NHS leaders offered free access to resource to help address air pollution across England

By Gabriel Blaazer

A new resource is to be offered to every NHS Integrated Care System (ICS) to support their development as ‘Clean Air Champions’.

Data confirms that everyone in the UK is exposed to the threat of air pollution, with more than 97 per cent of postcodes in breach of at least one World Health Organisation (WHO) limit for toxic pollutants.¹

This includes vulnerable environments such as healthcare settings, including the one million people who attend GP appointments every day in the UK and the approximately 16 million people who travel to major A&E departments in England every year.²

In the UK, 36,000 premature deaths per year are caused by air pollution, one in five of all premature deaths, and tackling air pollution will be a vital strand of integrated care systems’ (ICS) efforts to address and reduce environmental determinants of poor health.^3,4

Launched at the NHS ConfedExpo, the ICS Clean Air Framework is a practical tool that empowers healthcare leaders to take action on cleaner air and has been developed to support every ICS in England to become a ‘Clean Air Champion’. Joining forces to drive the initiative forward are the environmental change charity Global Action Plan, Newcastle Hospitals and Boehringer Ingelheim. The Framework is freely available to all 42 ICSs nationally to aid the development of an action plan to improve air quality around all healthcare access points in England.

The Framework links to the mandated requirements of Green Plans, the NHS Standard Contract, the Delivering a greener NHS report and the UN’s Sustainable Development Goals. The tool supports the newly established ICS healthcare leaders to incorporate air quality improvement measures around hospitals and health hubs as part of their broader commitment to address environmental challenges.

The Framework launch coincides with Clean Air Day on June 16th, which this year reveals how air pollution impacts almost every organ in the body. Professor Sir Stephen Holgate, Special Advisor on air quality to the Royal College of Physicians and UKRI’s Clean Air Champion, explains “Air pollution is an invisible killer and plays a role in many of today’s major health challenges. The ICS Clean Air Framework is a ground-breaking resource to support the NHS in implementing air quality improvement initiatives that will ultimately protect the health, wellbeing and economic sustainability of today’s communities and future generations.”

The Framework is being pioneered by Newcastle Hospitals, who are first to drive the development of an action plan in their region. James Dixon, Associate Director of Sustainability at Newcastle Hospitals, explains “The NHS has an opportunity to lead by example and set the benchmark for clean air and safe workplaces. Through the creation of an action plan guided by the ICS Clean Air Framework, here at Newcastle Hospitals, we are already making progress and seeing direct benefits to our communities.”

Larissa Lockwood, Director of Clean Air, Global Action Plan, explains how the ICS Clean Air Framework can support healthcare leaders in taking action: “Air pollution kills seven million people globally each year, which is more than malaria, HIV/AIDS and obesity combined.^5,6,7 It is a public health crisis that needs immediate action from the health sector. It also cannot be right that our most vulnerable are exposed to it in our places of care – is it fair that a baby must take its first breath in a polluted environment? By developing this framework and working at the Integrated Care System level, we have the opportunity to tackle some of those area-wide issues, empowering healthcare leaders to pursue action on air pollution to secure a healthier future for their region.”

Uday Bose, Managing Director at Boehringer Ingelheim UK & Ireland, explains the impact of the project both now and for future generations, “People who are already suffering with poor health are most at risk of the detrimental effects of air pollution, so this initiative plays an important role in addressing health inequalities. Our commitment to transforming lives goes beyond the provision of medicines, as this initiative clearly illustrates. It also demonstrates the power of partnerships and delivers a real opportunity to create a healthier future for families, the NHS and the planet.”

The ICS Clean Air Framework aims to provide healthcare leaders with a platform to drive positive change and support the implementation of initiatives to improve air quality, without adding to the administrative burden. The NHS net zero targets are as ambitious as possible and are supported by the need for immediate action and commitment to continuous monitoring, evaluation and innovation. It is therefore critical that key stakeholders and local authorities work collectively to turn ambition into action.

More information regarding the Integrated Care for Cleaner Air initiative and the ICS Clean Air Framework is available from today at www.actionforcleanair.org.uk/health/ics-framework.

¹ addresspollution.org. 2022. Providing the public with the most accurate air pollution data available. [online] Available at: <https://www.addresspollution.org/> [Accessed 26 May 2022].

_{2</sup)The Kings Fund. 2019. Key facts and figures about the NHS. [online] Available at: <https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs#what-does-the-average-day-in-the-nhs-look-like> [Accessed 12 May 2022].}

³GOV.UK. 2019. Public Health England publishes air pollution evidence review. [online] Available at: <https://www.gov.uk/government/news/public-health-england-publishes-air-pollution-evidence-review#:~:text=Air%20pollution%20is%20the%20biggest,lung%20cancer%2C%20and%20exacerbates%20asthma.> [Accessed 26 May 2022].

⁴Who.int. n.d. Air pollution. [online] Available at: <https://www.who.int/health-topics/air-pollution#tab=tab_2> [Accessed 25 May 2022].

⁵Who.int. 2022. Fact sheet about malaria. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/malaria> [Accessed 25 May 2022].

⁶Who.int. 2021. Obesity. [online] Available at: <https://www.who.int/news-room/facts-in-pictures/detail/6-facts-on-obesity> [Accessed 25 May 2022].

⁷Who.int. 2021. HIV/AIDS. [online] Available at: <https://www.who.int/data/gho/data/themes/hiv-aids> [Accessed 25 May 2022].

Award win for Keysource and CENTIEL for project designed to underpin world-class vaccine, cell and gene therapy manufacturing capability

By Integrated Care Journal

Global data centre and critical infrastructure specialists, Keysource, in association with Swiss-based UPS manufacturer CENTIEL, have been named as winners of the Edge Project of the Year at the DCS Awards 2022 DCS Awards Voting. The award winners were announced at a gala dinner held at the Leonardo Royal Hotel London St Pauls on 26 May 2022.

The team’s work has been recognised following the completion of an installation of a truly modular, scalable, and highly efficient UPS and Electrical Infrastructure solution to help underpin growth in the government’s efforts to develop world-class, innovative vaccine research and manufacturing capability.

Scientists and researchers based in the centre will accelerate the time taken for new treatments to be delivered to patients by developing cutting-edge therapies to treat life-changing diseases.

The edge data centre that supports the essential laboratory work, is responsible for ensuring that samples and vaccines remain in optimal condition. The installation is now the first medical facility in the UK to take advantage of Li-ion batteries in combination with CENTIEL’s fourth generation three phase, true modular UPS, CumulusPowerTM which offers industry leading 99.9999999 per cent (nine nines) availability translating to just milliseconds of downtime per year.

Louis McGarry, Sales and Marketing Director, CENTIEL UK explained: “The facility runs off different energy sources from the grid, to sustainable power. This means the UPS is called on more often to provide a clean, continuous source of power to support the laboratory environment and ensure optimal conditions. Li-ion batteries offered the perfect solution as they are highly capable of cycling many times over, unlike traditional VRLA batteries, where cycling shortens their design life significantly.

Richard Clifford, Head of Solutions at Keysource, commented: “At Keysource, we deliver the finest and most efficient facilities, utilising the latest in critical power and cooling technologies. Our solutions support the latest generation of high-performance, high-density computing and have been internationally recognised as examples of best practice. We are proud to support clients that lead the development of new, innovative technologies to bolster the UK’s medical research capability. This project is a perfect example of why investing in critical infrastructure, and its protection, is essential to ensure these vital services continue to operate, now and in the future.”

For more information please see: www.centiel.co.uk or www.keysource.co.uk

Report reveals 229% rise in social care needs assessment enquiries

By Integrated Care Journal

The number of social care needs assessment enquiries increased by 229 per cent in the year 2021/2022 compared to 2019/2020, according to Access Social Care’s annual State of the Nation report.

The report, released yesterday, paints a desperate picture of the English social care system, with a significant rise in advice demand far outstripping available resources.

Access Social Care is a nationwide charity providing free legal advice for people with social care needs. Its second annual State of the Nation report is based on a data collaboration project in partnership with Royal Mencap Society, Age UK, Carers UK and Independent Age.

With the use of 74,000 separate data points, the report outlines the key challenges facing people who need social care and looks at the extent to which advice demand and provision has changed.

The nationwide data in this year’s report also shows an increase in enquiries that were identified as needing specialist legal advice in the year 2021/22, compared to 2019/20.

The report also reveals that the number of enquiries regarding concerns about existing social care and support rose by 43 per cent in the year 2021/22 compared to 2019/20.

The wellbeing of both care users and care providers has continued to spiral downwards. According to Access Social Care, pressure on capacity has meant that helplines have been required to take on additional staff and expand opening hours to cope with the increased demand on their services.

Charging has also become an increasingly pressing issue, accounting for 25 per cent of the dataset. Local authorities have been pushed into further unsustainable cost efficiencies, increasing charges for social care to meet budget targets and causing further demand for advice on charging.

Kari Gerstheimer, Chief Executive of Access Social Care said: “Whether we are self-funders or in receipt of state funded care, we will all need social care at some point either for ourselves or for a loved one.

“The Government claims to have fixed social care and continues its promises to help ease the cost-of-living crisis, but the sums don’t add up. Millions of people are feeling the effects of an underfunded system.

“We want a social care system that is properly financed, readily available and fairly distributed. Currently, vital services are overstretched, and people are going without the necessary social care they so desperately need – something needs to change.”

Caroline Abrahams CBE, Charity Director of Age UK said: “The findings in this report provide clear evidence of a system under severe duress.

“Councils are struggling to discharge their responsibilities to people in need of care and support and are having to adopt explicit prioritisation measures to deal with the overwhelming demands they face.

“In these difficult circumstances navigating the always complex social care system is a real challenge. It makes the role of charities who provide information and advice about social care more important than ever, both for the people in need of help and by shining a light on what’s really going on in care services across the country.”

Access Social Care provides expert legal advice to disabled people, elderly people, and their family carers to ensure their social care needs are met.

Report finds white nurses twice as likely as black and Asian colleagues to be promoted

By Niamh Macdonald

White nurses are twice as likely to be promoted as Black and Asian staff in the NHS, new survey results from the Royal College of Nursing (RCN) show.

According to the RCN, the survey results demonstrate that racism is ‘endemic in health and care’. The UK-wide survey of almost 10,000 nursing staff found that across all age groups, White respondents and those of mixed ethnic background were more likely than Black and Asian colleagues to have received at least one promotion since the start of their career.

The survey, which was published at the annual RCN congress in Glasgow, showed the difference is most stark between those aged 35 to 44. While 66 per cent of White and 64 per cent of respondents from mixed ethnic backgrounds in this age group said they had been promoted, this fell to just 38 per cent of Asian and 35 per cent of Black respondents.

The RCN also said that their biennial employment survey showed structural racism is having a ‘devasting impact’ on minority ethnic nursing staff in other ways.

The survey found that Black respondents working in hospital (39 per cent) and community (32 per cent) settings are more likely to report having experienced physical abuse than respondents of other ethnic backgrounds.

The RCN is calling on the UK government to ‘seize the opportunity of its planned reform of human rights legislation’ to ensure that health and care organisations, regulatory bodies and inspectorates are required by law to tackle racism, including in the workplace.

According to the RCN this could include a legal requirement to eliminate disparities in recruitment, retention and career progression, or a greater responsibility for employers to protect minority ethnic groups.

RCN Diversity and Equalities Co-ordinator Bruno Daniel said: “The pandemic has shone a spotlight on structural racism in health and care services and we must seize this opportunity to stamp out this vile behaviour once and for all.

“The UK government and devolved administrations must properly acknowledge and address this problem and the devastating impact it has on Black and minority ethnic staff and patients.”

Responding to the Royal College of Nursing’s (RCN’s) research, the interim chief executive of NHS Providers, Saffron Cordery said: “As the largest employer of Black, Asian and minority ethnic people in the country, the NHS must recognise and confront the structural racism and discrimination that still exists within its ranks.

“These important findings are the latest in a long string of evidence highlighting the unacceptable presence of structural racism within our health and care system.

“Time after time we see similar findings that show ethnic minority staff face higher levels of discrimination, and are more likely to face bullying, harassment or abuse from patients or colleagues.

“It is only by recognising these facts and having an honest conversation about racism, its structural roots and its impact, that change can be achieved.

Fuller Stocktake: Time for a radical overhaul of primary care

By Niamh Macdonald

The Next steps for integrating primary care: Fuller stocktake report was published yesterday, outlining a vision for transforming primary care led by integrated neighbourhood teams.

The review was carried out by Dr Claire Fuller, CEO (Designate) of Surrey Heartlands ICS, commissioned by NHS England and NHS Improvement.

With weeks to go until integrated care systems (ICS) are granted statutory footing, the report emphasises this opportunity to radically overhaul the way health and social care services are designed are delivered.

According to Dr Fuller, ‘Primary care must be at the heart of each of our new systems – all of which face different challenges and will require the freedom and support to find different solutions.’

Support, enablement and respect are three key themes of the reviews findings. The report states that these sentiments are important to set the right tone and accelerate the change that needs to be delivered in primary care.

To improve access, experience and outcomes in primary care across all communities, the report outlines three key offers:

Streamlining access to care and advice for people who get ill but only use health services infrequently: providing them with much more choice about how they access care and ensuring care is always available in their community when they need it
Providing more proactive, personalised care with support from a multidisciplinary team of professionals to people with more complex needs, including, but not limited to, those with multiple long-term conditions
Helping people to stay well for longer as part of a more ambitious and joined-up approach to prevention.

Matthew Taylor, chief executive of the NHS Confederation, said: “This review must be a watershed moment for establishing primary care as an integral part of local systems, working across boundaries to deliver population-based care, and a demonstration of the benefits of the integration agenda.

“Our members – from primary care leaders through to ICSs – agree that investing in local relationships, developing and supporting frontline workers, and maintaining stability in general practice are the key components to achieving fully integrated primary care.

If we are to get serious about ramping up prevention, improving patient outcomes including by tackling health inequalities, and providing more personalised care, primary care’s deep-rooted connection to its local communities cannot be overstated.”

Responding to Dr Fuller’s stocktake, interim chief executive of NHS Providers Saffron Cordery said: “Trust leaders will welcome the findings of the Fuller ‘stocktake’ which sets out how primary care can work with partners across health and care to best meet the needs of their local communities.

“The welcome focus in the stocktake on creating neighbourhood health teams to offer continuity of care and support those with complex, ongoing health needs is essential and will help to tackle the health inequalities which have been exacerbated by the Covid-19 pandemic.

“But with just over a month to go before integrated care systems become statutory bodies on July 1st, we now face the challenge of making this vision a reality.

“First and foremost, Dr Fuller’s stocktake underlines the need to tackle the serious challenges facing those who need to access same day, urgent care. This is no small undertaking and will require collaboration across mental health, community services, primary care and secondary care if it is to succeed.”

The social care workforce: Overworked, undervalued and poorly paid

By Mary Brown

On 27 April 2022, Public Policy Projects (PPP) hosted a roundtable entitled The Social Care Workforce: Averting a Crisis as part of its report series The Future of Social Care. The PPP Social Care Network, made up of senior cross-sector stakeholders in social care and a Lived Experience Panel, sought to find practical solutions to the challenges relating to the workforce.

The crisis facing social care is fundamentally a workforce one, and low pay and poor working conditions are impacting the experience of staff and end users alike.

One Network member described the long journey they have had with trying to find carers for their son, and how “the problems with the social care workforce have now caused [their] son to receive inadequate care”. For the Network member, it was evident that poor conditions for workers make it difficult to consistently provide high levels of care.

Social care: A fulfilling and worthwhile career

The Network members emphasised that social care can be a fulfilling and worthwhile career. However, one member expressed that “Nobody talks about it.”

“Nobody talks about the difference they’ve made to somebody’s life, somebody who lived at home and couldn’t manage independently anymore, and their friends and family were under enormous pressure,” they explained.

A social care career is a skilled and challenging career route, but tends not to be publicly regarded as one. Social care must become a more attractive and respected career path for students.

Network members with experience working in universities noted that very few students harbour ambitions to go into social care, with greater ambition being shown towards childcare, social work, the NHS or physiotherapy. Put simply by one network member, “there is simply no ambition to be an adult social care worker”.

Improved advertising campaigns offer one solution. One network member shared a heart-warming TikTok showing the day-to-day life of a carer supporting a disabled adult, showing that his profession was not simply that of a support worker, but a “gym buddy”, a “swim coach”, a “karaoke performer”, a “culinary professor”, and a “Lego architect”.

The video showcased the bond he has with the individual he cares for and the varied tasks in his working day, demonstrating the positive aspects of a career in social care. The Network member suggested that it “might inform recruitment campaigns” for social care in England.

A clear career trajectory

Network members were in general agreement that social care requires a clearer career trajectory. If there was a visible route for progression within the system, the sector would be more attractive to young, bright school leavers and university graduates. It was suggested that cross sector career paths should be formed.

“No one in any career expects to progress without spending time in different departments; we need to do the same in social care and for its providers”, said one member.

To attract more people to the sector, there needs to be greater clarity of the differentiation in provision. Not every member of the caring profession does the same job there are a variety of roles, areas of expertise, and levels of seniority which people should be made aware of.

We must make caring into a proud profession in its own right, not something that is ancillary to nursing.

Recognising social care qualifications

A career in social care may be more attractive if it were formally recognised. One Network member criticized the care certificate as it is not an accredited qualification. The only way that the care certificate would be accredited through the QCF would be through the employer hiring a qualified assessor “and the cost of that for the employer is astronomical, so most employers don’t do that”. This makes the care certificate “almost redundant and it certainly doesn’t attract young people to the sector to see it as a long-term career”.

One network member mentioned that Florence Nightingale is generally crediting with “professionalising” the role of nurses, and that the Royal College of Nursing was later founded at a time when, arguably, nurses were performing many of the hands-on caring jobs performed today by care assistants.

The network member added “as far as I can ascertain, They Royal College of Nursing does currently admit some care assistants, but only those working in roles directly supervised by nurses .This excludes most care workers. We must make caring into a proud profession in its own right, not something that is ancillary to nursing”. The network member added that there is perhaps a case to be made for the establishment of a College of Care Assistants or workers.

Care workers should be paid fairly for the value of their work, and the level of skill and expertise required.

Better pay for care staff

Across the Network, there has been a consistent consensus that carers must receive better pay, and the latest meeting showed no change of course on this point.

It was described as “scandalous” that professions such as retail work and cleaning are paid more than social care, despite being less technically and emotionally demanding. One Network member, as a provider of care, expressed outrage that “[they] get to pay £10 an hour in a town where you can get £15 for dog walking, how can this be conducive to successful recruitment and retention?”

While there was widespread agreement on the fact that carers are underpaid, some Network members warned against the idea of increasing pay to be a cure all to the current workforce crisis.

“There is an unnerving conflation between the rate at which staff should be paid for their skills, and whether that will attract them to work in the sector. These two things are being confused. Care workers should be paid fairly for the value of their work, and the level of skill and expertise required, which is not the same as raising pay in the hope that the system would receive an influx of workers.”

This point serves to emphasize that any changes to the workforce must start with a fundamental change in attitudes toward social care work, and “this will then lead to a conversation about what we pay our professional staff”.

Support and collaboration

The latest MHA care workforce report showed a 23 per cent disparity exists in pay between the NHS and comparable roles in social care. “A big part of that gap is salary, but a significant portion comes from disparities around sick pay, payment for additional hours worked, and pensions, which are all benefits that social care providers cannot hold a candle to.”

It was broadly agreed that the social care system should mirror the NHS Agenda for Change pay scale. If the NHS and social care are to work more closely within integrated care systems (ICSs), then staff must undoubtedly be paid the same for equivalent roles.

One network member highlighted that this would facilitate the better collaboration of multidisciplinary teams, ultimately enabling better care. They also promoted the concept of new “cross-sector roles”, working across different departments in health and social care, which would help to facilitate easier patient flow throughout the system.

Without the right support structures in place, the social care workforce will continue to face a struggle in providing quality of care. In order to successfully implement meaningful changes, the PPP Social Care Network could all agree that a fundamental change in attitude to value the social care workforce is necessary.

The roundtable concluded with a sentiment shared by the Network, “Carers need to be paid more money, they need to be supported and valued more highly by society so that they can lead full and active lives”.

For more information on PPP’s work on social care, please contact policy analyst Mary Brown at Mary.brown@publicpolicyprojects.com

Health-tech sector can prosper from UK’s commitment to unleash potential of data

By Joost Bruggeman

The role of digital data in the UK’s healthcare systems is set to gain newfound recognition and clarity when the government unveils its Data Saves Lives strategy this spring. If it lives up to its promise, the plan will help to drive the efficiency and effectiveness of data infrastructure and promote interoperability, while establishing clear and open standards for safely sharing data.

The backdrop to the new strategy is the tumult caused by the pandemic, and the ensuing acceleration of digital trends. The government now wants to build on the momentum which has been established in the push towards digital transformation. Similar exercises can be seen elsewhere in Europe, such as in Germany, which is set to invest €59 billion into healthcare technology and digitalisation in the rush to improve services.

While the UK’s strategy is primarily focused on the internal workings of the national healthcare system, the implications are positive for all healthcare technology organisations which have demonstrated a commitment to data safety and security. It means they are well-placed, both technically and culturally, to support the NHS on its journey.

Encouraging innovation

On reading the draft document, what is most encouraging is the focus on supporting innovators – those most likely to be responsible for developing and delivering new solutions to benefit both healthcare professionals and patients. The new strategy is set to provide a clear set of standards for those creating or deploying new data-driven technology.

“We find ourselves in the middle of a very exciting time in the digital development of healthcare in the UK.” Joost Bruggeman, Siilo messenger co-founder

This commitment to creating an innovation-friendly environment, with a framework for testing, approval and deployment, can be the catalyst for continuous improvement in the technologies used by healthcare professionals. It will provide the confidence to support investment, rather than the hit-and-miss, rather opportunistic nature of the current environment.

**Joost Bruggeman, CEO of co-founder of Siilo**

As CEO and co-founder of Siilo, a healthcare specific digital communications tool, I understand the fine line that the Government needs to walk. On the one hand, it needs to build on the huge opportunities that new technologies present by keeping its doors open to innovation – doors which opened because of the challenges brought by the pandemic. But on the other hand, the Government needs to regulate and manage the relentless growth of new technologies.

Covid-19 played a part in Siilo’s own pathway into the UK healthcare market, due to the urgent need for rapid, reliable communication and information sharing. The other issue which facilitated Siilo’s entry was a series of daunting ransomware attacks in the UK, which prompted hospital boards to take preventive measures on all digital aspects of healthcare, pushing data security to the forefront, and seeing hospitals reject unsafe commercial messenger apps that posed a threat to data safety.

**Siilo’s image ‘edit’ function allows users to blur and anonymise information and point out specific details on an image using the ‘Arrow’ tool**

Without these driving factors, there is no doubt that Siilo’s route into the UK healthcare sector would have been far more difficult, especially as a tech company from outside the UK. So now that the panic of the pandemic is subsiding, the Data Saves Lives strategy is aiming to create an environment which is conducive to technological innovation, at a level which is appropriate for the NHS.

This is a significant challenge because oversight boards have to make decisions on topics and technologies that they may not be familiar with. Conversely, technology often develops so quickly that in vast structures such as the NHS, conducting a swift quality assurance and compliance strategy, as well as putting new regulations in place, is far more easily said than done.

**Siilo’s Messenger App allows patients and healthcare professionals to communicate instantly**

Siilo looks at the proposed strategy with great anticipation, while at the same time. understanding how things work in the real world. There’s unlikely to be a perfect solution, but that doesn’t mean that innovators should sit and wait until everything becomes more crystalised. It is the responsibility of the technology sector to interact with healthcare providers and the NHS, so we can hold up our side of any mutual agreement.

In short, it is also our job to provide clear data on our services so that decision makers have a good understanding of what we bring to the table, how we work, and how we can contribute to the NHS’s future aspirations and security regulations. And the sector should welcome any opportunities for dialogue, for we find ourselves in the middle of a very exciting time in the digital development of healthcare in the UK.

Joost Bruggeman is a former surgery resident at Amsterdam University Medical Centre and now CEO and co-founder of Siilo – Europe’s largest medical messenger app. For more information, please visit www.siilo.com.

North East and North Cumbria ICS initiative drives air quality improvement

By Niamh Macdonald

A new pilot project in the North East and North Cumbria aims to drive air quality improvement at an NHS systems level.

Poor air quality in the UK is an increasing health concern, new data published by The Lancet has revealed that pollution remains responsible for approximately nine million deaths per year, corresponding to one in six deaths worldwide.

Approximately 30 per cent of preventable deaths in England are due to non-communicable diseases explicitly connected to air pollution. The health and social care costs of air pollution in England could reach £18.6 billion by 2035 if air quality is not improved.

Global Action Plan, an environmental change charity, has been working with the North East and North Cumbria (NENC) Integrated Care System (ICS) over the last six months to identify opportunities to drive change around air quality improvement at healthcare access points.

The project aims to make sure air quality levels are controlled around health centres and help to protect the people who need to visit hospitals most frequently.

Newcastle upon Tyne Hospitals NHS Foundation Trust has committed to ensuring all employees will be given basic sustainability training. The green procurement is to be embedded across the organisation with the aim of encouraging all ICS members to switch to a renewable energy tariff.

The findings from the pilot project were published on 17 May in the ‘Levers for Change’ report. The report highlights how air pollution is linked to health challenges and inequalities and identifies key opportunities that developing an ICS focused action plan would present.

The progress being made in the NENC region forms part of the broader Integrated Care for Cleaner Air initiative with the goal of improving air quality around all healthcare access points in England.

Newcastle Hospitals, Global Action Plan, and Boehringer Ingelheim have formed a partnership with the joint goal of supporting every ICS in England to become a ‘Clean Air Champion.’

In preparation for ICS statutory footing in July, ICS leaders are currently submitting system-wide Green Plans. Many are already incorporating air quality improvement measures around hospitals as part of their broader commitment to tackle environmental challenges.

James Dixon, Associate Director Sustainability at The Newcastle upon Tyne Hospitals NHS Foundation Trust, said: “Sadly we know that people in the North East and North Cumbria are disproportionately burdened by ill health.

“The research presented in the ‘Levers for Change’ report is key to understanding the impact that air quality has on the health outcomes of the people of the region.

“The framework will be an extremely useful resource for us, as an ICS to use, to identify ways to work across organisations and reduce the impact that poor air quality has on the health and quality of life for the most vulnerable members of our society.”

Larissa Lockwood, Director of Clean Air, Global Action Plan, explains: ‘It is vital that we tackle air pollution at the regional ICS level, with partners from all across the health system, across primary and secondary care but also with local government.

“It is vital that everyone understands the NHS cannot tackle air pollution alone. Insights from the ‘Levers for Change’ report will be packaged into an interactive, freely available tool for all Integrated Care Systems in England to use. This tool will build on the Clean Air Hospital Framework developed in partnership with Great Ormond Street Hospital.”

Over half of Brits say their health has worsened due to rising cost of living

By Gabriel Blaazer

Over half of Brits (55 per cent) feel their health has been negatively affected by the rising cost of living, according to a YouGov poll commissioned by the Royal College of Physicians (RCP).

Of those who reported their health getting worse, 84 per cent said it was due to increased heating costs, over three quarters (78 per cent) a result of the rising cost of food and almost half (46 per cent) down to transport costs rising.

One in four (25 per cent) of those who said that their health had been negatively affected by the rising cost of living, had also been told this by a doctor or other medical professional.

16 per cent of those impacted by the rising cost of living had been told by a doctor or health professional in the last year that stress caused by rising living costs had worsened their health. 12 per cent had been told by a healthcare professional that their health had been made worse by the money they were having to spend on their heating and cooking.

The experiences of RCP members who responded to the poll include a woman whose ulcers on their fingertips were made worse by her house being cold and a patient not being able to afford to travel to hospital for lung cancer investigation and treatment. Other reports include respiratory conditions such as asthma and COPD being made worse by pollution and exposure to mould due to the location and quality of council housing.

Health inequalities – unfair and avoidable differences in health and access to healthcare across the population, and between different groups within society – have long been an issue in England, but the rising cost of living has exacerbated them.

The Inequalities in Health Alliance (IHA), a group of over 200 organisations convened by the RCP, is calling for a cross-government strategy to reduce health inequalities – one that covers areas such as poor housing, food quality, communities and place, employment, racism and discrimination, transport and air pollution. The government recently announced that it will publish a white paper on health disparities and the IHA is calling for it to commit to action on the social determinants of health. These largely sit outside the responsibility of the Department of Health and Social Care and the NHS.

Responding to these findings, Dr Andrew Goddard, President of the Royal College of Physicians, said: “The cost-of-living crisis has barely begun so the fact that one in two people is already experiencing worsening health should sound alarm bells, especially at a time when our health service is under more pressure than ever before.

“The health disparities white paper due later this year must lay out plans for a concerted effort from the whole of government to reduce health inequality. We can’t continue to see health inequality as an issue for health directives to solve. A cross-government approach to tackling the underlying causes of ill health will improve lives, protect the NHS and strengthen the economy.”

Professor Sir Michael Marmot, Director of the UCL Institute of Health Equity, commented: “This survey demonstrates that the cost of living crisis is damaging the perceived health and wellbeing of poorer people. The surprise is that people in above average income groups are affected, too. More than half say that their physical and mental health is affected by the rising cost of living, in particular food, heating and transport.

“In my recommendations for how to reduce health inequalities, sufficient income for a healthy life was one among six. But it is crucial as it relates so strongly to many of the others, in particular early child development, housing and health behaviours. As these figures show, the cost of living crisis is a potent cause of stress. If we require anything of government, at a minimum, it is to enable people to have the means to pursue a healthy life.”

Also responding to the survey was NHS Providers Chief Executive, Chris Hopson, who said: “Trust leaders are acutely aware of the soaring cost of living crisis facing the nation and the impact rising financial pressures could have on people’s health.

“This is particularly concerning in the wake of the COVID-19 pandemic which exposed deeply entrenched social, racial and health inequalities. As highlighted in this survey, there is a risk that the current cost of living crisis widens those inequalities.

“Trust leaders share the view that there is an opportunity to tackle the factors which lead to health inequalities and poor health. They have committed time and resource to reducing inequalities across their local communities.”

Health Inequality, News, Population Health, Primary Care, Thought Leadership May 17, 2022

How ICSs can help uproot risk aversion and progress innovation

By David Duffy

Integrated Care Journal speaks with Kathy Scott and Aejaz Zahid of the Yorkshire & Humber Academic Health Science Network (AHSN) on how the implementation of a dedicated innovation hub within ICS frameworks has helped to streamline innovation and improve patient care.

Above: Barnsley Hospital, part of South Yorkshire and Bassetlaw ICS.

Integration and innovation are two increasingly prominent principles that are, in part, designed to address the growing problems of unmet health needs. Each is intended to supplement and support the development of the other.

Integrated care systems (ICSs) offer new frameworks through which innovation can be adopted at scale, streamlining past previous bureaucratic and individualistic barriers to change and adopting a transformation led approach. Innovation is crucial in turning the core aspirations of integrated care into tangible realties, to use technology and sophisticated approaches to data to help address the root causes of ill-health and expand health service offerings.

The above outlines the core principles of integration and innovation, which can be found reiterated from a wealth of sources, if one is to engage in the sector for even a few days. Integrated care is not a new concept and neither is innovation, so how are these two principles coming together to improve patient outcomes in reality?

“There is a vast range of unmet need across the whole health and care sector.”

“There is a vast range of unmet need across the whole health and care sector,” says Aejaz Zahid, Yorkshire & Humber AHSN’s Director for the ICS Innovation Hub at South Yorkshire & Bassetlaw Integrated Care System (SYB ICS). “Much of this is of course clinical, but a huge part of this is more operational, system level needs.

“The ICS needs intelligence on all of this, but then must ascertain how it can use innovation to leverage economies of scale in terms of investing and finding solutions to those problems and challenges. What we are trying to do within the innovation hub is create straightforward and easily accessible processes which enable busy staff working on the ground to regularly bring those challenges and problems to our attention, while enabling ICS leadership to ascertain and prioritise needs which could benefit from a systemwide innovative solution.”

The ICS Innovation Hub is a single point of contact for health and care innovators in the SYB region. The hub works, via the AHSN, to identify and validate market ready innovations and help drive improved health outcomes, clinical processes and patient experience across the SYB health economy. The idea to set up a dedicated innovation hub within an ICS was developed by the Yorkshire & Humber Academic Health Science Network (Yorkshire & Humber AHSN) and has proved a successful model to help spread and adopt innovations at pace and scale. Yorkshire & Humber AHSN also provides innovation support to three different ICSs in the region.

Fostering a culture of innovation

Explaining how the Hub, and by extension, Yorkshire & Humber AHSN are working to cultivate innovation in the region, its Chief Operating Officer and Deputy CEO, Kathy Scott says “it is as much about identifying good practice as it is implementing the ‘shiny stuff’.

“As an AHSN we also have sight of a lot of potential solutions that can address those needs often identified by the innovation hub. So, we are able to nudge the ICS leadership towards potential solutions.

“We can push out new ideas and innovations as much as we like, but if you don’t have that culture of innovation and improvement there, it’s not going to stick.”

“It’s about growing the capability and capacity for change within a locality and for improvement techniques and innovation adaptive solutions to be implemented. Not simply implementing new technology and essentially running away.

“We can push out new ideas and innovations as much as we like,” continues Kathy, “but if you don’t have that culture of innovation and improvement there, it’s not going to stick.”

The ICS’s digital focus has also enabled significant work on pre-emptive care. For example, through the Yorkshire & Humber AHSN’s digital accelerator programme Propel@YH, the AHSN has worked with innovator DigiBete to support the adoption of their “one stop shop” app to help young people living with diabetes manage their treatment.

The app was clinically approved during the height of the pandemic, with extra funding provided from NHS England, and is now being used in 600 services across England. “This is an excellent example of how we can pre-emptively assess unmet need and streamline innovation into the system,” says Kathy.

Innovation as an antidote to health inequality

“Health inequalities are part of our design thinking from the get-go in any project,” says Aejaz, who points to the recent implementation of SkinVision, a tele dermatology app, as an example.

“The app was originally developed in the Netherlands, where predominantly you would have Caucasian skin that the AI would have been trained on,” he explains, “so, from the beginning, we have been mindful to capture more data on how well the app works on other skin types and feed that back to the company to improve their AI algorithms for wider populations.”

The Innovation Hub also works to ensure that implementing digital technology does not exacerbate inequality for less digitally mature users. “If somebody, for example, doesn’t have a smartphone that is able to run that app, there is always the non-digital pathway in parallel. So, it’s never either/or.”

An appetite for risk

“There is always a level of risk aversion when it comes to adopting something new in healthcare,” says Aejaz, “even with evidence backed solutions, we find there’s sometimes a level of reluctance. Staff want to know whether it’s going to work in their local context or not and whether introducing innovation would entail a significant ‘adoption’ curve. Building enthusiasm around a new idea and overcoming hesitancy to innovation is, therefore, central to the role of organisations such as the AHSN and, by extension, ICS innovation hubs.

“Building a culture of innovation is fundamentally about building a culture of increased risk appetite, where failure is most certainly an option.”

“Building a culture of innovation is fundamentally about building a culture of increased risk appetite, where failure is most certainly an option,” Aejaz continues. “We need to create systems which provide innovators with the necessary psychological safety that allows them to experiment.”

To help shift the mindset of NHS staff in favour of innovation, the Innovation Hub established a series of ‘exemplar projects’, designed to erode the fear of failure and capture learnings in the process. For example, for Population Health Management exemplars, one of the priority themes for the ICS, the hub called for providers to submit ideas to the Hub, all framed under high priority population health challenges such as cardiovascular health. Successful applicants with promising ideas received funding in the region of £25,000 as well as co-ordination support from the Hub towards their project.

The programme has enabled frontline innovators and has led to the development of a host of new services incorporating novel technologies, such as virtual wards and remote rehabilitation. The Hub is also working to transform dermatology pathways throughout the SYB region by introducing an app that allows patients to upload images of skin conditions and be processed more efficiently through the system. Funded by an NHSx Digital Partnerships award, this pilot project with Dermatology services in the Barnsley region will test out the use of this AI-enabled app to ascertain how well it can successfully identify low risk skin lesions which can be addressed in primary care. Thereby reducing demand on secondary care and speeding up access for higher risk patients. Each of these projects demonstrate the capacity for transformation when on the ground staff are given the freedom to innovate.

Interestingly, many of the ideas that the Hub works with are non-tech solutions. For example, primary care providers working with local football teams via a 12-week health coaching programme to engage with fans who may be at risk of cardiovascular disease, or introducing Cognitive Behaviour Therapy techniques to patients with severe respiratory conditions to help reduce anxiety when experiencing an episode of breathlessness.

To nurture a mentality more open to change, the Innovation Hub has developed learning networks across South Yorkshire. Through these networks, the Innovation Hub and AHSN teams have been reaching out to key leads from each of the provider organisations who are involved in innovation, improvement or research and invited them to become innovation ambassadors. “These ambassadors have become our eyes and ears on the ground across health providers, where they can start to introduce what we do and also help capture unmet needs from colleagues in their respective organisations,” explains Kathy.

Following in the footsteps of the first innovation hub established by the Yorkshire & Humber AHSN in South Yorkshire, other AHSNs across the country are now looking at setting up innovation hubs within their ICS by bringing leadership together, getting them out of their ‘comfort zone’ and giving them the space to innovate, and hoping to chip away at risk aversion and fear of experimentation. Introducing solutions outside of traditional domains will enable a culture of innovation and improvement. To streamline past bureaucratic and individualistic hurdles, ICS frameworks are key to facilitating transformational change in every region of the country.

If you would like to find out more about the Yorkshire & Humber AHSN, please contact info@yhahsn.com

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