Are ICSs bringing the right voices together?

By Gabriel Blaazer

Part one of the ICS Roadshow report recommends that the government should consider broadening the statutory composition of integrated care partnerships to ensure a minimum level of representation to tackle the social determinants of health.

Integrated care system (ICS) leaders have called for the formal inclusion of a broad spectrum of partners in integrated care partnerships, in a report released by PPP. The report, Ensuring ICSs represent a partnership of equals, also recommends that the statutory inclusion of provider collaboratives on ICPs will be essential if ICSs are to effectively make meaningful gains on health inequalities and population health.

These insights and recommendations were gathered from last year’s ICS Roadshow series, which saw ICS leaders and health and care stakeholders debate national and regional integrated care policy in Leeds, London, Birmingham, Bristol and Manchester.

ICS leaders were broadly optimistic that the collaborative and partnership-driven ethos of ICSs has real potential to enable the broad representation of stakeholders who have a positive role to play in population health. However, this is not a given; in its statutory framework for ICSs, the government has taken a ‘minimalist approach’, intended to ensure that the composition of integrated care partnerships (ICPs) is not overly prescriptive, and is flexible enough to reflect the particular needs of local populations.

However, this creates the potential for glaring omissions in the composition of ICBs across the country; for example, it was noted by Dr Justin Varney, Director of Public Health at Birmingham City Council, that “in the creation of ICSs, there was a requirement to have the representation of an NHS provider collaborative”, but no such obligation exists for the social care sector.

“A proper partnership going forward has to have a more structural framework.”

Professor Vic Rayner OBE, Chief Executive, National Care Forum

Pearse Butler, Chair of the South Yorkshire Integrated Care Board, stated a widely-shared opinion at the Roadshow in Leeds, saying “I don’t think an ICB can be remotely successful unless there’s really good partnership arrangements with its local authority and its voluntary sector.”

Chair of the Bristol, North Somerset and South Gloucester ICB, Dr Jeff Farrar, explained how his ICS had worked to achieve real partnership through “inclusive structures” that ensure that as many parts of the system as possible are represented at the top level; “We’ve got a large integrated care board, and we’ve also got a large integrated care partnership”, said Dr Farrar, who added: “we are trying to incorporate VCSEs at all levels.”

L-R: Stephen Dorrell, Executive Chair, Public Policy Projects; Helen Hughes, Chief Executive, Patient Safety Learning; Frances O’Callaghan, Chief Executive, North Central London ICS; Catherine Skilton, Partner, Deloitte

Professor Vic Rayner OBE, Chief Executive of the National Care Forum, argued that this inclusion must extend to citizens – the actual service users themselves. Rayner said that “a proper partnership going forward has to have a more structural framework that requires both the voice of the people who are providing services, and indeed, the voice of people who are receiving those services.”

To address this point, the report, therefore, recommends that the government consider broadening the statutory composition of ICPs to ensure a minimum level of representation to tackle the wider social determinants of health.

“Create a voice [that] represents not your organisation, but your profession.”

Yousaf Ahmed, Chief Pharmacist and Director of Medicines Optimisation, Frimley Integrated Care Board

It was acknowledged by most attendees that following such a seismic reform of the health system, it will take time for the different parts of ICSs to become acquainted with one another and adjust to differences in process and culture. Dr Tracey Vell, Associate Lead for Primary and Community Care at Greater Manchester ICS, argued that instituting formal, cross-sector leadership training would “make people around the boardroom understand what [other sectors] are and what they can do, and the restrictions” on them, facilitating better decision making and resource allocation across each ICS.

Accordingly, the report makes the recommendation that ICSs should consider implementing formal, cross-sector leadership training, to ensure that all parts of the system are aware of the capabilities and limitations of the others.

As participants grappled with the question of how to include different partners at the top level of ICSs, the principle emerged that if population health is to be effectively addressed, the default primacy of one sector over the others must be eschewed in favour of creating a ‘partnership of equals’.

Most notably, participants observed that GPs function as the de-facto point of entry into the health system for the vast majority of those in need of healthcare. This dynamic has led to immense pressure on general practice, and could be remedied if ICSs can leverage the full range of assets at their disposal, particularly the VCSE sector.

“The voluntary sector in Greater Manchester has organised itself.”

Sir Richard Leese, Chair, NHS Greater Manchester Integrated Care.

To this end, leaders overwhelmingly agreed that provider sectors and VCSE organisations must organise themselves, creating a unified voice with which they can influence meaningful change at the top levels. Yousaf Ahmed, Chief Pharmacist and Director of Medicines Optimisation at Frimley Integrated Care Board said that this means creating a “voice [that] represents not your organisation, but your profession.”

In his keynote speech in Manchester, Sir Richard Leese, Chair of NHS Manchester Integrated Care, emphasised that “the voluntary sector in Greater Manchester has organised itself. It has a leadership group that went through a competitive appointment process to appoint the partner member on the board of the ICB.”

While the representation of provider collaboratives on ICPs is not obligatory, the report considers this representation essential. As such it recommends that the government consider mandating the formation of provider collaboratives who can provide an elected chair to sit on ICPs, to guarantee the inclusion of providers from a broad spectrum, if only indirectly.

Download the full report here.

Recommendations from the chapter:

Government should consider broadening the statutory framework of ICPs to ensure a minimum level of representation to tackle the wider social determinants of health.
ICSs should consider the implementation of formal, cross-sector leadership training, to ensure that all parts of the system are aware of the capabilities and limitations of the others.
Government should consider mandating the formation of provider collaboratives who can provide an elected chair to sit on ICPs.
The upcoming Hewitt review should examine CQC’s ability and capacity to regulate cultural changes, as well as encourage greater scrutiny of how ICSs ability to represent a ‘partnership of equals’.

How Starmer is laying the foundations for a Labour life science vision

By David Duffy

Former Director of Communications for Keir Starmer and current Senior Counsel for Lexington Communications, Ben Nunn, speaks with David Duffy about Labour’s five-pillar strategy, the potential of UK life sciences and the future of the NHS.

If there has been a constant within government rhetoric in recent years, it is the ambition of turning the UK into a ‘life science superpower’. With huge untapped potential to revolutionise health and care delivery and generate significant investment, the life science sector has rightly been identified as a key pillar of Britain’s future economic growth.

“What we have now is the intellectual framework through which Labour will govern”

Recognising this potential, Labour Leader Keir Starmer has placed science innovation, and in particular, life science innovation, central to his vision for government, to give Britain its “confidence, hope and future and to build an “NHS fit for the future”. Last month, the Labour Leader unveiled his vision in the form of a five-pillar strategy – with life science innovation playing a central role.

The party has been careful to avoid potential criticism in the initial run up to the election, protecting what is still an enormous lead – currently hovering around 20 points in the polls. However, Nunn argues that this vision is “not just about winning the next election, it is about ensuring there is a programme of government in place.”

Pushing back on claims Starmer’s party has been light on policy detail so far, Nunn stresses that “this is an iterative process,” and that “what we have now is the intellectual framework through which Labour will govern.” Nunn argues that “being out of power for 14 years, Labour will inherit some of the most challenging circumstances of any incoming government. The public won’t expect Labour to learn on the job, and so they shouldn’t – they will expect an effective government that can start immediately addressing the issues.”

Unlocking industry potential

That Starmer has placed central importance on maximising life science innovation is down to the UK’s untapped potential in the sector. Britain has one of the strongest cases for becoming a superpower in life sciences, with a globally renowned research base and enviable educational institutions boosting its global credentials. This potential has not been lost on Labour, who are seeking to position themselves as the government-in-waiting that will finally capitalise on the nation’s potential.

“The public now view the sector in a more human way than before – it literally saved our lives”

“We have a strong story to tell for UK life sciences,” insists Nunn, “with considerable investment and research potential.” Nunn points to the transformative impact that the Covid-19 pandemic had upon the ways in which people viewed life sciences; “the public now view the sector in a more human way than before – it literally saved our lives.” Nunn does suggest that the current government deserves credit for opening the door to UK life sciences during the pandemic. “For all the many mistakes that were made,” he says, “the government did successfully bring these companies to the table in a meaningful way.”

Looking at the current multifaceted crisis facing the NHS, Nunn insists that Labour understands that the UK will not navigate through these challenges without further developing its relationships with the life sciences industry; “we were not going to get out of that situation [Covid-19] unless industry could step up and provide some of the solutions and the same goes for our current set of challenges,” he reflects.

As it did during its rise to government in the late 90s, Labour is again seeking to position itself as the party of competence, innovation and economic growth. With the momentum currently being garnered, Nunn sees it as “business crucial” for the life sciences sector to engage with Labour. “Ultimately, they should be planning for a change in government. ‘Complacency’ is the dirtiest word in the Labour party at the moment – no one can predict politics – that is a fools’ game, but they should be listening and reading what Labour is saying.”

While the vision is there, the devil will be in the detail, and it remains to be seen exactly how Labour would look to boost the UK market in life sciences. The UK’s share of R&D expenditure has been in steady decline over the last decade. Recent attempts to rectify this trend have come in the form of a new UK life science investment position outlined by the Department of International Trade last year, designed to bring global companies to the UK market. The latest effort to spark new growth UK life science came from Chancellor Jeremy Hunt’s Spring Budget, which revealed new regulatory reductions for simplified rapid drug approvals by the MHRA, as well as tax credit incentives for UK R&D.

“This is an area he has talked about consistently throughout his career”

If these efforts to boost sector growth are not successful, the UK risks being caught in the cold. The passing of the Inflation Reduction Act last year leaves the UK in an isolated position with regard to life science investment, potentially stuck between a rejuvenated US investment environment and further exposed following its exit from the European single market.

Having worked under Starmer while Shadow Brexit Secretary, Nunn insists the Labour Leader is prepared to grapple with what is a profoundly challenging economic environment and is confident that Labour would develop the right engagement techniques with business. He points to Rachel Reeves’ ambitious plan for UK economic growth more broadly, combined with Starmer’s long-held admiration for the life sciences sector as clear indicators of Labour’s intent. “This is an area he has talked about consistently throughout his career,” Nunn emphasises.

A vision for government?

On wider health policy, Nunn insists that Labour “would be loathe” to pursue another series of reforms, suggesting that Starmer will look to work with England’s nascent 42 integrated care systems. “We cannot lose more years to a reform agenda while there are so many urgent system priorities,” he argues. What we may expect to hear from Labour, Nunn suggests, are firm commitments to preventative health policies, an agenda which is vital to the success of integrated care and of the NHS. “Keir sees the value in prevention from his time as Director of Public Prosecutions,” says Nunn, where the impact of a disconnected approach to health, care and wider public services has been repeatedly laid bare.

“It’s about developing sound, high-level ambitions and turning that into retail, election winning arguments”

While Starmer’s outreach to the life science sector is fundamentally about creating a framework for government, there is still an election to be won and, Nunn urges Labour to avoid complacency. The former party comms guru stresses that Labour must remain grounded and develop a message that will offer tangible benefits to people’s lives. “It’s about developing sound, high-level ambitions and turning that into retail, election winning arguments,” Nunn explains

“Keir has long spoken about his desire to move past what he refers to as ‘sticking plaster politics’ – short-term efforts to obtain daily headline coverage.” This, Nunn argues, is where the UK has been trapped in its politics for some time; “this isn’t because of the Tories, it is the way our politics operates.”

Ben Nunn is Senior Counsel for Lexington Communications and former Director of Communications for Labour Leader Keir Starmer.

The Hewitt Review is a unique chance to commit to the ICS agenda

By David Duffy

Barely six months in and ICSs are already subject to their first independent review – but Patricia Hewitt’s re-evaluation of integration represents a genuine attempt to finally empower ICSs, not another deck chair reorganisation.

Unless you were plugged into the health and care sector, you could be forgiven for not even realising that the NHS had only just undergone its biggest reorganisation in a decade. As we emerge from the toughest winter health and care services have ever faced, images of patients waiting on trolleys for emergency care and of people waiting years for life-altering elective treatment are now etched into the public psyche. The situation has, unsurprisingly, led to calls for fundamental reform in our system of health and care.

But while honest conversations about the state of UK health and care are essential, so too are accurate depictions of the current state of reform – as well as clear and realistic expectations of what these reforms can be expected to achieve.

“It is welcome, therefore, that rather than announce more ‘deckchair reorganisation’, the government has this time opted for a more considered re-evaluation as to the role of ICSs.”

Integrated care systems (ICSs) took up statutory footing in July 2022 with a mandate to deliver joined-up services along a place-based approach, using population health management techniques to bring down health inequalities across the country. Achieving improved health outcomes through these means cannot be accurately assessed in six months’ time, but that hasn’t stopped many commentators from calling for further wholesale reform of the NHS. No major corporation would expect instantaneous results following a merger or acquisition, so why are such patently unrealistic achievements persistently expected from the largest employer in Europe?

The answer, of course, is that our health matters to all of us, and that the government has consistently mismanaged the health service over the course of 13 years. However, the ‘holy grail’ of any health system in the world is a locally responsive integrated care system (or whatever name is used for it) and ICSs do represent a step in the right direction. What they require is time and support to harness their still new statutory position and achieve their goals.

It is welcome, therefore, that rather than announce more ‘deckchair reorganisation’, the government has this time opted for a more considered re-evaluation as to the role of ICSs. The ongoing review of ICS autonomy and accountability, led by former Health Secretary Patricia Hewitt and commissioned by former Health and Care Secretary Jeremy Hunt, amounts to a recognition of two key points: 1) that ICSs are here to stay 2) that if they are to work at a truly local level, central NHS and Whitehall must finally learn to let go.

Hewitt’s combined experience as a former Health Secretary and current ICB chair of Norfolk and Waveney ICS makes her more than well suited to conducting such a timely review. That a Tory Chancellor has asked a former Labour cabinet minister to review the government’s flagship health reform could be seen as something of an olive branch to a Labour Party that will likely inherit England’s nascent 42 ICSs. Any government would be loath to commit to another reform agenda and more legislative upheaval would neglect the significant impact ICSs have already had.

“ICSs have finallly started to build bridges between NHS providers, who are finally taking system-wide views to finance and care strategy based on joint working.”

What ICSs have been able to do so far is address tensions between commissioners (CCGs) and NHS trusts – a dynamic deliberately designed to spark competition and innovation across health and care. Many NHS regions were plagued by tense relationships as NHS trusts competed with each other for funding and CCGs sought to avoid giving said funding. This collaborative, joined-up approach has already promted system-wide approaches to financial decision-making and better adoption of digital innovation.

Hewitt will look to build on this momentum – and first among her six priorities for the review is collaboration.

The issue of collaboration versus competition in the NHS has long been debated, with proponents of the latter arguing that it promotes innovation, while those favouring the former stress that collaboration can reduce risk, expedite information sharing and facilitate scaled innovation. Evidence suggests that, given the choice, most NHS leaders prefer collaborating over competing.

Despite moving towards a collaborative model, it is the age-old shortcomings of centralisation, and an ‘NHS first’ approach to health and care, that continue to hamper the progress of integrated care in England.

Fundamentally, Hewitt is examining the overly centralised, target-driven environment in which health and care operate. Central support and direction for ICSs cannot be overly proscriptive, as the delivery of a truly integrated system is reliant on developing collaborative frameworks that respond to the differences in size, stakeholders and priorities that characterise each ICS region.

“The Hewitt Review must help empower ICSs to cut through these tensions and develop locally responsive and locally reflective service delivery.”

Despite ICSs’ remit for locally managed healthcare with a new brief to connect with local authorities and wider community services, the 2022 Health and Care Act saw Whitehall assume more central power to outline targets, creating fundamental contradictions within the current reforms. At times, ICSs across the country feel squeezed by NHS England and DHSC at a national level, and by individual providers locally.

This tension has come into sharp focus as ICSs have sought to merge the NHS with local government. If ICSs have shown us anything so far, it is that the NHS is not yet ready to marry its own accountability frameworks to those from local government. The NHS is not democratically accountable to its citizens like local authorities are, but is subject to scrutiny from central NHS, DHSC and the Care Quality Commission (CQC) – the latter of which does of course regulate social care, but this is only one part of the community service offering from local government. The Hewitt Review must help empower ICSs to cut through these tensions and develop locally responsive and locally reflective service delivery.

“The absence of an all encompassing metric is not an admission of failure, but rather an acceptance that collaborative models for health delivery are inherently complex and unique to individual localities.”

It will be fascinating to see how Hewitt will seek to reimagine the role of the CQC, which has made repeated efforts to shift its inspection regime to evaluate the progress of integration and wider system working. However, without a comprehensive remit and authority to evaluate whole systems, their impact has been limited.

Assessing the impact of such a model is extremely complicated. Globally, few have been able to produce measurement frameworks or metrics to accurately assess the impact of integrated care. Even the government’s own impact assessment of the 2022 Health and Care Act stated that “there is mixed evidence on whether collaboration can provide cost savings in the delivery of services”.

The absence of an all encompassing metric is not an admission of failure, but rather an acceptance that collaborative models for health delivery are inherently complex and unique to individual localities. Ultimately, the introduction of the Hewitt review is a recognition that successful collaboration is as dependent on culture, management, and resources as it is on rules and structures.

So, before ICSs are consigned to the scrap heap of failed health reforms, Whitehall must finally let go and provide these still young organisations with the autonomy, accountability and cultural freedom to demonstrate what they can do.

David Duffy is Head of Content for Public Policy Projects.

The NHS must break the cycle on heart failure

By David Duffy

Integrated Care Journal recently spoke to Dr Ashton Harper, Head of Medical Affairs (UK & Ireland) at Roche Diagnostics, to examine the heart failure diagnostic pathway and identify where the biggest opportunities in NHS diagnostics exist.

In the midst of its most challenging period of pressure, diagnostics have a significant role to play in helping to alleviate patient backlogs and free up vital resources across the sector – and nowhere is this more critical than with heart failure.

The health challenge that heart failure, a serious and chronic disease that prevents the heart from pumping blood through the body, poses to the NHS is both immense and relentless. An estimated one million people live with heart failure in the UK, with approximately 200,000 developing the condition every year, creating a profound and multifaceted set of health challenges for the NHS.

Writing in a recently published report by PPP for Roche Diagnostics UK & Ireland, Professor Sir Mike Richards described diagnostics as a “Cinderella” service within the NHS. Yet the UK’s capacity to diagnose heart failure has been consistently hampered by broader capacity challenges in NHS diagnostic service provision, as well as the lack of uptake of, and access to, innovation. A combination of workforce shortages and outdated facilities have historically contributed to late diagnosis and poorer health outcomes. This realisation directly informed Professor Richard’s 2019 report, which led to the introduction of community diagnostic centres (CDCs).

A ‘silent epidemic’

Heart failure is notoriously difficult to diagnose, in part because its key symptoms – breathlessness, exhaustion and ankle swelling – can be caused by a number of other conditions. As a result, late diagnosis of heart failure is unfortunately common, often only occurring once a patient has presented in secondary care following the onset of severe symptoms.

“If heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better”

“Current estimates are that 80 per cent of patients are diagnosed [with heart failure] after a hospital admission,” explains Dr Harper, “and a significant proportion of those will be emergency cases, and so these patients are at the late stage, requiring more intense and complex treatment.” This matters because heart failure patients who require hospitalisation account for “somewhere in the region of a million inpatient days every year, which is about 2 per cent of total NHS annual bed days”. It is also estimated that between 2-4 per cent of the total annual NHS budget is spent managing patients with heart failure (up to £6 billion in 2022/23) and according to Dr Harper, “the majority of this burden is due to hospitalisation – and hospital admissions for heart failure have increased by 50 per cent in the last decade alone”.

“Somewhere in the region of 70 per cent of the total annual cost [of managing heart failure] is actually utilised by the management of stage four patients alone,” says Dr Harper, “but if heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better; they have a better quality of life; and significantly reduced requirements of both primary and secondary care services ongoing.”

Diagnostic reform

“The NHS must look to adopt innovative diagnostic tools at a faster rate”

As was made clear in Professor Richards’ report, the NHS must conduct a wholesale rethink of diagnostic service provision. “Early diagnosis is key to effective management and better outcomes for these patients”, explains Dr Harper, “but while the use of medicines which are deemed to be beneficial and cost effective is mandated in the UK, diagnostics aren’t. It can often take 10 or more years for a diagnostic test to be widely adopted across the NHS.” As such, the NHS must look to adopt innovative diagnostic tools at a faster rate.

NT-proBNP tests are fast, cost-effective, non-invasive and recommended by NICE for the diagnosis of heart failure. Recently updated NICE Quality Standards, recommend that this test be conducted on all patients presenting to primary care with a possible heart failure diagnosis, but this guidance is not universally followed with recent data showing that only 18.3 per cent of heart failure patients had an NT-proBNP test recorded.

“Following the NICE guidance for NT-proBNP testing can reduce unnecessary referrals and allow GPs to better identify patients that do need more urgent referrals for echocardiograms”, Dr Harper notes, which is important because “we’ve got massive echocardiogram backlogs, with patients waiting months”, many of whom may not need one at all. The ability to preclude a heart failure diagnosis early would reduce the echocardiogram bottleneck, meaning those who really need one can access one sooner. “I think mandated funding for NT-proBNP would go a long way,” says Dr Harper. “This approach could help to potentially flip the site of primary diagnosis from 80 per cent in hospital to 80 per cent in the community, and therefore reduce pressure on the NHS.”

Reprioritising and reframing the issue of heart failure

Dr Harper believes that “there’s a strong case for heart failure to be prioritised by NHS England in the upcoming NHS Long Term plan refresh with clearly defined targets, such as exist for stroke and cardiac arrest.” Accordingly, “there needs to be increased collaboration between the NHS, industry and patient organisations to tackle inequalities in the diagnosis and management of patients.”

Much of this comes down to a need to educate and raise awareness of heart failure and its symptoms. “It has been described as a ‘silent epidemic’ because it hasn’t received as much attention as other pressing healthcare issues,” Dr Harper remarks. This lack of awareness has produced some alarming disparities, particularly around gender and misdiagnosis.

“Clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list”

“There is an historical presumption that heart failure is a more male-dominated disease rather than female,” he explains, “when actually it’s about a 50/50 split.” Despite this, women are more likely to be misdiagnosed than men or to wait for much longer than men for their diagnosis. Dr Harper continued, “clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list.”

Echoing recommendation three of Breaking the cycle, Dr Harper also encourages widespread adoption of the Pumping Marvellous Foundation’s BEAT symptom tracker. If shared with the wider public, this checklist – Breathlessness, Exhaustion, Ankle Swelling, Time for a simple blood test – could increase heart failure symptom awareness and ensure that more cases are identified sooner and treated more effectively.

Conclusion

“Ensuring primary and secondary care professionals share a common goal is key”

A coherent and system-wide approach will be needed if capacity is to be increased across all diagnostic modalities, but especially in heart failure. “Ensuring primary and secondary care professionals share a common goal is key,” Dr Harper says, “[and] the introduction of integrated care systems is a great opportunity to foster this collaboration.”

“By increasing diagnostic capacity in the community, we might be able to reduce the pressure on hospital admissions and NHS bed days,” and the use of NT-proBNP tests to confirm or rule out suspected cases of heart failure will be crucial. Taking the present opportunity to radically overhaul the heart failure diagnosis pathway will help to decrease the societal burden of the disease, create extra capacity for the NHS and, most importantly, help heart failure patients lead longer, healthier lives.

Breaking the cycle: Tackling late heart failure diagnosis in the UK, finds that late diagnosis of heart failure is a significant hindrance to the effective management of heart failure. It makes a series of recommendations to NHS England, Health Education England, and integrated care systems, as well as patient groups and industry to come together to improve heart failure diagnosis across the entire healthcare system.

News, Thought Leadership February 15, 2023

How climate resilience can future-proof healthcare

By Rusheen Bansal

ICJ spoke to Kavitha Hariharan, Director of Healthy Societies at Marsh McLennan Advantage, to explore the urgency of climate resilience in the healthcare sector.

The climate crisis is a health crisis. Increasing greenhouse gas emissions, rising temperatures, pollution levels and natural disasters are among the leading causes of serious, but preventable, medical issues such as asthma and antibiotic resistance. This growing disease burden will coincide with operational and financial disruption directly caused by increasingly frequent weather events and natural disasters, which will fracture supply chains and damage healthcare facilities.

Given this dynamic, and the fact that the healthcare sector is a major contributor to climate change, the sector should perhaps be taking a more central role in reducing its impact. The global healthcare sector is responsible for 4.4 per cent of annual global greenhouse gas emissions (two gigatons), the equivalent of 514 coal-fired power plants. Were the sector a country, it would be the world’s fifth-largest greenhouse gas emitter.

Articulating this dual challenge for health providers, global risk management firm, Marsh McLennan, last year published Feeling the heat: How Healthcare Providers Can Meet the Climate Challenge in 2022. The report outlines how the health sector can make use of standardised frameworks and tools to identify risks and opportunities and assess their impacts. It also discusses strategies for mitigating and adapting to evolving climate risks. Among the report’s core recommendations are focuses on investment, planning and collaboration.

Kavitha Hariharan, one of the key authors of this report, leads Marsh Mclennan’s societal ageing and health agenda, exploring long-term trends, risks, and opportunities in public healthcare as demographics change and health expenditures rise around the world.

“It can make the difference between life and death for patients and for people in the community.”

A major barrier to climate action within healthcare, Hariharan notes, it is the lack of prioritisation. “There are several other competing pressures on healthcare systems at the moment. There are backlogs, low staff retention rates, etc.,” Hariharan explains. “There are plenty of other things that are clamouring for their attention. Adding an assessment of climate risks and subsequent actions required to that list can pose a significant challenge for the leadership of healthcare organisations.”

However, according to the report, climate change is an “Environment, Society and Governance (ESG) risk multiplier” that is directly and indirectly aggravating the multitude of social issues healthcare leaders are already dealing with, such as increased disease incidence, workforce burnout and unequal access to public healthcare. Thus, building climate resilience through community and stakeholder collaboration can collectively ease the pressures on the healthcare sector.

Hariharan notes that “every healthcare system, regardless of their structure or the model that they’re currently part of, is going to have to become climate resilient at some point, and they’re going to have to start the journey somewhere. The nature of climate impacts is such that continued delivery of essential services is vital today. Not only would they make communities less vulnerable to environmental shocks,” she says, “but the same types of measures could also help improve social issues such as disparities in terms of access to healthcare.”

According to Hariharan, the framework of integrated care systems (ICSs) provides a good model for collaborating on climate resilience strategies because “they are founded on collaboration that involves community engagement as well as big healthcare facilities and local stakeholders.”

The second, perhaps more crucial obstacle, is the lack of related knowledge or expertise in climate issues within the sector itself. She explains, “the technical analysis that may be required to understand the type of climate-related risks and opportunities that they face, the range of tools that are required and the funding that may be necessary, alongside the skill sets required to make the changes translate into effective mitigation, may go beyond the core skill sets of many healthcare organisations.”

However, Marsh McLennan’s report can act as a beginner’s guide for those assessing where to start and it suggests three steps upon which healthcare systems can focus. First is selecting a reporting framework – it recommends using the Task Force on Climate-Related Financial Disclosures (TCFD) framework, a tool widely used by governments and public companies alike. Second is to “understand, assess and disclose” climate-related risks and opportunities specific to the local organisation and community. Third is assessing the negative and positive impacts of the risks and opportunities identified.

According to Hariharan, the context of the healthcare facility dictates its next steps; “it’s probably going to depend on which risks are material and transitional to which organisation, depending on which location they’re in, what type of services they provide, the underlying needs and vulnerabilities of the communities they serve and so on.”

“Climate change isn’t only a source of risk. It’s also a source of opportunity.”

Discussions of climate-related solutions can often involve spending large sums of money, which deters many small organisations from climate-related actions.

“Different organisations are going to be at different points on their journey towards climate resilience [and] the kind of investments that they will need to make are going to differ,” explains Hariharan, when asked how relevant the recommendations are to smaller facilities with limited budgets. “Obviously, very little funding is going to limit what you can do”, she states. “But there are still ways that these organisations can identify the risks and opportunities of climate action and start to address them.”

“For instance, they could identify hotspots, or particular locations if they are a hospital group or a group of clinics, where there might be more or less at climate-related risk and prioritise actions based on those risk drivers. This could be just one or two issues. Starting small that way and then scaling up these initiatives might be one way to proceed.

“Another could be making changes in infrastructure with a climate lens”, Hariharan suggests. According to the report, such adaptions often produce positive returns in the longer-term. For example, the Cleveland Clinic in Ohio saved $2.5 million a year after switching from fluorescent lights to LEDs, and another $2.5 million by adjusting air exchanges in operation theatres without increasing infection risk. “These savings can then be channelled into other climate resilience initiatives,” says Hariharan.

For those struggling with financing, the rapid rise in sustainability-linked bonds and green subsidies can help healthcare providers secure funding for climate-related initiatives. Ramsay Health Care, for instance, was able to meet its climate resilience targets by taking a sustainability-linked loan of $1.5 billion. Moreover, healthcare firms taking climate-related actions are able to negotiate more affordable insurance premiums and access additional capacity from insurers such as Beazley.

The business case for action

In terms of who should be involved in implementing climate resilience strategies, Hariharan asserts, “this is such a large challenge that an effort must be made by the whole [of] society. There’s a role for every stakeholder to play.”

Embedding climate risk mitigation and resilience into enterprise management, strategy and reporting can serve to facilitate collaboration among leaders. It can also help direct strategic investments across business functions, instead of sporadic expenditure during times of crisis that can cost exorbitant amounts. For example, due to a lack of telemedicine, the travel costs for NHS Cumbria’s community health teams amounted to £7 million after 2009 UK floods closed roads and bridges – this exceeded the trust’s total spending on health facilities in the preceding year, according to the report.

A good place to start can be aligning strategic and financial goals with climate priorities. In particular, reaching large-scale targets such as emissions reductions can only be achieved through major investments into new facilities or by financing incremental improvements by refurbishing existing facilities, both of which require long-term financial planning and board input. Another approach can be creating an internal “green team” involving clinicians who can identify and formulate policies that would have both environmental and clinical impacts.

Moreover, communicating climate strategies and goals to internal and external stakeholders can help attract talent, boost workforce morale, and improve confidence in a company and its reputation. “During our research, a hospital revealed to us that, in the recruitment section of their website, the most visited page was the page describing sustainability and climate initiatives”, Hariharan recounts. “Employees seem to be increasingly screening for ESG compliance in their employers.” A recent survey also revealed a trend in consumer choice favouring healthcare providers that pursue climate and sustainability initiatives.

A climate-resilient financial strategy will need to be built around new relationships with climate friendly suppliers. Nearly 70 per cent of the healthcare sector’s emissions are attributed to the supply chain. Healthcare providers can minimise supply chain emissions by raising environmental and ethical standards for purchasing and increasing screening measures for suppliers.

The NHS is currently dealing with some of the worst crises in its history. Climate-related action is a cross-cutting solution that is bound to improve workforce retention and employee wellbeing, care provision, equitable access, and rising work burdens, all of which will make the system more resilient to future crises. When asked where healthcare providers should begin on their journey, “simply get started,” says Hariharan – the case for not acting shrinks by the day.

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Shared Services in the age of integrated care systems – friend or foe?

By Jordon Beevers

The introduction of integrated care systems (ICSs) gives the NHS a once-in-a-generation opportunity to streamline, standardise and level up care across an area – coordinating services and planning in a way that improves population health and reduces inequalities, writes Jordon Beevers, Director of ICS Solutions, NHS Shared Business Services.

While much has been made of the importance of provider collaboratives and the need to reach beyond the NHS, relatively little attention has been paid to the opportunities presented by back-office integration, with a lack of actionable insight causing some ICSs to put it on the ‘too difficult’ pile.

NHS England 2023/24 Priorities and Operational Planning Guidance stipulates that Integrated Care Boards (ICBs) and providers should work together to:

Develop robust plans that deliver specific efficiency savings and raise productivity consistent with the goals set out in this guidance to increase activity and improve outcomes within allocated resources.
Put in place strong oversight and governance arrangements to drive delivery, supported by clear financial control and monitoring processes.

Plans, it says, should also set out measures to:

Reduce corporate running costs with a focus on consolidation, standardisation and automation to deliver services at scale across ICS footprints.
Reduce procurement and supply chain costs by realising the opportunities for specific products and services.
Improve staff experience and retention.
Use forthcoming digital maturity assessments to measure progress towards the core capabilities set out in What Good Looks Like – the framework that sets out to enable healthcare leaders to digitise, connect and transform services safely – and identify the areas that need to be prioritised in the development of plans.

When it comes to corporate services, however, the problem for the diverse range of organisations coming together to work as one system is in knowing what’s already working well, and what needs improvement.

Using insight diagnostics to provide system-wide data and intelligence can aid decision-making across corporate services

By taking an agnostic and independent view, it’s possible to co-create a holistic, joined-up roadmap for organisations to drive collaboration and best value across ICSs.

Data and benchmarking can help ICSs to transform the back office. Detailed analysis can help identify what’s working well, areas of inconsistency within and across an ICS, where the greatest improvements opportunities lie – and how investments can be best targeted – to support better and more informed decision-making across multiple organisations and identify potential savings.

In this vein, an insight diagnostic exercise we ran with a leading pathfinder ICS highlighted not only the potential for system-wide service improvements, but also significant savings of £7.3 million (26 per cent) on operational expenditure over the next ten years, including cash releasing savings of almost £4 million.

Shared Corporate Services for the digital age – the shared service ecosystem

It is now more than 20 years since the concept of shared services for NHS business support functions came into existence.

Philip Hewitson was acting Chief Executive at Northwick Park & St Marks Hospitals in North London when he was asked to lead the Department of Health’s national programme to develop shared service arrangements for NHS business support functions.

In Hewitson’s view, shared services provide the best of both worlds. They enable the operational and strategic levels of an NHS organisation to concentrate on what they need to without having to worry about managing back-office systems as well.

This frees up NHS Trusts, commissioners – and now ICSs – to concentrate on and develop the job they must do in delivering healthcare, planning, and commissioning health services. There’s less duplication and access to high levels of automation from sophisticated systems that talk to each other. This, in his view, can only improve management and therefore, patient care.

As he puts it, “there’s a whole suite of benefits. Shared services are applicable in so many areas. When skills are so scarce and when money is so tight, why wouldn’t you look to things that already exist?”

John Yarnold, another original proponent of shared services was Finance Director at Plymouth Hospitals NHS Trust when he took up the post of Project Director of the programme.

He points out that to successfully manage the health component of the ICS, the ICB will need transparent financial activity information consolidated at system level, but able to be interrogated at transactional level.

“If I were directing this nationally, I’d make it mandatory for all NHS organisations within an ICS to go with shared corporate services. From a finance and accounting perspective, have one common chart of accounts, one set of common processes, and then introduce enhanced systems to enable consolidation of the accounts at a national or regional level. Then, the ability to extract data from different sources and combine it with financial information. Data that’s available to all partners within an ICS to inform and improve decision-making. That’s what we need.”

Creating a shared services ecosystem of Finance, HR and Procurement services can empower healthcare leaders, giving them control to improve outcomes for their patients, staff and suppliers by reimagining shared corporate services for the digital age.

At NHS Shared Business Services, we’ve crunched the numbers and estimate shared services have the potential to deliver £400 million in operating savings across ICSs, can enable them to realise £726m+ of Procurement savings opportunities and attain 25 per cent in operational savings.

With numbers like these at stake, and ICSs reportedly likely to post a combined deficit of £600 million for the current financial year, we simply cannot afford to let a lack of insight relegate these savings to the ‘too difficult’ pile.

Negotiations at an impasse as further industrial action looms

By Gabriel Blaazer

Almost 9,000 ambulance workers were on strike yesterday (Monday 6th February), with the GMB and Unite also striking across 9 regions in England – the most NHS settings ever affected by a single day of industrial action.

Following Monday’s unprecedented strike action, nurses with the RCN are striking today (7th February), with the Chartered Society of Physiotherapy striking on 9th February and the ambulance union, Unison, striking on 10th February. This means that Wednesday (8th February) will be the only day this week on which no strike action is taking place.

Official figures show that more than 88,000 appointments have been postponed already this winter due to industrial action, yet unions have accused the government of intransigence over the disputes, which centre largely around pay and conditions and a perceived lack of investment in recruitment and retention.

Despite claims that comparatively low pay and high levels of in-work stress are contributing to the difficulty in recruiting and retaining health and care professionals, unions say that the government is in effect refusing to discuss improvements to pay and conditions. There are more than 130,000 vacancies across the NHS in England alone, and a worrying number of health and care professionals plan to leave their jobs in the coming years, citing burnout, anxiety and working in a system that has reached its breaking point.

Further, a recent analysis of official figures has shown that burnout and stress among health staff has led to more NHS staff absence than the Covid-19 pandemic. NHS sickness figures show that more than 15 million working days have been lost since March 2020, more than double were list to Covid infections and self-isolation.

A government spokesperson has claimed that Health Secretary, Steve Barclay, is ready to resume talks with unions, and said that “the Health and Social Care Secretary has held constructive talks with unions on pay and affordability.” This was disputed by the General Secretary of Unite, Sharon Graham, who said that no such discussions were taking place. On the negotiations, she added: “In 30 years of negotiating, I’ve never seen such an abdication of responsibility. Categorically…there have been no conversations on pay whatsoever with Rishi Sunak or Steven Barclay about this dispute in any way, shape, or form.”

Pat Cullen, General Secretary of the RCN, today accused the government of ‘punishing’ nurses for their stance, after Maria Caulfield, (the minister for mental health and women’s health strategy, herself a nurse and RCN member), said that nurses’ pay would be discussed, “but only [for] next year’s deal.” However, all 14 health unions have declined to continue talks on this basis, saying that they would only negotiate a settlement that covers the 2022-23 pay deal.

Hope remains for a breakthrough, however, with the new Chief Executive of NHS Providers, Sir Julian Hartley pointing out that industrial action in Wales and Scotland have been suspended following fresh pay offers.

Saffron Cordery, who until 1st February was interim Chief Executive of NHS Providers, said: “For many trusts, Monday [6 February] will be the toughest challenge they’ve ever had as nurses and ambulance staff strike together for the first time, and in more places than before. Leaders are doing everything they can to prepare by putting plans in place to minimise effects on patients and making sure they can provide high-quality, timely care where possible. But without a resolution, disruption is inevitable.

“We need to do everything we can to ensure industrial action doesn’t become the new normal. The government has the power to end this disruption right now by talking to the unions about working conditions and, crucially, pay for this financial year. Their reluctance to do so is getting in the way of efforts to tackle elective recovery for patients.”

Rachel Harrison, National Secretary of the GMB said: “It’s been almost a month since the Government engaged in any meaningful dialogue – instead, they’ve wasted time attempting to smear ambulance workers. The NHS is crumbling; people are dying and this Government is dithering.”

Empowering young people with digital mental health tools

By Beth Gibbons

Beth Gibbons explains how her team created a digital tool that acts as a single source of truth for the mental health resources available to young people in the area, and how it’s given them more control in their care.

Earlier this year, NHS Gloucestershire’s children and young people’s mental health services launched its digital support finder. On Your Mind Glos aimed to get young people to the right support at the right time and improve their experience of accessing mental health support.

We know that young people can find asking for help with their mental health difficult. We also know that Covid-19 disruption caused waiting lists for mental health support to grow significantly and the barriers to support became difficult. Gloucestershire has a wide range of mental health services for children and young people but following the pandemic, there was a clear need to digitalise access to these services so that people are put in touch with the support they need as quickly and easily as possible.

And so, at the start of 2022, the Trust wanted to explore ways to use digital tools to increase awareness of the range of support available.

One collaborative team

With the support of tech specialists, Made Tech and Mace & Menter, NHS Gloucestershire created a team of designers and technologists along with our NHS staff to research and build this new tool. The work was commissioned rather than built in-house because of the specialist skills and capabilities needed around service design and agile service delivery.

The team worked with clinicians, frontline workers, children, young people and the local community to research user needs. We found that interaction with these specific groups was crucial to help us create a tool that truly worked for those that needed it. Mental health support practitioners, GPs, school nurses and mental health leads in schools were also included in the research to help to understand the specific problems that needed fixing.

These conversations highlighted specific challenges – knowing where and how to access support, the length of waiting times once referred and the lack of support whilst waiting. There were already many services (including outside the NHS) where individuals could get support but it became clear that people simply weren’t aware of them.

The discovery and first version of the tool was completed in 8 weeks. We looked for feedback from our users throughout the whole process, meaning that the final tool truly delivers on the needs of children and young people in Gloucestershire.

A single source for local mental health support information

An online support finder on the dedicated website guides users through a series of questions to understand how they’re feeling and what support they might need. They’re then signposted to the most relevant service for their needs and given useful information about mental health.

The results are available to young people, their parents and carers via the website and SMS. Providing SMS access was an important element of the service as it needed to be accessible and secure for any child or young person to use, regardless of their access to a computer. Just three months after the initial launch, a round of user research revealed that young people like using the service, with more than 2,500 visiting the site to date.

Today, the support finder is an easier solution for young people to understand, find and access over 100 mental health support services while giving them more choice and control of their care. For health practitioners it provides accurate advice and helps them signpost to services.

The Trust is delighted this tool helps children, young people and their families get the right support for them. This means that young people are not being passed around multiple services having to repeat their story. It also means that services are less likely to duplicate triage efforts for the same young person. With the introduction of self-referral young people are empowered to access support earlier, removing potential barriers.

It has since been launched in schools alongside a programme of mental health awareness and has reached around 10,000 young people. While it was developed for young people, it’s expected that professionals, parents and carers will use it too.

A wider impact across the health service

The support finder has been designed with security at its core, making sure user data is protected. The baseline architecture and codebase was developed under open standards principles, making it available to other NHS organisations with similar patient needs to use and adapt for free.

Thorough and rapid discovery, alpha and beta testing phases with one fully collaborative team meant we were able to make the best possible version of this technology. We designed the service based on feedback from users, helping us meet their needs. As a result thousands more young people can now access mental health support quickly.

Beth Gibbons is the Programme Manager for Children’s Mental Health & Maternity at NHS Gloucestershire.

Finding the right support to provide the NHS with the capacity needed

By David Duffy

Dr Jean Challiner, Medical Director for Medinet, outlines how the NHS must harness spare capacity from all corners of the health and care sector to meet this period of unprecedented service demand.

As has been made abundantly clear by the Prime Minister earlier this month, the NHS is suffering from a severe capacity crisis. In addition to emergency departments tackling the toughest winter on record, 7.21 million people are currently on an elective care waiting list and staff shortages are crippling service delivery.

The Prime Minister himself acknowledged that these trends existed prior to Covid-19 but the pandemic has escalated the problem beyond what the NHS is able to tackle without added support. “With so many people waiting longer and longer for elective care, patients’ conditions are worsening and becoming urgent for some,” reflects Dr Jean Challiner, Medical Director for independent healthcare provider, Medinet.

Dr Challiner stresses that for Medinet, who have a two decade history of providing dedicated ‘insourcing’ for NHS trusts to boost capacity, the time patients are spending waiting for treatment is having a drastic impact on their work. “We used to almost exclusively offer capacity in the NHS for low complexity day cases, but now the priorities within the NHS are very different, and there is a growing need for us to address more urgent and more complex cases.”

Medinet holds the country’s largest pool of expert clinicians across 20 different specialties, and supplies teams to provide additional clinical capacity to enable hospitals to meet waiting times targets and then work with them to ensure these are not breached. In the last 12 months, 170,000 patients have been seen and treated by Medinet’s clinical teams.

The fact that Medinet teams work in close conjunction with NHS clinical teams and within existing estates means that they can adapt their service offering to include more complex surgery when needed. This includes cancer surgery and other procedures that fall under the realm of specialised commissioning. Medinet’s large pool of consultants, often made up of part-time NHS doctors or recent retirees, can perform most procedures, although they rarely tackle acute emergency procedures.

Reforming the referral process

Beyond directly boosting capacity with additional staff, Medinet have looked to enhance NHS efficiency and bring down backlog figures by reducing time to referral for patients. With cataract surgery, (accounting for one of the largest elements of the elective waiting list with 600,000 patients waiting for a procedure) patients are now having to wait up to two years to have their cataracts assessed.

“We are seeing some trusts getting twice as many referrals in certain areas as before and you can’t instantly train the necessary staff to meet this demand in the short term,” says Dr Challiner. “Part of our process is to not only bring in additional direct expert capacity where required but also help enhance overall efficiency or perhaps deploy existing resource differently.”

Based on a study conducted with a customer in Scotland, Medinet consultants have recently put forward recommendations to bring down cataract wait times across England, particularly for low risk patients. The study set out to determine the suitability of community cataract referrals for a one-stop cataract surgery service and the target areas for referral refinement. The results of the study showed that waiting time was significantly reduced – an average of 30 weeks for one-stop patients. Approximately one quarter of referrals were considered suitable for the one-stop service and many more may have been suitable if there had been more information in their referrals.

Capitalising on system reform

While Medinet services are still primarily commissioned by individual NHS trusts, the development of integrated care and closer collaboration between individual providers could potentially create opportunities for Medinet to expand its service offering elsewhere. “There is a huge opportunity within ICSs to change the model of harnessing spare capacity and applying [it] to other parts of the system. ICSs must provide the framework for providers to break out of regional, professional and organisational silos and boundaries to alleviate the capacity crisis currently being faced by the NHS.

“As providers evolve their service offerings to meet new challenges, they must be able to highlight where new capacity where is required without fear of reprimand.”

Encouraging active dialogue

Under no illusions, Dr Challiner acknowledges that the Medinet model is not a magic bullet to NHS capacity pressures as there are fundamental obstacles that can restrict impact. “Operating within existing NHS estate allows us to work much closer with NHS teams,” she says, “but we face regular challenges with bed availability, as we cannot conduct day case surgery unless there are beds available for recovery if needed. We also often have difficulty in simply finding the space within a trust for Medinet to operate in work or having a trust staff lead on hand to provide trouble shooting assistance or can locate replacement equipment if required.

“We encourage trusts to highlight new ways in which we can boost capacity. We are seeing an NHS that is working tremendously hard, and we want to help them. Nothing is off bounds for us, to help tackle what is most important, so we need the NHS to talk to us, and engage in discussions to look for possible solutions that are risk assessed and will work.”

Medinet’s position as a capacity booster has placed it in a unique position to reflect on the various challenges that lie within the NHS backlog. Last year, the organisation released its Manifesto for Better, outlining how they plan on supporting hospitals across the country to support commitments to improve access to treatment, empower patient choice, and provide the capacity required in response to the growing backlog of elective services.

Radar Healthcare report ranks UK second on overall healthcare equalities

By Integrated Care Journal

Report from Radar Healthcare shows Canada leading the way on overall healthcare equality, with the UK and other northern European Countries making up the rest of the top six.

A new Healthcare Inequalities Report, released by Radar Healthcare, has ranked 35 of the most developed countries around the world, offering a comprehensive insight into which of these countries offers the best healthcare rights to its citizens through their laws and regulations.

The report places Canada, the UK and Norway in the top three for global healthcare equality, with each generally offering fair and equitable access to healthcare for its citizens.

Radar Healthcare’s report also makes reference to a recent Public Policy Projects report, A Women’s Health Agenda: Redressing the Balance, which produced a series of recommendations aimed at improving the design, delivery and outcomes of women’s healthcare.

While the UK places well overall, the report ranks it number 1 for factors relating specifically to women, with Canada coming in second place.

Below is a snapshot of the report’s findings on maternity and paternity leave.

Maternity and paternity leave

The UK lags behind Denmark and Norway on the ‘paid maternity leave’ metric, offering 39 weeks of paid leave and 13 weeks of unpaid leave, compared with 52 weeks of paid leave in Denmark, while Norway offers 49 weeks of paid leave and 59 weeks of unpaid leave.

The report draws key distinction between paid and unpaid maternity leave; a high number of overall weeks of maternity leave may appear impressive but the degree to which this includes paid leave is highly consequential. For example, Italy offers 4 months of paid maternity leave and 17 weeks of unpaid leave, however, leaving a new mother without a salary for 17 weeks places them in a potentially vulnerable situation, perhaps leaving them more reliant on a partner or family for support.

On paternity leave, the UK scores poorly, scoring offering just 14 days of paid leave to new fathers, while Sweden offers 240 days, the Netherlands 182 days and Denmark 168 days. Germany, meanwhile, has no laws mandating employers to offer new fathers paternity leave, either paid or unpaid.

The lower provision of paid paternity leave is a key metric of gender-based healthcare inequality, since less leave for fathers places more of the burden for childcare on mothers, as well as limiting the valuable bonding time between a newborn and their father.

Further to maternity and paternity leave, the report assesses each country’s standing in regard to the following categories:

The legal age of consent – the age at which a person is considered to be legally competent to consent to sexual acts
Doctor / patient confidentiality ages – the age a resident can speak confidentially to a healthcare professional without parents/guardians being informed
Cervical cancer screening – what age they are recommended for women around the world
Mammogram screening tests – what age they are recommended for women
Flu vaccines – at what age is this offered to elderly residents around the globe
IVF treatment age range – how age impacts the chances of becoming a parent via in-vitro fertilisation in different countries around the world
Cosmetic surgery – at what ages someone can have a cosmetic surgery procedure
Transgender hormone treatment – at what age do healthcare practitioners in different countries allow transgender patients to start hormone treatment
Access to birth control around the world – (age requirements/costs/the countries offering free birth control)
Abortion laws – how they differ across the world

Commenting on the report, Hayley Levene, Head of Marketing at Radar Healthcare, said: “Radar Healthcare partners with organisations such as Public Policy Projects who are learning from experience (both their own and others) to make contributions to the policy debate which address real-world choices on the basis of real-world evidence.

“As a healthcare supplier, Radar Healthcare is passionate about helping to make a difference and delivering improved outcomes. Working with PPP to produce reports such as ‘The Social Care Workforce: averting a crisis’, ‘The Digital Divide: reducing inequalities for better health’ and ‘Integrating Health and Social Care: a national care service’ is vital in helping to drive change and improve some of these health inequalities.

“For example, technology could offer oversight that 80 per cent of patients or healthcare workers themselves are having suicidal thoughts – and this could prompt a process to be followed to tackle it, which will encourage decisions of change.”

To find out more, please visit www.radarhealthcare.com.