Category: Population Health

News, Population Health, Primary Care

Pioneering diabetes prehab service launches in Wirral

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Service uses population health data to identify those most at risk of having surgery postponed

One Wirral CIC, a non-profit community interest company that proactively helps to bridge gaps in health services and support for local communities, has launched a ground-breaking diabetes prehabilitation service to reduce surgery postponements, tackle waiting lists, and improve postoperative outcomes for patients. The service uses population health tools and analysis of hospital waiting lists to identify and support those most at risk of having surgery postponed.

Since April 2023, the service has supported two Primary Care Networks – Moreton and Meols PCN and North Coast Alliance PCN, funded by the North West Coast Clinical Networks. However, the service will now be extended across Wirral to all Primary Care Networks. The goal is for the approach to be adopted nationally.

The diabetes prehabilitation service uses the Cheshire & Merseyside Combined Intelligence for Population Health Action (CIPHA) population health management system, on Graphnet Health’s CareCentric platform. CIPHA surgical waiting lists at Wirral’s Arrowe Park Hospital are used to identify diabetic patients who are awaiting surgery and have a HbA1C (hemoglobin A1C – a test commonly used to diagnose diabetes and prediabetes) over 69mmol/mol or a BMI above 40.

The early identification of patients at risk of having their surgery postponed removes the need for GP surgeries to make referrals. The service also receives referrals directly from secondary care, for people that have had their surgery postponed, and have diabetic risk factors.

Once identified, patients are contacted within 48 hours and booked in for an appointment with a diabetes prehabilitation health coach, in a local community setting, such as a library. If a person’s HbA1c is over 69, they are automatically booked in for an appointment with a diabetes specialist nurse, who will look at medicines management and optimisation. Once they have seen the health coach and nurse, they commence a personalised prehabilitation lifestyle plan, which they follow up until surgery, whether that is a matter of weeks or months.

Lucy Holmes, Wellbeing Lead at One Wirral CIC, explained: “The population health and data-driven approach means we are able to contact the right people at the right time and give them the best intervention before their procedure, without anyone slipping through the net. We look at their lifestyle and they’re encouraged to participate in activities, including the free diabetes exercise sessions that are held in the community each week. Their medications are also assessed. It means we’re looking at a person from a holistic point of view, not just clinically and not just non-clinically. It’s a true community-based, multi-disciplinary team approach.

“We’re so pleased to be able to roll this out across Wirral, but it’s an approach that could easily be lifted and shifted. We would love to see it adopted nationally, because we have seen the many benefits of getting people fit before surgery.”

Dr Dave Thomas, Wirral Diabetes GP Lead, added: “With diabetes, we know that if someone is living with excess weight or their sugar levels are very high, then that comes with additional surgical risks, higher complication rates, they’re more likely to have a longer hospital stay, and they’re more likely to generally have a poorer outcome. So, a service where we’re getting people fit and healthy, and optimising their diabetes care prior to their operation can only benefit the patients. From a Wirral-wide point of view, it’s going to help reduce surgical waiting times, reduce complication rates, and it will allow us to reduce hospital stays.

“This really is a fantastic service. We haven’t seen anything like it anywhere else, which is really exciting and hugely positive for the patients that we’re supporting.”

To hear more about the benefits of the diabetes prehabilitation service, please click the video link: Wirral Diabetes Prehabilitation Service | How It’s Changing Lives.

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Community Care, News, Population Health

Transforming rehabilitation services in England: A new model for community rehab

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By Sara Hazzard, Assistant Director Strategic Communications at The Chartered Society of Physiotherapy (CSP) and Co-Chair Community Rehabilitation Alliance

Change is in the air when it comes to rehabilitation in NHS England.

And while the word ‘change’ may send shivers up the spines of many, the change that is underway in the rehab space must be seen as positive, if we are to safeguard the future of the service for current and future generations.

At the Chartered Society of Physiotherapy, we have long been calling for change and transformation when it comes to rehabilitation. Our Right To Rehab campaigning has made significant progress in pushing this issue up the agenda. And we are not alone. As part of the Community Rehabilitation Alliance (CRA), which we are proud to convene and co-chair, 60 health and care charities and professional bodies are also united in seeing rehabilitation become a central part of NHS thinking and future planning.

So, what does the most recent change, when it comes to rehab, mean?

For the answer, we need to look at two landmark publications from NHS England: the Integrated Care Framework and a new model for community rehabilitation.

Issued in September this year, this framework and model, read together, signal a step-change in the way community rehabilitation is regarded at a system-level within the NHS. While rehab has been steadily growing in prominence over the last few years, to have tangible, clear policy setting out the expectations for what good rehab looks like is a seminal moment.

What is hugely encouraging is that the ICF and new model for rehabilitation reflect strongly the rehab best practice standards, which were developed and endorsed by the CRA. This again shows that there are many voices all calling for the same thing, and for everyone’s right to rehabilitation to be realised.

Significant, too, is that before looking at the detail of the ICF and new rehab model, their very existence is an acknowledgement from the top of the service in England that rehabilitation must be taken seriously and delivered comprehensively to improve patient and population health outcomes. It is a pillar of health care as important as medicines and surgery.

The evidence for needing this shift is clear to see.

Stroke rehabilitation for example, delivered at the optimum time, reduces the risk of a further stroke by 35 per cent. It enables people to regain function and independence yet only 32 per cent get the recommended amount of rehab.

Updated guidance from NICE in October 2023 (the month of this publication) has further bolstered the importance of rehab, by advising that the level of rehab offered is increased to at least three hours a day at least five days a week. This is significant because NICE are guided by effectiveness and cost.

Roughly one in four emergency hospital admissions and ambulance call outs are due to a fall.

Falls prevention saves the NHS £3.26 for every £1 invested because it reduces admissions and bed days. Preventive rehab such as Fracture Liaison Services (FLS) are therefore a cost-effective intervention.

COPD exacerbations are the 2nd largest cause of emergency hospital admissions. Rehab is vital and can reduce admissions by 14 per cent and hospital bed days by 50 per cent yet less than 40 per cent of eligible people are offered rehab.

It is the same with cardiovascular disease and heart attacks. Only 50 per cent of eligible patients receive cardiac rehab. There would be 50,000 fewer hospital admissions if access was 85 per cent.

The release of the ICF and new model for community rehabilitation could therefore not come soon enough.

But with publication, all efforts must now ensure that the actions set out in them, including an adequate rehab workforce, are delivered at pace. We need roles created in the community. It is where people need the help and support. The Chartered Society of Physiotherapy stands ready, alongside our partners in the Community Rehabilitation Alliance, to work with the NHS to make this happen.

The good news is that maximising the rehabilitation workforce is a key feature of the ICF and rehab model, as it highlights AHP leadership at system level to lead implementation. This focus to make the best use of the workforce ensures that individual expertise is used to best effect and has a potential valuable knock-on impact when it comes to the progression and retention of staff.

Also of key importance is the use of data to make the best decisions about service delivery. While there is some data available, much of it is condition specific and/or held in just one place. Now work must develop to ensure that information is shared, and silos broken down.

We must at minimum collect information to identify who needs rehab, who gets rehab and the outcomes.

We therefore have an opportunity, with the momentum and appetite for rehabilitation firmly behind us from the top of the NHS. We must not waste this moment and instead work together, understand what this new approach to rehab means for us in practical terms and then forge a way forward. We owe this effort to the more than one million people waiting for NHS community services, of which rehabilitation makes up a large part.

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Health Inequality, News, Population Health

Gypsy, Roma and Traveller communities subject to stark access and mental health outcome inequalities, report finds

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Suicide rate among Gypsy, Roma and Traveller community is up to seven times higher than for all other communities in England, with poor service provision identified as major factor.

A report published last week says that Gypsy, Roma and Traveller communities experience among the starkest inequalities in access to healthcare of any community in England. The report was commissioned by the NHS Race and Health Observatory and was led by The University of Worcester.

It addresses a marked lack of mental health care provision and captures first-hand insights from service users and providers, as well as examples of good practice from six effective services. Most of these services are run by voluntary organisations from within the Gypsy, Roma, and Traveller community themselves.

Inequalities in Mental Health Care for Gypsy, Roma, and Traveller Communities estimates that the suicide rate among this group is up to seven times higher for this community than for others, and that life expectancy among the Gypsy, Roma and Traveller community is up to 10 years lower than the national average.

It further identifies a lack of access to digital services, low literacy levels, shortage of local and national data collection, and limited financial investment as presenting significant barriers to accessing to local health services and preventing the development of customised services.

Considerable stigma is still attached to mental health concerns within many communities, and a lack of granular data to support tailored services is contributing to the problem of poor access for Gypsy, Roma and Traveller communities.

Data was difficult to fully assess regarding the uptake and impact of services, due in part to the organisations studied not having the resources to collect and analyse such data and also to non-reporting of ethnicity (for fear of discrimination).

In response, Joan Saddler, who is Director of Partnerships and Equality at the NHS Confederation, said: “Leaders will be increasingly concerned about the troubling findings this report has illustrated which show a huge disparity in access, experiences and outcomes for gyspy, roma and traveller communities. These are people’s lives – impacted and in some cases shortened by preventable inequalities.

“We have known for some time that Gypsy, Roma and Traveller communities experience poorer care access, experience, and outcomes as a result of discrimination. The Race and Health Observatory report helpfully builds on this, but we must now focus on action. We would welcome the opportunity to be part of a coalition working with NHS England to reduce such inequalities particularly with Gypsy, Roma and Traveller communities at the heart of creating solutions, so we can take the first step to finally eradicating discrimination.”

National strategy lacking

Professionals’ lack of expertise and knowledge about Gypsy, Roma, and Traveller cultures was further identified as a significant deterrent to take-up of mainstream services. In 2022, Friends, Families and Travellers noted that out of 89 suicide prevention plans in England, only five mentioned Gypsy, Roma, and Traveller communities and only two listed any action plan strategy.

The government’s latest England Suicide Strategy (2023-2028) mentions the Gypsy, Roma and Traveller community twice, but does not afford these communities priority status nor mention them in its associated Action Plan.

Despite the lack of national investment in national mental health care provision, there are many examples of locally organised services doing targeted work with these communities. Researchers visited effective services run in Hertfordshire, Leeds, Lincolnshire, York, Cambridgeshire, and Ireland (the latter due to its provision for young people). Each site represents an example of novel, progressive initiatives which have broken down barriers for Gypsy, Roma, and Traveller communities in need of mental health support.

These, and more findings, were presented at an online report launch of Inequalities in Mental Health Care for Gypsy, Roma, and Traveller Communities, Identifying Best Practice, on Thursday September 28.

The launch included a presentation of the research around the significant mental health needs of these communities; first-hand experience and insight from those involved in the case study sites; a Q&A and practical recommendations for health and mental health providers to action around the country.

Panellists included representatives of the Observatory’s Mental Health working group, the Gypsy, Roma and Traveller Social Work Association and the University of Worcester. Insight gathered over 12 months of research was undertaken in collaboration with research co-authors, Gypsy and Traveller Empowerment Hertfordshire UK (GATE Herts), and the Gypsy, Roma, Traveller Social Work Association (GRTSWA) and involved 70 community and 21 staff members.

“Deeply concerning”

Speaking ahead of the launch, Dr Habib Naqvi, Chief Executive of the NHS Race and Health Observatory said: “We know that Gypsy, Roma, and Traveller communities face stark challenges in accessing psychological therapies and other mental health services. This report lays bare the mental health issues and stigma faced by these communities first hand. We are pleased to have co-produced with these communities, a clear set of practical, tangible actions and recommendations for more equitable mental healthcare provision.”

Dr Peter Unwin, Principal Lecturer in Social Work, University of Worcester, said: “It has been a pleasure to carry out this research in co- production with community members and to have met so many inspiring people who have developed mental health services against the odds. We should all now work together to ensure that this report on the health inequalities in Gypsy, Roma and Traveller communities leads to real change and equality of opportunity.”

Responding to the Race and Health Observatory report, Saffron Cordery, Deputy Chief Executive at NHS Providers, said: “Gypsy, Roma and Traveller (GRT) people’s experiences of health services are dented severely by discrimination. It is deeply concerning to see how GRT communities struggle to access mental health services they need.

“There should be no ‘winners and losers’ when it comes to physical and mental health provision. NHS trusts work hard to reduce health inequalities but years of funding cuts to councils’ public health and preventative services mean that already stretched NHS services face more strain.

“Government must tackle the root causes of why some minorities are more likely to have worse physical and mental health outcomes and address barriers and discrimination facing too many groups of people including GRT communities.”

 

 

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Community Care, News, Partners, Population Health

Transforming leg ulcer service provision

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It is estimated that more than a million people in the UK have lower limb ulceration. With their 160 years’ experience in developing wound care solutions, L&R hypothesised that a self-care delivery model could both improve outcomes and ease the burden on the healthcare system.

L&R has more than 160 years of experience in developing outstanding wound care and compression therapy solutions. They are passionate about transforming outcomes in leg ulcer service provision to support the NHS, the nursing workforce, and patients. Working in partnership with organisations, L&R supports them to drive the self-care agenda, which frees up resources, reduces appointment times and clinic costs, and releases nursing time to care.

Lower limb ulceration is a common cause of suffering in patients and its management poses a significant burden on the NHS, with venous leg ulcers (VLUs) being the most common hard-to-heal wound in the UK. It is estimated that more than one million people in the UK have lower limb ulceration, of which 560,000 are categorised as VLUs. Much of burden of VLUs currently sits within the community and primary nursing workforce, with up to 50 per cent of community nursing workload being taken up by chronic wound management.

In South West Yorkshire Partnership Trust (SWYPT), it was hypothesised that a self-care delivery model, in partnership with the Leg Ulcer Pathway could reduce wound care burden on the health service and improve patient empowerment, with little or no reduction in healing outcomes.1 Therefore, L&R, in partnership with SWYPT, created a project called the “Big Squeeze”, with the aim of delivering transformative outcomes for venous leg ulcer care, achieving a big squeeze on its financial burden and unwarranted variation in treatment and outcomes.

This was implemented through L&R’s three-step approach:

  • Implementation of a best practice leg ulcer pathway1 – ensuring the right treatment for the right patient at the right time in line with the National Wound Care Strategy Programme recommendations.
  • Service efficiencies – driving clinical and health economic outcomes through adoption of the self-care delivery model.
  • An education and coaching programme – for patients and clinical workforce to embed sustainable practice.
Click to enlarge

 

Evidence of success

95 patients were enrolled into the service evaluation, and:

  • VLUs of 84 patients had healed by week 24 on the pathway.
  • VLUs in a further 10 had healed by week 42.
  • One remaining patient reached 42 weeks without healing.

Comparing the results of implementing the Best Practice Leg Ulcer Pathway in isolation and the Best Practice Leg Ulcer Pathway and the Self Care Delivery Model combined:

  • Nursing hours per patient reduced from 24.5 to 1.3, releasing up to 95 per cent in nursing hours.
  • Total cost per patient reduced from £2,168 to £361, saving up to 83 per cent in total cost of care per patient.
  • Product cost per patient reduced from £629 to £177, saving up to 72 per cent in product costs per patient.

In addition to healing and financial outcomes, improvements in staff motivation and wellbeing were recorded through survey feedback, as well as 1,471kg saving in C02 per 100 patients through a reduction in miles driven by the community workforce.

1 Leanne Atkin and Joy Tickle (2016). Wounds UK, A new pathway for lower limb ulceration. Available from: https://www.researchgate.net/publication/304989292_A_new_pathway_for_lower_limb_ulceration

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News, Population Health

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

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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.”

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News, Population Health

People with severe eczema face a hidden cost of living crisis

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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

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News, Population Health

PPP’s Population Health Management Collaboration Framework

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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.

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News, Population Health

Cost of living driving worsening health, finds Nuffield Health

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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.

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Community Care, Population Health, Thought Leadership

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

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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    

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Community Care, Health Inequality, Population Health, Thought Leadership

Prioritising local ‘business progression’ within ICS population health strategy

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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.    
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