Pharmacy First service agreed as Recovery Plan set to launch

By Gabriel Blaazer

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 and Dr Paulina Ramirez

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.

Pioneering diabetes prehab service launches in Wirral

By Integrated Care Journal

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.

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

By Sara Hazzard

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.

Health Inequality, News, Population Health October 2, 2023

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

By Integrated Care Journal and Gabriel Blaazer

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.”

All news

Transforming leg ulcer service provision

By Leanne Stevens, Abbe Ruston, Laura Hallas Hoyes

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.

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

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

By Gabriel Blaazer

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.”

People with severe eczema face a hidden cost of living crisis

By Rippon Ubhi, Sanofi Specialty Care General Manager

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 item s 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

PPP’s Population Health Management Collaboration Framework

By Mary Brown

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.

Cost of living driving worsening health, finds Nuffield Health

By Gabriel Blaazer

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

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

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

A central role for ICSs

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

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

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

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

Leadership on prevention

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

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

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

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