Has the government given up on its health ambitions?

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David Duffy analyses Theresa's Coffey's start as health secretary.

Despite the already catastrophic impact of the government’s mini-budget, the first casualty of the government’s short-termist approach to governing was health and care.


Amid the ongoing response to the government’s remarkably misguided mini-budget, recent announcements from DHSC have flown somewhat under the radar of national media. But last Friday’s postponement of the health inequalities white paper is a reflection of a 12-year-old government who have become devoid of long-term strategic thinking in health and care.  

Much like how Mr Kwarteng’s budget is being criticised for seeking a short-term growth boost while sacrificing economic stability, Ms Coffey’s health announcements so far seem to be aimed at garnering public support in the short term, and fail to into account the long-term causes of ill health and the enduring challenges facing the sector. Our Plan for Patients, Thérèse Coffey’s first stab at a plan for health and care, is receiving as much attention for what it misses as what it includes, with glaring omissions around workforce strategy and health inequality. 

Last week it was reported that new Health and Care Secretary intends to postpone, and potentially scrap, the publication of the long-awaited government health inequalities white paper. It is estimated that health inequalities cost the UK £31 billion to £33 billion per annum before Covid-19 and the paper was a key part of Boris Johnson’s leveling up initiative. When first announced by then Health Secretary Sajid Javid back in February, the intention was to set out “bold action” to deal with disparities in health outcomes based on race, gender and income. 

In response, over 155 members of the Inequalities in Health Alliance (IHA) last week wrote to Coffey urging her to maintain the commitment to publishing a Health Disparities White Paper (HDWP) by the end of this year. 

The Alliance said: “The DHSC and NHS will be left in the ultimately unsustainable position of trying to treat illness created by the environments people live in”. 

The IHA have urged for the government to restate its commitment to health inequalities, warning that “focusing on individual behaviors and access to services alone will not be enough to close the almost 20-year gap in healthy life expectancy that exists in England between those from the least and most deprived communities.” 

“that the Secretary of State has so far chosen to ignore the issue almost entirely poses ominous signs for the future health of the nation”

Whether or not you agreed that Johnson’s levelling up initiative was ever truly going to become a reality, it did help kickstart hugely beneficial discourse around health inequality, further prompted by the uneven impact of Covid-19. It was clear from recent Public Policy Projects meetings between system leaders that there is a growing consensus that tackling health inequality is the central objective of integrated care systems (ICSs). With ICS leaders in agreement on the need for action, what has happened to the government’s desire for “bold action” on health inequality? 

The obvious answer is that while the economy is rapidly deteriorating and every government department is being asked to find ‘efficiency savings’, long term social and economic rejuvenation is taking a back seat. But in the context of a deepening cost of living crisis, the fact that the new Secretary of State has so far chosen to ignore the issue almost entirely poses ominous signs for the future health of the nation. 


Cost of living 

Recent polling from the Roya College of Physicians has found that even by May 2022, 55 per cent of people felt their health had been negatively affected by the rising cost of living, with the increasing costs of heating (84 per cent), food (78 per cent) and transport (46 per cent) reported as the top three factors. 

Rising costs are creating environments for preventable ill health to manifest in deprived areas across the nation, ultimately impacting health services – but of course, the crisis directly impacts health providers, as well as those delivering care. 

NHS Providers have published a shocking new survey from its membership, revealing that some staff are electing to not eat during work hours in order to provide for their children, with some quitting altogether to find better paid work in pubs and bars. Other key findings from the survey include: 

  • 71 per cent of trust leaders reported that many staff are struggling to afford to travel to work; 
  • 69 per cent said the cost of living is having a ‘significant or severe’ impact on their ability to recruit lower-paid roles such as porters and healthcare assistants; 
  • 61 per cent reported a rise in mental health sickness absence; 
  • 81 per cent are ‘moderately or extremely’ concerned about staff’s physical health; 
  • 95 per cent said that cost of living increases had significantly or severely worsened local health inequalities; 
  • 72 per cent said they have seen more people coming to mental health services due to stress, debt and poverty; 
  • 51 per cent said they have seen an increase in safeguarding concerns as a result of people’s living conditions. 

The health and care community is united in its concern for the wellbeing of its staff and for their capability to respond to the underlying causes of the nation’s health challenges. Unfortunately, the government is failing to match this concern with sound, long-term policy – this epitomised by Our Plan for Patients. 

In some ways, it can hardly be a shock that the government is losing its desire to implement long-term health policy; Coffey is the country’s fifth Secretary of State for Health in as many years and must also balance this role with the position of Deputy Prime Minister. Even still, much of the sector has been taken back by some of Our Plan for Patients’ glaring omissions, as well as questioning some of the key commitments within it. 

In setting out her key priorities as Health Secretary, the threadbare document published last week attempts to establish Coffey as a “champion” for patients. So far, the plan has achieved little more than alienating much of the health and care community, while simultaneously discrediting the last 12 years of government health policy.   


Primary care  

“Ministers are quick use the pandemic to excuse ominous backlogs in elective care, yet they do not offer the same leeway for the primary care sector”

One of the central aims of Our Plan for Patients is the expectation for all patients to receive a GP appointment within two weeks of request. In setting this wholly unrealistic, arbitrary national target, without providing additional support for GPs to achieve it, Coffey is seeking to create a doctors vs patients dynamic.  

It’s a cheap tactic, designed to pick up votes, and the right wing press immediately came out in support of it. The Daily Mail blamed ‘soulless megapractices’ for ‘Glastonbury style 8am ticket rushes’ – the simple and highly flawed suggestion is that GPs must ‘do more’ and ‘care more’ to improve access to services. 

“Targets don’t create doctors,” said Helen Buckingham from the Nuffield Trust, one of many organisations and figures who criticised the target. Former Health Secretary Jeremy Hunt insisted in the Commons that “adding a 73rd national” target for GPs would not address the challenges in the sector. Matthew Taylor Chief Executive of the NHS Confederation simply said the plans “do not go far enough”.  

Fundamentally, the UK has a rapidly ageing population with increasingly complex conditions and comorbidities to manage – and it does not have the staff to deal with it. The Health Foundation recently revealed a shortage of full-time 4,200 GPs, with that number projected to rise to about 8,900 by 2030/31. Further, there are 132,000 vacant posts across the NHS. This number includes 47,000 nurses and more than 10,000 doctors.

In the face of these challenges, primary care teams continue to perform remarkably. The latest figures show that GPs carried out 26.6 million appointments in August, up from the previous month and over three million more than in August 2019 – before the pandemic. Nearly half of appointments in August took place on the same day that they were booked and over 80 per cent within two weeks of booking. Almost 70 per cent of these appointments were delivered face-to-face.  

Ministers are quick use the pandemic to excuse ominous backlogs in elective care (despite the fact that there were already four million people on waiting lists before Covid-19 hit), and yet they do not offer the same leeway for the primary care sector and continuously fail to acknowledge its achievements.   

Primary care was at the centre of the UK’s highly successful Covid vaccine rollout, one of the few genuine achievements of Boris Johnson’s government. All the while the sector maintained impressive rates of service delivery in other areas and managed to rapidly adapt to digital consultations, ensuring that as many patients as possible received care with little to no infection risk.   

Rather than support and celebrate a sector that delivered when we most needed it, the government has decided to point the finger at primary care – demanding more from GPs without providing them with the means to deliver.   

Unfortunately, initial noises from the current ‘government in waiting’ will have done little to reassure primary care professionals. Shadow Health Secretary Wes Streeting has not only reaffirmed the gas lighting of GPs but has gone a step further, promising same day face-to-face GP appointments to anyone who wants them if Labour were to win power – an announcement already dismissed by the British Medical Association as “not being grounded in reality”.   

Even in a political sense, this seems a needless promise to make while the Tories continue to haemorrhage support in all policy areas. A recent YouGov poll suggests that Labour are four times more trusted by the public to manage healthcare – the party should use this political capital to outline long-term health policy that addresses fundamental workforce shortages.  

We need our leaders to be realistic and honest with the public about what is possible, and not automatically assume “meeting public expectations” is best for primary care without seeking to manage those expectations.  

In the absence of a bona fide, long-term workforce strategy from Westminster, perhaps it is time that we had a government that faced a hard truth: that not every patient should get to see their GP upon request. Patients and end-users should be better engaged with system reform so that they are more aware of the options available to them within health and care and not resort to using GPs for every request – there are simply not enough doctors to see everyone. 


Where is the integration agenda?  

This is ‘sugar rush’ politics at its worst. A short-termist approach to governing that is designed to garner a quick dose of public support while the long-term needs of the sector go ignored.”

Political leaders must reaffirm the aims and objectives in the NHS Long Term Plan and indeed the recent Health and Care Bill. In integrated care, there is a principle for care delivery which is designed to segment patients to different parts of the system – delivering them the care that most appropriately addresses their needs while protecting the precious capacity of seriously understaffed and under-resourced parts of the sector.   

It is concerning that supporting the development of ICSs, and their focus on addressing health inequality through population health strategies relevant to specific regions, received so little attention in last week’s announcements. If properly supported, ICSs can act as conveners of public services beyond health and care, and so have a huge role to play in revitalising communities and addressing broader inequalities. 

The term ‘ICS’ does not appear once in Our Plan for Patients, and the only references to ‘integrated care’ are made in the context of describing integrated care boards as ‘local NHS services’. The whole point of integrated care, i.e., the heart of the government’s flagship health legislation only published two months ago, is to unite a disparate health and care system under a common purpose to improve health outcomes. This of course includes providers within the NHS, but it also includes social care, primary care and wider local government and community care.   

As Richard Vize outlined recently in the British Medical Journal, the government has repeated the age-old trope of essentially treating social care as a discharge service for NHS hospitals. Yes, it is true that that a healthy social care sector would alleviate pressure on the NHS, but social care should be so much more than a pressure valve for hospitals.  

For many with serious and lifelong conditions, social care is the lifeline that enables them to interact with the world and live with dignity and independence. Politicians who treat social care as a mere afterthought would do well to remember this.   

As well as this, the care sector harbours unique insight and intelligence into local health challenges and could provide a hugely meaningful career option for thousands of new recruits. The government should be looking to professionalise the social care sector while helping ICSs to harness the expertise that already exists within it to improve population health outcomes.  

There should always be a dual purpose to health reform: addressing immediate challenges while moving towards common, long-term objectives. Immediate problem solving is essential – patients deserve the best possible care that the system is able to give them and right now they are having to wait too long to get it or not receiving it at all. But in purely focusing on the immediate, more visible issues, such as GP waiting times, the government fails to address the root of the problems. The sector needs more staff, better equipment and more resource.   

To make matters worse, there are already worrying rumours that the government plans to scrap its obesity targets. Alongside smoking, obesity is one the largest preventable causes of ill health and contributes significantly to cancer rates. Scrapping targets before they have barely had a chance to have an impact makes the promise in this plan to “support people to live healthier lives” ring rather hollow.  

This is ‘sugar rush’ politics at its worst. A short-termist approach to governing that is designed to garner a quick dose of public support while the long-term needs of the sector (and ultimately the public) go ignored. It seems that finally the Conservatives have now stopped pretending they have any intention of fixing this very broken health and care system.  

It will be of little reassurance that DHSC has already begun rolling back some of these expectations, with the two-week GP appointment target pushed back to the Spring of 2023. The damage has been done, Coffey has drawn her ‘battle lines’, and seeds for a crisis winter like no other for health and care have already been sown. Compounding this is the fact that the government seems incapable or unwilling to provide light at the end of the tunnel in the form of a long-term plan for health and care.  

 

How Tunstall Healthcare is investing in the leaders of the future 

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Global market leading health and care technology company, Tunstall Healthcare is investing in the next generation of health, housing and social care professionals with the launch of a new range of Continuing Professional Development (CPD) accredited courses.


Part of ‘Tunstall Academy’, the online courses have been developed by Training Accreditation Programme (TAP) and CIPD accredited trainers. The courses aim to strengthen the knowledge and expertise of professionals in a range of areas related to health and care technology. The first courses available focus on telehealth and a range of other courses relate to the remote management of specific long term conditions including COPD, heart failure and diabetes. A Telecare Assessor course will be available soon, which will be followed by a number of other telecare-focused courses.

Gavin Bashar, UK Managing Director at Tunstall Healthcare, commented: “The role of technology in adult social care has been radically reshaped over the past couple of years, leading to 63% of directors in adult social care reporting that their local authorities are implementing positive investment strategies in digital and technology.

“We must therefore work to upskill staff members in these sectors to improve care service delivery, facilitate collaboration, and build a bigger and better workforce post-Covid. Our specialist training team works closely with participants to help them get the most out of technology for their own organisations and the people they support, and ensure they are ready to make the most of a more digital future as we transition to a fully digital communications network.”

CPD courses enable professionals to stay up to date with current and best practice in their chosen field, enhancing their skills and effectiveness in the workplace. Tunstall also offers a number of non-CPD accredited courses which can be delivered online or in person, designed to upskill people working in monitoring centres and group living environments as well as those delivering telecare and telehealth services.

All courses are designed for a range of learners, from beginners to advanced professionals, and can also be configured to develop skill sets for particular job roles, as well as achieving broader personal and organisational objectives, such as meeting TEC Services Association standards and enhancing customer experiences.

Andy Hart, Head of Technical Delivery and Support at Tunstall Healthcare, added: “People are the greatest asset of any organisation, and at Tunstall we have a responsibility to drive change across the sector as a whole. We are committed to educating and upskilling the next generation of professionals in the use of telecare and telehealth technology to modernise our health, housing and social care systems.

“Technology enabled care solutions (TECS) support individuals to live independently for longer and alleviate pressures on care and health services. It’s crucial that professionals are aware of the benefits of technology within service provision so that it can be deployed effectively, and education plays a key role in achieving this.”

Tunstall Academy brings together a range of initiatives designed to raise awareness of the value and potential of technology across the health, housing, and social care landscape, and to increase the benefits to users, carers, professionals and providers.

To find out more about the training services available, please visit www.tunstall.co.uk/training-services.

Community Care, News, Primary Care

Leading health charities highlight “untapped potential” of pharmacy services

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Untapped potential of pharmacy sector

Leading UK health charities have highlighted the untapped potential of pharmacy services in tackling the nation’s major health conditions. 


Just one in ten adults in Britain have turned to their local pharmacy for advice and information on lowering their risk of serious health conditions including cancer, heart disease and type 2 diabetes, according to a new YouGov survey.  

The survey, commissioned by the British Heart Foundation (BHF), Cancer Research UK, Diabetes UK and Tesco, suggests that many people could be missing out on opportunities to access free advice via their local pharmacies that could help them make life-changing improvements to their health.   

The findings come as the BHF, Cancer Research UK and Diabetes UK have been working with Tesco to deliver specialist training to Tesco pharmacists and pharmacy colleagues to support their conversations with the public. The training will help them provide more information and support as to how people can help lower their risk of these serious conditions through small changes to their day-to-day routine.  

The survey also found that, of those who had visited a pharmacist for health-related advice or checks, 43 per cent said talking to a pharmacist had eased their concerns around wasting their GP’s time.    

Meanwhile, 24 per cent of those who had visited a pharmacist for health-related advice or checks found it easier to speak to someone in a pharmacy than in other healthcare settings, while 53 per cent identified not having to book an appointment as a benefit of using a pharmacy for information and advice about a health-related concern.

The leading health charities say that supporting people to make lifestyle changes and seek referrals for concerning symptoms could “save thousands of lives” every year from some of the UK’s most prevalent and serious diseases.   

More than 7.6 million people in the UK are living with heart and circulatory diseases, while 4.9 million are living with diabetes, 90 per cent of which are cases of type 2 diabetes, and it’s estimated that almost three million people are living with cancer (2020). Yet, around four in 10 cases of cancer, many heart and circulatory diseases and up to five in 10 cases of type 2 diabetes could be prevented or delayed.   

Dan Howarth, Head of Care at Diabetes UK, said on behalf of the charities: “Thousands of lives could be saved every year through people making positive changes that lower their risk of type 2 diabetes, cancer, and heart and circulatory diseases.  

Far more people could be taking advantage of the advice and support available to them from their Tesco pharmacy while they do their weekly shop, this includes tips and information on stopping smoking and weight management services”  

The survey also found that only two per cent of adults in Britain had visited their pharmacist for a blood pressure check in the last twelve months, despite an estimated 4.8 million people in the UK living with undiagnosed high blood pressure.   

The three leading health charities, in partnership with Tesco, are encouraging people to use their local Tesco pharmacies for information and support on lowering their risk of cancer, type 2 diabetes, and heart and circulatory diseases.  

Tesco and the health charity partners hope that shoppers take advantage of the convenience of having their local pharmacist in store. Customers can easily seek advice when they do their weekly shop and get support for making positive changes or seeking information on concerning signs or symptoms.  

Acute Care, News, Primary Care

Experts urge NHS to leverage position as England’s largest employer to help fight health inequalities

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NHS ICS health inequalities

Public Policy Project’s ICS Network has urged the NHS to leverage its position as England’s largest employer and to realise its potential for social and economic rejuvenation.


The calls came at a recent webinar, where PPP and ICJ released the latest findings from the ICS Futures roundtable series. The series saw ICS leaders from across the country convened for three Chatham House debates to identify challenges and opportunities in integrated care, to scale best practice and provide ongoing practical advice for system leaders and care providers. The series ended with an open webinar discussing the Next steps for integrated care. 

The webinar was held to coincide with ICSs taking statutory footing on July 1st, and was chaired by Matthew Swindells, Joint Chair of West London’s four Acute NHS Trusts & former Deputy Chief Executive of NHS England. Mr Swindells was joined by Dr Penny Dash, Chair, NW London Integrated Care System, Paul Maubach, NHS Midlands’ Strategic Advisor on ICS Collaboration and Laura Stamboulieh, Partner, Strategic Advisory for Montagu Evans.  

The role of the NHS  

There was a particular focus was on the role of the NHS itself in tackling the wider determinants of health. One lesson from the pandemic that was learnt across the country was the impact of low trust – particularly among more deprived areas of the country. As is well documented, vaccination rates were significantly lower in parts of the country relatively high on the deprivation index, and these sectors of the population tend to have poorer health outcomes more generally.  

“Part of the problem is not employing people from those areas”, suggested Paul Maubach, contending that a lack of representation from these areas has contributed to low trust of authorities and public services, healthcare included. It was agreed that choosing to adopt more proactive and inclusive recruitment strategies would align with the wider agenda to address and reverse health inequalities.  

The need to differentiate between health inequalities and healthcare inequalities was also a central topic of the session, particularly in view of what the NHS and ICSs can feasibly impact upon. Many drivers of poor health are deeply rooted in socioeconomic trends far outside the purview of health and care professionals, but there is much that can be addressed in the short term with the right focus and the right policies.  

For example, one of the greatest drivers of poor health in later life are educational outcomes. In turn, a crucial indicator of lower educational outcomes in the future is poor oral health at the age of two, so ensuring better access to NHS dentistry among more deprived cohorts would allow those more at risk to be identified, engaged, and supported by their local health and care systems, as well as improving access to dental services themselves.  

This area of discussion highlighted one crucial, but often overlooked point; that all health and care services are interconnected, and ultimately, are trying to achieve the same outcomes. Part of the role of ICSs, therefore, is to create a culture where all stakeholders collaborate to achieve this shared goal (improving population health).   

To this end, Dr Penny Dash argued the importance of those on integrated care boards (ICBs) having clearly delineated areas of responsibility and accountability, to create clarity over how different parts of the system fit together and to ensure that decision making does not become bogged down in bureaucratic hierarchies. “If you can’t answer the question related to your remit, you shouldn’t be at the table.”   

The importance of data was emphasised throughout the session – both from a population health management perspective, as well as the effective planning and monitoring of estates and facilities. 

It was posited by Laura Stamboulieh that “the role of the estate as an enabler is often overlooked. The ultimate delivery of ICSs will rely on a well-developed health and care estate.” On this point, it was noted that NHS estate planning has evolved little since the introduction of digital healthcare and the increase in remote working. As such, an updated, modernised approach to estate planning will be essential to delivering effective, integrated care, at scale. 

 

 

News, Primary Care

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

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RCN racism survey

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.

News, Primary Care

Fuller Stocktake: Time for a radical overhaul of primary care

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Fuller Stocktake primary care

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.”

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

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Cost of living

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.”

How ICSs can help uproot risk aversion and progress innovation

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Barnsley Hospital - innovation

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

News, Primary Care, Workforce

LDC Confederation: taking an active role in combatting discrimination

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discrimination

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.

News, Primary Care, Social Care

New white paper seeks to clarify what integration means for patients

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integration white paper

The government has published its eagerly awaited Integration white paper, designed to clarify exactly how integrated services will improve care for patients and end users across England.


The paper outlines a series of priorities for integrated care systems to improve health and care delivery. These include enhancing transparency and choice of care increasing earlier intervention of care, as well as increasing flexibility and developing clearer communications between different service providers and enhancing overall value for the taxpayer.

Commenting on the paper, Prime Minister Boris Johnson said: “These plans will ensure no patient falls between the gap [between services], and that everyone receives the right care in the right place at the right time.”

This sentiment was echoed by Health and Care Secretary Sajid Javid, who said: “Our Integration white paper is part of our wider plans to reform and recover the health and social care system, ensuring everyone gets the treatment and care they need, when and where they need it.”

The Integration white paper follows a day after the NHS published its Elective Care Recovery Plan, outlining how the health service intends to bring down ominous backlog figures and repair waiting times following Covid-19 disruption to services.

Proposals outlined in the recovery plan include a focus on community diagnostics and new approaches to care that will only be possible to deliver through integrated care systems (ICSs). This new white paper seeks to outline how health and care systems will draw on the resources and skills from across NHS and local government to “better meet the needs of communities, reduce wating lists and help level up healthcare across the country”.

Also commenting on the Integration white paper, Mathew Taylor, Chief Executive of the NHS Confederation said: “As these proposals are developed further, it is important that we recognise the differences that exist in local areas including in local relationships. They will need to evolve in their own way if we are to crack this agenda.

“Finally, for integration to work there needs to be joined up thinking across government as well as at local level. Ensuring this will allow local leaders the freedom to work with their communities to identify what will provide the best outcomes for the public.”

Hugh Alderwick, Head of Policy at the Health Foundation, highlighted the importance for adequate funding if these system reforms are to be possible: “Better integration between services is no replacement for properly funding them. The social care system in England is on its knees and central government funding over the coming years is barely enough to meet growing demand for care – let alone expand and improve the system.

“More integration is also little good if there aren’t enough staff to deliver services. Staffing shortages in health and social care are chronic, yet government has no long-term plan to address them.”


Analysis

For those who have been close to the integrated care agenda in recent years, or indeed attended virtually any event around integration, there will be little new insight within this white paper – nor will there be much to disagree with. Health and care integration is not a new concept, and so the broad concepts within the government’s latest paper come with little in the way of new proposals. The paper is more of a clarification on what integrated care seeks to achieve rather than an explanation as to how it will be delivered (the absence of additional funding proposals and clear strategy to address workforce shortages is telling).

Not that the document isn’t useful, public perception and understanding of integrated care is still very poor. Delivering integrated care in practice will be difficult unless this understanding is improved and, to this end, the white paper provides some useful clarifications.

But the timing of the paper is as important as its contents. Building on the recent publication of the Levelling Up white paper and published a day after the NHS elective care recovery plan, the Integration white paper is an attempt to show that the government are looking beyond the acute sector and are serious about “Levelling Up”.

The white paper also comes as the Prime Minister is desperately trying to build some policy momentum and move away from what has been a disastrous period for his premiership. Time will tell whether this series of flagship policy proposals (which will precede a further paper outlining specific plans to address health disparity) will provide the antidote to the partygate scandal.


Key priorities of the white paper:

  • Better transparency
  • More personalised care
  • Earlier intervention
  • Clear communication
  • Improved access to social care services through NHS data sharing
  • Better treatment
  • Better NHS support to care homes
  • Coordinated services
  • More flexible services
  • Better value for money