Featured, News, Population Health

Urgent action needed to prevent retirement disability benefit ‘timebomb’ – report


Report finds total number of retired benefits recipients likely to rise by 60 per cent in next decade, with costs expected to rise to £10.5bn.

A significant increase in the number of people spending a decade or more of their retirement on disability benefits is expected unless urgent preventative action is taken, according to new research from consultancy firm LCP.

Although much of the public discussion around ‘economic inactivity’ focuses on those of working age in receipt of benefits for those unfit to work, these benefits stop at pension age, when individuals switch to a state retirement pension. By contrast, disability benefits such as Personal Independence Payments (PIP) continue to be paid throughout retirement for those already eligible when they retire. The new analysis suggests that unless action is taken to improve the health of these individuals, the cost of funding these benefits will rise significantly in the coming years.

The research finds that just under 100,000 people aged 66 (the state retirement age) are currently in receipt of PIP or its predecessor, Disability Living Allowance (DLA), and are expected to draw these benefits for another 11 years, on average. It estimates that of those individuals, half will continue claiming PIP until they die. The total payment per person would be around £70,000, but this could rise for individuals on low incomes and those claiming means-tested benefits.

Without mitigation, the total number of pensioners on PIP/DLA is likely to rise by around 60 per cent in the next decade, from approximately 1 million now to 1.6 million in 2023, LCP’s research suggests. The total cost of funding these benefits would rise from around £6bn to £10.5bn.The total current cost of PIP in 2023/24 is £21.8 billion, and the benefit is paid to 3.2m people.

The number of adults in receipt of PIP (plus DLA) has risen by around 1 million in the last decade and is forecast by DWP to rise by another million in the next three years. For younger PIP recipients, the fastest growing reported health condition is mental health problems, whereas, for older claimants, it is more likely to be musculoskeletal complaints. The fastest growing group of recipients is those who have been in receipt for five years or more, suggesting a risk of a large and growing ‘core’ of recipients with a dwindling prospect of flowing off benefit at all.

Looking at all PIP/DLA recipients aged 16 or over, receipt of benefits is heavily concentrated in more deprived areas. The table (below) shows the 10 parliamentary constituencies with the highest absolute numbers of PIP/DLA recipients as of 2023, and how the number has changed in the last decade. Five of the top six are in the Merseyside area, and all have seen a growth in numbers of between 20-30 per cent in the last decade.

If targeted action is not taken, many of the working age claimants in these areas will reach pension age on disability benefits and then be more likely to die in receipt than cease claiming.

Table: Westminster constituencies with largest numbers of 16+ recipients of PIP / DLA in 2023 (England and Wales only). Source: DWP ‘Stat Xplore’ database. Click to enlarge.

The higher levels of benefit receipt in more deprived areas suggest the potential for targeted health interventions, which could reduce the number of people who need to claim in the first place and/or reduce the length of claim for those who do receive benefits. However, the authors argue that past government interventions have proven insufficiently focused on those most in need.

The research cites as an example the DWP’s recent expansion of the “Individual Placement and Support in Primary Care Programme” (IPSPC), which was designed to support individuals in receipt of disability benefits. However, the list of local authorities chosen to date excludes those where disability benefit receipt is at its highest.

Another example is NHS England’s ‘Elective Recovery Programme’, which aims to increase capacity to tackle the waiting list backlog that significantly worsened during the Covid-19 pandemic. This programme has not specifically prioritised areas of greatest unmet health need, according to the researchers.

The paper argues that with each person who reaches pension age on PIP likely to receive another £70,000 in benefit on average, there is great potential for cost-effective interventions which would benefit the individuals concerned as well as the taxpayer. For example:

  • Clinically recommended Diabetes meters for those with Type-2 Diabetes cost just £5.50 each; roughly 13,000 such meters could be funded from the savings of just one person fewer needing PIP through retirement.
  • Where people have mental health problems alongside physical problems, low intensity psychological treatments have been demonstrated to be a cost-effective method of treatment. The cost of such ‘collaborative care’ is around £2,140 per person, a fraction of the potential cost saving of £70,000 through avoided benefit payments.

Commenting on the results, co-author and Head of Health Analytics at LCP, Dr Jonathan Pearson-Stuttard, said: “The prospect of large numbers of people going into retirement facing long-term disability benefit receipt is not in the interests of the individuals concerned or the taxpayer.  If just one less person needs to claim Personal Independence Payment through retirement the saving is likely to be around £70,000 and that money could be much better spent keeping people well and supporting those who have disabilities. More targeted interventions, particularly focused on areas of greatest deprivation and highest health needs, could pay off many times over in terms of benefit savings and gains to the wider economy.”

Featured, News, Population Health

People with severe eczema face a hidden cost of living crisis


New report from Sanofi shines a light on the hidden financial burden faced by sufferers of severe atopic eczema.

Nearly everybody has felt the pressures of the cost-of-living crisis. Prices rising, bills soaring, and having to do more with less. This is a real concern for so many, but it’s even worse for people living with uncontrolled atopic eczema, who have to contend with additional costs, both direct and indirect, which are causing a significant strain on both individuals and the healthcare system.

Atopic eczema – known medically as atopic dermatitis (AD) – is the most common form of eczema in the UK, affecting 5-10 per cent of all adults, and causing the skin to become itchy; during a flare-up it can become red, cracked and sore. From the financial costs of medications to an increased risk of developing depression, the costs of uncontrolled eczema to many people living with the condition are wide-ranging and detrimental to their quality of life, particularly for people from lower socioeconomic backgrounds.

Eczema can often be overlooked as a healthcare issue by the general public, and Sanofi recognises the significance of highlighting the genuine effects on the individual that it can cause. Sanofi’s aim is to increase awareness and shine a light on the true cost of the condition. So, we commissioned leading cross-party think tank Demos to produce a report which analyses the impact that uncontrolled atopic eczema has on patients, the NHS and wider society.

The Costs of Atopic Dermatitis report, published in April 2023, draws on an evidence review of UK and international literature, interviews with clinicians in England and the experiences of people living with eczema to examine the costs, the current state of patient care and how patient care can be improved.

The financial burden of eczema

The report provides insights into the costs borne by people living with uncontrolled eczema. This financial burden is far more significant than many might expect. One clinician Demos interviewed said that sometimes patients with lower socioeconomic status have to make a choice between paying for medication or buying food. This cost to society goes beyond just the healthcare system, hitting the economy as a whole. In the UK, the indirect costs of work impairment to the economy for adult patients with moderate-to-severe atopic eczema is estimated to be between £6,741-£14,166 per patient, per year.

But why does it cost so much? Firstly, people living with severe eczema have to spend money on both medical and non-medical items such as medicines, emollients and moisturizers. The impact the condition has on their ability to work also adds to the personal financial cost. Patients with severe, uncontrolled atopic eczema often need to take additional sick days and they may even lose work because of their condition. Then there are the intangible costs: people living with eczema may have to deal with sleep impairment and other mental health issues exacerbated by the irritation and appearance of their skin.

There is an impact on the NHS too. The direct cost of mild-to-moderate eczema to the health service was estimated as being at least £257m in 2020, though there have been no comprehensive studies encompassing the costs of severe atopic eczema. It is estimated that around 15-20 per cent of GPs’ workload is dermatology, with a large quantity of that work being eczema.

Reforming dermatology pathways

The Costs of Atopic Dermatitis report has shone a light on the problem. We now need to focus on how we can alleviate this financial burden. That means investment in improvements to the standard of care for people living with atopic eczema, to drive positive outcomes for patients and reduce long-term costs to the health service and the economy.

If integrated care systems develop dermatology strategies and ensure that psychological support is commissioned as part of the dermatology pathway, these costs can be significantly reduced, by lessening the mental burden of eczema. We as a country need to do more to ensure that healthcare professionals know about the full range of support available to patients. It is vital that patients feel supported by their doctors to access mental health care where appropriate, and that GPs have the training and resources needed to provide the best care possible to their patients with eczema.

Through commissioning this report, Sanofi hopes it has played some small part in bringing the issue of atopic eczema and its cost to us all into relief. The next steps, however, need to be taken by decision makers as they decide whether they want to act to rescue the costs of eczema to patients and our healthcare system.

This article was written by Sanofi.

Job bag code: MAT-XU-2304180 (V1.0)
Date of prep: Sept 2023

News, Population Health

PPP’s Population Health Management Collaboration Framework


A new framework from PPP enables ICSs and business to assess and measure the progress of their collaboration on population health management.

Over the first half of 2023, PPP ran a series of roundtables for our Population Health in Business series, to analyse and explore the impact of business on the health of local populations, and explore how this impact can be leveraged to deliver benefits to businesses, workforces and communities. As the report highlights, ensuring that local business activity is sensitive and responsive to local health challenges requires close collaboration between business and local authority leaders. This collaboration, ideally, should occur within the framework of the integrated care partnership (ICP).

ICPs are intended to allow ICS leaders to “bring together a broad alliance of partners concerned with improving the care, health and wellbeing of the population”, as well as spearheading the integrated care strategy for a given system. Each ICS can decide which partners are included in the ICP, however suggested partners include local Health and Wellbeing Boards (HWBs), social care providers and members of the VCSE sector.

As conveners of local health-relevant organisations beyond the NHS, ICPs have the potential to rebalance the focus of health and care away from acute hospital settings and towards the broader health needs and goals of communities. This will empower organisations not traditionally involved in health-related decisions to make more active contributions to public health outcomes. Businesses have the potential to serve as partners in the delivery of a health inequalities strategy given their impact on their workforce and surrounding communities, and grow the impact of assessments such as the JSNAs already produced by HWBs.

The PPP PHM Collaboration Framework – part 1 of 2 (click to enlarge)

Joining up business and public health

By bridging the gap between public services and local industry, ICPs can support and monitor actions taken by businesses to create healthy workplaces and support employee health, assisting in setting priorities and objectives and advising on health and wellbeing issues. ICPs can also serve as forums of communication and alignment between ICSs, businesses and local health-relevant organisations, enabling businesses to contribute more effectively to community health.

ICPs could also play a central role in enabling better public-private data exchange, which will be crucial in determining the quality and impact of PHM insights. As a broad alliance of partners, ICPs can provide a forum through which businesses and local authorities can improve the accessibility and availability of data. While the needs and capabilities of businesses with regards to data usage vary significantly within an ICS region, the development of PHM strategies is ultimately a process that caters to the needs of a specific population reflected in health-relevant data collected and held by businesses.

The full Population Health in Business report can be accessed here.

Where businesses are able to share insights and collaborate to improve health outcomes within the same population (both with one another and with local authorities), there is a significantly greater opportunity for mutual needs to avail themselves – thereby laying the groundwork for more effective collaboration. The blueprints for such a collaboration can then be shared between ICSs and with central authorities such as DHSC, and local government including the Local Government Association and the Department for Levelling Up, Housing and Communities, to facilitate their development of data standards as recommended by the Hewitt Review.

However, though the report suggests that businesses should collaborate with one another and local authorities, using the ICP as a connecting forum, it must be recognised that many of these partnerships remain underdeveloped and that their progress is likely to be asymmetric. It is therefore necessary that businesses take an active role in assessing the strength of their own actions on health inequalities and their collaborations with local authorities.

PPP’s PHM Collaboration Framework – part 2 of 2 (click to enlarge)

A framework for collaboration

There are ongoing concerns within ICSs around the challenges of balancing the unique local needs and priorities of regions with national standards. In order for all ICPs to partner with local businesses in achieving improved regional health, collaboration and data sharing frameworks should be utilised to ensure consistent goals and progress across regions with different priorities, while avoiding duplication and so as not to discourage inter-ICS collaboration.

In order to support businesses and ICPs to implement the findings and recommendations from the series, PPP has crafted a suggested framework for ICS and businesses to collaborate and measure progress.

The framework is intended to compliment other matrices, such as the Leeds City Council Business Progression Framework, the JRF Business Progression Framework (both assembled by Les Newby and Nicky Denison), and the ICS Maturity Matrix (created by Cathy Elliott). These matrices provide examples of best practice and rough guides for organisations to evaluate their own progress as health-enhancing institutions. As such, the PPP PHM Collaboration Framework is intended to guide businesses to evaluate their own progress towards partnering with local authorities and interacting against local health systems to develop robust preventative healthcare and target causes of ill health.

The full Population Health in Business report can be accessed here.

News, Population Health

Cost of living driving worsening health, finds Nuffield Health


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.

Can ICSs unlock the value of private business to health equity?

population health in business

New insight from Public Policy Projects (PPP) outlines how businesses can support health equity through community engagement, why they should, and how integrated care systems (ICSs) can support them.

The findings go on to suggest that should these community engagement strategies be co-designed by ICS members involved in the setting of priorities for the public sector in a local area. Private businesses can align their strategies with public bodies and with one another, maximising the value of their role as community stakeholders.  

The insight piece outlines how businesses can impact the health of a community – such as by implementing healthy workplace policies, implementing inclusive local recruitment practices, partnering with community organisations, investing in community development, implementing local procurement strategies, and advocating for health equity. The piece goes on to make the business case for community investment, outlining how investing in communities can increase community loyalty and trust, improve employee morale and retention, enhance brand visibility, and increase innovation. 

The value of community engagement to businesses, the document suggests, can be further grown through collaboration with the public sector. This can support better knowledge sharing, as a number of NHS trusts already oversee effective community engagement strategies, and enable initiatives from both the public and private sector to better support oneanother and accelerate the improvement of health equity within a region.  

Improving health outcomes in the community provides the following recommendations to business leaders and policymakers: 

  • Businesses should be incentivised to invest in communities – through recruitment, procurement and outreach – and should be encouraged to partner with other businesses and public bodies to improve the quality of data and insight. 
  • ICSs, local authorities, central government and businesses should explore opportunities to utilise ICPs as a forum for private, public and third sector stakeholders in a local area to communicate, establish shared priorities and create plans of action. 
  • In order to develop stronger guidance for businesses to collaborate with ICPs, there should be a tailored section within the Maturity Matrix for ICSs discussing partnerships with private businesses. 
  • Businesses should communicate regularly with other local stakeholders, including Health and Wellbeing Boards. These communications should ensure businesses are supporting local health equity ambitions by responding to Joint Strategic Needs Assessments. 
  • Businesses and local authorities alike should seek to grow their investment into tools to understand the impact of community engagement and the health value of social investment. 
  • Further guidance on partnerships within the ICS framework should be issued – with a specific focus on enabling effective public-private collaboration. The Department of Health and Social Care (DHSC) should collaborate with the Department of Work and Pensions to issue this guidance. 
  • ICSs and DHSC should seek to develop guidance for businesses to support local health outcomes through recruitment, procurement and outreach. This guidance should not be overly proscriptive, but should provide a clear idea of the relationship between various social determinants of health and business practices. 

Improving health outcomes in the community is the second instalment of the Population Health in Business series, which discusses the health creation value of business and suggest to business leaders and policymakers alike how they may re-envisage their roles, collaborate and deliver better outcomes.  

The roundtable that served as the evidence-base for this report was conducted in February 2023 and chaired by Professor Donna Hall CBE, Chair of New Local, Integrated Health and Care Systems Advisor for NHS England, and a woman once described as a “public service pioneer” by Mayor of Greater Manchester, Andy Burnham.

Professor Donna Hall CBE said of the series: “The three workshops by PPP have explored the practical ways businesses can support health and wellness in their local communities. We have had engagement from a wide range of businesses, public health experts and academics which has been a rich and diverse discussion. The report provides helpful support and advice to local health and care system leaders, businesses and communities on making the most of private employers as a key part of the local infrastructure to support breed health and wellness for all.”

The PHIB roundtable series has concluded, however the final insight summary and final report are still being written and will be launched in June 2023.  

Read the full insight piece here.

For further information about the report please contact eliot.gillings@publicpolicyprojects.com    

Prioritising local ‘business progression’ within ICS population health strategy

population health in business

PPP’s Population Health in Business series examines the impact of businesses on health outcomes. The first roundtable examined the impact of the employee-employer relationship on health equity within a given region.

Integrated care systems should prioritise the development of local ‘business progression frameworks’ within population health strategy. This is according to a new recommendation from Public Policy Projects (PPP). 

Business progression frameworks, developed by ICS leaders and local authorities, can provide local businesses with clear guidance regarding how their employee health and wellbeing strategies can impact local health, thereby driving accountability. 

Employment can greatly impact an individual’s health, though this impact varies depending on the nature of the work and workplace environment. Variations in these health implications are significant contributors to health inequalities in the UK and can have a major effect on the impact of ICS population health strategy.  

Health inequalities have been found to exist within individual businesses, with poorer health outcomes typically experienced by those at lower occupational grades

The insights were uncovered during a roundtable of PPP’s Population Health in Business series, which convenes key experts, including ICS leaders, to examine the impact that businesses, and employment more broadly, have on health outcomes. The series makes practical recommendations for ICS and business leaders to collaborate to inform population health strategies and improve health outcomes at a community level.   

The series is chaired by Professor Donna Hall CBE, Integration and Transformation Advisor to NHS England. Commenting on the insights gathered so far, Professor Hall said: These sessions explore the practical ways in which businesses can support health and wellness in their local communities. We have had engagement from a wide range of businesses, public health experts and academics which has been a rich and diverse discussion. The report provides helpful support and advice to local health and care system leaders, businesses and communities on making the most of private employers as a key part of the local infrastructure to support breed health and wellness for all.”

Read the full insight piece from roundtable one here.

PPP has found that good employee health and wellbeing strategies and a positive workplace culture are associated with increased productivity and better staff retention – meaning that the quality of a business’s approach to employee health directly impacts their strength as an organisation. A positive workplace culture is one that fosters clear and open communication and strong co-working bonds. PPP also believes that businesses can influence the health and wellbeing of their employees through better pay, flexibility in location and working hours, and increased control over tasks and responsibilities.  

Health inequalities have been found to exist within individual businesses, with poorer health outcomes typically experienced by those at lower occupational grades. Businesses that incorporate health into every level of their corporate decision-making, and seek to prioritise those in greatest need, are more easily able to impact health equity than businesses that do not.   

How a progression framework is improving health outcomes in Leeds 

Leeds City Council’s ‘Business Anchor Progression Framework’ provides an example of what such a framework could look like. Broken down into four sections (employment; procurement; environment and assets; and corporate and community) the framework is “designed for businesses with a large or influential local presence who want to play a full anchor role locally and is a wide-ranging tool that considers the breadth of a company’s activities.”  

Anchor institutions can be defined as large organisations whose sustainability is connected to the populations they serve and who seek to utilise their assets and resources to support improvements in health equity and the overall quality of life within their local area. The framework used in Leeds poses questions to businesses such as “to what extent do you encourage the mental and physical health and wellbeing of staff through facilities, policy, culture and support?”  

The framework is primarily aimed at private sector businesses that have generally yet to be incorporated into UK anchor networks. The framework also asks businesses to grade their present status and their organisation’s ambitions on a scale of one to four and is intended to provide businesses with clarity on their responsibilities as community anchors and support them in identifying key areas of improvement.   

Read more analysis from PPP’s Population Health in Business series. 

Recommendations from roundtable 1 

  • ICSs should craft ‘business progression’ strategies to chart the progress of private businesses within their local system. These frameworks should share some universal objectives and metrics but must also be tailored to the specific needs of the system in question.   
  • Businesses should identify the key health conditions and inequities within their business and should share findings with their local ICS.  
  • Businesses should be further encouraged to submit case studies documenting their approaches to employee health and wellbeing, and their perceived success, to the DWP and their local ICBs.  
  • The DWP should support ICSs in developing ‘business progression’ frameworks by developing a more robust Voluntary Reporting Framework.    
  • Health equity considerations should be incorporated into corporate decision making at every level.   
  • An employee health and wellbeing strategy should include objectives for improving communication between employees, particularly between different seniority levels. Strategies should also view socialisation and the development of workplace ‘rituals’ as key to developing a healthy culture.   
  • Employee health and wellbeing strategies should target those at higher risk of health inequalities, particularly those at lower occupational grades. Strategies should prioritise interventions that help employees easily access support linked to improved social determinants of health and should be extended to contracted employees where possible.  
  • ICSs should encourage employers to re-evaluate their Employee Assistance Programmes (EAPs) to ensure support programmes are easy to use and deliver a clear benefit to employees.    

Empowering young people with digital mental health tools


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.

Has the government given up on its health ambitions?

David Duffy analyses Theresa's Coffey's start as health secretary.

Despite the already catastrophic impact of the government’s mini-budget, the first casualty of the government’s short-termist approach to governing was health and care.

Amid the ongoing response to the government’s remarkably misguided mini-budget, recent announcements from DHSC have flown somewhat under the radar of national media. But last Friday’s postponement of the health inequalities white paper is a reflection of a 12-year-old government who have become devoid of long-term strategic thinking in health and care.  

Much like how Mr Kwarteng’s budget is being criticised for seeking a short-term growth boost while sacrificing economic stability, Ms Coffey’s health announcements so far seem to be aimed at garnering public support in the short term, and fail to into account the long-term causes of ill health and the enduring challenges facing the sector. Our Plan for Patients, Thérèse Coffey’s first stab at a plan for health and care, is receiving as much attention for what it misses as what it includes, with glaring omissions around workforce strategy and health inequality. 

Last week it was reported that new Health and Care Secretary intends to postpone, and potentially scrap, the publication of the long-awaited government health inequalities white paper. It is estimated that health inequalities cost the UK £31 billion to £33 billion per annum before Covid-19 and the paper was a key part of Boris Johnson’s leveling up initiative. When first announced by then Health Secretary Sajid Javid back in February, the intention was to set out “bold action” to deal with disparities in health outcomes based on race, gender and income. 

In response, over 155 members of the Inequalities in Health Alliance (IHA) last week wrote to Coffey urging her to maintain the commitment to publishing a Health Disparities White Paper (HDWP) by the end of this year. 

The Alliance said: “The DHSC and NHS will be left in the ultimately unsustainable position of trying to treat illness created by the environments people live in”. 

The IHA have urged for the government to restate its commitment to health inequalities, warning that “focusing on individual behaviors and access to services alone will not be enough to close the almost 20-year gap in healthy life expectancy that exists in England between those from the least and most deprived communities.” 

“that the Secretary of State has so far chosen to ignore the issue almost entirely poses ominous signs for the future health of the nation”

Whether or not you agreed that Johnson’s levelling up initiative was ever truly going to become a reality, it did help kickstart hugely beneficial discourse around health inequality, further prompted by the uneven impact of Covid-19. It was clear from recent Public Policy Projects meetings between system leaders that there is a growing consensus that tackling health inequality is the central objective of integrated care systems (ICSs). With ICS leaders in agreement on the need for action, what has happened to the government’s desire for “bold action” on health inequality? 

The obvious answer is that while the economy is rapidly deteriorating and every government department is being asked to find ‘efficiency savings’, long term social and economic rejuvenation is taking a back seat. But in the context of a deepening cost of living crisis, the fact that the new Secretary of State has so far chosen to ignore the issue almost entirely poses ominous signs for the future health of the nation. 

Cost of living 

Recent polling from the Roya College of Physicians has found that even by May 2022, 55 per cent of people felt their health had been negatively affected by the rising cost of living, with the increasing costs of heating (84 per cent), food (78 per cent) and transport (46 per cent) reported as the top three factors. 

Rising costs are creating environments for preventable ill health to manifest in deprived areas across the nation, ultimately impacting health services – but of course, the crisis directly impacts health providers, as well as those delivering care. 

NHS Providers have published a shocking new survey from its membership, revealing that some staff are electing to not eat during work hours in order to provide for their children, with some quitting altogether to find better paid work in pubs and bars. Other key findings from the survey include: 

  • 71 per cent of trust leaders reported that many staff are struggling to afford to travel to work; 
  • 69 per cent said the cost of living is having a ‘significant or severe’ impact on their ability to recruit lower-paid roles such as porters and healthcare assistants; 
  • 61 per cent reported a rise in mental health sickness absence; 
  • 81 per cent are ‘moderately or extremely’ concerned about staff’s physical health; 
  • 95 per cent said that cost of living increases had significantly or severely worsened local health inequalities; 
  • 72 per cent said they have seen more people coming to mental health services due to stress, debt and poverty; 
  • 51 per cent said they have seen an increase in safeguarding concerns as a result of people’s living conditions. 

The health and care community is united in its concern for the wellbeing of its staff and for their capability to respond to the underlying causes of the nation’s health challenges. Unfortunately, the government is failing to match this concern with sound, long-term policy – this epitomised by Our Plan for Patients. 

In some ways, it can hardly be a shock that the government is losing its desire to implement long-term health policy; Coffey is the country’s fifth Secretary of State for Health in as many years and must also balance this role with the position of Deputy Prime Minister. Even still, much of the sector has been taken back by some of Our Plan for Patients’ glaring omissions, as well as questioning some of the key commitments within it. 

In setting out her key priorities as Health Secretary, the threadbare document published last week attempts to establish Coffey as a “champion” for patients. So far, the plan has achieved little more than alienating much of the health and care community, while simultaneously discrediting the last 12 years of government health policy.   

Primary care  

“Ministers are quick use the pandemic to excuse ominous backlogs in elective care, yet they do not offer the same leeway for the primary care sector”

One of the central aims of Our Plan for Patients is the expectation for all patients to receive a GP appointment within two weeks of request. In setting this wholly unrealistic, arbitrary national target, without providing additional support for GPs to achieve it, Coffey is seeking to create a doctors vs patients dynamic.  

It’s a cheap tactic, designed to pick up votes, and the right wing press immediately came out in support of it. The Daily Mail blamed ‘soulless megapractices’ for ‘Glastonbury style 8am ticket rushes’ – the simple and highly flawed suggestion is that GPs must ‘do more’ and ‘care more’ to improve access to services. 

“Targets don’t create doctors,” said Helen Buckingham from the Nuffield Trust, one of many organisations and figures who criticised the target. Former Health Secretary Jeremy Hunt insisted in the Commons that “adding a 73rd national” target for GPs would not address the challenges in the sector. Matthew Taylor Chief Executive of the NHS Confederation simply said the plans “do not go far enough”.  

Fundamentally, the UK has a rapidly ageing population with increasingly complex conditions and comorbidities to manage – and it does not have the staff to deal with it. The Health Foundation recently revealed a shortage of full-time 4,200 GPs, with that number projected to rise to about 8,900 by 2030/31. Further, there are 132,000 vacant posts across the NHS. This number includes 47,000 nurses and more than 10,000 doctors.

In the face of these challenges, primary care teams continue to perform remarkably. The latest figures show that GPs carried out 26.6 million appointments in August, up from the previous month and over three million more than in August 2019 – before the pandemic. Nearly half of appointments in August took place on the same day that they were booked and over 80 per cent within two weeks of booking. Almost 70 per cent of these appointments were delivered face-to-face.  

Ministers are quick use the pandemic to excuse ominous backlogs in elective care (despite the fact that there were already four million people on waiting lists before Covid-19 hit), and yet they do not offer the same leeway for the primary care sector and continuously fail to acknowledge its achievements.   

Primary care was at the centre of the UK’s highly successful Covid vaccine rollout, one of the few genuine achievements of Boris Johnson’s government. All the while the sector maintained impressive rates of service delivery in other areas and managed to rapidly adapt to digital consultations, ensuring that as many patients as possible received care with little to no infection risk.   

Rather than support and celebrate a sector that delivered when we most needed it, the government has decided to point the finger at primary care – demanding more from GPs without providing them with the means to deliver.   

Unfortunately, initial noises from the current ‘government in waiting’ will have done little to reassure primary care professionals. Shadow Health Secretary Wes Streeting has not only reaffirmed the gas lighting of GPs but has gone a step further, promising same day face-to-face GP appointments to anyone who wants them if Labour were to win power – an announcement already dismissed by the British Medical Association as “not being grounded in reality”.   

Even in a political sense, this seems a needless promise to make while the Tories continue to haemorrhage support in all policy areas. A recent YouGov poll suggests that Labour are four times more trusted by the public to manage healthcare – the party should use this political capital to outline long-term health policy that addresses fundamental workforce shortages.  

We need our leaders to be realistic and honest with the public about what is possible, and not automatically assume “meeting public expectations” is best for primary care without seeking to manage those expectations.  

In the absence of a bona fide, long-term workforce strategy from Westminster, perhaps it is time that we had a government that faced a hard truth: that not every patient should get to see their GP upon request. Patients and end-users should be better engaged with system reform so that they are more aware of the options available to them within health and care and not resort to using GPs for every request – there are simply not enough doctors to see everyone. 

Where is the integration agenda?  

This is ‘sugar rush’ politics at its worst. A short-termist approach to governing that is designed to garner a quick dose of public support while the long-term needs of the sector go ignored.”

Political leaders must reaffirm the aims and objectives in the NHS Long Term Plan and indeed the recent Health and Care Bill. In integrated care, there is a principle for care delivery which is designed to segment patients to different parts of the system – delivering them the care that most appropriately addresses their needs while protecting the precious capacity of seriously understaffed and under-resourced parts of the sector.   

It is concerning that supporting the development of ICSs, and their focus on addressing health inequality through population health strategies relevant to specific regions, received so little attention in last week’s announcements. If properly supported, ICSs can act as conveners of public services beyond health and care, and so have a huge role to play in revitalising communities and addressing broader inequalities. 

The term ‘ICS’ does not appear once in Our Plan for Patients, and the only references to ‘integrated care’ are made in the context of describing integrated care boards as ‘local NHS services’. The whole point of integrated care, i.e., the heart of the government’s flagship health legislation only published two months ago, is to unite a disparate health and care system under a common purpose to improve health outcomes. This of course includes providers within the NHS, but it also includes social care, primary care and wider local government and community care.   

As Richard Vize outlined recently in the British Medical Journal, the government has repeated the age-old trope of essentially treating social care as a discharge service for NHS hospitals. Yes, it is true that that a healthy social care sector would alleviate pressure on the NHS, but social care should be so much more than a pressure valve for hospitals.  

For many with serious and lifelong conditions, social care is the lifeline that enables them to interact with the world and live with dignity and independence. Politicians who treat social care as a mere afterthought would do well to remember this.   

As well as this, the care sector harbours unique insight and intelligence into local health challenges and could provide a hugely meaningful career option for thousands of new recruits. The government should be looking to professionalise the social care sector while helping ICSs to harness the expertise that already exists within it to improve population health outcomes.  

There should always be a dual purpose to health reform: addressing immediate challenges while moving towards common, long-term objectives. Immediate problem solving is essential – patients deserve the best possible care that the system is able to give them and right now they are having to wait too long to get it or not receiving it at all. But in purely focusing on the immediate, more visible issues, such as GP waiting times, the government fails to address the root of the problems. The sector needs more staff, better equipment and more resource.   

To make matters worse, there are already worrying rumours that the government plans to scrap its obesity targets. Alongside smoking, obesity is one the largest preventable causes of ill health and contributes significantly to cancer rates. Scrapping targets before they have barely had a chance to have an impact makes the promise in this plan to “support people to live healthier lives” ring rather hollow.  

This is ‘sugar rush’ politics at its worst. A short-termist approach to governing that is designed to garner a quick dose of public support while the long-term needs of the sector (and ultimately the public) go ignored. It seems that finally the Conservatives have now stopped pretending they have any intention of fixing this very broken health and care system.  

It will be of little reassurance that DHSC has already begun rolling back some of these expectations, with the two-week GP appointment target pushed back to the Spring of 2023. The damage has been done, Coffey has drawn her ‘battle lines’, and seeds for a crisis winter like no other for health and care have already been sown. Compounding this is the fact that the government seems incapable or unwilling to provide light at the end of the tunnel in the form of a long-term plan for health and care.  


Acute Care, News, Population Health

Virtual wards are failing patients and clinicians: we must bridge the gaps before winter

virtual ward

With virtual wards vital to the NHS’s ability to function this winter, three experts assess what is needed to bridge the gaps in provision ahead of increased demand.

In early August, NHS England unveiled its new plan to increase the NHS’s capacity and resilience ahead of winter’s inevitable pressures. An increased use of virtual wards featured prominently in this plan, in line with their national target of 25,000 virtual beds to be operational by 2023.

With hospitals overwhelmed like never before, it’s not hard to understand why transferring patient care into the home – in a safe and controlled way – is an extremely beneficial proposition. But existing solutions are missing the mark. Despite much innovation, delays in adoption mean that the full transformative potential of the tech-enabled hospital at home has not yet been realised. We are now at a tipping point: on the heels of a global pandemic and one of the busiest summers yet, a tough winter is looming. It is time to get virtual wards right; for patients, for healthcare professionals and for the NHS.

Existing solutions don’t go far enough

‘Virtual wards’ are not new and versions of the concept – including ‘Hospital at Home’ – are already being used to support unwell and deteriorating patients to stay at home, as well as to discharge patients from hospital sooner.

What is generally considered to be a virtual ward often extends to little more than remote monitoring at home. While this does free up hospital beds, the impact on both clinical time saving and patient outcomes falls well short of potential.

This is because, overwhelmingly, staff must use old, inappropriate tools to manage remote patients – tools that weren’t built for this new paradigm. Many approaches are manual, slow, admin-intensive, and not advanced enough to scale.

New ways of working need new solutions

Remote care requires an entirely different way of working, and needs new technologies to manage it and make it scalable. Right now, communication and the flow of critical information is blocked. Electronic task lists and care coordination features are not flexible enough to fulfil the unique needs of virtual wards, where patients are not co-located with healthcare staff. Integration is near non-existent, and workflows are not built for mobile access, nor do they allow tasks to be allocated and tracked in real-time.

We must go further for patients or clinicians. A true virtual ward solution can do more – should do more – to protect patients and make clinicians’ jobs more manageable.

Creating a true virtual ward

If virtual wards are to be done correctly, and their potential fully realised, innovation and action must focus on six areas:

1. The right information at the right time

For virtual wards to save valuable clinical time and ensure high quality care, data generated in patients’ homes must be of equivalent quality to that captured in hospital. It should also be distilled into actionable insights to save clinicians from filtering large amounts of data. And here lies the problem.

The 2019 Topol Review emphasised that large volumes of unfiltered data can be immensely overwhelming for an already overworked workforce. We know that conventional remote monitoring generates noisy data that wastes clinical time and can mislead clinical assessments, introducing risk.

To overcome this, advanced tools are needed, such as those utilising AI, to take on the time-consuming task of reviewing millions of data points to ensure quality and translate data into insights.

    2. Seamless patient engagement

Patient engagement tools must be a core component of virtual wards, ensuring patients have a positive experience and feel confident that they can contact the clinical team if they need.

Good patient engagement provides a seamless experience whether a patient is co-located with clinicians in an acute hospital setting, or in the community.

Patients should receive ad hoc or scheduled contact via a method that suits them. This could be a digital assessment form sent to the patient, providing a low cost but highly effective method that complements data gathered from remote monitoring devices.

Patients should also be able to easily request a phone, video, or in-person appointment at a time that suits them.

In combination with care coordination and remote monitoring tools, effective patient communications are a powerful way to keep patients safe and them and their families reassured.

    3. Proactive rather than reactive management of health

Moving from reactive to proactive management of patients’ health means two things for virtual wards:

Firstly, care must be targeted to patients pre-admission to hospital instead of post-discharge. This means initiating virtual care in the community to minimise the risk of admission, especially for ambulatory care sensitive conditions. More importantly, when it comes to avoidable admissions to hospital and frail patients, this could prevent a deterioration in their condition, which could happen off the back of a hospitalisation and could cost them their independence.

Secondly, mechanisms must be in place for early detection of deterioration. Therefore, being able to identify early signs and intervene before complications and readmissions to hospital become inevitable.

    4. Health equity by design

The pandemic has revealed the multi-layered inequities that impact healthcare access and healthcare outcomes. One way in which virtual wards must address these is by investing in scalable community workforce models – that include healthcare assistants – to support care delivery to patients who cannot self-administer.

A second way to promote equity is by ensuring that no one is digitally excluded due to, for example, poor WiFi connectivity or lack of digital confidence or capability. Equally important is to look beyond physical symptoms to integrate social determinants of health into the modelling, planning and delivery of virtual wards.

5. Effective skill-mixing and empowerment

Enabling a diverse network of multidisciplinary staff to participate in the delivery of virtual wards is critical to resourcing these new models of care without adding to doctors’ and nurses’ workloads.

From healthcare assistants, to patients, to their friends and family members, different stakeholders should be empowered to fuel a proactive model of care at home. This includes training, decision-support tools and streamlined workflow management – and requires tools to handover and assign the right tasks to the right healthcare professionals – to cover the effective identification and appropriate escalation of health issues.

    6. Effective task management

The best outcomes from virtual wards will result from multidisciplinary staff having secure access to a shared list of patients and the tasks that need to be done for them. They should be able to review the list in virtual ward rounds or whenever required, add and allocate tasks, and mark them as accepted, in-progress, or completed for colleagues to see or track. The entire team ought to have visibility and be able to collaborate and coordinate care remotely, ensuring caseload management is efficient and safe.

Automated workflows can make it easy for staff to identify where readings from intelligent remote monitoring devices fall outside of set ranges, supporting safer and more effective clinical decision-making.

Enabling a new era of care delivery

At this moment, NHS organisations have a unique opportunity to begin the virtual wards roll out on the strongest possible footing, with the best solutions in place. A focus on the six pillars that encompass care coordination, patient communication and remote monitoring, will accelerate a successful transition to a new era for care delivery, and help establish virtual wards as a credible, scalable alternative to acute hospital admissions.

Elliott Engers is CEO at Infinity Health.

Tom Whicher is CEO at DrDoctor.

Elina Naydenova is CEO at Feebris.

More groups join call for fairer deal for social care

social care sector

As the race to become the next Conservative leader and Prime Minister of the UK heats up, and the government accepts the recommendations from the independent NHS pay review bodies in full, Care England and Access for Social Care have urged the government to act to protect the standing of social care workers, in statements issued yesterday.

The calls echo recommendations contained in a summary document of a recent Public Policy Projects report on integrated care. The report argues that the social care sector should be placed on an equal footing with the NHS, both in terms of its representation within integrated care partnerships and investments made to accelerate digitisation and modernisation.

Representative groups are increasingly urging the government to ensure suitable plans are in place to protect social care, amid an increasingly dire workforce shortage that is threatening the sector’s ability to provide its services. Vacancy rates in social care (9.5 per cent in January 2022) remain stubbornly above the national average (4.4 per cent from December 2021 to February 2022), while more than 400,000 social care workers left their roles in 2021.

A fairer deal for social care must be a priority

On Tuesday 19th of July, the government accepted, in full, the recommendations of the independent NHS pay bodies, meaning more than one million staff who fall under the Agenda for Change contract will receive a pay rise. This includes nurses, midwives, and paramedics, who are set to benefit from a pay rise of at least £1,400 this year, backdated to April 2022.

Groups who represent and advocate for the social care sector are now urging the government to implement a similar deal for care workers.

While rates of pay for social care work have increased in real terms since 2014, the rate of increase has not kept pace with other sectors, decreasing the social care sector’s ability to compete in the jobs market. Data shows that when overall national employment rates fall, vacancies in social care rise, suggesting that the sector is struggling to attract and retain workers.

The King’s Fund cites “high levels of staff vacancies, sickness absence, turnover, and work-related stress [as] having a damaging impact on staff,” and calls “the case for a fully funded, multi-year health and social care workforce plan… overwhelming.” Although many of these factors were exacerbated by the Covid-19 pandemic, the King’s Fund and other groups maintain that they long predate the pandemic and are the results of successive governments neglecting the social care sector.

In October 2021, the Workforce Recruitment and Retention Fund made £162.5 million available to local authorities to help recruit and retain social care workers, along with a further £300 million in December 2021. However, both funds lapsed in March 2022.

A neglected care sector

Poor staff retention is being further compounded by increased pressure on the social care system. The number of new requests for social care support have increased by 5.6 per cent, while costs have risen by more than a quarter, with areas with higher levels of deprivation being disproportionately affected.

Lack of available social care capacity is also increasing pressure on the acute hospital sector as hospitals have fewer methods of discharging patients safely. This is causing unsustainably high hospital occupancy rates and serving to undermine the wider healthcare system.

In a statement issued yesterday, CEO of Access Social Care, Kari Gerstheimer, warned about a “complete lack of discourse about the future of the social care system,” in the current leadership race, and claims the outgoing Prime Minister, Boris Johnson, has all but abandoned his pledge to “fix social care once and for all.”

The concerns mirror those expressed by UNISON Social Care Lead, Gavin Edwards, who said on Wednesday that “the scale of vacancies is alarming, and not just for those who rely on care and their families. The sorry state of social care is having a disastrous effect on the NHS, causing massive treatment waits, letting down patients and putting unbearable pressure on health staff.

“The care sector is acutely underfunded. Wages are way too low leaving staff unable to cope with the rising cost of living. Supermarkets are paying better rates without the stress, so it’s no surprise that people are jumping ship.”
In Care England’s statement, released on Thursday, Chief Executive Professor Martin Green OBE, said: “The adult social care workforce is our biggest resource. The lack of government action has had an inevitable consequence on the nature of employment opportunities within the sector and has hampered providers’ efforts to recruit and retain staff, as evidenced by the 52% increase in vacant posts in the sector over the past year. This has not only affected the overall financial attractiveness of the adult social care sector as an entity, but also providers’ ability to compete with the NHS.

“As a first step, Care England suggests the Government accepts the recommendations of the Low Pay Commission for the 2023 rates, however, this increase must be properly funded. Simply applying National Living Wage inflation without appropriate funding undermines the ability of providers to aid workforce pressures, especially given the fact that providers are having to pay increases above the National Living Wage annual uplifts as a means of recruiting and retaining staff.”

Kari Gerstheimer added that ”as Sunak and Truss fight it out, there is everything to play for by way of their approach to Health and Social Care. The Association of Directors of Adult Social Services has warned that the year ahead will be the most challenging people needing and working in adult social care have ever faced. I am saddened, however, to see social care being kicked down the road with little mention of any commitments from either leadership contender about the future of the social care system.

“Failure to invest in social care amounts to poor fiscal planning and inefficient use of taxpayers’ money – it harms our productivity because people with unmet social care needs can’t reach their potential, and unmanageable caring roles keep people out of work. It harms those working in social care, who are choosing to leave the sector because of problems with pay. And it harms our health system because a failure to invest early in preventative social care leads to more crisis admissions in critical care.”