Cost of living driving worsening health, finds Nuffield Health

By Gabriel Blaazer

Efforts to improve health outcomes being stifled by cost-of-living crisis, with many unable to afford simple measures to improve their physical and mental health

A new report from Nuffield Health has reaffirmed the damaging link between the high cost of living and worsening health outcomes in England. Nuffield Health’s The State of the Nation’s Health and Wellbeing in 2023 summarises the findings of Nuffield Health’s third annual Healthier Nation Index, a survey of 8,000 UK adults that asks detailed questions of all aspects of respondents’ physical and mental wellbeing.

It found that slightly more than one-third of people have experienced declining physical and mental health over the last twelve months (35.1 per cent and 33.7 per cent, respectively), and that nearly 50 per cent of people have experienced declining financial health over the same period. 63.2 per cent of respondents believed that the cost of living crisis is having a ‘negative impact’ on the nation’s health – a fact supported by an ever-growing body of research.

A central role for ICSs

On 13 June, Nuffield Health convened a roundtable discussion at the House of Commons, supported by MPs Kim Leadbeater and Dr Lisa Cameron, to explore the findings of the report. The roundtable highlighted the vital role that integrated care systems (ICSs) will have in ensuring that local population health strategies are responsive to the many factors influencing health, not least cost-of-living challenges.

The attendees of the Nuffield Health roundtable at the House of Commons (click to enlarge)

It was also noted that collaboration is crucial to effectively addressing the health impacts of the cost-of-living crisis “across multiple sectors – not just the NHS”, according to Nuffield Health’s post-event briefing. Contributors agreed that ICSs should seek to use “their convening ability… to collaborate with local anchor institutions, voluntary and community sector partners and local residents” to produce holistic solutions that address the multitude of factors driving poor physical and mental health.

An example of local solutions that can promote good health is the local prioritisation of building healthy environments. The need for these spaces can be best understood at neighbourhood and place level, and this insight can be turned into action through integrated care partnership strategies and collaboration with local partners, including local authorities. Participants in the roundtable identified that individual behavioural changes will only go so far, and that policies that ignore the contextual environment in which people live and work are bound to be limited in their effectiveness.

Leadership on prevention

While the key role of ICSs was discussed, it was also acknowledged that leadership around the prevention of ill health must come at the national level, with accountability shared across all government departments. It was emphasised that the most impactful preventative measures are best driven at the local level, so the role of national government should be that of an enabler for localised action, “empowering and supporting residents to be engaged in solutions, from inception to delivery”.

At the same time, greater clarity around terminology and the ultimate objectives of prevention are required, which can be instigated at a national level. Helping the population to understand how vital prevention is, and will be, for the sustainability of the healthcare system, will help to increase buy-in for measures that require the active participation of citizens.

There is also a role for employers to play in supporting the health and wellbeing of their workforce. As working practices have shifted so much in recent years, so too should employers’ strategies for supporting workers, particularly those working in remote or hybrid working environments. This is especially important for women, who tend to be disproportionately affected by poor mental health in the workplace.

Many of the themes to come out of the roundtable discussion understandably align with Nuffield Health’s recommendations made in the report, which argues that the health and wellbeing of the population is our most important national asset, and should be a national priority.

Time to reprioritise rehabilitation

By Sara Hazzard

This historically under-funded service could be key to reducing pressure on acute NHS services, and pave the way for a healthier, happier workforce, writes Sara Hazzard, Assistant Director Strategic Communications and Co-Chair Community Rehabilitation Alliance at The Chartered Society of Physiotherapy (CSP).

Transformation doesn’t always need to be complicated, expensive or even that radical. Sometimes, it can be achieved by simply prioritising an existing, under-utilised asset. Rehabilitation services are a case in point and if the NHS is to have any hope of tackling some of its biggest challenges, it is exactly that kind of transformation that will be required.

At its best, rehab makes lives worth living. It adds life to years and years to life, enabling people to recover from major trauma or serious events like stroke and cancer, while supporting others to live with long-term conditions, such as COPD or arthritis. Rehab gives people the mobility and function to maintain independence and reduce the need for other NHS and social care services.

At its best, rehab keeps the NHS moving. It reduces the number of people being admitted to hospital by helping people to manage their conditions in the community.

This means greater system capacity for anyone who needs to arrive at the front door of a hospital, while inpatient rehab ensures they recover promptly and are ready for discharge, often to those much-needed community services, in a timely manner.

All of this allows for greater flow throughout the system, unblocking some of the most pressurised parts of the NHS.

Finally, at its best, rehab also yields benefits for wider society, reducing health inequities and sustaining a healthy, productive workforce by reducing sickness absence. Unfortunately, too many people do not find rehab at its best.

It has been under-funded for decades and shown a chronic lack of prioritisation, sometimes derided as a Cinderella service of lower importance than surgical treatment and medication. Historically, the problems were most significant in the community, with patients often discharged and then waiting weeks, if not months, to be picked up by outpatient services.

During the pandemic, however, hospital gyms and other spaces were lost to make way for overspill wards and to allow social distancing, making high-quality rehab harder to access for inpatients too. This has been further exacerbated by the most recent winter crisis when further rehab space was lost to create room for extra beds.

The irony of investing in beds rather than the rehab that could prevent so many needing one has not been lost on the profession. The impact of this loss of space is taking a toll on patients, staff and the system alike.

Six in ten physiotherapy staff in a recent survey said they are seeing increased levels of disability and 50 per cent report depression and anxiety among patients as they struggle to cope with long-term pain and immobility.

The survey also reveals that the issue is having a further impact on the NHS workforce crisis, with 32 per cent saying it means they struggled to recruit staff and four in ten citing retention problems. What is more, 60 per cent of respondents say they are considering quitting the profession altogether because of the issue.

The lack of rehab is also increasing the need for readmission to hospital and more intensive treatment, the survey shows. Clearly that situation cannot continue. Services need to be given the appropriate space, staff and resources to provide high-quality rehab.

That’s just the minimum required, however, to meet the enormous patient demand that has built up in recent years and continues to grow every month, according to NHS figures. To truly transform how we deliver healthcare in this country, we must break free of the outdated mode of thinking and place a far higher priority on the value of rehab.

That shift appears to be happening – and not a moment too soon. In a letter to the Community Rehabilitation Alliance, which the CSP co-chairs and convenes, Health Minister Will Quince said he agreed that “rehabilitation is as essential to good health outcomes as medicines and surgery”. With millions on waiting lists and large parts of the system falling down, rehab’s time has come.

Now’s the time to invest in rehabilitation and the workforce to deliver it, recognising the ripple effect these vital services have through the system. But this requires leadership, and it is vital that there are accountable leaders whose focus is on the effective commissioning and delivery of personalised rehab.There is much work to do, but this shift of emphasis could unleash the enormous potential of rehab and have a transformative impact on the NHS at a time when it’s needed most.

The Chartered Society of Physiotherapy will be joining ICJ and Public Policy Projects at the Integrated Care Delivery Forum in Leeds, on Wednesday 28 June. The event is free to attend for relevant healthcare professionals, so come and say hello!

“Time for health and care to face the right way” – Stephen Dorrell

By Stephen Dorrell

In his foreword to Public Policy Projects’ (PPP) latest ICS Delivery Forum report, Chair, Stephen Dorrell, argues that now is the moment to reorientate the health and care system and seize upon cross-party support for integrated care systems.

It is an old truth that our system of health and care services faces the wrong way. Success obviously requires the ability to respond in a timely way to demand for high quality care and treatment, but the objective should be to support people to enjoy healthy, happy years of life rather than simply to treat disease. Delivery of this objective is the focus of our work at Public Policy Projects.

To borrow a word chosen by Coventry and Warwickshire ICS Chair Danielle Oum, integrated care has the potential to ‘subvert’ our system of health and care. Resources and effort can finally be rebalanced to better target health prevention, early intervention and reducing health inequality.

This thought process underpins the development of ICSs; furthermore, it is a thought process which, crucially, is the subject of bipartisan support between the Labour and the Conservative Party.

“National government has created the structures and can coordinate their development, but it cannot micro-manage delivery.”

This is vital. As we go into the pre-election period, the framework of health policy for the next decade is not the subject of party-political debate. There will of course be intense arguments about the health service in the run-up to the election, focused in particular on funding levels which do represent a political choice, but the principle of integrated care is now a shared ambition across the political divide.

But, although the aspiration has been articulated many times, the ICS programme is still in its very early stages. Despite the predictable journalistic desire to declare the system “broken” and call for headline-grabbing “reforms”, it is important to remind ourselves that the current structure is only 12 months old.

The policy challenge centres on the development of properly integrated care systems at local level. National government has created the structures and can coordinate their development, but it cannot micro-manage delivery. Any attempt to do so is not only certain to fail; worse than that, attempts to over-centralise will ensure that valuable local initiatives will fail too.

This is not a prediction; it is a history lesson. The NHS has always struggled to create a healthy balance between local initiative and central accountability; the requirement to create more integrated local systems makes that balance more urgent and more difficult.

The ICS Delivery Forum is a series of events designed to address these challenges. Our focus is on developing ICSs and helping them to deliver integrated care for citizens and populations.

Our inaugural Delivery Forum convened leaders from across the West Midlands at the City Library of Birmingham. This centre for local excellence epitomises the ambition of integrated care – an anchor institution that creates space for creativity, employment and learning while bringing communities together and fostering close ties between public services and the public themselves.

We believe these events help create the space to allow ICSs to deliver on their promise. We also believe that the successful delivery of that promise is what will ensure that the NHS maintains the position it established 75 years ago as a global role model for universal healthcare.

The full version of the West Midlands ICS Delivery Forum Key Insights report can be found here.

Stephen Dorrell is Executive Chair of Public Policy Projects, and was a Member of Parliament from 1979 to 2015. He served as Secretary of State for Health from 1995 to 1997, and was Chair of the NHS Confederation from November 2015 until 2019.

Majority of public would use health tech to avoid hospital, research finds

By Integrated Care Journal

Survey highlights increasing public acceptance of healthcare technology to self-manage care and take greater individual responsibility for health.

The majority of people would use health technology if it meant they could avoid going into hospital, new research carried out by Ipsos on behalf of the NHS Confederation, supported by Google Health, shows.

The same proportion – more than 7 in 10 people (72 per cent) – would also use technology including wearable and health monitoring devices to help better manage and monitor their health and would also be willing to share the information and data gathered with their doctors and other medical professionals.

The survey of 1,037 members of the public highlights people’s increasing appetite for using technology to self-manage their care, and more broadly, to take greater responsibility for their health and that of their families.

Nearly 4 in 5 people (78 per cent) also said they would be happy to use different types of health monitoring equipment to help manage their health if an NHS professional recommended it to them, with nearly 9 in 10 (89 per cent) people aged over 75 willing to do so.

The results have also found that just over half (53 per cent) of the 92 people included in the survey who have been diagnosed with a long-term condition resulting in them interacting with the health service four or more times a year, are already using the NHS App to access personal health information, compared with one third (33 per cent) of the general population.

The government recently announced a target for patients at more than 90 per cent of general practices across the country to be able to use the app to see their records, book appointments and order repeat prescriptions by March 2024.

Commenting on the findings, Matthew Taylor, chief executive of the NHS Confederation said: “This research shows the potential of technology in empowering patients to better manage and monitor their own health, especially if it means they can avoid being admitted to hospital.

“There is clearly an appetite amongst the public to use technology to self-manage their long-term conditions, and more broadly, to take greater responsibility for their health and that of their families.

“The government’s recent commitment to accelerate and widen the use of the NHS App should also help to strengthen the public’s understanding of the benefits of digital engagement.

“However, the decisions we make now as a society will determine whether technological change means we can make continuous improvement in the offer we make to everyone through the NHS, or whether it will divide ever more widely the ‘healthy haves’ from the ‘unhealthy have nots’. We must always deliver greater digitisation with equity in mind.”

Elsewhere, the survey findings showed that just over 8 in 10 (83 per cent) adults already use some form of technology to manage their health, and this increases to nearly 9 in 10 (89 per cent) people living with one or more long-term condition. However, only just over half of those surveyed were currently satisfied with the technologies and tools available for them at present.

The research also showed that that nearly three-quarters (73 per cent) of patients want their doctors to provide them with the “best technology available”, with three-fifths (58 per cent) wishing “their doctor provided them with technology to monitor their health”.

Ease of appointment booking and the ability to communicate via messaging services with healthcare teams are also high on the list of priorities. The research also found that more than two thirds (68 per cent) of people believe that healthcare in the future will include more technology and less reliance on healthcare professionals, although this comes with the concern that without access to the right technologies, access to healthcare could be limited.

Susan Thomas, UK Director, Google Health added: “Google Health has been privileged to partner with NHS Confederation and Ipsos to drive this piece of research; the findings have resonated with our mission to help everyone, everywhere be healthier through products and services that connect and bring meaning to health information.”

The reality of the world: anticipating failures to achieve success

By Emil Bernal

Emil is a former British Army officer who now specialises in change and transformation in complex environments, including the NHS. He is currently Head of Transformational Programmes and Projects at NHS Shared Business Services.

I recently walked into my local high street bookshop. I counted dozens of books telling me how to succeed at project delivery. There was no shortage of people offering their tips for success. I couldn’t find any books about how to avoid failure.

This is odd but not surprising. From childhood, we’re conditioned to be uncomfortable with the thought of things going wrong. No-one likes making mistakes. Our education system is built on telling us ‘how to do things’, and punishes us for getting things wrong. The world is filled with motivational speakers talking about the sunny uplands. Can you think of a single modern motivational speaker who talks about avoiding the dark abyss?

Emil Bernal, Head of Transformational Programmes and Projects, NHS Shared Business Services

Programmes and projects are no different. We start with optimism and marvel at the promise of a brighter tomorrow. And, for sure, optimism is needed to motivate a team to take on challenging goal. But excessive optimism in our ability to shape and influence the future has led to spectacular failures.

Things can and do go wrong. The NHS has the dubious honour of hosting one of the most expensive failures – the world’s largest civil IT programme, the £12.4 billion National Programme for IT.

In their book, “How big things get done”, Bent Flyvbjerg and Dan Gardner researched the outcomes of over 16,000 projects in 136 countries. Their data shows that 92 per cent of projects overrun on time, cost or both. And cost overruns can be dramatic.

The average cost over-run for every Olympic Games since 1960 is 157 per cent. NASA’s James Webb Space Telescope was 450 per cent over budget. Scotland’s Parliament building was 978 per cent over budget.

The private sector doesn’t do any better. In 2000, Kmart launched two IT projects. Costs exploded, contributing to the company going bankrupt in 2002. Even families get it wrong: you only have to watch Grand Designs to see people’s home renovations go over budget and run late.

We need to learn what went well with previous projects. And we need to understand what went wrong – “how not to” repeat the same mistakes. So, when wide-ranging reports are published – like Patricia Hewitt’s recent review of Integrated Care Systems – I start, as many people do, by thinking “how are we going to get this done”? The next thought is perhaps less common. How do we avoid things going wrong?

Here, then, are five ways to stop things going wrong:

1. Go to the cinema. Or, rather, think about projects in the same way as the film industry: get the balance right between planning and delivery. There’s often a push to start “doing something”. This misses the point that planning is doing something. The film industry understands this, and gives film producers time to plan. During planning, costs are relatively low while film producers explore ideas, produce storyboards, and redraft scripts. Costs explode when production starts and Hollywood stars and crews are working. The work that producers put in upfront means that filming follows a well thought-through plan and avoids costly delays.

2. Find experience and expertise. Very few projects are genuinely unique. There will always be something that makes a project different from others. But, in many ways, your project will be “another one of those”. People who worked on “one of those” will have valuable experience and expertise. Find those people.

3. Listen to that experience. Having found your experts, listen to them even if – especially if – it’s something you don’t want to hear. Listen when they tell you that the project will cost more than the figure you have in mind. Listen when they tell you the project is likely to be more complex and take longer that you ideally wanted. Listen when they tell you about the issues and risks you’re likely to face. It’s better to be told a painful truth early, rather than push ahead in comfortable ignorance.

4. Ask four questions. There is a cultural tendency to shy away from disagreement. So, be explicit and ask for alternative views. As we start to form an outline solution to a problem, I’ll often ask four interrelated questions: what’s good about our solution that we should keep? What needs to be changed? What’s not needed? And – probably the hardest question to answer – what’s missing?

5. Get hindsight in advance. Lessons learnt – or after-action reviews – are standard practice. Flipping this on its head is a useful way of identifying where things could wrong. This approach was popularised by psychologist Gary Klein and Nobel laureate Daniel Kahneman and is often called a ‘pre-mortem’. It’s simple but powerful. Get the team to imagine that their project has already failed. What caused the failure? Work backwards to figure out the causes. Run through a few scenarios. The time spent visualising different outcomes will bring to life the future for the team. And, after the pre-mortem session, make sure that you re-energise the team’s belief in the project.

By taking these steps, you can give yourself the best chances for success. But even the best planning won’t stop issues from cropping up. A supplier lets you down. A team member falls ill. A pandemic. A ship getting stuck in the Suez canal. You’ll have to be ready to manage issues and find practical solutions. But, by getting the planning right, the window of time when risks can come crashing into your world will be smaller – like the film industry which spends time in planning so that the costly production phase can zip along from start to finish.

Learning from your mistakes is called experience. Learning from other people’s mistakes is called wisdom. I wonder how long it will be before I start to see the shelves of my local bookshop filling up with stories about things that went wrong and how to avoid making the same mistakes?

Poor work/life balance driving NHS exodus

By Integrated Care Journal

As vacancies hit record levels, doctors and nurses want more flexible work arrangements to carry on working in healthcare, study from Deloitte finds.

Poor work-life balance is a key driver of job dissatisfaction for healthcare workers, and improvements are within the power of employers, according to new research from Deloitte’s Centre for Health Solutions.

The findings come from the report, Time to Change: Sustaining the UK’s clinical workforce, which looked at the experience and resilience of front-line clinicians, based on a survey of 1,286 UK public healthcare workers. The study examines how attitudes within the profession have changed since 2017, when a similar piece of research was conducted, and includes input from doctors, nurses and other clinical staff working in primary, community and secondary care.

Having a ‘sense of fulfilment/making a difference’ (42 per cent) and a good ‘work-life balance’ (41 per cent) are the top two drivers of job satisfaction for healthcare workers, the study found. By contrast, pay (60 per cent) and having a poor work-life balance (42 per cent) were found be the two main drivers of job dissatisfaction within the professions.

The high ranking of work-life balance for job satisfaction and dissatisfaction is in stark contrast to five years ago, when work-life balance was the fifth-biggest driver of job satisfaction, according to Deloitte’s 2017 study.

When asked how their feelings on job satisfaction and dissatisfaction has affected career intentions, the most common response, among 53 per cent of all respondents and 59 per cent of doctors, was to reduce hours and move to part-time working in healthcare. In addition, 40 per cent of clinicians overall, including 35 per cent of doctors and half of nurses and midwives had considered leaving the profession and changing career.

The study follows a slew of unwelcome news in recent days, including (now-confirmed) speculation that the government’s long-awaited NHS workforce plan (due to be published Tuesday 30th May) is to be delayed as it is considered too costly and the admission from the Health Secretary, Steve Barclay, that the 40 new hospitals will now not be built by 2030 – in contravention of the Conservative government’s flagship pledge.

Additionally, NHS vacancies remain at record levels as the health service continues to struggle to attract and retain staff. One-fifth of all nursing posts in England are estimated as vacant, and NHS trusts fear that the situation will not change until the government sets out a fully-costed workforce plan.

Karen Taylor, Director and Head of Research at Deloitte Centre for Health Solutions, said: “The problem has worsened over the past few years and our findings mirror recent staff surveys from the industry. There is a clear need to address the physical and mental health needs of staff if employers are to build a resilient workforce.

“Many solutions are in the hands of local health organisations to address and several have implemented effective solutions, just not at the scale needed.”

Sara Siegel, Partner and UK and Global Head of Health at Deloitte, said: “The most vital asset in healthcare is its workforce. Our study shows that the availability, accessibility and quality of care available to patients depend on having the right professionals, with the right skills, in the right place, at the right time.

“Healthcare leaders have a real opportunity to make a long-lasting impact in this crucial area. Those that have adopted new ways of working and technologies, have already realised the benefits to empower their workers. Not only will this help patients, but it will have a positive impact on job satisfaction that supports individuals to build rewarding, long-term careers in healthcare.”

Implications for physical and mental health

The study also revealed that 87 per cent of clinicians had experienced an increase in their workloads since March 2020, including 90 per cent of nurses and midwives and 84 per cent of doctors, with serious mental health and wellbeing implications for those staff affected; 46 per cent of clinical staff reported experiencing a negative impact on their physical health, including 50 per cent of hospital doctors and 45 per cent of hospital nurses. The study also found 57 per cent disclose a negative impact on their mental health, including 58 per cent of hospital doctors and 59 per cent of hospital nurses.

This contrasts with the 2017 study, in which 30 per cent of hospital doctors and 32 per cent of hospital nurses said that their workload had a negative effect on their physical health; and 23 per cent of hospital doctors and 33 per cent of hospital nurses said that it affected their mental health.

Digitisation will help – eventually

Numerous policy documents and reports, including the NHS Long Term plan, have identified the importance of adopting technology across healthcare. Deloitte’s study therefore asked healthcare workers which technologies they think are helping to improve the quality of patient care. The top five technologies included Electronic Health Records (EHR) (87 per cent), e-prescribing (78 per cent), patient apps (73 per cent), at-home diagnostics (70 per cent) and remote consultations (70 per cent).

Adoption remains low, however, and only 64 per cent of clinicians said they are using EHRs, while fewer than half of respondents have adopted e-prescribing (46 per cent), patient apps (33 per cent), at-home diagnostics (22 per cent) and remote consultations (39 per cent). Likewise, automation of human resource and occupational development services is lagging behind other industries and the study points out the crucial need to modernise these areas.

Dr Karen Kirkham, partner and Chief Medical Officer at Deloitte added: “While healthcare workers know that technology-enabled care models, systems and processes can improve outcomes and safety for patients, simplify tasks and reduce the significant administrative burden for clinicians, adoption remains fragmented.

“Healthcare leaders need to modernise and unlock better ways of working that improve the employee – and employer – experience. More efficient HR and people policies that focus on equality, diversity and inclusion, investing in leadership and professional development, and accelerating the digitalisation of healthcare infrastructure, will go a long way towards developing new ways of working that release time to care.”

News, Workforce May 23, 2023

NHS must seize upon growth in physiotherapist numbers

By The Chartered Society of Physiotherapy

Growth in the physiotherapy workforce should be the solution to the workforce crises in the NHS community rehabilitation services.

The physiotherapy workforce is ripe for expansion, which is good news for the public, policy makers and service providers. But this good news is not resulting in a high-quality rehabilitation service for all with a well-resourced physiotherapy workforce.

Many people do not know what good quality rehabilitation should look like, and there exists a growing unmet population need, combined with historic understaffing of community services, particularly of rehabilitation services.

At present, nearly a third of people in England has a long-term health condition. People with long-term conditions are being pushed into the most expensive and overburdened parts of health and care because they are not being supported in the community to manage their conditions effectively.

The needs of people with long-term physical conditions account for half of all GP consultations, 70 per cent of bed days in hospital and 70 per cent of total health and social care spending, while more than 60 per cent of patients admitted to hospital as an emergency have one or more long-term conditions.

Lack of access to high quality rehabilitation services

Narrowing the gap in healthy life expectancy will only happen with better access to quality community and primary care services for people with long-term conditions and for these services to be integrated around their needs.

NHS community rehabilitation services have been developed in a piecemeal way, often siloed by medical condition, with varying criteria for access. Furthermore, poor access to rehabilitation is particularly concentrated in areas of deprivation and among marginalised groups, resulting in more demand for GP appointments, increased A&E attendance and admissions.

Delivery plans for NHS policies have been also undermined by the lack of calculations on the additional staff capacity needed. For example, policies on urgent community response and discharge to assess have been implemented at the expense of rehabilitation, because they are delivered by the same group of staff. This has meant the policies have failed to reduce emergency admissions or the harm from delayed discharge.

However, for the last five years, additional roles in primary care have improved access to expert advice and diagnosis within primary care.

The value of Musculoskeletal first contact physiotherapist roles

An example of this is the establishment of the role of the Musculoskeletal first contact physiotherapist (MSK FCPs). MSK FCPs are improving patient outcomes, reducing demands on GPs, cutting medicine prescribing and reducing unnecessary onward referrals and tests.

The initial target provided in the Interim People Plan 2019 was stated as 5000 MSK FCPs, but currently there are only 1376 posts covering many GP surgeries and population sizes several times more than originally modelled. Due to these issues, GPs report that they don’t feel the impact of MSK FCPs, and issues of MSK FCPs retention are emerging.

This dynamic undermines implementation and has slowed down the evolution of the MSK FCP role which would support integration with community services.

How can we expand the physiotherapy workforce?

Community rehabilitation services are experiencing difficulties with recruitment and retention, but even greater issues are a lack of established posts and gaps in provision. 15 per cent of physiotherapy staff are leaving the NHS each year and almost half of them are leaving within the first five years of qualifying.

Many are moving to the private sector, but some newly qualified physiotherapists are seeking positions in low-skilled roles in the commercial sector citing less stress, flexible working hours and better pay. There is also the worrying issue of support workers retiring; a 2019 CSP survey of support workers shows that approximately 24 per cent of the current physiotherapy support worker workforce are over 55 years of age.

To compound this, a recent CSP staffing survey, showed that 93 per cent of physiotherapy managers reported that there were insufficient staffing numbers to meet patient needs and 39 per cent of physiotherapy staff reported that this was something they were very concerned about. CSP members also reported having less time to spend with patients, longer waiting times and a lack of available time to improve services, while issues around staff retention and an inability to fill vacant posts were also highlighted by members as contributing factors to insufficient staffing levels.

In the UK, there are currently nine registered physiotherapists for every 10,000 people compared to Denmark, where there are 26.8 physiotherapists for every 10,000 people and Norway, where there are 25.3 physiotherapists for every 10,000 people.

What are the solutions?

Over the years, the NHS has not grasped that, if done well, an increase in physiotherapy provision can help to meet patient needs and reduce pressures on the most overstretched parts of the system.

Insufficient staffing levels are contributing to recruitment and retention problems, which has led to a vicious cycle of high workloads and too few staff.

Change can happen but this requires increased staffing as well as doing more to attract and retain the physiotherapy workforce. The growth in the numbers of registered physiotherapists is increasing, but a sustainable and long-term workforce solution is urgently needed.

The NHSE Long Term Plan must support integrated workforce planning, with targets across primary and community sectors based not on the status quo but on Government and system policy objectives to improve provision to meet population need.

Support workers also have a vital role to play – they need expanding in number and should be upskilled through Rehab Assistant Practitioner apprenticeships to take on greater responsibility, making it possible to safely expand the support worker workforce as a proportion of the workforce overall.

As well as addressing under-staffing, community services also need more strategic leadership, consistency of provision and visibility within the NHS. The lack of leadership in community services is worrying; where Trusts have Chief AHPs at a senior level, community service leadership is strengthened, improving visibility. As well as ensuring this is the case within all Trusts, there need to be more clinical therapy roles within the community working at an advanced practice or consultant level to drive up consistency in standards, lead integration across pathways and partnership working with primary care.

The good news is that the number of registered physiotherapists is growing, alongside a supply of students. Now is the time for the NHS to utilise this rise in numbers. Doing so will go a great way towards tackling the current workforce crisis in NHS community rehabilitation services.

The Chartered Society of Physiotherapy will be joining ICJ and Public Policy Projects at the Integrated Care Delivery Forum in Manchester, this Thursday 25th May. The event is free to attend for relevant healthcare professionals, so come and say hello!

All news

Number of repeat prescriptions ordered via NHS App up 92% in last year

By Integrated Care Journal

2.4 million repeat prescriptions were requested through the NHS App in April and more than 500,000 repeat prescriptions are now booked through the app every week.

New figures released by NHS England show that since the NHS App’s launch in December 2018, more than 42 million repeat prescriptions have been ordered through the app. In April 2023 alone, the NHS App enabled 2.4 million repeat prescriptions to be ordered, compared with 1.7 million in April 2022 and 393,000 in April 2021.

The latest figures represent a 92 per cent year-on-year increase in repeat prescriptions ordered via the app from 13 million in 2021/22 to 25 million in 2022/23. The increase comes ahead of the NHS’s milestone 75th birthday on 5 July, when the achievements and innovations of the NHS and its staff will be celebrated.

Patients across England were reminded of the benefits of using the NHS App to order repeat prescriptions, ahead of the upcoming bank holidays in May.

Chief Pharmaceutical Officer for England David Webb said “we are reminding people of the excellent benefits of the NHS App,” particularly in the context of May’s long bank holiday weekends limiting access to GPs.

Webb continued: “Patients can order repeat prescriptions through the app at a time and date convenient to them and access community pharmacy information about local healthcare advice and services available during the bank holidays.

“The NHS has always innovated and adapted to meet the needs of each generation and as we approach the NHS 75th birthday, the NHS App is yet another fantastic example of how we are doing this.

“The app offers a digital front door for interacting with the NHS with a host of new features launched in the last year– empowering patients to access services from the comfort of their homes. As ever, if you need care during the bank holiday weekend, come forward – using 999 in life threatening emergencies and NHS 111 online for other health concerns.”

Some of the features available on the NHS App enable patients to view their GP health record, nominate their preferred pharmacy, find local NHS services and get health advice via 111 online.

New and innovative features continue to be rolled out to help patients access convenient and high-quality care when and where they need it. Patients in many parts of the country are now able to view and manage their hospital appointments on the app, and many GP practices are now sending NHS App notifications to patients with appointment reminders and other messages relating to their care.

Health and Social Care Secretary Steve Barclay said: “Technology is transforming the way we deliver healthcare for patients, and I’m determined that the NHS App plays a vital role in this.

“Repeat prescription orders through the app have increased by 92 per cent in the last year – including 2.4 million in last month alone. This is freeing up valuable time for clinicians and helping people access services easily and conveniently from the comfort of their own homes.

“A host of new innovative features have also been rolled out– from viewing GP records to finding local health services – offering a digital front door to the NHS.”

The NHS App has now recorded more than 32 million sign-ups (as of April 2023).

More than 28 million of these have fully verified their identity through NHS login, which means they can now access a variety of digital healthcare services quickly and securely through the NHS App.

Workplace discrimination and equality concerns driving NHS acute staff exodus

By Integrated Care Journal and Gabriel Blaazer

Almost a quarter of surveyed staff working for NHS England acute trusts stated in their 2022 Staff Survey that they intend to leave their role in the next 12 months.

Workplace discrimination and equality concerns are the most significant factors driving acute staff to leave the NHS, according to analysis of the 2022 NHS Staff Survey conducted by consultancy firm Lane Clark & Peacock (LCP).

In a workforce already plagued by burnout, stalling pay and low morale, the findings will come as concern for policymakers seeking to staunch and reverse the flow of acute staff leaving the NHS. The acute sector employs more than 850,000 full-time equivalent staff, 25 per cent of whom are Asian, black or another minority ethnicity, compared to 13 per cent of all working-age adults in the UK.

Among the diversity and equality issues highlighted in the NHS Staff Survey were: a lack of fairness in career progression and promotion (reported by one in eight respondents); discrimination from managers or other colleagues (nearly one in ten); discrimination from patients, their relatives, or members of the public (more than one in twelve); and a lack of respect for individual differences (almost one in twelve).

There was variation in staff responses based on their ethnic background. In particular, 17.2 per cent of staff from ethnic minority backgrounds reported experiencing discrimination from their manager or colleagues, compared to 6.8 per cent of white staff members. These findings are notable in light of recent reports documenting a pattern of racism and discrimination in the NHS.

LCP also looked at all the acute trusts across England to identify which areas most struggle with the diversity and equality issues named above. London and the East of England are the worst-performing regions, but the problem is widespread.

Source: LCP. Data source: 2022 NHS Staff Survey. Diversity and equality score is reported on a 0-10 point scale and is based on responses to four contributing questions. Acute trust catchment boundaries adopted from the Office for Health Improvement & Disparities. (Click to enlarge.)

Hotspots for staff dissatisfaction

There is a stark geographical contrast across England when it comes to staff planning to leave the NHS. Trusts with the highest percentages of staff intending to leave are overwhelmingly located in London and the East of England, while trusts with the lowest percentages of staff intending to leave are concentrated in the North West and North East and Yorkshire.

Source: LCP. Data source: 2022 NHS Staff Survey. Acute trust catchment boundaries adapted from the Office for Health Improvement & Disparities. (Click to enlarge.)

Natalie Tikhonovsky, Analyst in LCP’s Health Analytics team, said: “Our analysis reveals a grim picture of low satisfaction levels and higher staff turnover rates currently facing the NHS acute sector. Understanding what is driving this will be key to the success of the government’s new workforce plan and to the overall aim of reducing steadily increasing wait lists.”

Catrin Treharne, Principal in LCP’s Health Analytics team, also commented: “The next steps for improving the NHS’s organisational health could include addressing disparities in staff satisfaction levels between trusts and investing in diversity and equality efforts to foster inclusive workplace environments. By understanding the root cause of NHS workforce challenges and designing solutions to properly address these, we can improve not only workforce satisfaction in the NHS but also patient satisfaction and outcomes.”

Leaders call for ICSs to “subvert” health and care system

By Integrated Care Journal

Public Policy Projects’ ICS Delivery Forum event in Birmingham on Tuesday, 18 April, saw integrated care leaders from across the West Midlands convene for localised debate on the future of integrated care for the region.

“Ambition and partnership” are the central ingredients to successful integrated care, according to Danielle Oum, Chair of Coventry and Warwickshire ICB (pictured above). Oum was speaking at the Public Policy Projects (PPP) ICS Delivery Forum at the Library of Birmingham on Tuesday, 18 April, where hundreds of key health and care stakeholders, including ICS leaders, clinicians, local authority leadership and community representatives gathered for a day of localised debate and networking.

The ICS Delivery Forum is a series of localised events designed to monitor the progress, and help realise the aspirations, of integrated care. Throughout 2023, PPP is hosting Forums in: Birmingham, Manchester, Leeds, Bristol and London.

The setting for this Forum was the Library of Birmingham, a place described by Oum as a “centre of excellence for research, for learning, for creative expression, for health information.” In many ways, Oum said, this visible anchor institution epitomises the ambition and partnership a that should define an ICS.

“If integrated care is successful, it can totally subvert our model for health and care”

Oum used her keynote address to call for the NHS to be more “mindful” of the impact it has on local economies, emphasising the role of the NHS as key local employer to regions.

“If integrated care is successful, it can totally subvert our model for health and care,” said Oum, who stressed that resources must be “refocused and rebalanced” in order to target energies onto health prevention, early intervention and reducing levels of ill health and inequality.

ICS Delivery Forum — Hundreds of health and care leaders from across the midlands attended the Delivery Forum.

Following Oum’s keynote address, a series of panel discussions and case study presentations were provided to an audience of more than 150 local ICS, NHS and local authority leaders and community representatives. Key topics of the day included:

Developing partnerships to deliver services
Collaborating to optimise the patient pathway
Effectively addressing health inequality in the West Midlands
Developing a truly integrated workforce strategy

While topics may be familiar to many who will have attended health and care conferences, this Delivery Forum was unique in that it was entirely focused on the West Midlands region. “If integrated care is to be developed locally, then it must be discussed and debated locally,” said PPP Head of Content, David Duffy, who also stressed that, in the shadow of the Hewitt Review, it is vital that, now more than ever, that local leaders are given the necessary platforms to identify the challenges and opportunities in integrated care most relevant to them.

Also speaking was Tapiwa Mtemachani, Director of Strategy and Partnership for Black Country ICB. Emphasising the importance of partnership and of assets to transform care presented by the local community, Tapiwa Mtemachani, Director of Strategy and Partnership for Black Country ICB. Mtemachani emphasised the importance of partnership and prevention in bringing down stubborn levels of deprivation and health inequalities seen across the Black Country, which has the second most deprived population of any of the 42 ICSs in the country.

“There is a narrative that prevention is too costly, but prevention is how the system should be managing demand, how it can reduce costs and expenditure while improving outcomes,” said Mtemachani. Black Country ICB has been doing this through extensive partnership working with local housing providers, using their local reach to promote prevention and overall health promotion. “At fairly low cost, we have developed a health coaching model for citizens, in close partnership with Walsall Housing Group, with impact already visible for our citizens,” Mtemachani explained.

Other notable local ICS representation included Dr Ananta Dave, Chief Medical Officer for Black Country ICB, who outlined how ICSs can help optimise patient pathways across the West Midlands. Also in attendance was Former MP, Salma Yaqoob, who is now Programme Director for Health Inequalities for Birmingham and Solihull ICB and Shajeda Ahmed, Chief People Officer for Black Country ICB.

The next ICS Delivery Forum takes place in Manchester on 25 May . PPP will be publishing a full report of the key insights uncovered at the Birmingham ICS Delivery Forum. For more information on the Delivery Forum, please visit the PPP website.