Featured, News, Population Health

Prioritise nutrition and hydration to boost broader health outcomes, says new report


New report from PPP finds that efforts to implement a multidisciplinary approach to nutrition and hydration are needed to help address the dysphagia burden across the NHS.

A new report from Public Policy Projects (PPP) finds that with the UK becoming a ‘super-aged’ society, declining nutritional and hydrational status among elderly and frail populations will place increasing strain on health and care services.

The report, Prioritising nutrition, hydration and dysphagia in an integrated care context, states that while considerable work and investment has been allocated to reduce the incidence of obesity and the diet-related diabetes, malnutrition and hydration are not given the same focus, despite their significant impact on health outcomes and its role in the management of other conditions.

The report is the culmination of two roundtables held by PPP in 2023, which convened stakeholders to discuss how ICSs embed nutritional and hydrational health into integrated care strategies. The discussions focused on specific elements of the debate, including improving the management of dysphagia and care provided for frail populations in different care settings. Attendees included NHS England clinical leadership, allied health professionals (AHPs), including speech and language therapists (SLTs), social care providers, primary care representation nurses and other key health and care stakeholders.

Graphic showing levels of elderly population at ICS level in 2021. Source: Census 2021

According to the report, recent reforms to the health and care sector (most notably, the introduction of ICSs) present new opportunities to develop comprehensive approaches to nutrition and hydration, in a way that improves holistic patient care and saves valuable resource for the NHS.

However, among its recommendations, the report calls on the Department of Health and Social Care to launch a national review into food and drink provided across the care sector, to help improve the nutritional and hydrational status of frail citizens in social care. This review should follow the structure and ethos of the NHS Hospital Food programme, the report argues.

It adds that addressing dysphagia should be central to broader NHS goals of enhancing the quality of life for the elderly population, and that by prioritising the management and screening of dysphagia, the NHS could prevent avoidable hospital admissions and promote more efficient use of resources across the health and care sector.

Download the report here

To address the complex and multifaceted challenge of dysphagia, with various medical, neurological, and anatomical elements potentially contributing, will require systems to adopt a multidisciplinary approach, says the report. This will necessitate close collaboration between diverse teams of healthcare professionals, each with specialised expertise.

It finds that a multidisciplinary approach that includes speech and language therapists, dietitians, and physicians, is essential for managing dysphagia and addressing the complex healthcare needs of the elderly in a holistic fashion. To help enable this multidisciplinary approach, the report argues that the model of speech and language therapy sitting in community settings should be scaled nationwide, and adopted across ICSs within integrated care strategies. These strategies should also closely involve the voluntary sector.

The report also recommends an expansion of the speech and language therapy workforce, with ring-fenced funding for broader allied health professionals – in line with ambitions set out in the NHS Workforce Plan.

“The nutritional and hydrational needs of our elderly and frail citizens has been neglected for far too long. As the UK moves towards a ‘super-aged’ society, NHS organisations, care providers and integrated care systems must increasingly focus efforts on improving nutritional and hydrational health,” said report author and Group Editor at PPP, David Duffy. “It is vital that resources are orientated to support allied health professionals, particularly speech and language therapists, who play a vital role in maintaining nutritional health for elderly and frail citizens.

“Nobody in the UK should suffer from malnutrition or dehydration in this day and age, especially not our frailest and most vulnerable citizens. We hope that this report will help shine a light, not just on the scale of the problem, but also on achieveable solutions that we believe will help address the terrible burden of dysphagia.”


  1. NHS England must prioritise nutrition, hydration and dysphagia as part of its drive to improve system performance and broader health outcomes. Nutrition and hydration management are underdeveloped areas which can help enable success in key national strategies, such as the elective care backlog plan, workforce strategy, the urgent and emergency care plan and the delivery plan for recovering access to primary care.
  2. Integrated care systems should consider dysphagia and wider nutritional and hydrational health as key parts of preventative health policies that can help future proof local health systems.
  3. The Department of Health and Social Care (DHSC) should commission a national review into food and drink provided across the care sector. This review should follow the structure and ethos of the NHS Hospital Food programme. The review should be led by a range of stakeholders from within the NHS and social care, as well as representatives from industry and the private sector.
  4. As the population becomes a ‘super-aged’ society, an integrated strategy is required to manage the health of the elderly and frail population. This should draw upon global and international frameworks provided by the WHO’s ICOPE framework.
  5. ICSs should ensure that maximising the ‘intrinsic capacity’ of citizens is a key priority within integrated care strategies, to prevent deterioration of health and supplement preventative health policies.
  6. ICSs should work to prioritise evidence-based nutritional and hydrational approaches within the social care sector, harnessing tools such as nutritional supplements where necessary, to assist those who have difficulty eating, drinking and swallowing.
  7. The model of speech and language therapy sitting in community settings should be scaled nationwide, and adopted across ICSs within integrated care strategies. These strategies should also closely involve the voluntary sector.
  8. NHS England should undertake a national dysphagia screening drive to identify individuals as early as possible. Social care staff and AHPs should be trained to conduct dysphagia screenings for all elderly and frail patients in their care, and much like falls, dysphagia should be considered among the primary risks in any risk assessment of elderly and frail patients.
  9. The speech and language therapy workforce should be expanded with long-term ring-fenced funding for broader allied health professionals.

Download the report here.


News, Population Health

Will the disposable vape ban save the NHS from another health epidemic?


As the government confirms its plans to ban the sale of disposable vapes, Sienne Amer examines the impact of vaping on the NHS so far, and to what extent the ban will help avert another health epidemic.

The UK government recently announced its plan to ban disposable vapes to protect children’s health and tackle the significant rise of vaping among young people. While we have not yet seen the full health impact of the younger generation using vapes, this ban may be a welcome first step in limiting the impact of what could have become the next health crisis.

The devices have appeared on the market recently and rapidly risen in popularity, which is why there is still little research available on the extent to which vaping harms our health. Introducing this ban has the potential to limit the impact vaping has on the NHS, which is already stretched responding to other health crises caused by tobacco smoking, alcohol abuse, obesity, and an ageing population.

There are 4.7 million people in Great Britain who use e-cigarettes, 31 per cent of whom are disposable vape users. Disposable vape brands are targeting children, using bright colours for packaging and a variety of interesting flavours, with the fruit flavours making them far more likely to appeal to children. A shocking 21 per cent of secondary school children have tried vaping and 57 per cent of disposable vape users are aged between 18 and 24. The most popular brand of disposable vapes, Elf Bars, were removed from supermarket shelves last year after the nicotine levels were found to be at least 50 per cent higher than the legal limit. The lack of regulation of these products is an issue, regardless of the effects of use.

Disposable vapes contain nicotine, and inflict similar impacts to any other nicotine product, including heart disease and other cardiovascular disorders, along with respiratory and gastrointestinal disorders. Children are especially susceptible to the toxicity of nicotine, which can impact brain development, leading to shorter attention spans, anxiety, depression and reduced cognitive function.

It has also been shown that when the coils in the e-cigarette are heated, toxic metals, including aluminium, chromium, iron, lead, manganese, nickel and tin leak into the e-liquid, which are then aerosolised, inhaled and absorbed by the lungs. E-liquids have been shown to contain ingredients that generate pulmonary irritants and carcinogenic carbonyl compounds, all of which can lead to respiratory, gastrointestinal, and constitutional symptoms, in addition to an increased risk of early onset strokes.

Although vaping is still recognised as a safer alternative to smoking by the NHS, there has not been sufficient investigation into the long-term impacts on health. Other countries, such as the United States, have recognised the impacts of vaping; in 2019, the US Center for Disease Control and Prevention announced an outbreak of e-cigarette/vaping product use-associated lung injury (EVALI) after it caused the deaths of several young people.

While there have not been any recorded e-cigarette related deaths reported in the UK, in 2023, the NHS recorded 420 vaping related hospital admissions, 15 of which were for children aged under 9, demonstrating the severe risk to health young children are exposed to.

When compared to just under half a million hospital admissions caused by cigarette smoking-related illnesses, the health impacts of disposable vapes appear to be minor. However, conventional cigarettes were only recognised as a significant health hazard in 1964, more than 40 years after the introduction of cigarette manufacture, showing the time it can take to fully understand the long-term effects a product can have on human health.

The NHS is already dealing with several other health epidemics, with smoking costing the NHS in England £2.6 billion per year, approximately 2 per cent of the NHS budget. Obesity costs around £6.5 billion a year and is the second biggest cause of preventable cancer. Alcohol abuse costs £3.2 billion a year in England. This is a total of £12.3 billion of the yearly NHS budget going towards preventable illnesses, and the cost of vaping would be an additional burden on NHS.

To what extent is vaping impacting the NHS?

At present, there is no record of the health-related costs associated with vaping. But modelling the cost to the NHS using smoking data could provide an estimation of the impacts vaping will have. The UK smoking population is equal to 6.4 million people, causing 474,000 hospital admissions a year at a cost of £2.6 billion. The model assumes that 7 per cent of the population requires hospital admissions, with each admission costing approximately £400.

The 420 admissions related to vape use last year would have cost the NHS approximately £168,000. However, vape-related hospital admissions only started to be recorded in 2019 and since then, there has been a 237 per cent increase in admissions. An annual growth of 10 per cent in the vaping population is also expected to cause an increase in admissions. This means that, if only 7 per cent of the vaping population is admitted, the cost to the NHS would be £132 million per year, excluding any impact of an uptake in the number of young people seeking mental health services as a result of the toxic effects of vaping.

The ban on disposable vapes is estimated to affect 2.6 million people in Great Britain – including 316,000 18-to-24-year-olds, who other than vaping, have never regularly used tobacco products – saving a large proportion of young people from the risks caused by nicotine dependence and vaping. As disposable vapes were initially introduced to the market as an alternative to cigarettes, there is a high risk that 75 per cent of people will revert to traditional tobacco products.

Since the focus of the ban is solely on disposable vapes, alternative e-cigarette products will continue to be available for people trying to quit smoking. It is crucial that information should continue to be collected and published, through platforms such as NHS Digital, to monitor and understand the health impacts of the current vaping generation, even post-ban. Hospitals should be advised to continue to use the ICD-10 code to improve data on vaping-related admissions, along with adjusting advisory information to support the disposable vape ban.

Sienne Amer is a Net Zero Graduate at Lexica.

News, Population Health

West Midlands rolls out pharmacy-based bowel cancer screening


Region becomes country’s first to speed up bowel cancer screening using technology as part of Levelling Up Smart City Region programme.

The West Midlands has become the first English region to screen people for bowel cancer in their local pharmacy, at home or at other local settings, using new colon capsule endoscopy services (CCE) – also known as ‘pill cam’.

Screening people in their own community rather than in hospital will help to significantly cut waiting times and speed up lifesaving diagnosis. It is expected that 2,000 people will use the new technology across the West Midlands in its first year, with waiting times cut from 30 weeks to just two.

The rollout of ‘pill cam’ is the first time this innovative, clinically proven screening technology will be available to residents in Birmingham and Solihull. It will also significantly increase bowel cancer screening capacity in Coventry and Warwickshire and follows successful trials led by University Hospital Coventry and Warwickshire NHS Trust and WM5G.

This is the first part of the pioneering £10 million Levelling Up Smart City Region programme led by the West Midlands Combined Authority (WMCA). It is a key part of the £1.5 billion deeper devolution deal agreed between the government and the WMCA last year.

The programme sets out to use cutting-edge wireless technology to help revolutionise the way healthcare is delivered within local communities and aligns closely with plans to increase NHS productivity set out in last week’s Budget.

The NHS Productivity Plan focuses on three key areas: transforming access and services for patients, using data to reduce time spent on unproductive administrative tasks, and updating fragmented and outdated IT systems.

Through the Smart City Region programme, the West Midlands is already leading the way in all three areas, rolling out CCE, developing an exemplar hospital that addresses issues around capacity and flow, and trialling the use of AI and data to improve primary care tasks and measure intervention outcomes for conditions such as diabetes.

WM5G, which is part of the WMCA, leading health-tech innovation, has partnered with Corporate Health International (CHI) to provide the ‘pill cam’ service and will work in close partnership with the NHS Birmingham & Solihull and Coventry & Warwickshire Integrated Care Boards to deliver the screening.

In addition to colon capsule endoscopy, the WMCA will also be expanding prevention, remote monitoring, and smart hospital services. This will help more people stay healthy and in-work, avoid being admitted to hospital or get discharged faster and be supported to live at home for longer.

Andy Street, Mayor of the West Midlands and WMCA chair, said: “The roll out of this life saving technology is a direct result of the West Midlands winning the competition in 2018 to become the UK’s 5G testbed.

“That has left a lasting legacy for the West Midlands which is now the UK’s best connected 5G region and a national leader in the real-world use of innovative 5G products and services like the ‘pill cam’.

“Bowel cancer is the second biggest cancer killer in the UK but the disease is treatable and curable if diagnosed early. The ‘pill cam’, as part of the Smart City Region programme, has the potential to provide thousands of local people with an earlier and easier diagnosis and the treatment they need to survive this disease.”

Dr Adil Butt, Consultant Gastroenterologist and Clinical Service Lead for Endoscopy at Queen Elizabeth Hospital Birmingham, said: “Adopting clinically proven and remotely available technologies, such as CCE, enables both quicker diagnosis by streamlining existing referral pathways and releases valuable extra capacity within existing systems.

“This makes the diagnostic process more convenient for all, bringing previously hospital-based specialist care closer to patients by delivering screening services in their local community. This vital extra capacity comes at a critical time when the UK is facing a significant diagnostic backlog.”

Dr Mark Andrew, Consultant Gastroenterologist and Clinical Service Lead for Endoscopy at Good Hope Hospital said: “CCE is an established diagnostic examination that helps provide access to patients whilst protecting their dignity. I am pleased to see with the support of WM5G and CHI we can hope to offer this bowel test on a larger scale, whilst also reducing our carbon footprint.”

Dr Cornelius Glismann, Managing Director at Corporate Health International, said: “This contract is clearly a game-changer for the region and we are looking forward to working in partnership with WM5G and the health care providers to rapidly roll out Colon Capsule Endoscopy across the region.

“Our Colon Capsule Endoscopy technology was developed in direct response to a team-member’s personal experience of bowel cancer screening and was therefore designed with a firm focus on reducing waiting times while improving patient experience.”

Genevieve Edwards, Chief Executive at Bowel Cancer UK, said: “Around 43,000 people are diagnosed with bowel cancer in the UK each year, but a lack of capacity to meet demand in endoscopy services means there are often long waits between referral and testing, leaving thousands of people awaiting tests that could either confirm a diagnosis or put their minds at rest.

“The use of new technologies such as Colon Capsule Endoscopy helps identify those who require urgent colonoscopies so they can be tested and begin treatment more quickly.”

Rehab for all: fixing the NHS rehab access gap


ICU nurse and creator of the Right to Rehab Campaign, Kate Tantam, shares her perspective on the importance of universal access to rehabilitation in the NHS.

I am an ICU nurse who has been collecting stories of recovery and rehabilitation since 2018.  The reason is simple – the wider public and even many health care teams absolutely do not see the impact of rehabilitation services. For many years rehabilitation services have been seen as the “nice to have, the icing on top of the cake”. I fiercely believe that rehabilitation is the icing in the middle of the cake, it cements everything together.

Rehabilitation is transformative. It is vital. It ensures that our patients make a full recovery and gets them back to the people and things that they love.  And while myself and my multi-disciplinary colleagues are aware of this fact every single day, the NHS system is not prioritising rehab. This fails dedicated and skilled healthcare workers and our patients across the UK.

My patients’ goals may not seem big – to hold their grandson, to make a cup of tea, to go to the loo on their own, to say ‘I love you’ – but for those who can’t move their arms or legs or have lost the power of speech, this is a mountain to climb.

Universal access to quality, person-centred rehab doesn’t exist across the NHS. It means that millions of people don’t have access to NHS rehab services in their area. Many of these people can’t afford to pay for private rehab services, creating huge economic inequality when it comes to recovery. Tragically, this means people’s lives must be put on hold, their conditions deteriorate, and they don’t stand a chance to reach those important personal goals or make a full recovery. This clearly impacts long term return to work, caring responsibilities for loved ones, ability to keep hold of housing and income with reliance on external financial support.

Christian is one of these stories – a young man working full time in his own business. He came into ICU over Christmas in 2022, was in multi-organ failure, and was an alcoholic. He spent months in ICU, and nearly a year in hospital. He was so unwell he had to have multiple abdominal operations, is now diabetic and has a colostomy. He had a rocky time, but I am incredibly proud to say that he is back at work. He is fitter than he has ever been and is debating becoming a model for Colostomy UK, sharing his recovery to support others and clinical teams.

Rehabilitation is work that needs all of us to partner with patients, loved ones and each other.  When healthcare professionals get it right, it makes every single person involved remember why they joined Team NHS. It doesn’t matter where they are in this team – the paramedic who brought the patient in, the GP who supported them after admission, the manager who sorted the funding for the service or the domestic assistant who cleans the ward – everyone impacts that story and shares its success.

Credit: Right to Rehab Campaign

I started this campaign for all the patients who aren’t as lucky as Christian. I see it every day across the UK and hear from clinical teams who feel lost fighting against the tide.

So, I joined forces with independent creative agency, Pablo, to create a campaign that celebrates patients’ ‘firsts’ since hospitalisation – the first tentative footsteps or first halting words – those monumental milestones for patients lucky enough to receive specialist rehabilitation care. The aim of the campaign is to raise awareness of the impact of rehabilitation and to ask for a rehabilitation strategy in every trust and a named lead.

This is a campaign that has had no budget – everything has been donated and we have all been working clinically full-time. For me, this demonstrates perfectly that the people who value rehabilitation will do anything they can to support and improve it. I work with a team of nurses, physiotherapists, speech therapists, doctors, occupational therapists, psychologists, dietitians and when we have the resources to support our patients to reach their goals and return home to their lives following traumatic accidents or life-threatening conditions, there is nothing more rewarding.

Some of my own patients’ first steps are now on billboards across the UK, including one patient who suffered a bilateral stroke on either side of her brain stem. She couldn’t sit, use her right arm or legs, she could no longer talk or even swallow and had to be fed via a tube. Her re-learned voice is now on a national radio advert promoting the campaign. The overarching message is for NHS leaders to provide much needed rehab services in all areas of the UK.

The campaign directs people to PetitionForRehab.com, where they can sign a petition calling for rehab to be made available everywhere and for a named rehab lead to be appointed on every hospital trust and board in the UK.  And much like it takes a multi-disciplinary team to support a person’s recovery through rehab, the call for universal access to quality rehab comes from a multitude of individuals, teams and organisations.

The campaign is supported by more than 30 healthcare charities, royal colleges and professional bodies such as the Chartered Society of Physiotherapy (CSP), the British Geriatric Society, Asthma+Lung UK, the Royal College of Occupational Therapists, and the Stroke Association who are all members of the Community Rehabilitation Alliance.

My ask of you is that you talk about rehabilitation, share your local stories of rehabilitation success, listen to your patients, their loved ones and each other.  The NHS is the sixth largest employer in the world – together we surely can achieve anything.

To sign the petition and call for universal access to access rehab services, please visit PetitionForRehab.com.

News, Population Health

Unpacking cancer disparities in England


Despite major gains in diagnosis and treatment, England continues to experience high disparities in cancer outcomes, with social and financial deprivation major drivers.

In December 2023, The Lancet Oncology published a landmark paper highlighting the “astounding inequality” in the risk of dying from cancer in England. Researchers from Imperial College London looked at the 10 most deadly cancer types in England and analysed the risk of dying from these across England’s 314 districts from 2002 to 2019.

Although the overall risk of dying from cancer before the age of 80 had declined over that time period, their analysis shows huge inequalities in risk depending on where in the country someone lives. For women, the risk of dying from cancer was one in 10 in Westminster, while for women in Manchester the risk was one in six. Meanwhile, the picture for men ranged from one in eight in London’s Harrow to one in five in Manchester. The study found that lung cancer had one of the highest inequalities in risk across areas with those at greatest risk areas having triple the risk of dying from lung cancer compared with those in lowest risk regions.

The concept of health inequalities is now well established in the UK and beyond. The publication of the DHSC Black Report in 1980 demonstrated that, although there had been a general improvement in public health since the introduction of the welfare state, there were widespread health inequalities across the country. It found that the primary cause for these inequalities was deprivation. Over four decades later, there is now a vast body of evidence examining health inequalities and the evidence suggests that despite new treatments and technologies, overall health is deteriorating, and the inequalities are widening.

Social determinants still a major influence

Research has shown that for cancer, the social determinants of health impact both prevalence and prognosis. The Health Foundation describes the social determinants of health as the “social, cultural, political, economic, commercial and environmental factors that shape the conditions in which people are born, grow, live, work and age”.

A 2020 report demonstrated that more than 30,000 extra cases of cancer in the UK each year can be attributed to social and financial deprivation, while survival was found to be worse among the most deprived groups. Many of the risk factors for cancer are influenced by the social determinants of health. For example, individuals residing in areas with higher levels of deprivation are 2.5 times as likely to smoke compared to those in the least deprived areas, and they find it harder to quit.

Diet inequality is also an issue that affects the most deprived in society. Research has shown that people in deprivation have poorer diets, and consumer higher levels of poor quality, ultra processed, high calorie food than those in the least deprived areas. This population also suffers from much higher rates of obesity. As a result of such social determinants of health, those that grow up and live in deprivation are more likely to get cancer, but the story doesn’t stop there.

Variations in diagnosis

There is huge variation across the UK in cancer diagnosis. There are currently three UK screening programmes: for bowel, breast and cervical cancers. In theory these screenings are open to everyone eligible, however, in reality there are various barriers to screening that disproportionately affect certain populations, and this leads to inequalities in diagnosis.

Barriers to screening are an active area of research but there are several factors that have been identified to contribute. Stigma is one factor, with research showing that cancer stigma is linked to lower screening uptake, and this tends to be more prevalent among people from ethnic minority backgrounds.

Another barrier recognised is the practicality of attending a screening. For example, other responsibilities such as work or caring may make it difficult to get to an appointment. There are ways to overcome these barriers and increasingly NHS services are implementing changes to make screening more accessible to everyone. For instance, research suggests language barriers hamper screening uptake and therefore translation services can help overcome this. Also, offering greater flexibility on appointment times and re-invitations for those that haven’t responded have been found to positively impact uptake in underserved populations.

Overall, there are clearly gross inequalities across both the risk of developing cancer and the prognosis once it has developed. However, as researchers gain deeper insights into these inequalities and the mechanisms that contribute to them, NHS and public health services can implement best practices in order to try and level the playing field for cancer care. In April, Public Policy Projects will be hosting a round table event looking at regional inequalities in prostate cancer, so look out for the report later this year.

News, Population Health

Heart disease single largest factor behind out of work ill health


New report finds that people are more likely to leave work due to a heart condition than any other health issue, and warns that faltering efforts at prevention have cost thousands of lives.

Heart disease is the single largest driver of people leaving the workforce due to ill health, according to new research from the Institute for Public Policy Research (IPPR).

The new paper, Broken hearted: A spotlight paper on cardio-vascular disease, finds that a heart disease diagnosis brings with it the largest risk of a person leaving the labour market, and that someone diagnosed with cardiovascular disease (CVD) has a 22 per cent chance of leaving their job. This compares to a 14 per cent risk for someone with a mental health condition and 16 per cent for a person with cancer.

Almost one in three of all working-age people who are economically inactive have a heart, blood pressure or circulatory condition, the report says. This figure rises among over 50s, a group the government is currently targeting in its efforts to get people back to work.

The report also reveals significant variation in CVD mortality across England and Wales, with the North West the worst affected region. It estimates that if the entire UK saw the same outcomes as the best tenth of local authorities, there would have been 32,000 fewer deaths in 2021 along – equivalent to 5 per cent of total CVD mortality.

Around 80 per cent of deaths from heart disease are preventable, with diet and nutrition, metabolic risks (e.g. high BMI) and tobacco use constituting the three greatest risk factors.

The report cites analysis from the British Heart Foundation that since February 2020, there have been nearly 100,000 more deaths involving CVD than would otherwise have been expected. It attributes this decline in outcomes to a slowdown in progress on prevention over the last decade. If the last decade had seen even half of the progress on preventable CVD mortality observed between 2005-2020, the report estimates that there would have been nearly 33,000 fewer deaths in 2019- equivalent to one in 20 deaths that year.

While virtually all NHS waiting lists have grown steadily in recent years, exacerbated by the pandemic, cardiology is something of an outlier, and waiting lists have tripled since 2012, higher than the overall growth in NHS waiting lists.

IPPR is calling on the government to implement a recovery plan for treating cardiovascular disease, helping both the NHS and the economy, by:

  • Delivering new preventative policies, such as extending the current ‘sugar levy’ on soft drinks to all high-fat and high-salt products, and using the revenue to subsidise healthy food options.
  • Getting waiting lists for cardiology down, through increasing access to preventative medications, retaining staff and expanding access to personalised care.
  • Investing in research, with an immediate injection of £220 million for R&D in cardiovascular disease prevention – with an explicit goal of crowding in private investment.

Chris Thomas, author of the report and Head of IPPR’s Commission on Health and Prosperity, said: “After great strides in tackling cardiovascular disease in the 20th century, the UK is now stalling if not reversing. This is not just costing lives, but also livelihoods. The good news is that heart disease is one of the most preventable health conditions, but the government has to get on to the front foot and deliver proactive policies. Both human lives and economic prosperity depend on it.”

The full report can be accessed here.

News, Population Health

New study finds no cervical cancer cases in HPV-vaccinated women


Study proves efficacy of HPV vaccination at preventing cervical cancer, as UK Health Security Agency statistics show that uptake has still not returned to pre-pandemic levels.

Public Health Scotland announced this week that a new study has found no cases of cervical cancer in young women vaccinated as part of the HPV vaccination programme. The news comes as the UK marks Cervical Cancer Prevention Week 2024 and MPs commit to tackling inequality in the uptake of cervical screening and HPV vaccination.

The HPV vaccination programme was introduced in 2008 and aimed to vaccinate young women against HPV to prevent the development of cervical cancer, on the advice of the Joint Committee on Vaccination and Immunisation (JCVI).

The human papillomavirus (HPV) is a type of sexually transmitted virus, of which there are more than 100 strains. Many individuals will be infected with HPV over the course of their lifetime and in most cases the infection is harmless and clears on its own. However, persistent infection with high-risk strains of HPV can occur and lead to the development of cervical cancer.

Cervical cancer is the 4th most common cause of cancer in women worldwide, and HPV is responsible for almost all cases. Infection with the HPV virus is also linked to an increased risk of mouth, throat, and urogenital cancers in both men and women.

From 2019, the JCVI recommended that 12-13-year-old males, as well as females, should be offered the HPV vaccine to protect against these non-cervical cancers. Further, in 2023 the dosing schedule of the programme also changed to one dose only, as it was shown to be just as effective as two doses at protecting from HPV infection.

However, the most recent UK Health Security Agency statistics on HPV vaccination coverage published on 23 January this year demonstrate that although vaccination uptake has increased since the previous year, it has still not returned to pre-pandemic levels. Further effort is required to bolster vaccination programmes in schools to ensure young people across the UK are getting sufficient coverage.

“It is possible to make cervical cancer a rare disease”

NHS England announced in November last year that it aims to eliminate cervical cancer by 2040. To meet this ambition, it must ensure as many people as possible are vaccinated against HPV, as well as come forward for cervical screening. In addition to the vaccination programme in schools, NHS England plan to improve access to online vaccination appointments and offer vaccinations in more convenient settings such as libraries, community centres and local leisure facilities.

The Scottish study published in the Journal of the National Cancer Institute also concludes that “women from more deprived areas benefit more from vaccination than those from less deprived areas.” It found that cervical cancer incidence was significantly higher in women from the most deprived areas in Scotland, and that incidence substantially decreased for those who had three doses of the vaccine. This demonstrates the role that vaccination can play in the reduction of health inequality, emphasising the importance of ensuring vaccination efforts cover deprived areas.

Dr Kirsty Roy, a consultant in health protection at Public Health Scotland and co-author of the study, said: “It shows how effective the HPV vaccine is as there have been no cervical cancer cases to-date in fully vaccinated women who were given their first dose at age 12-13 years. Vaccination against HPV is shown to be effective in preventing cervical cancer, and along with regular screening for early detection and treatment, it is possible to make cervical cancer a rare disease.”

Dr Vanessa Saliba, UKHSA consultant epidemiologist, said: “The HPV vaccination programme is one of the most successful in the world with millions of doses given since it started in 2008. It has dramatically lowered the rates of cervical cancer and harmful infections in both women and men – preventing many cancers and saving lives.”

Jenni Minto, a Scottish Minister for Public Health, said: “The HPV vaccine programme is having a huge impact on preventing these cancers for those who have been vaccinated. Vaccination and screening remain the most effective ways of preventing and detecting cervical cancer and I would encourage those eligible to come forward to have the vaccine or attend screening appointments.”

Public Policy Projects’ (PPP) 2024 Cancer Care Programme will be investigating how to implement innovation in cancer care, as well as discussing how to overcome inequalities in access to care like screening and vaccination. Working with a range of cancer care stakeholders, including ICB and ICS leadership, cancer alliances, diagnostic and imaging networks, trusts, health innovation networks and charities, PPP will use examples, such as the work leading to Scotland’s exciting results, to produce policy recommendations aimed at improving cancer care for all across the UK.

For more information about PPP’s Cancer Care Programme in 2024 please contact:

Willy Morris, Senior Partnerships Manager, willy.morris@pppinsight.com.

Samantha Semmeling, Policy Analyst, samantha.semmeling@publicpolicyprojects.com.

News, Population Health

New report models true economic impact of breast cancer to the UK


The report from Demos and Breast Cancer Now estimates the economic and wider societal costs of breast cancer and urges UK governments to enact measures to reduce the burden of the disease.

Breast cancer is predicted to cost the UK between £2.6bn and £2.8bn in 2024, potentially rising to £3.6 by 2034, according to new research from the cross-party think tank, Demos, and research and support charity, Breast Cancer Now.

The study, The Cost of Breast Cancer, warns that unless radical change is enacted to reduce the impacts of the disease on patients, the costs to the NHS (including screening and treatment), wider society and individual patients will rise by 40 per cent over the next decade. The report sets out the results of modelling to demonstrate some of the measures that could mitigate the worst of the human and financial impacts of breast cancer.

The report also highlights the human cost of breast cancer, and estimates the overall wellbeing costs associated with the disease at £17.5 billion in 2024. This is around six times higher than the estimated economic costs, and accounts for the wider impacts of breast cancer including costs incurred through reduced quality of life and early death, as well as the impact on carers, partners and children of breast cancer patients.

Around 55,000 women and 400 men are diagnosed with breast cancer each year in the UK (47,000 in England), with eight in 10 cases diagnosed in women 50 and over. This amounts to one woman being diagnosed with breast cancer every 10 minutes across the UK. Although breast cancer survival rates are improving, and 85 per cent of women with breast cancer now survive for five years or more, more than 11,500 women and men die from the disease each year in the UK, and the financial and emotional costs can be long-lasting.

Within the report, Breast Cancer Now urges UK governments “to urgently engage with the scale of the crisis” and to work with the charity on measures to improve the lives of people impacted by breast cancer and reduce the financial costs to the NHS and wider society. These include increasing screening uptake rates, which it estimates would produce economic savings of between £96m and £111m in 2034, and £1.2bn in wellbeing cost savings, also in 2034.

Also proposed is the introduction of cancer nurse specialists, who can provide support and information to cancer and their families and are specifically trained to offer psychological support. Research from Sweden indicates that having specialist psychology-trained nurses in place can lead to improvements in measured quality of life scores for patients and a reduction in total healthcare costs, including after the initial investment. Applying the same economic savings realised in Sweden to the NHS, the report estimates that providing cancer nurse specialists could produce more than £118m in savings to the NHS, as well as £312m in associated wellbeing costs.

Other proposals include measures to support patients to return to full-time work, which are estimated could potentially yield between £328m and £411m in savings in 2034. These savings would stem entirely from a reduction in productivity losses from illness and reductions in caring requirements.

Pharmacy First service agreed as Recovery Plan set to launch


Negotiations have concluded around the implementation of the Pharmacy First scheme, which is now set to launch in full on 31st January 2024.

The government, NHS England, and Community Pharmacy England (CPE), which represents all community pharmacy owners in England, have reached agreement regarding the launch of the new national Pharmacy First service, set out in this year’s Delivery plan for recovering access to primary care.

CPE’s Committee unanimously accepted the proposed deal, which outlines how the £645 million investment pledged in the Delivery plan will be used to support the rollout of expanded community pharmacy services. The agreement was reached following months of negotiation between CPE, the Department of Health and Social Care and NHS England.

Public Policy Projects has recently advocated for an expansion of pharmacy services in England in its report, Driving true value from medicines and pharmacy, which was chaired by Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation at Frimley Health and Care Integrated Care System.

It is now confirmed that the Pharmacy First services will be launched on 31st January 2024 as an Advanced Service, subject to the required IT infrastructure being in place. Under the new service, pharmacists will be able to offer advice and prescribe treatment for seven minor ailments, including sore throats, insect bites and uncomplicated urinary tract infections for women. Patients will be able to access the service without an appointment, as well as via referrals from NHS 111 and GPs.

Following consultations with pharmacists, patients with symptoms indicative of the seven conditions covered will be offered advice and prescription-only treatments where necessary, under a Patient Group Direction (PGD). CPE hopes that in the future, independent prescribers will be empowered to complete episodes of care without requiring a PGD.

As per CPE, the following stipulations have also been agreed:

  • The writing-off of previous funding over-delivery worth £112 million for CPCF Years 3, 4 and 5. If this money had been re-claimed from pharmacy owners over a year, it would have resulted in a reduction in the Single Activity Fee of around 10 pence per item.
  • Protecting baseline CPCF funding: the new money will be accessible as soon as possible rather than risk further over-delivery against Year 5 CPCF funding – the writing off of some Year 5 projected over-delivery supports this.
  • The inclusion of an upfront payment for of £2000 for Pharmacy First to support pharmacy owners to prepare and build capacity for the new service.
  • Increasing service fees to support ongoing capacity to deliver Pharmacy First, and for an uplift in fees across all services.
  • Reducing activity thresholds at the start of the scheme to “more achievable levels”.

The National Pharmacy Association (NPA) has welcomed the announcement, while also repeating calls for an increase in core funding for the community pharmacy contract to underpin sustainable future growth for the sector. NPA Chair, Nick Kaye, said: “We welcome this commitment to invest in a nationwide Pharmacy First service for common conditions. The new funding, whilst welcome, will not in itself solve the financial crisis in community pharmacy, but it is a substantial investment in a key service that could be a stepping stone to more.

“NHS England have put their faith in us, having seen community pharmacy successfully deliver other clinical services at scale. I’ve no doubt that pharmacies will once again deliver an impressive return on investment for the health service.

Highstreet pharmacist Boots has also welcomed the announcement pharmacy reforms. The chain announced today that it will roll out the NHS Pharmacy Contraception Service, allowing pharmacists to provide contraceptive advice and prescriptions, in the coming months. The service has already been successfully piloted in 22 stores in England.

The NHS Blood Pressure Check Service will also be expanded to most Boots stores in England, allowing pharmacists to check patients’ blood pressure and provide advice on reducing their risk of cardiovascular disease. Boots has said that the new and expanded NHS services will be good news for patients, pharmacy teams and GPs alike.

Seb James, Managing Director of Boots UK & Ireland, said: “We welcome the government’s announcement of plans to launch new contraception and minor ailments services in England, which will make life easier for patients to access the care and medicines they need quickly and help reduce GP wait lists.

“We have been working with our pharmacy teams in stores to roll out these new services to patients in England. We are already commissioned to deliver similar services for the NHS in Scotland and Wales and these are very popular with our patients and pharmacy team members.

“The free NHS blood pressure checks that we offer at most of our stores in England can save lives by spotting potential cardiovascular problems at an early stage, which also helps to reduce the burden on the NHS longer term.”

Inclusive innovation: using community co-innovation to tackle health inequalities and digital exclusion


By Fran Ward, Project Manager, NHS Arden & GEM CSU and Dr Paulina Ramirez, Academic, Birmingham Business School.

Digitalisation of the NHS has the potential to enable more personalised care and improve health outcomes. But it can also widen health inequalities. Some people in communities facing social and economic deprivation, which are also those experiencing the poorest health, find accessing care increasingly difficult as the NHS becomes more digital.

If those most in need of health services become less able to access them, health outcomes for these communities will worsen and the overall cost of healthcare will increase. Integrated care systems (ICSs), therefore, need to maximise the value of their investment in digitalisation by making it work for all their communities, not just the ones they know and understand well.

The ‘Building Inclusive Digital Health Innovation Ecosystems’ research programme, led by University of Birmingham’s Business School and supported by NHS Arden & GEM’s digital transformation team and Walsall Housing Group (whg), explores how community co-innovation could be used to develop digital healthcare that works for diverse communities and reduces the risk of exclusion.

Co-innovation is about understanding and framing problems and taking a bottom-up approach to generating new ideas in response. Specifically, this programme of community co-innovation is socially inclusive by design, creating an opportunity for disadvantaged communities to share their knowledge and lived experience. It gives these communities an equal share of voice alongside commissioners, clinicians and other stakeholders in the development of new digital health technologies or design of new online services.

Peer research

To genuinely hear what more deprived communities need, it is important to rethink how we in the NHS structure engagement to make it easier and more comfortable for those we most want to hear from. Training peer researchers from whg and local voluntary organisations enabled us to build on existing skills, connections and relationships. As trusted members of the community, peer researchers were better able to have relevant conversations within people’s homes, and elicit more honest and open responses on how people access technology and the barriers they face.

The resulting insights challenged some assumptions around barriers to adoption of digital technologies. The main source of inequality was found to be the lack of skills and confidence to engage with online services, with an individual’s type of work or family support structure often having a greater influence on digital proficiency than age, for example. Concerns around data privacy and information sharing were high, causing some not to access potentially valuable support. Despite positive attitudes towards digital in general, many felt digital services such as online GP appointments were not an adequate replacement for face-to-face health services due to a combination of trust, complexity and importance of healthcare in people’s lives.

Simply developing more digital services without addressing these fundamental barriers is inevitably going to limit success.

Changing the nature of engagement

Although good examples of user engagement in digital health services exist, there are constraints too. In particular, technology companies often have little or no engagement with deprived communities so can’t be sure their technology will work for those most likely to have the highest health needs. Alongside peer research, we need to create spaces for co-innovation to happen, bringing together these stakeholders to share information and work together to come up with new ideas.

A locally hosted co-innovation event enabled system partners in the Black Country ICS and health technology companies to hear from and engage with peer researchers and other local community organisations to start putting theory into action. Based on health priorities identified through the peer research, table group discussions addressed challenges such as how to ensure that a mental health app was used by those who most needed it, and how to increase numbers of patients from areas of high deprivation attending diabetes reviews. Peer researchers were able to articulate the day-to-day challenges people in their communities face and why, for example, simplicity and ease of use is often preferable to feature-packed, complex apps.

The event has already resulted in a dedicated task and finish group being set up at NHS Black Country Integrated Care Board to explore how community co-innovation can be applied to issues such as digital GP access. Whg is also keen to continue building a space for co-innovation within its community. More broadly, however, there is a wealth of learning from this approach which can be applied to digital transformation across the country.

Developing best practice

It is clear from this work that input from communities facing social and economic deprivation is essential in finding solutions to some of the nation’s most complex health challenges – and that how we do that is as important as why.

Findings from the ‘Building Inclusive Digital Health Innovation Ecosystems’ research have been used to develop a What good looks like for our communities report to support the NHS Digitalisation Framework. This highlights the need for affordable, simple, safe and inclusive technology that is well integrated with in-person services, guarantees data privacy and is supported with local skills training and support.

We have also developed a playbook to guide ICSs in using community co-innovation to develop digital health services, drawing on the learning from this programme to encourage greater use of this approach across the NHS. After all, there is no point in developing digital services that aren’t going to work for the communities we most need to help.

Photo caption: Peer researchers interviewing community members in their own homes in Walsall.

To find out more about digital inclusion and health inequalities, see: The digital divide: Reducing inequalities for better, prepared by Public Policy Projects.