Featured, News, Workforce April 16, 2024

New data reveals mental health toll on NHS staff

By Integrated Care Journal

Despite challenges facing the service, the NHS remains one of the UK’s most loved institutions, says survey data, as NHS Charities Together launches new campaign urging public to continue supporting NHS and its staff.

More than three quarters (76 per cent) of NHS staff surveyed said they have experienced a mental health condition in the last year, according to new data collected by NHS Charities Together. Conducted by YouGov on behalf of the charity, the survey of more than 1000* NHS professionals also found that 52 per cent reported experiencing anxiety and 51 per cent reported struggling with low mood.

More than two-fifths of respondents (42 per cent) said they had experienced exhaustion in the last year, while three in five (60 per cent) reported feeling concerned for the mental health of colleagues.

Despite these challenges, however, 79 per cent of respondents said they feel proud to work for the NHS and 68 per cent said that they are unlikely to leave within the next 12 months.

The survey reveals the impact of increasing pressure on NHS staff, who are now subject to ‘winter pressures’ throughout the year, and are increasingly facing high workloads, long and unsociable hours and exposure to traumatic, stressful events. 96 per cent of those surveyed said they believe that overall pressure on NHS services is growing, and 69 per cent said that morale is the lowest they have ever experienced. A similar number (70 per cent) said that work-related stress has negatively impacted their mental health in the last year.

The release of these findings comes alongside the launch of a new campaign from NHS Charities Together called Support Goes Both Ways, which aims to raise awareness of need to continue to support NHS staff, so that they can best support the public.

Commenting on the findings, Ellie Orton OBE, CEO of NHS Charities Together, said: “Staff working within the NHS do a hugely challenging job every day, often dealing with traumatic events most of us would never encounter. The majority of NHS staff love doing the job they do, and both NHS staff and the general public feel proud of our NHS. But the nature of the work can have a detrimental impact on their mental health, and stigma can prevent them talking about it.

“Many NHS Trusts are already doing what they can to prioritise the mental health and wellbeing of our NHS staff, but it doesn’t go far enough. We will continue to work closely with NHS England and across the UK to ensure the additional support we provide for NHS staff has the most impact.”

In a separate survey, also carried out by YouGov on behalf of NHS Charities Together, more than 2,000 members of the public were invited to give their opinion on the NHS. Despite the challenges facing the NHS, the 2024 survey revealed that almost four in five (78 per cent) agreed that the NHS is one of the UK’s most loved institutions, compared to three in five (60 per cent) of the 2,000 respondents surveyed in 2022 who stated that the NHS is the best thing about the UK.

The proportion of respondents saying that they would consider a role working for the NHS if they were starting their career again, has risen slightly, from just over one in four (28 per cent) in 2021 to three in 10 (30 per cent) in 2024**.

Author, comedian and former doctor, Adam Kay, whose number-one bestselling book and multi-BAFTA-winning TV show, This is Going to Hurt, provided an insight into the often funny but harrowing daily life of a junior doctor, said: “These figures sadly come as no surprise at all. I know from my own experience just how hard NHS staff work, day-in, day-out, and the mental toll that routinely takes. We are uniquely privileged to have the NHS and should be proud of the wonderful people who sacrifice so much and go so far beyond the call of duty to look after us when we need it. But they desperately need support too, which is why I’m very proud to get behind NHS Charities Together’s Support Goes Both Ways campaign.”

Pat Chambers, Charity Development Manager, County Durham and Darlington NHS Trust Charity, said: “During the pandemic, many staff were affected mentally and emotionally. The extra support from NHS Charities Together enabled us to fund wellbeing spaces, equipment and food and drink for staff, who were working exhausting shifts in the constraints of PPE.

“We also received funding for the Trauma Risk Management (TRiM) project. TRiM is a trauma-focused peer support system helping to prevent extreme trauma and PTSD – similar to interventions delivered for service personnel returning from conflict zones. Funding enabled us to recruit 53 staff volunteers to be trained in providing peer support and interventions. We also funded a staff choir, which was a great outlet for staff and even saw us recording a single during lockdown, which hugely boosted morale.

“The unique challenges of the job means many NHS staff still face mental health challenges today, and the extra support is still needed, allowing us to promote wellbeing across our workforce and therefore ultimately continue to support the delivery of safe, compassionate and quality patient care.”

Hannah Canning is the Health and Wellbeing Coordinator at North West Anglia NHS Foundation Trust. Her role is fully funded by NHS Charities Together, through the North West Anglia Hospitals’ Charity, and was created to support frontline workers in the hospital. She said: “Thanks to the funding from NHS Charities Together, I’m able to support the wellbeing and mental health of staff in the hospital. I’m focusing on individual and team wellbeing and encouraging breaks and rest – considering all things that affect staff while they are on shift. Using this funding, we are able to go ‘over and above’ to support our staff.”

Ellie Orton OBE, CEO of NHS Charities Together, added: “NHS Charities Together already funds extra support such as counselling, green spaces, helplines and wellbeing zones and we’re launching Our Support Goes Both Ways campaign to raise awareness that while those who work for the NHS have a duty to care and protect us all, we all have a responsibility to make sure those who work for the NHS are looked after too.”

Steph Gorman is an intensive care nurse at Guys and St Thomas’s Hospital in London. She said: “I’m passionate about my work as a nurse. It’s hard, and I’ve had my struggles, but despite everything, it’s still one of the best jobs in the world. In the past, I’ve needed to seek help and started one-to-one counselling sessions at the hospital, which was really beneficial.

“Working as a nurse is still incredibly challenging. It’s so vital that we continue to invest in NHS staff mental health. NHS Charities Together have funded wellbeing zones at the hospital, just one example of the types of measures that really help make a difference.”

*Healthcare Professional sample: Total sample size was 1078 NHS staff. Fieldwork was undertaken between 13th – 19th February 2024. The survey was carried out online. The figures have been weighted and are representative of all NHS staff by occupational group.

**GB/UK Omnibus: Total sample size was 2068 adults. Fieldwork was undertaken between 16th – 18th February 2024. In 2022, total sample size was 2132 adults. Fieldwork was undertaken between 13th – 14th January 2022. For the 2021 survey, total sample size was 2120 adults and fieldwork was undertaken between 11th – 12th March 2021. The surveys were carried out online. The figures have been weighted and are representative of all UK adults (aged 18+) while for the 2022 survey, the figures are representative of all GB adults (aged 18+).

All news

Supporting care companies in the digital switchover

By Kristian Torode

As many industries embrace the changes the Public Switched Telephone Network (PSTN) switch-off will bring, there are others that have cause for concern. Vital care devices such as telecare systems will be impacted by the switch off — so how can care companies ensure a smooth transition for their customers? Here, Kristian Torode, Director and Co-Founder of PSTN switch-off specialist, Crystaline, investigates.

Around 1.8 million UK residents use telecare devices, which enable vulnerable people to live independently by providing assistance in the case of accidents. These wearable devices alert family, carers or emergency services when pressed and can also connect to other safety equipment such as fall detectors, smoke alarms and door sensors.

However, the PSTN switch-off in December 2025 means that the copper wire phonelines that have historically connected these systems will be turned off, threatening their functionality.

In recent months, a number of stories of serious incidents that occurred when telecare devices no longer worked after users were switched from analogue to digital phonelines have hit the headlines. In February 2024, it was reported that Ofcom is investigating Virgin Media over its compliance with rules to protect vulnerable customers during the digital switchover. Consequently, Technology Secretary Michele Donelan met with telecoms providers to determine how best to safeguard vulnerable users during the switchover, which resulted in a commitment not to migrate customers if the functionality of a telecare system is at risk.

However, this poses challenges for vulnerable telecare users, telecoms operators and care providers alike.

Digital divide

Telecare systems are most beneficial to people who have communication, mobility or visual impairments, meaning many users are elderly or disabled.

While vulnerable users are likely to be more heavily impacted by changes to their phone service, it is difficult for them to access information relating to the switchover and how it affects them. According to Good Things Foundation data, non-internet users are twice as likely to have a disability or health condition than extensive users, and six times more likely to be over 65 years of age. As a result, many of those who rely on telecare lack the digital skills to find online information relating to switchover dates and to set up routers for digital phoneline services.

Although telecoms providers have put protections in place for those with disabilities and additional needs, many customers are unaware that they should give these details to providers, meaning existing lists are likely inaccurate.

Tackling telecare issues

So, what can telecare providers do to safeguard elderly and disabled residents? Firstly, telecare companies and local authorities offering these services should share data on who has a device with telecoms providers, allowing them to support vulnerable customers during the switch off.

The next step is to ensure that the right technology is in place before the switch off date. On the care provider’s end, upgrading to a PSTN alternative such as Voice over Internet Protocol (VoIP) now will make sure that there is time to perform checks on existing telecare devices before December 2025. As a result, non-compatible analogue systems can be replaced in advance of the switch off.

Finally, care companies and local authorities must make sure that customers are aware of how the PSTN being turned off will affect their telecare systems. This allows clients to test their personal alarm after their phoneline has been upgraded to ensure it is still fully functional.

As the PSTN switch off draws closer, elderly and disabled telecare customers stand to be one of the groups most heavily impacted but least informed about the effects of the digital switchover. Getting the systems in place in advance and performing thorough testing means telecare companies can guarantee a smooth switchover that safeguards vulnerable people.

To learn more about Crystaline’s PSTN switch off support services for SMEs, including those in the care sector, and to explore digital telephony alternatives, visit the website.

Is the push for collaboration causing a retention crisis?

By Rob McDonald

Rob McDonald, NHS Retention Services Manager at NHS Shared Business Services, asks whether exit interviews could hold the key to boosting NHS retention – a key goal of the NHS Long Term Workforce Plan.

Collaboration has been an NHS mantra for years now. According to all sources, no matter what the problem, collaboration (oh, and technology) will solve it.

But is that true? Intriguingly, my experience is that – far from being a panacea – the move towards collaboration might be exacerbating the NHS’s staffing problems.

Don’t get me wrong. I’m a fan of collaboration. It helps to spread good practice. It reduces or eliminates inconsistencies. It enables organisations to pool their resources and benefit from economies of scale. So it’s perhaps not surprising that the entire NHS has been reorganised to encourage (or mandate) partnerships, exemplified by system-wide reorganisations like the establishment of ICSs two years ago.

The drive for productivity is resulting in mergers as services are scaled. The changes affect all organisations – from acute providers to community, mental health and learning disability services and Community Interest Companies. These TUPE transfers (Transfers of Undertakings (Protection of Employment), affecting many thousands of front-line staff every year, are frequently seen by senior managers as routine or benign. After all, the individual’s terms of employment are protected – so what is there to worry about?

The reality is that the changes are often poorly managed, can be unsettling and – I believe – are contributing so much to staff turnover that they’re having a significant impact on patient care.

What does it feel like if you’re one of those staff?

Thankfully, that’s a question we can answer. NHS Shared Business Services provides an exit interview service, which I am privileged to run. We’ve done more exit interviews in the past three years than most people do in a lifetime. I say that as a statement of fact, not a boast!

One of the questions we’ve started to ask leavers is whether uncertainty around, or the impact of, mergers has influenced their decision.

The answer is yes. We’re finding that nurses in particular often cite service mergers as contributing to their desire to leave, frequently in combination with other factors, such as general stresses of the job.

It goes without saying that this is a problem. The NHS’s long-term workforce plan highlights the need for up to 190,000 additional nurses by 2037, requiring retention rates to improve by around 15 per cent over the course of the plan. Losing nurses has knock-on effects way beyond the immediate impact on patient care. The cost of recruitment to backfill; the cost and time of additional training; the stress on team members who have to provide cover and the cost of overtime – all of these erode both money and goodwill.

The recently published NHS staff survey confirms this. Although most of the People Promise indicators showed a modest improvement, many of the numbers are still concerning. Some 30 per cent of respondents said that they felt burnt out by their work, and 34 per cent found it emotionally exhausting, yet only around half said they felt able to make improvements happen or be involved in change.

The good news is that this can be fixed. Mergers and reorganisations do not need to make staff feel disempowered and uncertain. In fact, when handled well, they can have the opposite effect.

To do this takes time, care, and skill – I’ve provided a few hints below, based on the feedback we’ve been getting.

Uncertainty about a merger is often more damaging than the merger itself, so communication really is key. People subconsciously “triangulate” information – that is, they won’t absorb or believe it until they’ve heard it from three different sources. So think about what level of communication you might need, then triple it.

Identify flight risks. This is something we’ve done for years at NHS SBS; we even have an algorithm that predicts people at risk of leaving. Then take proactive action to address their concerns and bring them further into the fold. Leavers often tell us their manager knew they were thinking of leaving; managers, by contrast, tell us the resignation came as a surprise.

Conduct exit interviews – and use the data you collect. I may be biased, but I think exit interviews are possibly the most important conversation you can ever have – more important even than recruitment interviews. Yet, remarkably, the standard approach is for an automated tick box survey to be sent to leavers upon resignation. The response rate is usually around 30 per cent and the greatest reason for leaving is ‘unknown’ – in other words, the path of least resistance to complete the survey without discussing any real issues.

Finally, remember – a resignation doesn’t have to result in a leaver. Is there a feeling that once resignation is given, the horse has already bolted? I think there is. Yet when I ask leavers whether they would have stayed if somebody had done something differently, the answer is often yes.

Resignations can be withdrawn. And sometimes, a conversation is all it takes to retain a valued and valuable member of staff.

Given that the magic roundabout of change in the NHS is unlikely to slow down any time soon, learning to support and empower staff through periods of uncertainty is critical.

I’d love to hear from readers about their experiences of change – particularly the impact of service mergers on retention and how you use exit interviews. Contact me at Rob.McDonald1@nhs.net.

Rob McDonald, NHS Retention Services manager, NHS Shared Business Services

Prioritise nutrition and hydration to boost broader health outcomes, says new report

By Integrated Care Journal

New report from PPP finds that efforts to implement a multidisciplinary approach to nutrition and hydration are needed to help address the dysphagia burden across the NHS.

A new report from Public Policy Projects (PPP) finds that with the UK becoming a ‘super-aged’ society, declining nutritional and hydrational status among elderly and frail populations will place increasing strain on health and care services.

The report, Prioritising nutrition, hydration and dysphagia in an integrated care context, states that while considerable work and investment has been allocated to reduce the incidence of obesity and the diet-related diabetes, malnutrition and hydration are not given the same focus, despite their significant impact on health outcomes and its role in the management of other conditions.

The report is the culmination of two roundtables held by PPP in 2023, which convened stakeholders to discuss how ICSs embed nutritional and hydrational health into integrated care strategies. The discussions focused on specific elements of the debate, including improving the management of dysphagia and care provided for frail populations in different care settings. Attendees included NHS England clinical leadership, allied health professionals (AHPs), including speech and language therapists (SLTs), social care providers, primary care representation nurses and other key health and care stakeholders.

*Graphic showing levels of elderly population at ICS level in 2021. Source: Census 2021*

According to the report, recent reforms to the health and care sector (most notably, the introduction of ICSs) present new opportunities to develop comprehensive approaches to nutrition and hydration, in a way that improves holistic patient care and saves valuable resource for the NHS.

However, among its recommendations, the report calls on the Department of Health and Social Care to launch a national review into food and drink provided across the care sector, to help improve the nutritional and hydrational status of frail citizens in social care. This review should follow the structure and ethos of the NHS Hospital Food programme, the report argues.

It adds that addressing dysphagia should be central to broader NHS goals of enhancing the quality of life for the elderly population, and that by prioritising the management and screening of dysphagia, the NHS could prevent avoidable hospital admissions and promote more efficient use of resources across the health and care sector.

Download the report here

To address the complex and multifaceted challenge of dysphagia, with various medical, neurological, and anatomical elements potentially contributing, will require systems to adopt a multidisciplinary approach, says the report. This will necessitate close collaboration between diverse teams of healthcare professionals, each with specialised expertise.

It finds that a multidisciplinary approach that includes speech and language therapists, dietitians, and physicians, is essential for managing dysphagia and addressing the complex healthcare needs of the elderly in a holistic fashion. To help enable this multidisciplinary approach, the report argues that the model of speech and language therapy sitting in community settings should be scaled nationwide, and adopted across ICSs within integrated care strategies. These strategies should also closely involve the voluntary sector.

The report also recommends an expansion of the speech and language therapy workforce, with ring-fenced funding for broader allied health professionals – in line with ambitions set out in the NHS Workforce Plan.

“The nutritional and hydrational needs of our elderly and frail citizens has been neglected for far too long. As the UK moves towards a ‘super-aged’ society, NHS organisations, care providers and integrated care systems must increasingly focus efforts on improving nutritional and hydrational health,” said report author and Group Editor at PPP, David Duffy. “It is vital that resources are orientated to support allied health professionals, particularly speech and language therapists, who play a vital role in maintaining nutritional health for elderly and frail citizens.

“Nobody in the UK should suffer from malnutrition or dehydration in this day and age, especially not our frailest and most vulnerable citizens. We hope that this report will help shine a light, not just on the scale of the problem, but also on achieveable solutions that we believe will help address the terrible burden of dysphagia.”

Recommendations:

NHS England must prioritise nutrition, hydration and dysphagia as part of its drive to improve system performance and broader health outcomes. Nutrition and hydration management are underdeveloped areas which can help enable success in key national strategies, such as the elective care backlog plan, workforce strategy, the urgent and emergency care plan and the delivery plan for recovering access to primary care.
Integrated care systems should consider dysphagia and wider nutritional and hydrational health as key parts of preventative health policies that can help future proof local health systems.
The Department of Health and Social Care (DHSC) should commission a national review into food and drink provided across the care sector. This review should follow the structure and ethos of the NHS Hospital Food programme. The review should be led by a range of stakeholders from within the NHS and social care, as well as representatives from industry and the private sector.
As the population becomes a ‘super-aged’ society, an integrated strategy is required to manage the health of the elderly and frail population. This should draw upon global and international frameworks provided by the WHO’s ICOPE framework.
ICSs should ensure that maximising the ‘intrinsic capacity’ of citizens is a key priority within integrated care strategies, to prevent deterioration of health and supplement preventative health policies.
ICSs should work to prioritise evidence-based nutritional and hydrational approaches within the social care sector, harnessing tools such as nutritional supplements where necessary, to assist those who have difficulty eating, drinking and swallowing.
The model of speech and language therapy sitting in community settings should be scaled nationwide, and adopted across ICSs within integrated care strategies. These strategies should also closely involve the voluntary sector.
NHS England should undertake a national dysphagia screening drive to identify individuals as early as possible. Social care staff and AHPs should be trained to conduct dysphagia screenings for all elderly and frail patients in their care, and much like falls, dysphagia should be considered among the primary risks in any risk assessment of elderly and frail patients.
The speech and language therapy workforce should be expanded with long-term ring-fenced funding for broader allied health professionals.

Download the report here.

Will the disposable vape ban save the NHS from another health epidemic?

By Sienne Amer

As the government confirms its plans to ban the sale of disposable vapes, Sienne Amer examines the impact of vaping on the NHS so far, and to what extent the ban will help avert another health epidemic.

The UK government recently announced its plan to ban disposable vapes to protect children’s health and tackle the significant rise of vaping among young people. While we have not yet seen the full health impact of the younger generation using vapes, this ban may be a welcome first step in limiting the impact of what could have become the next health crisis.

The devices have appeared on the market recently and rapidly risen in popularity, which is why there is still little research available on the extent to which vaping harms our health. Introducing this ban has the potential to limit the impact vaping has on the NHS, which is already stretched responding to other health crises caused by tobacco smoking, alcohol abuse, obesity, and an ageing population.

There are 4.7 million people in Great Britain who use e-cigarettes, 31 per cent of whom are disposable vape users. Disposable vape brands are targeting children, using bright colours for packaging and a variety of interesting flavours, with the fruit flavours making them far more likely to appeal to children. A shocking 21 per cent of secondary school children have tried vaping and 57 per cent of disposable vape users are aged between 18 and 24. The most popular brand of disposable vapes, Elf Bars, were removed from supermarket shelves last year after the nicotine levels were found to be at least 50 per cent higher than the legal limit. The lack of regulation of these products is an issue, regardless of the effects of use.

Disposable vapes contain nicotine, and inflict similar impacts to any other nicotine product, including heart disease and other cardiovascular disorders, along with respiratory and gastrointestinal disorders. Children are especially susceptible to the toxicity of nicotine, which can impact brain development, leading to shorter attention spans, anxiety, depression and reduced cognitive function.

It has also been shown that when the coils in the e-cigarette are heated, toxic metals, including aluminium, chromium, iron, lead, manganese, nickel and tin leak into the e-liquid, which are then aerosolised, inhaled and absorbed by the lungs. E-liquids have been shown to contain ingredients that generate pulmonary irritants and carcinogenic carbonyl compounds, all of which can lead to respiratory, gastrointestinal, and constitutional symptoms, in addition to an increased risk of early onset strokes.

Although vaping is still recognised as a safer alternative to smoking by the NHS, there has not been sufficient investigation into the long-term impacts on health. Other countries, such as the United States, have recognised the impacts of vaping; in 2019, the US Center for Disease Control and Prevention announced an outbreak of e-cigarette/vaping product use-associated lung injury (EVALI) after it caused the deaths of several young people.

While there have not been any recorded e-cigarette related deaths reported in the UK, in 2023, the NHS recorded 420 vaping related hospital admissions, 15 of which were for children aged under 9, demonstrating the severe risk to health young children are exposed to.

When compared to just under half a million hospital admissions caused by cigarette smoking-related illnesses, the health impacts of disposable vapes appear to be minor. However, conventional cigarettes were only recognised as a significant health hazard in 1964, more than 40 years after the introduction of cigarette manufacture, showing the time it can take to fully understand the long-term effects a product can have on human health.

The NHS is already dealing with several other health epidemics, with smoking costing the NHS in England £2.6 billion per year, approximately 2 per cent of the NHS budget. Obesity costs around £6.5 billion a year and is the second biggest cause of preventable cancer. Alcohol abuse costs £3.2 billion a year in England. This is a total of £12.3 billion of the yearly NHS budget going towards preventable illnesses, and the cost of vaping would be an additional burden on NHS.

To what extent is vaping impacting the NHS?

At present, there is no record of the health-related costs associated with vaping. But modelling the cost to the NHS using smoking data could provide an estimation of the impacts vaping will have. The UK smoking population is equal to 6.4 million people, causing 474,000 hospital admissions a year at a cost of £2.6 billion. The model assumes that 7 per cent of the population requires hospital admissions, with each admission costing approximately £400.

The 420 admissions related to vape use last year would have cost the NHS approximately £168,000. However, vape-related hospital admissions only started to be recorded in 2019 and since then, there has been a 237 per cent increase in admissions. An annual growth of 10 per cent in the vaping population is also expected to cause an increase in admissions. This means that, if only 7 per cent of the vaping population is admitted, the cost to the NHS would be £132 million per year, excluding any impact of an uptake in the number of young people seeking mental health services as a result of the toxic effects of vaping.

The ban on disposable vapes is estimated to affect 2.6 million people in Great Britain – including 316,000 18-to-24-year-olds, who other than vaping, have never regularly used tobacco products – saving a large proportion of young people from the risks caused by nicotine dependence and vaping. As disposable vapes were initially introduced to the market as an alternative to cigarettes, there is a high risk that 75 per cent of people will revert to traditional tobacco products.

Since the focus of the ban is solely on disposable vapes, alternative e-cigarette products will continue to be available for people trying to quit smoking. It is crucial that information should continue to be collected and published, through platforms such as NHS Digital, to monitor and understand the health impacts of the current vaping generation, even post-ban. Hospitals should be advised to continue to use the ICD-10 code to improve data on vaping-related admissions, along with adjusting advisory information to support the disposable vape ban.

Sienne Amer is a Net Zero Graduate at Lexica.

Study developing AI to spot lung cancer risk from patient data

By Integrated Care Journal

Researchers are developing artificial intelligence which they hope will help to identify patients most at risk of lung cancer before symptoms have even appeared.

A team from Nottingham Trent University and Nottingham University Hospitals NHS Trust aims to create an AI-driven model which can autonomously piece together subtle clues and signs in patients’ data to identify those at risk so that they can be investigated further.

There are about 48,500 new cases of lung cancer in the UK alone each year with almost 35,000 people dying from the disease.

The team wants to address the current challenge of European health systems manually identifying people at risk of certain diseases and also help to reduce the financial burden by ensuring services are used by those who need them the most.

It will involve developing a system to recognise factors which might make an individual high risk and then creating ‘synthetic’ data in order to train it to pick up even the weakest signals that there could be an issue.

The aim is to help save lives by identifying people before the disease becomes symptomatic because that can be too late for patients with lung cancer.

The Nottingham team are the UK partners in PHASE-IV-AI, a much larger €7.6m project funded by the European Union’s Horizon Europe research and innovation program.

The project involves 20 partners from ten European countries and aims to unlock the full potential of AI and data analytics in health care in a secure and privacy-compliant way.

As well as lung cancer, the developments of PHASE-IV-AI project will also be validated by other partners in prostate cancer and ischemic stroke. Lung cancer and prostate cancer are among the top three priorities in tackling cancer in Europe, while neurodegenerative diseases are one of the most relevant issues with the EU’s ageing population.

If successful, it is hoped that the Nottingham team’s model could be trained to identify risk for other serious diseases and rolled out to hospitals and organisations across Europe willing to utilise AI-driven diagnostics.

It is thought that AI can enable real innovations in health care, and that AI systems which can process vast amounts of data quickly and in detail can be harnessed as a tool for preventative health care and clinical decision-making.

Despite this, the way in which information is currently stored across European countries and the limited access to health data can form a barrier to innovation, as developing trustworthy and responsible AI systems often requires large datasets for training and validation.

“The hope is that we could develop an AI-driven model for hospitals which they can then utilise and run to help find those most at risk,” said Dr Mufti Mahmud, an Associate Professor of Cognitive Computing in Nottingham Trent University’s School of Science and Technology.

He said: “Countries have huge amounts of clinical practice data, and we want to understand how we might harness this to identify the right people, so they can be invited for more focused diagnostics. We need the system to be able to find people before they start showing symptoms, and ultimately to help save lives.”

“Health care data storing is very sensitive, very private, so by developing synthetic data we can train the model to function responsibly and to provide the reasons why it selected an individual.”

Nottingham University Hospitals NHS Trust lung cancer consultant Professor David Baldwin said: “Identifying the right people for cancer screening is vital to ensure that the most people benefit whilst not harming people who have a low risk of developing lung cancer.

“AI offers the opportunity to improve the way we target screening programmes to make them more clinically and cost effective. AI is also changing practice in many other areas of lung cancer care. AI tools can help reduce the workload of specialists like radiographers and radiologists, as well as treatment costs, and improve outcomes for patients.”

Women spending 1.5 times more than men on personal health, report finds

By Gabriel Blaazer

Survey commissioned by Deloitte reveals that women in the UK are spending £1.5bn more each year across all categories of out-of-pocket spending, and recommends more specific action to support women’s health in the workplace.

Women in the UK are spending over £1.5bn more than men on medical-related expenses each year, according to a survey of working adults commissioned by the Deloitte Health Equity Institute Europe. YouGov conducted the survey of 3156 men and women aged over 18 for Deloitte, to gain a clearer picture of “out-of-pocket” health spend – how much money they spend on personal health and care each year.

The Women’s Health Cost Gap in the UK survey finds that 52 per cent of employed women spend out-of-pocket on health each year, versus only 39 per cent of men, suggesting that women experience more pressure to spend their own money on personal healthcare. In total, the women surveyed spent 1.5 times more than men, averaging £305 a year, compared to £210 for men. The figure of £1.5bn was reached by multiplying this £95 surplus by the number of working women in the UK – 16.06 million.

Women also spend more on all categories of out-of-pocket spending, according to the survey. These include fertility, menopause and menstrual health, but also medical diagnostics and wearables, private counselling or other mental health support and general healthcare (e.g. dentistry or physiotherapy). At least some of this differential may be explained by the ‘pink tax’, whereby products aimed at women are priced more expensively than those aimed at men. Women may also be more likely to seek specialist (and therefore more expensive) treatment for female-specific concerns.

In general, the survey finds that women are more aware of the women’s healthcare benefits being offered by employers than men. 40 per cent of men responding to the survey did not know if any women’s health benefits were being offered, versus just 17 per cent of women.

However, many employees lack awareness of measures that could be implemented to support women’s health; 42 per cent of men said they didn’t know how workplaces could support women’s health, versus 17 per cent of women.

The survey finds that 60 per cent women are more attracted to companies which invest in women’s health benefits, rising to 67 per cent among younger women. Only 31 per cent of men felt this way. Despite these figures, only 28 per cent of women consider the provision of women’s health benefits a key factor when choosing a job (compared with 14 per cent of men), suggesting that it is not a deal-breaker.

The report makes several recommendations to address gender-based health disparities in the workplace. Among these, it recommends employers work actively to create women-friendly working environments which understand and account for the specific health needs of women, and to promote a culture where women can take leave for conditions without it negatively impacting their career prospects. This recommendation supports recent guidance issued by the Equality and Human Right Commission guidance, which says that employers could be sued for disability discrimination if they fail to make “reasonable adjustments” for employees going through menopause.

To policy makers, it recommends action to ensure that women can access treatment and care regardless of their age, sexuality, ethnicity, disability or postcode, as well as provision of adequate funding for women’s healthcare services and the financial incentivisation of research into women’s health.

Liz Hampson, partner and head of Deloitte’s European Health Equity Institute, commented: “Women spend significantly more treating ongoing poor health, or seeking out specialist treatment at their own cost, contributing to a higher overall out-of-pocket spend. This ‘health cost gap’ which exists can be attributed to a variety of reasons, including being misdiagnosed more and incidents of pain ‘taken less seriously’ in the healthcare system, underinvestment in women’s health services and underrepresentation of women in medical research.

“Addressing gender-based disparities in health requires a collaborative approach – something that requires investors, healthcare providers, policy makers, life sciences companies and employers to take action on.

“Supporting women’s health is not only important for society, but a sound investment in the future of the workforce and overall economy.”

The full report, including the questions, responses and recommendations, can be accessed here.

West Midlands rolls out pharmacy-based bowel cancer screening

By Integrated Care Journal

Region becomes country’s first to speed up bowel cancer screening using technology as part of Levelling Up Smart City Region programme.

The West Midlands has become the first English region to screen people for bowel cancer in their local pharmacy, at home or at other local settings, using new colon capsule endoscopy services (CCE) – also known as ‘pill cam’.

Screening people in their own community rather than in hospital will help to significantly cut waiting times and speed up lifesaving diagnosis. It is expected that 2,000 people will use the new technology across the West Midlands in its first year, with waiting times cut from 30 weeks to just two.

The rollout of ‘pill cam’ is the first time this innovative, clinically proven screening technology will be available to residents in Birmingham and Solihull. It will also significantly increase bowel cancer screening capacity in Coventry and Warwickshire and follows successful trials led by University Hospital Coventry and Warwickshire NHS Trust and WM5G.

This is the first part of the pioneering £10 million Levelling Up Smart City Region programme led by the West Midlands Combined Authority (WMCA). It is a key part of the £1.5 billion deeper devolution deal agreed between the government and the WMCA last year.

The programme sets out to use cutting-edge wireless technology to help revolutionise the way healthcare is delivered within local communities and aligns closely with plans to increase NHS productivity set out in last week’s Budget.

The NHS Productivity Plan focuses on three key areas: transforming access and services for patients, using data to reduce time spent on unproductive administrative tasks, and updating fragmented and outdated IT systems.

Through the Smart City Region programme, the West Midlands is already leading the way in all three areas, rolling out CCE, developing an exemplar hospital that addresses issues around capacity and flow, and trialling the use of AI and data to improve primary care tasks and measure intervention outcomes for conditions such as diabetes.

WM5G, which is part of the WMCA, leading health-tech innovation, has partnered with Corporate Health International (CHI) to provide the ‘pill cam’ service and will work in close partnership with the NHS Birmingham & Solihull and Coventry & Warwickshire Integrated Care Boards to deliver the screening.

In addition to colon capsule endoscopy, the WMCA will also be expanding prevention, remote monitoring, and smart hospital services. This will help more people stay healthy and in-work, avoid being admitted to hospital or get discharged faster and be supported to live at home for longer.

Andy Street, Mayor of the West Midlands and WMCA chair, said: “The roll out of this life saving technology is a direct result of the West Midlands winning the competition in 2018 to become the UK’s 5G testbed.

“That has left a lasting legacy for the West Midlands which is now the UK’s best connected 5G region and a national leader in the real-world use of innovative 5G products and services like the ‘pill cam’.

“Bowel cancer is the second biggest cancer killer in the UK but the disease is treatable and curable if diagnosed early. The ‘pill cam’, as part of the Smart City Region programme, has the potential to provide thousands of local people with an earlier and easier diagnosis and the treatment they need to survive this disease.”

Dr Adil Butt, Consultant Gastroenterologist and Clinical Service Lead for Endoscopy at Queen Elizabeth Hospital Birmingham, said: “Adopting clinically proven and remotely available technologies, such as CCE, enables both quicker diagnosis by streamlining existing referral pathways and releases valuable extra capacity within existing systems.

“This makes the diagnostic process more convenient for all, bringing previously hospital-based specialist care closer to patients by delivering screening services in their local community. This vital extra capacity comes at a critical time when the UK is facing a significant diagnostic backlog.”

Dr Mark Andrew, Consultant Gastroenterologist and Clinical Service Lead for Endoscopy at Good Hope Hospital said: “CCE is an established diagnostic examination that helps provide access to patients whilst protecting their dignity. I am pleased to see with the support of WM5G and CHI we can hope to offer this bowel test on a larger scale, whilst also reducing our carbon footprint.”

Dr Cornelius Glismann, Managing Director at Corporate Health International, said: “This contract is clearly a game-changer for the region and we are looking forward to working in partnership with WM5G and the health care providers to rapidly roll out Colon Capsule Endoscopy across the region.

“Our Colon Capsule Endoscopy technology was developed in direct response to a team-member’s personal experience of bowel cancer screening and was therefore designed with a firm focus on reducing waiting times while improving patient experience.”

Genevieve Edwards, Chief Executive at Bowel Cancer UK, said: “Around 43,000 people are diagnosed with bowel cancer in the UK each year, but a lack of capacity to meet demand in endoscopy services means there are often long waits between referral and testing, leaving thousands of people awaiting tests that could either confirm a diagnosis or put their minds at rest.

“The use of new technologies such as Colon Capsule Endoscopy helps identify those who require urgent colonoscopies so they can be tested and begin treatment more quickly.”

Rehab for all: fixing the NHS rehab access gap

By Kate Tantam

ICU nurse and creator of the Right to Rehab Campaign, Kate Tantam, shares her perspective on the importance of universal access to rehabilitation in the NHS.

I am an ICU nurse who has been collecting stories of recovery and rehabilitation since 2018.  The reason is simple – the wider public and even many health care teams absolutely do not see the impact of rehabilitation services. For many years rehabilitation services have been seen as the “nice to have, the icing on top of the cake”. I fiercely believe that rehabilitation is the icing in the middle of the cake, it cements everything together.

Rehabilitation is transformative. It is vital. It ensures that our patients make a full recovery and gets them back to the people and things that they love.  And while myself and my multi-disciplinary colleagues are aware of this fact every single day, the NHS system is not prioritising rehab. This fails dedicated and skilled healthcare workers and our patients across the UK.

My patients’ goals may not seem big – to hold their grandson, to make a cup of tea, to go to the loo on their own, to say ‘I love you’ – but for those who can’t move their arms or legs or have lost the power of speech, this is a mountain to climb.

Universal access to quality, person-centred rehab doesn’t exist across the NHS. It means that millions of people don’t have access to NHS rehab services in their area. Many of these people can’t afford to pay for private rehab services, creating huge economic inequality when it comes to recovery. Tragically, this means people’s lives must be put on hold, their conditions deteriorate, and they don’t stand a chance to reach those important personal goals or make a full recovery. This clearly impacts long term return to work, caring responsibilities for loved ones, ability to keep hold of housing and income with reliance on external financial support.

Christian is one of these stories – a young man working full time in his own business. He came into ICU over Christmas in 2022, was in multi-organ failure, and was an alcoholic. He spent months in ICU, and nearly a year in hospital. He was so unwell he had to have multiple abdominal operations, is now diabetic and has a colostomy. He had a rocky time, but I am incredibly proud to say that he is back at work. He is fitter than he has ever been and is debating becoming a model for Colostomy UK, sharing his recovery to support others and clinical teams.

Rehabilitation is work that needs all of us to partner with patients, loved ones and each other.  When healthcare professionals get it right, it makes every single person involved remember why they joined Team NHS. It doesn’t matter where they are in this team – the paramedic who brought the patient in, the GP who supported them after admission, the manager who sorted the funding for the service or the domestic assistant who cleans the ward – everyone impacts that story and shares its success.

I started this campaign for all the patients who aren’t as lucky as Christian. I see it every day across the UK and hear from clinical teams who feel lost fighting against the tide.

So, I joined forces with independent creative agency, Pablo, to create a campaign that celebrates patients’ ‘firsts’ since hospitalisation – the first tentative footsteps or first halting words – those monumental milestones for patients lucky enough to receive specialist rehabilitation care. The aim of the campaign is to raise awareness of the impact of rehabilitation and to ask for a rehabilitation strategy in every trust and a named lead.

This is a campaign that has had no budget – everything has been donated and we have all been working clinically full-time. For me, this demonstrates perfectly that the people who value rehabilitation will do anything they can to support and improve it. I work with a team of nurses, physiotherapists, speech therapists, doctors, occupational therapists, psychologists, dietitians and when we have the resources to support our patients to reach their goals and return home to their lives following traumatic accidents or life-threatening conditions, there is nothing more rewarding.

Some of my own patients’ first steps are now on billboards across the UK, including one patient who suffered a bilateral stroke on either side of her brain stem. She couldn’t sit, use her right arm or legs, she could no longer talk or even swallow and had to be fed via a tube. Her re-learned voice is now on a national radio advert promoting the campaign. The overarching message is for NHS leaders to provide much needed rehab services in all areas of the UK.

The campaign directs people to PetitionForRehab.com, where they can sign a petition calling for rehab to be made available everywhere and for a named rehab lead to be appointed on every hospital trust and board in the UK.  And much like it takes a multi-disciplinary team to support a person’s recovery through rehab, the call for universal access to quality rehab comes from a multitude of individuals, teams and organisations.

The campaign is supported by more than 30 healthcare charities, royal colleges and professional bodies such as the Chartered Society of Physiotherapy (CSP), the British Geriatric Society, Asthma+Lung UK, the Royal College of Occupational Therapists, and the Stroke Association who are all members of the Community Rehabilitation Alliance.

My ask of you is that you talk about rehabilitation, share your local stories of rehabilitation success, listen to your patients, their loved ones and each other.  The NHS is the sixth largest employer in the world – together we surely can achieve anything.

To sign the petition and call for universal access to access rehab services, please visit PetitionForRehab.com.

Unpacking cancer disparities in England

By Rachel Millar

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

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

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

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

Social determinants still a major influence

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

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

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

Variations in diagnosis

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

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

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

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