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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LDC Confederation: taking an active role in combatting discrimination

By Martin Skipper

Martin Skipper, Head of Policy for the LDC Confederation, discusses how the organisation is taking an active approach to addressing racism, working as part of the London Workforce Race Equality Strategy (WRES), to ensure that the dental profession benefits from the programme of work.

The aim of the London Workforce Race Equality Strategy work is to address the inequality experienced by a large proportion of the NHS workforce. The experience of professionals from black and minority ethnic backgrounds continues to lag behind that of white colleagues.

To address this imbalance, the objective is for the NHS in London to be a more inclusive place to work. The workforce strategy aims to create a step change by increasing the diversity of the workforce and promoting equality, diversity and inclusion strategies. This includes improving the leadership culture and growing and training the workforce. In a recent survey undertaken by the London WRES for Equality and Discrimination in Primary Care, around half of respondents said they had faced some sort of discrimination or harrasment at work, with 39 per cent saying that they had received this from patients. The remaining 29 per cent had been on the receiving end of discrimination or harrasment from colleagues. Of these cases only one third were reported.

Colleagues from Asian or African backgrounds were most likely to be on the receiving end of discrimination, and also less likely to know where to turn for help. Additionally, while ethnicity was the main factor reported to underlie discrimination and harrasment by a considerable margin, gender was the second most common factor. Unfortunately, responses from dental practice were very low, so few conclusions about issues specific to dentistry can be drawn.

Registration data from the General Dental Council, however, shows that many of the issues reported above can be expected to be true in dental practice. Over 50 per cent of dentists on the register are women, leaping to almost 93 per cent of dental care professionals (DCPs). At least 31 per cent of the dental workforce identify as Asian, Black, Chinese, mixed or other non-white ethnicity, with a further 17 per cent unknown. Around nine per cent of DCPs by contrast, identify as non-white, with a further 14 per cent whose ethnicity is not known.

There will be sizeable groups within both parts of the dental profession with at least one characteristic strongly associated with discrimination and harrasment. With 60 per cent of DCPs and 52 per cent of dentists being aged under 40, expectations of professionals will vary considerably from this younger cohort of professionals to their more established colleagues.

The LDC Confederation is supporting dental teams in several ways to make sure that their workplace is inviting and supportive to everyone. One these is working with the National Guardian’s Office to ensure that all practices in member LDCs have access to a clear pathway to a dental guardian. This impartial champion provides support and guidance to those in the dental team who are unsure of where to turn when they have a concern.

As many dental practices continue to be independent providers with relatively small teams, the LDC Confederation act as an impartial body able to support practices and practitioners alike. By providing this opportunity for confidential and impartial support we hope that a more open and accepting culture will be developed in dental practice.

We will continue to work with the London WRES to embed their plans for increased awareness among teams of the issues and behaviours, as well as providing a trusted environment for all members of the dental team to seek support. We will also maintain a campaign of zero tolerance towards harrasment and discrimination from patients. Individual LDCs will be working with their local training hubs to embed training opportunities at the local level and with EDI leads in the Integrated Care Systems to align practice processes and outcomes with those of system wide strategic objectives. Through these combined efforts, the LDC Confederation will continue to take an active approach to promoting equality, diversity and inclusivity in the dentistry profession.

Social care crisis leaves 500,000 adults waiting for care

By Gabriel Blaazer

More than half a million adults in England are waiting for social care assistance, says the Association of Directors of Adult Social Services (Adass), as staff shortages continue to impact the provision of care.

According to Adass’ research, the number of people waiting for either social care assessments, direct payments or reviews of their care has risen sharply over the last year. The research marks a 72 per cent rise in the numbers waiting for support, as similar research last year put the figure at about 294,000.

Adass president Sarah McClinton said the figures represent “a devastating impact on people’s lives,” while the government has said that reforming social care is a priority.

Published in May 2022, the Adass report, Waiting for Care, found that during the first three months of 2022, an average of 170,000 hours a week of home care could not be delivered due to workforce shortages, and that 61 per cent of councils were having to prioritise care assessments.

“The situation is getting worse”

The report states the capacity of the care sector to deliver on people’s needs has been sharply reduced, at the same time as England’s ageing population develops ever more complex care requirements.

It says that “despite staff working relentlessly over the last two years, levels of unmet, under-met or wrongly-met needs are increasing, and the situation is getting worse. The growing numbers of people needing care and the increasing complexity of their needs are far outstripping the capacity to meet them.”

The report also says that the government’s focus “of resources on acute hospitals without addressing care and support at home, means people deteriorate and even more will need hospital care.”

Adass argue that not only are people waiting longer for care, “but family carers are having to shoulder greater responsibility and are being asked to take paid or unpaid leave from work when care and support are not available for their family members.”

This was echoed by Helen Walker, Chief Executive of Carers UK, who has said the current state of social care is putting “even more pressure on even more families who are propping up a chronic shortage of services.”

Changes welcome, but not enough

The government states publicly that fixing social care in England is a priority, and the Health and Social Care Levy passed last month will see £5.4 billion invested into social care over the next three years, including £3.6 billion to reform the charging system for social care and a further £1.7 billion to begin “major improvements” to the sector. The added funding is cautiously welcomed, but critics argue the government needs to go further.

However, ADASS president Sarah McClinton said: “We have not seen the bounceback in services after the pandemic in the way we had hoped. In fact, the situation is getting worse rather than better. Social care is far from fixed.

“The Health and Social Care reforms go some way to tackle the issue of how much people contribute to the cost of their care, but it falls short in addressing social care’s most pressing issues: how we respond to rapidly increasing unmet need for essential care and support and resolve the workforce crisis by properly valuing care professionals.”

Responding to the ADASS report, Miriam Deakin, Director of Policy and Strategy at NHS Providers said: “This valuable report paints a worrying picture of unmet care needs and lays bare the pressures on the social care system, which are having a serious knock-on effect on individuals’ quality of life and independence, as well as the timely discharge of patients from hospital.

“Although hospital patients who are medically fit for discharge are made a priority for assessment, any delay to those assessments means a delay to people receiving the care they need and makes it difficult to maintain the flow of patients through the NHS.

“Equally worrying is the obvious need for more support to help people stay well and live independent lives in the community which would in many cases prevent, or delay, any need for hospital care.

“We must recognise the efforts of social care staff delivering more care in people’s homes over the last year and ensure they are paid appropriately to acknowledge their valued contribution.

“The ADASS report highlights once again the urgent need to properly fund and reform the adult social care system.”

Mental Health Act reform to tackle detention disparities

By Niamh Macdonald

The Queen’s Speech yesterday outlined government plans to change the Mental Health Act 1983, empowering the individual to have more control over their care.

The announcement included plans to introduce a draft bill which will change the criteria for detaining so that it is only used when necessary: if the person is a genuine risk to their safety or others and there is therapeutic benefit.

The definition of a mental disorder will also be amended in the draft to ensure no one can be detained solely for having a learning disability or being autistic.

Plans to reform the Mental Health Act 1983 follow the government-commissioned Independent Review, published in December 2018 and the follow-up white paper produced in January 2021.

The government set out a goal to ‘deliver a modern mental health service that respects the patient’s voice and empowers individuals to shape their own care and treatment.’ It also made recommendations on how to address disparities in how the act affects people from black, Asian and people from ethnic minority backgrounds.

The next steps will likely be that the draft bill is considered by a parliamentary committee to inform full legislation to reform the act. It is not currently clear when the draft legislation will be published but the proposals will be considered over the next year.

Responding to the proposed new measures, director of policy and strategy at NHS Providers Miriam Deakin said: “A new Mental Health Act on its own won’t be enough to guarantee high-quality mental health services or transform the way we deliver them for years to come. Mental health services are under severe strain from huge demand and limited resources.

“Covid-19 has left a significant legacy on the nation’s mental health, particularly for children and young people, and the effects of poor mental health are expected to last longer than in some other areas of care.

“Coming hard on the heels of the biggest health service reforms for more than 10 years under the new Health and Care Act, we look forward to seeing detailed government proposals to reform the Mental Health Act as soon as possible.”

Vicki Nash, Head of Policy, Campaigns and Public Affairs for Mind, said: “Over 53,000 people were detained under the existing Mental Health Act in England in 2020/21 – an increase of four per cent on the year before. As these numbers continue to rise, we urgently need to see the UK government implement the long—overdue legislative changes needed to give people greater choice and control over their treatment

“In most cases, people are detained under the Mental Health Act against their will because they didn’t get the right help when they needed it. Black people are hardest hit, with higher rates of detention and practices that restrict their liberty, including face-down restraint, which can be fatal.

We need the new Mental Health Bill to change this and we must see more investment in early intervention to reduce the number of people becoming unwell in the first place. Mental health problems become more difficult to treat if left unchecked, as well as more costly to the NHS.”