How ICSs can help uproot risk aversion and progress innovation

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

Government failing on social care and health inequalities

health inequalities

The government’s failure to reform social care funding in the Health and Care Act is compounding regional health inequalities, writes Kari Gerstheimer, CEO and Founder of Access Social Care.

Speaking before a Cabinet meeting last month Boris Johnson stated that: “With household bills and living costs rising in the face of global challenges, easing the burden on the British people and growing our economy must be a team effort across Cabinet.” He added that “we will continue to do all we can to support people without letting Government spending and debt spiral, whilst continuing to help Brits to find good jobs and earn more, no matter where they live.”

However, the Prime Minister’s own assurances on protecting the British public from rising costs were set against the Government’s actions regarding the Health and Care Act, which has just been enshrined in law.

The Prime Minister continues to make promises to help the British people with the growing cost burden, while the Health and Care Act leaves those on the lowest income exposed to spending a greater proportion of their assets on care costs, during the worst financial crisis we have seen in generations.

The Government’s own amendment to the Bill, which was subject to a fierce debate in both chambers of Parliament before ultimately being voted through, means that the local authority support people receive to help them meet their care costs, will no longer count towards the proposed £86,000 cap.

This is all the while that the PM has continued to make promises to address the decades-long social care funding crisis and widening health inequalities. The £5 billion in extra money announced for social care over the next 3 years, is of course welcome. But there is no mathematical link between the amount of money and the level of need. The Health Foundation calculates that at least £8 billion are needed per year, just to deliver what councils are legally obliged to.

Failure on “levelling-up”

Research commissioned by Access Social Care, which provides free legal advice for those with care needs, shows that poorer areas with lower council tax and business rate yields have been worse affected by the reduction in the central Government grant for social care.

This means that people living in poorer areas where social care need is often the greatest, are already getting a bad deal compared to other parts of the country, which flies in the face of the much-vaunted concept of “levelling-up.”

Rather than addressing this unfairness, the Government’s amendment is compounding it, by leaving people living in ‘red wall’ areas having to spend a greater percentage of their total assets on care.

The Health and Care Act is a clear contradiction in the PM’s assurance to focus efforts on easing the burden for British people and protecting the public from rising costs. It will instead deepen the cost of living to the poorest of our society and widen long-standing health inequalities.

Access Social Care are already seeing cases where the cost of living crisis means that people cannot afford the social care they so desperately need. The Government urgently needs to do more to ensure that everyone can get the social care they need, at a price they can afford.

Health Inequality, News

Time to fix the gender diagnosis gap for autism

autism in girls

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

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

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

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

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

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

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

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

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

Health Inequality, News

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

women low life expectancy

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

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

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

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

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

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

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

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

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

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

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

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

Community Diagnostic Centres: A critical response to regional inequalities

CDC regional equality

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

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

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

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

To deliver high-quality diagnostic care in the face of the backlog, a joint up and co-ordinated approach is vital. The latest report from VanguardAssessing the current state of play of CDC delivery across England2021, outlines the findings of a Freedom of Information (FOI) research project, undertaken in 2021. The findings of the report not only provide a bigger picture on the current status of CDC rollout but also identifies where more support is needed in order to achieve regional equality in healthcare provision.

Compounding inequalities

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

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

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

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

Targeting inequalities with CDCs

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

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

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

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

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

Fair access to funding

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

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

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

A co-ordinated approach

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

The Vanguard report recommendations include:

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

How integrated care systems can improve digital inclusion

digital inclusion

Sarah Boyd, Head of Digital Experience and Transformation at Norfolk & Waveney Health and Social Care Partnership (NWHSCP), explores how her integrated care system (ICS) is using digital health to improve patient inclusion and help reduce health inequalities.

Health inequality is a growing problem but is still too often discussed separately from the core business of the NHS. Patients are treated through siloed care pathways, with conversations about why some populations have poorer health outcomes often treated as an aside.

The pandemic brought this into greater focus, especially around digital inclusion. Technology rolled out across the NHS in response to Covid-19 often widened the gap between those who could access online services and those who couldn’t.

The benefits of ICSs

When it comes to digital inclusion, there is little doubt that ICSs offer a huge opportunity to deliver more equitable access to healthcare and improved health outcomes for those previously underserved by the health system.

NWHSCP is a new type of organisation, working as a system across the Norfolk and Waveney region. Operating across the public sector, along with health and social care, councils and with voluntary organisations, presents an opportunity tackle health inequality and exclusion in a person-centred way.

The ICS allows health leaders to work across organisational boundaries, to test assumptions about exclusion, and to leverage the work that happens at the level of individual places.

Fixing existing digital inequalities

At every stage, NWHSCP are ensuring that their digital projects address digital inequalities. By implementing a pan-public sector hub-and-spoke model that provides personalised support to excluded groups, their plan is to gain the wider benefits of digital inclusion by engaging people – not only in health services – but more broadly in society.

For example, if a GP detects that an elderly person in their care is socially isolated, they can refer them to a central digital inclusion service. From there, they may be passed to a library or volunteer service who are able to provide connectivity or a 5G-enabled device, along with the ongoing support to use it. This allows the patient to order repeat prescriptions, but also to food shop online or video call family and friends, with positive benefits for their wider health and wellbeing.

“Creating an environment in which every service is digitally inclusive offers benefits not just to individuals, but also to wider society”

Asking people to go to an appointment at an unfamiliar location can create unnecessary barriers. As it proceeds, the ambition of NWHSCP is to work towards using services that people already access to provide a trusted contact point. If patients are already known to a church group or domestic violence shelter, for example, they might receive support there.

Through community partnerships, ICSs can build a network of digital tools and skill provision. For example, if a partially-sighted person, or family member, needs a speech-to-text reader, NWHSCP can point them towards their trusted toolkit. Once a person has access to this network, they can then download tools freely, ahead of their health needs.

Building an inclusive service

Creating an environment in which every service is digitally inclusive offers benefits not just to individuals, but also to wider society. As the Good Things Foundation’s Widening Digital Participation report found in March 2020, digital inclusion pays for itself in better mental and physical health, and stronger participation in the economy. For every pound spent, £6.20 is made back.

With this in mind, ICSs can leverage skills found in the private sector to identify new ways to increase inclusivity. Companies in the space include ThriveByDesign and CardMedic, an award-winning digital tool that provides instant access to communications options to improve engagement with healthcare professionals.

CardMedic is designed to help patients with a language barrier, visual, hearing or cognitive impairment, or to communicate through PPE and is unique in its space.

One issue with digital inclusivity tools is that they’re often seen as only affecting excluded communities, but digital inclusivity applies to everyone. Many people often struggle to retain emotionally-sensitive medical information, such as details about a cancer diagnosis. Tools like CardMedic allow any patient to review the basics of a hospital procedure or consultation – helping them to feel more secure in their care.

Applying innovation

Through pulling together with public sector and voluntary organisations, NWHSCP has built a strong, interconnected and multi-disciplinary team to implement their digital transformation agenda. As ICSs move towards statutory footing, the hope is to build on their initial successes though good recruitment and the implementation of innovative technology.

But there is only so much one system organisation can achieve on its own. To maximise the potential of integrated care systems, the NHS will require a national system for picking up on digital innovation. It should not be up to individual ICSs to find products, such as CardMedic, themselves. Digital inclusivity should be available to all.

PPP calls for adequate social care funding to end postcode lottery

social care

Public Policy Projects (PPP) has launched its first Social Care Network report, Mind the Cap: choices and consequences for financing social care, addressing the need for radical financial restructuring within the UK social care system.

The report, launched on 14 March, finds that the standard and financing of social care in the UK is subject to a postcode lottery. Given that social care is funded locally, there is vast regional inequality in the standard of care in the country.

Even with some level of means-tested support, and the newly introduced cap, the PPP Social Care Network found it a system unaffordable for many. The report concludes that these measures do not protect some low-middle income households from having to spend entire savings on social care.

PPP brought together 25 senior stakeholders and experts within the sector to discuss solutions to the crisis ahead of the spring budget. The report is sponsored by Radar Healthcare and the Royal Voluntary Service.

In September, parliament agreed to increase National Insurance Contributions by 1.25 per cent to establish a new ‘Health and Social Care Levy’ and introduced a new measure to cap care costs at £86,000. However, only a small proportion of money generated by the levy will go to social care, and the cap does not protect low-middle income individuals or families.

PPP’s social care network find that the Levy proposed by the government will not even begin to address the costs of care required by the system, and the cap protects those who are least likely to use the system.

Speaking at the report launch event, former Deputy Prime Minister Damian Green, said: “The current Health and Social Care Levy falls on the working age population, all of whom will be faced with inflationary cost of living pressures which we haven’t seen since the 1970s. It is falling on a particularly vulnerable portion of society.”

Key recommendations from the report include:

  • The government must focus its attention on how best to stimulate a wider insurance-based approach to care, encouraging individuals to participate in voluntary insurance schemes to cover costs up to the cap
  • The government should widen the scope of the Health and Social Care Levy; other forms of income and wealth for which National Insurance does not apply, such as rental income for private landlords, should also be considered for a social care levy
  • The government should explore greater flexibility around the Health and Social Care Levy, including the option of directing a proportion of the levy to an individual’s social care insurance scheme and/or contributions being made up by employers, as with pension schemes

The report emphasises that there is insufficient funding overall in the sector and that local authorities and care providers must be adequately funded for any improvement of the social care system. It also outlines that this funding should come from both private payment and higher state provision.

Mr Green said: “The adequate financing of social care is vital for the proper functioning of the system. Once we inject an appropriate amount of money into the system which has, quite frankly, been on its knees for years, we will begin to see the problems of the social care system begin to melt away. The measures proposed by the government are not sufficient, and more must be done to support those in need of care.”

Commenting on the report, Dame Esther Rantzen, Broadcaster and Founder of ChildLine and The Silver Line, said: “I know how crucial adequate funding is, both for those who offer care, and for those who receive it. The caring profession needs far better funding to give carers the opportunities and status they should have and enable them to give their work the time and skill it needs. And vulnerable people who need support should not have to worry whether they can afford the right care. Without proper funding carers will continue to be undervalued and their work unappreciated when in fact more and more people depend upon it.”

A new network to drive the integration agenda forward


Historical divisions between hospitals and family doctors, between physical and mental health, and between NHS and council services, have resulted in too many people experiencing disjointed care. All too often, it has been those from the most disadvantaged backgrounds and communities who have borne the brunt of disjointed care delivery, experiencing worse health outcomes than others.

Integrating both health and care has become a central mission both for the government and the NHS, with a clear focus on recently established integrated care systems (ICSs) as the driver of change.

Having been in development since 2018, July 2022 will see ICSs take up new statutory footing, providing a legal obligation to deliver joined up care and arrange services along a place-based approach. This will help ensure that decisions about how services are arranged should be made as closely as possible to those who use them. For most people their day-to-day health and care needs will be met locally in the town or district where they live or work. Partnership in these ‘places’ is therefore an important building block of integration, often in line with long-established local authority boundaries.

Yet the formal legal constitution of ICSs and their underlying new structures and governance, underpinned by integrated care boards (ICBs), can only be the start of a journey towards a fully realised vision of integrated care. With ICSs soon to be legally independent entities, the focus must now turn to their decision-making processes, and how they choose to adapt their services to meet local population needs.

Within this decision making will come the opportunity for more agile and rapid procurement processes, that allow for a more collaborative approach. Already the Department of Health has sought to support ICSs in their decisions, and has recently conducted a consultation on a new approach to arranging services – the Provider Selection Regime – which should make it easier to develop stable collaboration and to reduce some of the costs associated with the current procurement rules.

The government’s Integration White Paper: driving digital change in ICSs

Further to ICSs being established in law, the government’s Integration White Paper, published on 9 February 2022, goes further in ascribing a future strategic direction for ICSs and sets out a roadmap for better integration of services.

ICBs are expected to agree a plan for embedding population health management capabilities and ensuring these are supported by the necessary data and digital infrastructure, such as shared datasets and digital interventions. ICSs will use population health management (PHM) to help deliver personalised and predictive care based on an individual’s risk – which will be determined based upon an individual’s wider determinants of health.

Real-time insights from aggregated data will be crucial to achieving success in the fields of multi-disciplinary working, clinical decision support and waiting list management, at the same time as ensuring new diagnostic centres in the community can become a real success.

The Department of Health has also set out in the white paper an ‘ICS first’ approach, which will encourage organisations within an ICS to use the same digital systems, this will provide care teams with accurate and timely data, encouraging ease of information sharing. The department has set out a goal of 80 per cent adoption of digital social care records among CQC-registered social care providers by March 2024. To achieve this, ICSs must work with partners to drive adoption. Digital investment plans are expected to be finalised by June 2022, which include the steps being taken locally to support digital inclusion.

While more than 60 per cent of NHS trusts have made good progress into digitisation, with 21 per cent now digitally mature (as set out in the What Good Looks Like Framework), and only 10 per cent continuing to rely heavily on paper, the picture is often much more challenging in social care. Only 40 per cent of social care providers have electronic care records, and this is only improving slowly, at around three per cent per year. The Integration White Paper outlines a plan for adult social care that will ensure within six months of providers having an operational digital social care record in place, that staff are able to access and contribute to their local shared care record. Work is also underway to enable citizens to be able to amend their shared care records.

With these clear ambitions now set out in the Integration White Paper, there is a clear need to link policy ambition with the reality of enabling healthcare providers to deliver care within new ICS structures. As facilitators of joined up care delivery, ICSs will not be able to improve health outcomes without working closely with partners who share their vision of integration.

Integration can only be achieved by working alongside organisations with expertise in delivering patient management records and improved data collection methods – as well as with the pharmaceutical and health technology communities to deliver improved early-stage diagnostics and early access to treatments and therapies.

It is indeed these four areas of focus that represent the greatest opportunity both in the short and long term for ICSs to deliver real population health improvements in their local areas:

  • The future of healthcare data and the single patient record
  • The digital provision of healthcare
  • The improvement of diagnostics
  • The enhanced access to treatment and therapies

While the priorities for each ICS will rightly vary depending on the local patient needs and wider demographic demands, there is now a clear need to establish where common interests between ICSs exist, in order to enhance best practice. If ICSs are truly to become the benchmark of healthcare integration, then their own standards and performance will be monitored at a national level. It will therefore be incumbent for every ICS to engage fully in the wider policy debate about how they can deliver on the modernisation of healthcare through data, digital, treatments and technology. A wider forum is needed to help instruct ICSs on the right pathways to take for the future.

Public Policy Projects (PPP) has, for 25 years, been at the forefront of the healthcare policy debate; as an independent policy institute chaired by former Health Secretary Rt Hon Stephen Dorrell, it is recognised as a leading policy organisation that works with thought leaders across both health and social care, pharmaceuticals and more recently genomics. PPP has made the policy framework around the provision of integrated services a central mission of its work, and is responsible for publication of the Integrated Care Jounral.

ICJ brings together leaders in health, social care, local government, policy and research to engage with the latest insights and analysis surrounding the future of health and social care in the UK. Content is produced by and for the very leaders tasked with delivering joined up care across the country – covering every facet of ICS development.

To spearhead its outcomes-based approach to content, ICJ has recently established an Editorial Advisory Board. The board oversees content production pipeline, ensuring that our articles are insightful, practical and credible. The board is made up of some the country’s leading health and care experts and features system leaders at the very forefront of UK integrated care.

As part of its policy work for 2022, PPP is now seeking to establish a new Integrated Care Network which, alongside Integrated Care Jounral, will help provide ICS leaders with the policy guidance and support to make the best decisions for achieving improved patient health outcomes. PPP has already hosted a number of ICS related events, including a recent roundtable alongside IQVIA.

The start of this new Integrated Care Network work will begin with an ‘Integrated Futures’ roundtable series, beginning this Spring 2022, to mark the formal adoption of ICSs into law.

As part of the ‘Integrated Futures’ series, PPP will organise four roundtables focusing on the core areas of partnership between ICSs and healthcare providers which can deliver the greatest impact and benefit:

  • The future of healthcare data and the single patient record
  • The digital provision of healthcare
  • The improvement of diagnostics
  • The enhanced access to treatment and therapies

These roundtables will bring together both ICS representatives and leaders, together with healthcare partners at the forefront of working with ICSs to deliver on better care through innovation and improved access to data, digital technologies and enhanced treatments and therapies.

The Integrated Futures series will seek to position PPP as the forum for the high quality exchange of ideas and future policy, with those ideas intended to influence both NHS strategy and ICS leaders. As such, this will be an important forum for companies and organisations to be involved in, at a time when the future direction of ICSs both at a local and national level is still to be fully established.

Can Levelling Up help us Build Back Healthier?

levelling up

With the publication of the government’s White Paper, finally we have some definition and direction to what ‘levelling up’ actually aims to achieve.

The most illuminating part of the 700-page document came in the announcement of twelve levelling up missions, most to be achieved by 2030. Looking suspiciously like a return to the Public Service Agreements of the Brown-era, mission-based policy has been back in vogue, thanks mainly to the efforts of Mariana Mazzucato, whose work had been highly influential on the UK government’s now dormant Industrial Strategy.

Certainly that strategy seems to be making a return (it is worth noting that Andy Haldane, now on secondment from the RSA to lead levelling up policy was the Chair of the Industrial Strategy Council), with some of the missions reflective of the government’s previous ‘Grand Challenges’. Public Policy Project’s Social Care Policy Network Chair, Damian Green, highlighted this in the House of Commons, welcoming the focus on maintaining a commitment to five years of extra healthy life.

Yet missions are but words on a page without a clear and deliverable strategy behind them. How these missions are to be achieved remains unknown: what is known, however, is that there is unlikely – at this point in the spending cycle at least – to be any new money to deliver them. A rejuvenation of local economies on the scale that was seen in post-reunification Germany will require a level of sustained investment that is simply in a different league to the UK’s own Levelling Up agenda.

These twelve missions are an accurate and timely depiction of why Levelling Up must succeed – but without the cash required to turn these policies into a nationally transformative reality, they risk crashing and burning. And with at least two general elections to pass before 2030, who will finally be held accountable to deliver them?

The White Paper can only have a positive impact on society if locally led initiatives are given the necessary help to scale their success. This objective is central to PPP’s 2022 Health Inequalities policy programme.

Turning an aspirational slogan into a tangible reality

The white paper correctly acknowledges central government’s role in driving these reforms, but the results of local health rejuvenation will, naturally, be delivered locally

The 12 missions are central to the government’s policy and the Levelling Up agenda is designed to “give people control over their lives” and perhaps nowhere is this principle more important than with regards to health.

Recent data shows that, even before the Covid-19 pandemic, life expectancy was stalling and declining for poorer people in most regions. Successive governments have failed to address the crisis of health inequality – Covid-19 has now laid bare and worsened this growing ‘syndemic’.

In this context, perhaps a more fitting mantra would be ‘Build Back Healthier’.

It has been long established that healthcare alone cannot close the health inequality gap. It is the social determinants of health, such as employment, education and housing that make the real difference to people’s health outcomes.

The white paper correctly acknowledges central government’s role in driving these reforms, but the results of local health rejuvenation will, naturally, be delivered locally. As such, the government’s focus on devolution is welcome news for health providers, as there is a growing body of evidence to suggest that the most effective health interventions are undertaken at a local level.

Building on Sir Michael Marmot’s ground-breaking work on health inequality, PPP has highlighted a series of compelling case studies as to how collaboration between local government, the health service, voluntary sector, business sector and the wider community can create tangible improvements to health inequality. The report can be found here.

The road ahead

The results of the Level Up agenda will be demonstrated through localised endeavour and led by a new generation of system leaders and innovators

It is clear that much more work needs to be done. This year, PPP is launching two major health inequality policy projects, Build Back Healthier: The role of business in tackling health inequalities and The Digital Divide: reducing inequalities for better health.

Sir Michael has long made the case that health is a good indicator of how ‘well’ society is doing as a whole. It is therefore reasonable to argue that health inequality statistics can be used as a clear metric of how equal a society is across a broad spectrum of indicators. In the same way that we use GDP to measure economic growth, it is not unreasonable to argue we can consider population health metrics and their relationship to ‘social growth’ in a similar way (of course this in no mean neglects or fails to acknowledge the inextricable link between economic and social growth).

Gathering together a commission of businesses, Build Back Healthier will seek to take evidence on and lead the policy debate on what businesses can do to reduce health inequalities in 2022.

Covid-19 has revealed huge inequalities when it comes to digital health. The pandemic accelerated what has always been an inevitable move towards digital over the past decade.

The debate is often pitched as binary: either we move towards digital and leave underserved populations behind, or we don’t move technological advancements along to accommodate for those people. The Digital Divide will focus on what digital health can do for underserved populations. Digital transformation is the future of healthcare and as such, good policy is in urgent demand when it comes to addressing those at risk of being left behind. We aim to meet that demand with this exciting piece of policy work in 2022.

The results of the Level Up agenda will be demonstrated through localised endeavour and led by a new generation of system leaders and innovators. Public Policy Projects is pursuing a programme of works throughout 2022 and beyond to not only showcase this work, but scale the success across a marginalised society.

To find out more about PPP’s Health Inequality series, please write to