Broader partnerships within ICS essential to reduce hospital admissions

By Charles Waddicor

As Integrated Care Systems assume statutory footing from July, broad partnerships with the private and voluntary sectors will be essential to reduce pressure on acute NHS services, writes Charles Waddicor.

The NHS is working through one of the greatest challenges it has ever faced. With the pandemic still part of everyday life, there is an urgent need to reduce the constant pressure on the acute sector. Future plans must be based on a coordinated approach that makes the most of a wide range of partners, including the voluntary sector.

Up to seven million people are thought to have missed out on care during the pandemic, many from more deprived areas. The health system is still in a critical condition, with high rates of Covid-19, hospitalisations and waiting times rising. This perfect storm is ultimately widening the health inequalities that have come into even sharper focus during the pandemic.

The challenge is too great to leave up to the acute sector alone to solve. Every part of the health and care sector has a role to play, from primary and social care to councils, housing and the voluntary sector. The solution must lie in greater collaboration to unlock capacity and avoid preventable admissions.

Managing population health

Although the current ‘Payment by Results’ system does not always lend itself to more integrated system working, integrated care systems (ICSs) can provide an opportunity to broaden partnerships and collaboration, to help pave the way for change.

There is a case for developing health and care services that wrap around traditional care models, promoting healthier living, tackling loneliness and other areas that can impact on hospital admission. The mental health sector is already leading the way by working with other providers and some London trusts are investing £1 million annually in new contracts with the voluntary sector to strengthen support in the community.

Worcestershire County Council has also been working with the local NHS Commissioning Group and the voluntary sector since 2015, to tackle hospital admissions by providing personalised support to older people to deal with loneliness. Social isolation and loneliness reduce older people’s quality of life and are linked to poor physical and mental health outcomes.

Over five years, the reconnections service in Worcestershire supported more than 1,500 lonely older people with a majority reporting a marked reduction in their feelings of loneliness and others seeing increased independence and improvements in health and wellbeing. Once the model was shown to be successful, the service developed a relationship with Independent Age, a leading national older people’s charity, which had the resources and capability to scale up the work. The scheme has now been rolled out to two other sites – Barking & Dagenham and Havering and Guildford and Waverley.

Supporting the whole health system with greater range of partnerships

“Seeing healthcare with a broader view rather than simply through the lens of an acute hospital, can help to provide a more proactive health service”

ICSs cover larger populations than individual CCGs which means they have an opportunity to link up with a broader range of organisations. Rather than pushing back on acute trusts to accommodate a growing need for services, let us work with other non-NHS partners to support the system.

Seeing healthcare with a broader view rather than simply through the lens of an acute hospital, can help to provide a more proactive health service and avoid more hospital admissions through good population health management. Being able to target those who need care before they reach the acute stage is vital, as is proactively creating a healthier population through promotion and education.

Organisations in the voluntary sector can offer an in-depth knowledge of the communities within which they work, highlighting where and what care is needed as well as being able to increase the capacity of the health and social care system.

While quality and money are always likely to be top of the agenda for improvements to the health service, we know that people who are well-integrated into the community, who exercise and are careful with what they eat, generally do better. Therefore, promoting healthier lifestyles through a range of organisations and working in a truly integrated way will introduce good population health techniques, helping people to live independently for longer and reducing the significant pressures that are being felt across the whole system.

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NCF to help care providers navigate integration

By Integrated Care Journal

The National Care Forum (NCF), the membership organisation for not-for-profit organisations in the care and support sector, has created a range of dedicated resources and information to help social care providers understand, navigate, and improve the integration between health and social care as they prepare for the integrated care systems (ICSs) to go-live on 1 July 2022.

Having now been passed into law, ICSs will be given a statutory underpinning across England as the Health and Care Bill. This partnership model brings together providers and commissioners of NHS services across a specific geographical area with local authorities and other local partners, such as social care and housing, to collectively plan health and care services.

It is a fundamental shift in the way the health and social care system is organised in England – moving away from competition and organisation autonomy to collaboration between health and care organisations to integrate services, reduce health inequalities and improve population health and wellbeing.

The new resources launched by the NCF include:

Definitive, dedicated ICS training: What the social care provider sector can do for the ICS

NCF have partnered with the Housing Associations’ Charitable Trust (HACT) to bring together a dedicated learning and development programme during June and July to support the sector in working with ICSs. The programme aims to enable delegates to engage in long-term partnerships that transform the delivery of health and care, while simultaneously resulting in better integration between social care provider organisations and health. The training will help social care providers:

Understand more about ICSs
Strengthen their understanding of how to engage with their local ICS
Build awareness of the competencies needed to deliver within integrated care settings
Identify partnering opportunities and build credibility

A dedicated and facilitated discussion with NHSEI/DHSC and social care providers as part of a listening exercise on Monday 9th May to understand the challenges and successes of engaging with ICSs. The session will aim to achieve agreement to coproduce a model for engagement with the social care provider sector and to think about where efforts would be most effectively focused. This builds on the collaboration between NCF, NHSEI and DHSC over the last few months to support ICS engagement with the social care sector.

An online ‘one stop shop’ on the NCF website that offers a simple overview to ICSs, interactive maps to find out which ICSs operate in any area, key messages to help ICSs understand how social care is central to improving health and care for their local populations and case studies to showcase how engagement can work on the ground to make a difference for people using health and care services.

Vic Rayner OBE, CEO of the National Care Forum said that “the introduction of integrated care systems is a major change to the health and social care system in England and as such it is imperative that the social care sector fully understands and engages with the process of transition to this new model of partnership working.

“We have created these resources to support our colleagues from across the sector to strengthen their understanding, upskill their competencies and build their confidence in identifying partnering opportunities that integrate health and care services while improving peoples’ health and wellbeing.”

If you would like to find out more about the resources available on integrated care systems or to attend the training sessions, please visit the NCF website.

New IPPR report argues health is ‘holding back UK economy’

By Niamh Macdonald

The UK will suffer an £8 billion hit to economic activity this year due to lack of government action to improve the nation’s health, according to a report launching the new cross-party IPPR Health and Prosperity Commission.

The IPPR report published today marks the launch of a new Commission on Health and Prosperity. The report warns that health inequalities and ineffective policies are shortening life expectancy in the UK, coupled with more years spent in poor health.

New analysis by IPPR and health analytics company Lane, Clark & Peacock, reveals that the workforce is also being affected as people face barriers to staying in work.

The IPPR is calling for a ‘new post-pandemic approach’ to the nation’s health to ensure that people can live long healthy lives as well as to strengthen the UK’s suffering economy.

There are now more than a million workers missing from the workforce compared to pre-pandemic levels. About 400,000 of these individuals are no longer working due to health factors, including long Covid, disruption to healthcare and declining mental health. The researchers warn that without intervention, this will drag down economic activity this year by approximately £8 billion.

The report states that the relationship between health and the economy is a decisive factor in the UK’s low productivity, low growth and significant regional inequalities.

According to the report, local level analysis reveals that someone living in North East Lincolnshire can expect to fall into bad health eight years than the UK average, while the output of their work is also valued at £8 less than the average. The report argues that this is a vicious cycle and that factors like lack of job opportunities can harm people’s health.

To explore how good health can be the foundation for a fair and prosperous economy, IPPR is launching a new cross-party Health and Prosperity Commission. The cross-party commission will be chaired by Lord Ara Darzi and former Chief Medical Officer Dame Sally Davies.

The report argues that the UK’s poor health outcomes and stagnant economy are a result of poor policy choices. According to IPPR, policy makers must now ‘set about putting the building blocks of good health in place’, including ‘good work, quality housing, local public health services’ and a ‘well-funded and staffed NHS. ‘

Dame Sally Davies, former Chief Medical Officer and co-chair of the Commission on Health and Prosperity, said: “A fairer country is a healthier one, and a healthier country is a more prosperous one. While the restrictions have eased, the scars of the pandemic still remain deep on the nation’s health and our economy.

“Not only are we facing a severe cost of living crisis, driven in part by pandemic induced inflation, we’re also experiencing a workforce shortage driven by poor health that’s holding back the economy. It has never been more important to put good health at the heart of our society and economy – and our commission will bring forward a plan to do just that.”

Matthew Taylor, NHS Confederation chief executive and commission member said: “The pandemic has shown how deep health inequalities shape and cut across the lives and livelihoods of people across the country.

“Yet this is not new, disparities in health have not suddenly appeared, they have been part of the make-up of our society for decades. As millions of people now face the reality of a cost-of-living crisis there is an urgent need for a much bolder and more strident approach to tackling inequalities to create improved population health and stronger economic wellbeing.

“We are delighted to be part of the Commission on Health and Prosperity and look forward to reflecting member insight. ”

Change to Health and Care Bill: Costly consequences for poorer regions

By Niamh Macdonald

MPs in Yorkshire, the Midlands and the North East should vote down the government’s social care cap amendment to save their poorer constituents from ‘crippling care costs’, warn the Health Foundation and the King’s Fund.

The Health and Care Bill, due to reach final stages in the House of Commons on 25 April, includes an amendment from the government which would mean its social care reforms would offer less protection to poorer people.

According to the Health Foundation and the King’s Fund, people in Yorkshire, the Midlands and North East of England would feel the greatest impact on their protection against high care costs due to the amendment.

In 2021, the government proposed a cap of £86,000 on the lifetime care costs that an individual will have to pay for personal care. However, it also proposed amending the 2014 Care Act to mean that local authority support given to help meet an individual’s care costs would no longer count towards the cap.

This amendment will significantly reduce the benefits of the reforms for people with lower levels of wealth but those with housing wealth of more than £186,000 will be unaffected.

Irrespective of wealth and assets, the amendment will mean everyone will face the same costs. The effects of this are far more severe for those with low to moderate assets, meaning some may be forced to sell their home to finance their care.

A joint Institute for Fiscal Studies (IFS) and Health Foundation report, funded by the Health Foundation, recently assessed the impact of the government’s amendment. It analysed how the amendment would affect people in different regions of the country.

The report found that for people spending ten years in residential care:

People in the North East would spend on average an extra six per cent of their assets on care. This is equivalent to an average increase in contribution of £5,700.
In Yorkshire and Humber people would spend an extra five per cent of their assets, equivalent to £5,300.
In the Midlands it would see an increase in payments worth four per cent of assets, equivalent to £4,600.
These increases compare to two per cent in the South East and one per cent in London, equivalent to £3,800 and £2,800 respectively.

Charles Tallack, Director of Data Analytics at the Health Foundation, said: “The government’s amendment represents a significant watering down of the pledge to protect people from catastrophic care costs.

“At a time when the country is facing the biggest hit to household finances since the 1950s, government should be looking to increase financial protection for poorer households.

“Yet this measure will disproportionally affect people with lower wealth and in poorer areas of the country. This is not levelling up: it’s unfair and a backwards step.”

Sally Warren, Director of Policy at The King’s Fund, said: “The government’s change to the cap on social care costs is expected to save the Treasury money, but that saving comes at the expense of poorer people with lower levels of wealth and assets.

“Many of those people will be wondering why the Prime Minister’s pledge that no one will have to sell their home to pay for their care no longer applies to them, whilst wealthier people are still protected from catastrophic care costs.”

Time to fix the gender diagnosis gap for autism

By Charlotte Perry

As well as increasing global acceptance and understanding of the condition, this year’s Autism Awareness Month should be used to highlight growing and concerning gender diagnosis gaps.

Four times more boys than girls are diagnosed with autism, according to Spectrum News, yet more women are referred for a diagnosis in adulthood than men. This suggests they are missed in childhood and raises questions as to whether the prevalence of autism in girls is higher than those diagnosed.

Autism effects a range of behavioural traits, from difficulties with communication skills to repetitive behaviours and overreactive sensory experiences. However, medically and socially, society has grown accustomed to recognising autism through a male presentation. Well known hallmarks of the disorder, such as hyperactivity and fixated interests, tend to be heavily externalised by boys. Meanwhile, females internalise these symptoms, and may instead present with anxiety, emotional ‘breakdowns’, and more passive bouts of misbehaviour.

Whether due to genetic differences or social expectations, there remains a concerning gender gap in both research and diagnosis. The Autistic Girls Network (AGN) campaigns for better recognition and diagnosis for autistic girls. Their 2022 white paper, Autism, Girls, & Keeping It All Inside, outlines the key differences in presentation of autism in girls compared to boys. It addresses the stereotypes leading to late referral, such as girls simply ‘being shy’, and discusses the complications when autism is left undiagnosed.

As AGN boss Cathy Wassel recently said, “we need everyone to be able to see those young people who never raise their hand or speak up in class, who are situationally mute, who are on the edge of friendship groups, who have strong sensory sensitivities. ”

AGN’s paper also suggested that 20-35 per cent of females with anorexia nervosa may also be autistic. This evidence for an increased co-occurrence of autism and eating disorders in girls is lacking representation in autism diagnostic tools, therefore widening the gender diagnosis gap.

Within their white paper, The AGN lists key recommendations that would benefit both acceptance and diagnostic tools used in relation to autism. They suggest that the presence of co-occurring health conditions should act as a flag to referral for autism investigation, with diagnostic tools adapted to include typical female presentations as well as male. Improving research not only on autism in girls, but also the intersectionality of ethnicity, aging, menstruation, and menopause is needed.

“We need to get rid of the stigma as we have a whole generation of women who weren’t recognised and are only now realising why they have felt different, and often ‘not enough’ all their lives,” continued Cathy, “we need this to happen especially in schools, which can be very difficult places for our autistic young people. ”

As Autism Awareness Month draws to a close, the push for overall acceptance and understanding across society must continue. But so should the medical and research community be urged to take practical steps to shrink diagnosis gaps based on gender and ethnicity lines. It is essential for healthcare workers to understand gender-specific presentations of autism for diagnosis, consideration and education should be systemic.

Life expectancy significantly below average for women in England’s poorest areas

By Integrated Care Journal

Life expectancy for women living in the poorest 10 per cent of areas in England is lower than overall life expectancy in any OECD country except Mexico, reveals analysis by the Health Foundation.

The analysis shows that women living in the poorest 10 per cent of areas in England have an average life expectancy of 78.7 years. This is considerably below the average of 83.2 years for the whole of England and less than the overall life expectancy for women in countries including Colombia (79.8 years), Latvia (79.7 years) and Hungary (79.6 years). In Mexico, which has the lowest life expectancy at birth of any Organisation for Economic Co-operation and Development (OECD) country, women live on average 77.9 years.

Women living in the richest 10 per cent of areas in England have an average life expectancy of 86.4 years. This is higher than overall life expectancy for women in any OECD country, aside from Japan which has the highest female life expectancy for all OECD countries at 87.3 years.

These figures demonstrate the harsh reality of health inequalities in England, where those in the poorest areas can expect to live significantly shorter and less healthy lives in contrast with the richest areas.

The government white paper on ‘health disparities’ is currently expected in early summer, following a pledge in February to increase ‘healthy life expectancy’ by five years and reduce the gap between the healthiest and least healthy local authorities.

The Health Foundation warns that the government’s strategy for improving health has so far failed to ‘grasp the scale of the challenge’ and that based on pre-pandemic levels, it will take almost two centuries to achieve that increase.

The rising cost of living is a compounding factor which may further widen health inequalities. The Health Foundation notes that the pandemic has taken a toll on the finances of many poorer families. Rising prices will mean that increasing numbers will be forced to choose between going without essentials which are important for living a healthy life.

Jo Bibby, Director of Health at the Health Foundation, said: “The stark reality in the UK is that the poorest can expect to live shorter and less healthy lives than their richer counterparts.

“The government has committed to addressing stalling life expectancy and this has been described as a core part of the levelling up agenda. However, the government has so far failed to acknowledge the mountain it needs to climb to bring life chances in the UK in line with other comparable countries. Investing in people’s health is an investment in the economy.

“For many people, poor health is a significant barrier to work and training. The economic impact of lost output and health costs associated with poor health adds up – these are estimated to cost the UK economy around £100bn a year.

“If we are to see progress, there needs to be a fundamental shift in the government’s approach, from a focus on people’s individual responsibility and choices towards actively creating the social and economic conditions that enable them to live healthier lives. This means providing secure jobs, adequate incomes, decent housing and high-quality education.

“To achieve this, improving health should be made an explicit objective of every major policy decision. Otherwise, the gap between rich and poor will further widen and ‘levelling up’ will remain little more than a slogan.”

Acute Care, Health Inequality, News, Vanguard April 14, 2022

Community Diagnostic Centres: A critical response to regional inequalities

By Niamh Macdonald

The latest report from Vanguard, Assessing the current state of play of CDC delivery across England, 2021, provides much needed clarity on the current status of CDC rollout and identifies where more support is required to achieve regional equality in healthcare provision.

The backlog in patient care is affecting every region across England, with waiting lists at an all-time high and services struggling to keep up with demand. Community diagnostic centres (CDCs) were earmarked by Sir Mike Richards as a necessity across communities to support quicker and safer access to both elective and diagnostic procedures in 2019.

A few years and a global pandemic later and the need for streamlined diagnostic service provision is now greater than ever.

An additional layer to the elective care crisis is the disproportionate impacts being felt across England; while no region of the country has been left untouched by the crisis, some are clearly being affected more severely than others. The approach to delivering CDCs is also disjointed across regions and their respective integrated care systems (ICS).

To deliver high-quality diagnostic care in the face of the backlog, a joint up and co-ordinated approach is vital. The latest report from Vanguard, Assessing the current state of play of CDC delivery across England, 2021, outlines the findings of a Freedom of Information (FOI) research project, undertaken in 2021. The findings of the report not only provide a bigger picture on the current status of CDC rollout but also identifies where more support is needed in order to achieve regional equality in healthcare provision.

Compounding inequalities

Health inequalities have been widening across England in recent years and these societal fault lines were underscored by the impact of Covid-19. There is currently a gap of almost 19 years in healthy life expectancy between the most and least deprived areas of the country. Further still, during the pandemic average life expectancy fell for the first time since 2000.

Higher rates of Covid-19 were concentrated in the most deprived areas of England, intensifying pressure on the hospitals and care services within these regions. This has caused patients living in these areas to suffer the greatest disruptions to elective care services.

According to evidence submitted by the Health Foundation to the House of Commons Health and Social Care Committee, patient treatment completion in the most deprived areas of England has fallen by 31 per cent, while completion fell to 26 per cent in the least deprived areas. Regional inequalities are only set to widen as the effects of the pandemic continue to impact patient waiting times.

“A joint up and co-ordinated approach across England is vital to minimise the disruption to services and reduce the patient care backlog.”

Targeting inequalities with CDCs

The Vanguard report, Assessing the current state of play of CDC delivery across England, 2021, provides an overview of current CDC delivery across England. The region with ICS, STP and Clinical Commissioning Groups (CCGs) that are farthest along in their delivery strategy is the Southeast. A high proportion of respondents reported to have a strategy in place and expect their CDC to be fully operational in the next three years. The Southeast also had the highest proportion of respondents that identified CDCs as a high spend priority.

Contrastingly, just one-third of respondents in the West Midlands identified CDCs as a high spend priority. Furthermore, the West Midlands region has the highest waiting lists for all procedures in England, accounting for 20.5 per cent of all national waiting lists as of July 2021. It is evident from the current picture of CDC roll out that more regionally tailored support is needed to level out delivery across the country, ensuring that the impact of CDCs is maximised.

Central to the CDC ‘mission’ is to minimise regional inequalities by supporting the delivery of integrated care, helping to join up disconnected patient pathways and bring services closer to the communities that use them. It is hoped this will expand capacity and improve access to care. By increasing the capacity to tackle waiting lists, the successful implementation of CDCs could help to reduce healthcare inequalities and disparities in patient outcomes.

Lindsay Dransfield, Chief Commercial Officer at flexible Healthcare Spaces provider, Vanguard said: “CDCs are an essential component to reducing patient care backlogs, creating more accessible healthcare for individuals in more deprived areas.

“Following the recent government announcement that £2.3 billion is to be spent on increasing diagnostic activity across the UK, it is now more important than ever to reduce regional health inequalities through the introduction of more CDCs.”

Fair access to funding

While the Health and Care Levy, introduced in September 2021, provides significant funding for tackling waiting lists and elective care backlogs, there remains significant challenges in ensuring equitable distribution of funding. For CDCs to be rolled out with more consistency across England, the government must ensure that regions are able to fairly access funding and support. There is currently a lack of clarity across ICS/STP/CCGs around how decisions are made to allocate funding, this lack of guidance is detrimental to regions already being impacted by higher waiting lists and capacity issues.

The Vanguard report recommends that the government and NHS “remove bureaucracy in the national procurement process to ensure CDC delivery is accessible for all bodies involved with the ICS”. Unnecessary bureaucracy in the procurement process has cost and time implications for healthcare providers, in some cases making it impossible for them to undertake the application process.

On top of reducing bureaucracy around funding, the report recommends putting in place regionally ringfenced budgets for CDCs that are calculated based on a number of indicators, such as waiting lists, current budgets, staffing requirements and available land. This will ultimately help to provide a more consistent approach in the roll out of CDCs and subsequently generate fairer patient outcomes.

A co-ordinated approach

Central to the NHS Long Term Plan is the goal of delivering fully integrated community-based healthcare. To achieve this, the Vanguard report demonstrates the need for a clear framework for CDC delivery to provide clarity across ICSs. A joint up and co-ordinated approach across England is vital to minimise the disruption to services and reduce the patient care backlog, but the benefits must be felt equally. With the most deprived areas of England facing some of the harshest consequences of the pandemic, the roll out of CDCs is an important step in ensuring accessible and equal healthcare.

The Vanguard report recommendations include:

Put in place clear, accessible national funding streams in order to secure confidence in CDC delivery and enable the development of long-term, futureproofed plans.
Ringfence central Government funding for CDC delivery per region, assessed on a range of factors (such as number of patients, average time for delivery of care, number of ICSs in region) to ensure the roll out of CDCs is fair and serves to actively reduce regional inequalities.
Develop localised awareness and education programmes for ICSs to ensure all bodies involved with CDC delivery are aware of the opportunities available to them in terms of funding, partnership opportunities and have access to necessary additional support to ensure the success of CDC delivery.
Broaden the national awareness of regional health inequalities and provide additional support and resources, beyond funding alone, to regions suffering from covid-related backlogs to better prepare them for future incidences of heightened pressure and to prioritise patient outcomes.
Remove bureaucracy in the national procurement process to ensure CDC roll out is accessible for all bodies involved in the ICS.
The Government and NHS should actively identify appropriate infrastructure partners who can rapidly design, build and commission appropriate high quality, safe clinical infrastructure and develop a register of verified infrastructure delivery partners to ensure CDC delivery is consistent on a national scale.
Develop a sustainability guide for CDC delivery to help the NHS reach its goal of Net Zero carbon by 2045.
Promote Modern Methods of Construction (MMC) for CDC delivery to transform existing facilities and create purpose-built new estates that have the flexibility to be re-purposed and expanded upon, enabling a rapid response to changing demands and enabling ICSs to build out there CDC in a modular fashion to tackle patient waiting lists.

All news

Making the creative leap: a healthcare case study

By Simon Dodds; Alan Macdonald; Fay Wilson; Terry Young

Amid greater demand for NHS services, increased use of computer modeling in the planning stages can improve efficiency of delivery.

Plan-Do-Study-Act (PDSA) is deeply embedded in the NHS – and why not? It is simple to grasp and easy to explain. It puts improvement in the hands of those who deliver the care, empowering staff with knock-on benefits for patients. However, it is focused on incremental improvements, and may miss what works well already.

Increasingly the NHS must introduce new systems and services quickly, which is where PDSA runs out of steam as a way to manage innovation. In early 2021, Birmingham and District General Practitioner Emergency Room (Badger) Group set out on its final phase of rapid access delivery. Badger group, which delivers out-of-hours primary healthcare to local patients, was preparing to open a drive-through facility in Bourne Road in Aston. When planning for the opening of this facility, the team used an adapted form of PDSA and added something new.

The adapted feature was to stick to a cycle – study, plan, do (SPD) – which emphasises iterative solutions. Cycles are key to systems design, because it is impossible to specify anything completely from scratch. Also, as a solution is developed, the problem often changes. With rapid access, for instance, making it easier for people to reach the care they need can risk creating bottlenecks and queues as people converge on the new facility.

The innovation was to use computer simulation alongside measurement based on physical facilities. Models may be built and assessed faster than a real service, which speeds the design process up enormously. Models are also safe, since nobody suffers during a simulation. Figure 2 shows an example of two cycles of a design process using SPD at its core.

Study

GK Chesterton said, “The Reformer is always right about what’s wrong. However, he’s often wrong about what is right.” It is critical, therefore, to analyse what works well at each stage of an emerging design, as well as to understand what remains problematic.

With each cycle of the design complete, there is usually more evidence and data to feed into the next plan and computer models can address two questions:

Is the plan likely to work as intended? This is the ‘what works’ question.
Under what circumstances is it likely to fail? This is the ‘what risks’ question

In this case, as several rapid access, drive through facilities were built over a short period, the data available for study became very detailed – as shown in Figure 3.

**Figure 3: Example of the depth of data available for later deployments of rapid access clinics based on earlier clinics.**

Plan

Given increasingly sophisticated data, it is possible to plan in ever greater detail and with greater confidence. Planning is an interactive process, ideally drawing in as many stakeholders as possible. White boards, as shown in Figure 4, are an effective thinking tool at all stages of the process.

**Figure 4: Hand drawing used as part of the design process**

Do

The strength of the Badger approach is that it could use a variety of protoypes throughout the process, starting with a computer model of the local spread of the Covid pandemic. Computer models were also built to test out each clinic that was commissioned, and those clinics in turn were used to prototype aspects of the next stage of delivery.

This process sustained rapid cycles of development and successful deployment of a new type of care delivery through a series of easy access units in less than two years from initial concept to the latest drive through clinic.

Did it work?

On October 21 2021, the first patients drove through Badger Group’s purpose-built clinic. There is capacity for up to 500 a day, and they are still coming.

The mass vaccination campaign has alerted many in healthcare to the potential of pop-up provision, and many examples exist, run out of anything from tents to cathedrals. What is unique about this example is the advanced methods used to deliver a sequence of easy-access clinics during a time when the NHS was under extreme pressure.

Each opened as planned and worked as predicted. And that is exceptional.

About the authors

Mr Simon Dodds, MA, MS, FRCS

Simon Dodds is a general surgeon at University Hospitals Birmingham NHS Foundation Trust. He studied medicine and digital systems engineering before following a career in general and then vascular surgery. In 1999, he was appointed as a consultant surgeon at Good Hope Hospital in North Birmingham and applied his skills as an engineer and a clinician in the redesign of the vascular surgery clinic and the leg ulcer service.

In 2004, the project was awarded a national innovation award for service improvement. This experience led to the design, development, and delivery of the Health Care Systems Engineering (HCSE) programme.

Alan MacDonald, BSc

Alan studied at Nottingham Trent University and has a BSc (Hons) in Biomedical Science.

He worked for the Badger Group as an Out-Of-Hours primary care team leader and later became a data analyst. Since the start of the COVID-19 pandemic in March 2020, he became directly involved with the development of a multi-lane drive through Covid Referral Centre at the NEC.

He has been instrumental in the deployment of other temporary drive through clinics across Birmingham. He has also been actively part of the original team who were successful in applying this concept to the first purpose-built drive through clinic in the UK

He is frequently involved in new & novel projects within the out of hours primary care sector and is currently studying Health Care Systems Engineering.

Dr Fay Wilson, MBChB, FRCGP

Fay trained in Birmingham and has practiced there as a GP there since 1985. Her extensive national and local portfolio includes: NHS HA Non Exec, GMC fitness to practise chair, and associate postgraduate dean at Health Education West Midlands. She has served on the council of the BMA and other bodies. Fay brings people together to develop new models of care, a notable success being the Birmingham Multifund co-operative, a pioneering nurse-led walk-in centre and a prototype GP provider-at-scale ahead of its time in the mid-1990s.

Dr Wilson is medical director and co-founder of Badger, a GP social enterprise since 1996 providing out of hours and urgent primary care. COVID-19 introduced her to systems engineering, new people and new ways of thinking. Her ambition for the last decade has been to slow down.

Prof Terry Young, BSc, PhD, FBCS

After 16½ years as a research Engineer, Divisional Manager and Business Development Director, Terry became a professor at Brunel University London for 17 years.

He has a BSc in Electronic Engineering and Physics, a PhD in laser spectroscopy both from the University of Birmingham, UK.

His research has been in health technology, health services, and information systems. He has taught information system management, project management and e-Business.

His awards include the Operational Research Society’s Griffiths Medal, 2021, for analysing the return simulation methods offer when used to improve healthcare services.

Prof Young set up Datchet Consulting in 2018 to support innovation on the borders of academia, health and industry, of which the project reported here is an excellent example.

Care employers come together for Ukraine

By Integrated Care Journal

With the conflict in Ukraine raging, care employers are working together to provide opportunities for those displaced to work and find a home in the UK.

Care employers have been working together to understand how they can provide a meaningful employment opportunity for those displaced from Ukraine and other parts of the world and finding a home within the UK.

The National Care Forum (NCF), the leading association of not-for-profit care and support providers, in association with the Care Provider Alliance, have brought together a wide range of partners committed to offering support. This includes expertise from across national and local government, housing, recruitment specialists, legal and immigration experts and regulators.

Employers and partners are working closely with recruitment experts to enable displaced people from Ukraine and other parts of the globe to identify roles within the care sector, direct individuals to localised support and ensure that employers work together to provide the best opportunity for those who wish to work.

While this work progresses, the broader support for people displaced from Ukraine through the Homes for Ukrainians scheme is being clarified. Alongside this, local government has an important role in regards to how local support will work, and specific roles and responsibilities are still emerging. It is imperative that the desire to work is aligned with the need for displaced people to be connected into wider community and pastoral support.

Vic Rayner OBE, CEO of the NCF said: “Like many people affected by the plight of the people of Ukraine, care employers are pulling together to take action to help. The ideas are progressing at pace, and there is a strong desire to do something meaningful to help the people of Ukraine, and others from around the globe who arrive into the UK.

“We are pulling together opportunities for care and support employers to share details of available job vacancies, which we hope will be tied into the broader communications for displaced people. There are many other ways for people to offer support, including support to Ukrainians needing care and support, assistance with vetting and matching, and those who have a housing solution.

“However, there remain significant unanswered questions around regulatory requirements, right to work entitlement, safeguarding, etc. We need the government to work at pace alongside adult social care employers to resolve this. Furthermore, we are working with other partners, to understand how most effectively the sector can be engaged to provide a solution at this moment of crisis.”

WHO reveals almost entire global population breathing unhealthy air

By Niamh Macdonald

Almost the entire global population (99 per cent) breathes air that exceeds World Health Organization (WHO) air quality limits, and threatens their health, according to the 2022 update of WHO air quality database.

The new air quality database, released on 4 April, is the most extensive yet in its coverage of air pollution exposure on the ground. The database now includes measurements of annual mean concentrations of nitrogen dioxide (NO2), a common urban pollutant and measurements of particulate matter with diameters equal or smaller than 10 μm (PM₁₀) or 2.5 μm (PM_2.5).

A record number of over 6,000 cities in 117 countries are now monitoring air quality, revealing how their populations are breathing unhealthy levels of fine particle matter and nitrogen dioxide. The data also shows that people in low and middle-income countries are suffering the highest exposures.

A worsening health emergency

The database demonstrates the threat of air pollution to human health. Particulate matter is capable of penetrating deep into the lungs and entering the bloodstream which can cause cardiovascular, stroke and respiratory impacts. There is also emerging evidence that particulate matter impacts other organs and causes other diseases.

Nitrogen dioxide is associated with respiratory diseases, particularly asthma, which lead to respiratory symptoms, such as coughing or difficulty breathing. This further leads to increased hospital admissions and visits to emergency rooms.

Dr Maria Neira, WHO Director, Department of Environment, Climate Change and Health, said: “After surviving a pandemic, it is unacceptable to still have 7 million preventable deaths and countless preventable lost years of good health due to air pollution. That’s what we’re saying when we look at the mountain of air pollution data, evidence, and solutions available. Yet too many investments are still being sunk into a polluted environment rather than in clean, healthy air.”

Last year, WHO responded to the growing evidence base for the significant harm caused by even low levels of many air pollutants by revising its Air Quality Guidelines. The guidelines were made more stringent, especially for Nitrogen dioxide and particulate matter, an action that was supported by the health community, medical associations and patient organisations.

Now, through the 2022 database WHO aims to monitor the state of the world’s air and feed into progress tracking of the Sustainable Development Goals.

Commenting on the report, Francesco Tamilia, Policy Analyst at Public Policy Projects and author of The climate crisis and its impacts report said: “The science and data are increasingly clear on the extreme threat air pollution poses on human health, damaging every organ in the human body. World Health Organization has done an incredible job revising its Air Quality Guidelines last year, making them more rigorous. The latest air quality database is another important step in measuring the damaging affects air pollution has on the population’s health.

“National governments have no excuses, either they implement those guidelines and avert millions of premature deaths, or they will knowingly neglect the health of their populations.”