has crumbled. Some of our patients wait as long as four years for treatment, meaning too many people – including children – continue to fall through the gaps, and all the while funding remains insufficient. We’re having to make hard prioritisation choices that leave many patients without care and support that they urgently need.

“The demand for mental health services has changed dramatically, but funding has not kept pace. Mental healthcare funding must be based on what people need today, instead of being based on what we spent yesterday, which was inadequate even then.

“We need these changes to the system to be able provide good quality care and tackle the huge cost of mental health to people’s lives, the NHS, and the economy.”

Voting opens as Our Health Heroes 2024 finalists announced

By Integrated Care Journal

Voting has opened to decide the winners of the 2024 Our Health Heroes Awards.

Our Health Heroes recognises the extraordinary people at the heart of our NHS and is delivered by Skills for Health in partnership with NHS Employers, NHS England, NHS Shared Business Services and more.

Fifteen finalists have been shortlisted across five categories celebrating the UK’s health heroes.

Votes are welcome from across the community – including colleagues and service users – to decide who will be crowned gold, silver and bronze award winners at a ceremony held in Central London on 16 April.

And the finalists are…

Apprentice of the year:

Phoebe Edwards, Podiatry Apprentice, East London NHS Foundation Trust
Ben Martin, Data Quality Support Analyst, Bradford Teaching Hospitals NHS Foundation Trust
Debbie Harris, Healthcare Assistant, Essex Partnership University NHS Foundation Trust

Healthcare Volunteer of the Year:

Rezmin Islam, Volunteer, Liverpool Women’s NHS Foundation Trust
Tracy Spencer, Volunteer, WithYou in North Lincolnshire
Paul Fox, Yoga4Health & Yoga4NHS Co-ordinator, The Yoga in Healthcare Alliance

Outstanding Life Contribution sponsored by NHS Employers

Philip Helliwell, Rheumatology Consultant, Bradford Teaching Hospitals NHS Foundation Trust
Tony Westacott, Learning and Development Manager, Avon & Wiltshire Mental Health Partnership NHS Trust
Elaine Allison, Matron, St. Bartholomew’s Court Nursing Home

Operational Support Worker of the Year

Paula Di Palma, Housekeeping Manager, St Raphael’s Hospice
Cat Carman, Social Prescriber, Fenland Group Practice
Tina Jackson, Family Liaison Officer, Portsmouth Hospitals University NHS Trust

Clinical Support Worker of the Year:

Chido Munyanyi, Therapy Support Worker, University Hospitals of Leicester NHS Trust
Swati Gor, Healthcare Assistant, Havergal Surgery
Kerry Clark, Macmillan Cancer Support Worker, Nottingham University Hospitals NHS Trust

Voting opens today (20 February) and closes at 11.59pm on 5 March. To find out more about the finalists and to cast your vote visit: www.skillsforhealth.org.uk/awards/vote

Follow #OurHealthHeroes on Twitter for all the latest updates.

Patients support expansion of at-home testing, report finds

By Gabriel Blaazer

Patients report declining mental and physical health while waiting for test results, as well as desire for greater transparency on waiting times and testing options.

A new report from the Patients Association, the independent charity campaigning for improvements to health and social care for patients, finds that patients would be supportive of an expansion of at-home testing, if it means speeding up diagnostic pathways.

The Patient Experience of Diagnostics Report analyses the opinions and experiences of more than 1,000 NHS patients, 77 per cent of whom stated they would be happy to test themselves at home, if this was available.

The paper also illustrates patient frustration with long diagnostic waiting times, as well as with the opacity of testing and treatment options. 60 per cent of respondents said that they would consider paying privately for tests if they faced a long wait on the NHS, but 93 per cent said they would like to see an increase in investment into testing capacity over the coming years, with 91 per cent stating that this investment should be a priority for the NHS.

The report captures the real impact of long waiting times for diagnostic tests, with more than a third of respondents reporting declines in both their physical health (36 per cent) and their mental health (34 per cent) while awaiting tests.

It also highlights calls for greater transparency throughout the patient journey, as 73 per cent of respondents reported wanting a better understanding of why they are being sent for tests, and what the tests will involve, and 82 per cent said they want more discussion about the different types of tests they could be referred for. 88 per cent reported wanting more explanation of how their results may impact their treatment options.

Respondents also voiced their backing to improving access, with 78 per cent stating they would be happier to travel outside their local area for testing if it meant faster access. As well as the 77 per cent who would be happy testing themselves at home, 44 per cent said they would willingly test themselves in a clinical setting.

Based on the findings of the NHS patients who responded, the report makes the following recommendations to improve access to diagnostic testing in the NHS:

Expand community diagnostic hubs by removing NHS estate restrictions and expanding the number and types of tests offered. With demand rising by 7 per cent annually, the current 5 per cent capacity target for new hubs is described as inadequate.
Increase transparency on waiting times through better use of data held by the NHS.
Support appropriate expansion of at-home testing options where considered clinically safe and effective.
Improve communication with patients throughout the testing process. This includes explaining the reason for tests, available options, timelines for results, and what results mean.
Ensure political commitments to improve diagnostic access from all parties in upcoming election manifestos.
Review NHS Constitution pledges on waiting times based on patient experiences.

Heart disease single largest factor behind out of work ill health

By Integrated Care Journal

New report finds that people are more likely to leave work due to a heart condition than any other health issue, and warns that faltering efforts at prevention have cost thousands of lives.

Heart disease is the single largest driver of people leaving the workforce due to ill health, according to new research from the Institute for Public Policy Research (IPPR).

The new paper, Broken hearted: A spotlight paper on cardio-vascular disease, finds that a heart disease diagnosis brings with it the largest risk of a person leaving the labour market, and that someone diagnosed with cardiovascular disease (CVD) has a 22 per cent chance of leaving their job. This compares to a 14 per cent risk for someone with a mental health condition and 16 per cent for a person with cancer.

Almost one in three of all working-age people who are economically inactive have a heart, blood pressure or circulatory condition, the report says. This figure rises among over 50s, a group the government is currently targeting in its efforts to get people back to work.

The report also reveals significant variation in CVD mortality across England and Wales, with the North West the worst affected region. It estimates that if the entire UK saw the same outcomes as the best tenth of local authorities, there would have been 32,000 fewer deaths in 2021 along – equivalent to 5 per cent of total CVD mortality.

Around 80 per cent of deaths from heart disease are preventable, with diet and nutrition, metabolic risks (e.g. high BMI) and tobacco use constituting the three greatest risk factors.

The report cites analysis from the British Heart Foundation that since February 2020, there have been nearly 100,000 more deaths involving CVD than would otherwise have been expected. It attributes this decline in outcomes to a slowdown in progress on prevention over the last decade. If the last decade had seen even half of the progress on preventable CVD mortality observed between 2005-2020, the report estimates that there would have been nearly 33,000 fewer deaths in 2019- equivalent to one in 20 deaths that year.

While virtually all NHS waiting lists have grown steadily in recent years, exacerbated by the pandemic, cardiology is something of an outlier, and waiting lists have tripled since 2012, higher than the overall growth in NHS waiting lists.

IPPR is calling on the government to implement a recovery plan for treating cardiovascular disease, helping both the NHS and the economy, by:

Delivering new preventative policies, such as extending the current ‘sugar levy’ on soft drinks to all high-fat and high-salt products, and using the revenue to subsidise healthy food options.
Getting waiting lists for cardiology down, through increasing access to preventative medications, retaining staff and expanding access to personalised care.
Investing in research, with an immediate injection of £220 million for R&D in cardiovascular disease prevention – with an explicit goal of crowding in private investment.

Chris Thomas, author of the report and Head of IPPR’s Commission on Health and Prosperity, said: “After great strides in tackling cardiovascular disease in the 20th century, the UK is now stalling if not reversing. This is not just costing lives, but also livelihoods. The good news is that heart disease is one of the most preventable health conditions, but the government has to get on to the front foot and deliver proactive policies. Both human lives and economic prosperity depend on it.”

The full report can be accessed here.