Category: Health Inequality

Community Care, Digital Implementation, Health Inequality, News, Population Health, Social Care, Thought Leadership

How integrated care systems can improve digital inclusion

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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.

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Health Inequality, News, Population Health, Social Care, Thought Leadership

PPP calls for adequate social care funding to end postcode lottery

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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.”

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Health Inequality, News, Population Health, Thought Leadership

A new network to drive the integration agenda forward

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integration

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.

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Health Inequality, News, Population Health, Thought Leadership

Can Levelling Up help us Build Back Healthier?

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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 lottie.moore@publicpolicyprojects.com

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