North East and North Cumbria ICS initiative drives air quality improvement

By Niamh Macdonald

A new pilot project in the North East and North Cumbria aims to drive air quality improvement at an NHS systems level.

Poor air quality in the UK is an increasing health concern, new data published by The Lancet has revealed that pollution remains responsible for approximately nine million deaths per year, corresponding to one in six deaths worldwide.

Approximately 30 per cent of preventable deaths in England are due to non-communicable diseases explicitly connected to air pollution. The health and social care costs of air pollution in England could reach £18.6 billion by 2035 if air quality is not improved.

Global Action Plan, an environmental change charity, has been working with the North East and North Cumbria (NENC) Integrated Care System (ICS) over the last six months to identify opportunities to drive change around air quality improvement at healthcare access points.

The project aims to make sure air quality levels are controlled around health centres and help to protect the people who need to visit hospitals most frequently.

Newcastle upon Tyne Hospitals NHS Foundation Trust has committed to ensuring all employees will be given basic sustainability training. The green procurement is to be embedded across the organisation with the aim of encouraging all ICS members to switch to a renewable energy tariff.

The findings from the pilot project were published on 17 May in the ‘Levers for Change’ report. The report highlights how air pollution is linked to health challenges and inequalities and identifies key opportunities that developing an ICS focused action plan would present.

The progress being made in the NENC region forms part of the broader Integrated Care for Cleaner Air initiative with the goal of improving air quality around all healthcare access points in England.

Newcastle Hospitals, Global Action Plan, and Boehringer Ingelheim have formed a partnership with the joint goal of supporting every ICS in England to become a ‘Clean Air Champion.’

In preparation for ICS statutory footing in July, ICS leaders are currently submitting system-wide Green Plans. Many are already incorporating air quality improvement measures around hospitals as part of their broader commitment to tackle environmental challenges.

James Dixon, Associate Director Sustainability at The Newcastle upon Tyne Hospitals NHS Foundation Trust, said: “Sadly we know that people in the North East and North Cumbria are disproportionately burdened by ill health.

“The research presented in the ‘Levers for Change’ report is key to understanding the impact that air quality has on the health outcomes of the people of the region.

“The framework will be an extremely useful resource for us, as an ICS to use, to identify ways to work across organisations and reduce the impact that poor air quality has on the health and quality of life for the most vulnerable members of our society.”

Larissa Lockwood, Director of Clean Air, Global Action Plan, explains: ‘It is vital that we tackle air pollution at the regional ICS level, with partners from all across the health system, across primary and secondary care but also with local government.

“It is vital that everyone understands the NHS cannot tackle air pollution alone. Insights from the ‘Levers for Change’ report will be packaged into an interactive, freely available tool for all Integrated Care Systems in England to use. This tool will build on the Clean Air Hospital Framework developed in partnership with Great Ormond Street Hospital.”

Over half of Brits say their health has worsened due to rising cost of living

By Gabriel Blaazer

Over half of Brits (55 per cent) feel their health has been negatively affected by the rising cost of living, according to a YouGov poll commissioned by the Royal College of Physicians (RCP).

Of those who reported their health getting worse, 84 per cent said it was due to increased heating costs, over three quarters (78 per cent) a result of the rising cost of food and almost half (46 per cent) down to transport costs rising.

One in four (25 per cent) of those who said that their health had been negatively affected by the rising cost of living, had also been told this by a doctor or other medical professional.

16 per cent of those impacted by the rising cost of living had been told by a doctor or health professional in the last year that stress caused by rising living costs had worsened their health. 12 per cent had been told by a healthcare professional that their health had been made worse by the money they were having to spend on their heating and cooking.

The experiences of RCP members who responded to the poll include a woman whose ulcers on their fingertips were made worse by her house being cold and a patient not being able to afford to travel to hospital for lung cancer investigation and treatment. Other reports include respiratory conditions such as asthma and COPD being made worse by pollution and exposure to mould due to the location and quality of council housing.

Health inequalities – unfair and avoidable differences in health and access to healthcare across the population, and between different groups within society – have long been an issue in England, but the rising cost of living has exacerbated them.

The Inequalities in Health Alliance (IHA), a group of over 200 organisations convened by the RCP, is calling for a cross-government strategy to reduce health inequalities – one that covers areas such as poor housing, food quality, communities and place, employment, racism and discrimination, transport and air pollution. The government recently announced that it will publish a white paper on health disparities and the IHA is calling for it to commit to action on the social determinants of health. These largely sit outside the responsibility of the Department of Health and Social Care and the NHS.

Responding to these findings, Dr Andrew Goddard, President of the Royal College of Physicians, said: “The cost-of-living crisis has barely begun so the fact that one in two people is already experiencing worsening health should sound alarm bells, especially at a time when our health service is under more pressure than ever before.

“The health disparities white paper due later this year must lay out plans for a concerted effort from the whole of government to reduce health inequality. We can’t continue to see health inequality as an issue for health directives to solve. A cross-government approach to tackling the underlying causes of ill health will improve lives, protect the NHS and strengthen the economy.”

Professor Sir Michael Marmot, Director of the UCL Institute of Health Equity, commented: “This survey demonstrates that the cost of living crisis is damaging the perceived health and wellbeing of poorer people. The surprise is that people in above average income groups are affected, too. More than half say that their physical and mental health is affected by the rising cost of living, in particular food, heating and transport.

“In my recommendations for how to reduce health inequalities, sufficient income for a healthy life was one among six. But it is crucial as it relates so strongly to many of the others, in particular early child development, housing and health behaviours. As these figures show, the cost of living crisis is a potent cause of stress. If we require anything of government, at a minimum, it is to enable people to have the means to pursue a healthy life.”

Also responding to the survey was NHS Providers Chief Executive, Chris Hopson, who said: “Trust leaders are acutely aware of the soaring cost of living crisis facing the nation and the impact rising financial pressures could have on people’s health.

“This is particularly concerning in the wake of the COVID-19 pandemic which exposed deeply entrenched social, racial and health inequalities. As highlighted in this survey, there is a risk that the current cost of living crisis widens those inequalities.

“Trust leaders share the view that there is an opportunity to tackle the factors which lead to health inequalities and poor health. They have committed time and resource to reducing inequalities across their local communities.”

Health Inequality, News, Population Health, Primary Care, Thought Leadership May 17, 2022

How ICSs can help uproot risk aversion and progress innovation

By David Duffy

Integrated Care Journal speaks with Kathy Scott and Aejaz Zahid of the Yorkshire & Humber Academic Health Science Network (AHSN) on how the implementation of a dedicated innovation hub within ICS frameworks has helped to streamline innovation and improve patient care.

Above: Barnsley Hospital, part of South Yorkshire and Bassetlaw ICS.

Integration and innovation are two increasingly prominent principles that are, in part, designed to address the growing problems of unmet health needs. Each is intended to supplement and support the development of the other.

Integrated care systems (ICSs) offer new frameworks through which innovation can be adopted at scale, streamlining past previous bureaucratic and individualistic barriers to change and adopting a transformation led approach. Innovation is crucial in turning the core aspirations of integrated care into tangible realties, to use technology and sophisticated approaches to data to help address the root causes of ill-health and expand health service offerings.

The above outlines the core principles of integration and innovation, which can be found reiterated from a wealth of sources, if one is to engage in the sector for even a few days. Integrated care is not a new concept and neither is innovation, so how are these two principles coming together to improve patient outcomes in reality?

“There is a vast range of unmet need across the whole health and care sector.”

“There is a vast range of unmet need across the whole health and care sector,” says Aejaz Zahid, Yorkshire & Humber AHSN’s Director for the ICS Innovation Hub at South Yorkshire & Bassetlaw Integrated Care System (SYB ICS). “Much of this is of course clinical, but a huge part of this is more operational, system level needs.

“The ICS needs intelligence on all of this, but then must ascertain how it can use innovation to leverage economies of scale in terms of investing and finding solutions to those problems and challenges. What we are trying to do within the innovation hub is create straightforward and easily accessible processes which enable busy staff working on the ground to regularly bring those challenges and problems to our attention, while enabling ICS leadership to ascertain and prioritise needs which could benefit from a systemwide innovative solution.”

The ICS Innovation Hub is a single point of contact for health and care innovators in the SYB region. The hub works, via the AHSN, to identify and validate market ready innovations and help drive improved health outcomes, clinical processes and patient experience across the SYB health economy. The idea to set up a dedicated innovation hub within an ICS was developed by the Yorkshire & Humber Academic Health Science Network (Yorkshire & Humber AHSN) and has proved a successful model to help spread and adopt innovations at pace and scale. Yorkshire & Humber AHSN also provides innovation support to three different ICSs in the region.

Fostering a culture of innovation

Explaining how the Hub, and by extension, Yorkshire & Humber AHSN are working to cultivate innovation in the region, its Chief Operating Officer and Deputy CEO, Kathy Scott says “it is as much about identifying good practice as it is implementing the ‘shiny stuff’.

“As an AHSN we also have sight of a lot of potential solutions that can address those needs often identified by the innovation hub. So, we are able to nudge the ICS leadership towards potential solutions.

“We can push out new ideas and innovations as much as we like, but if you don’t have that culture of innovation and improvement there, it’s not going to stick.”

“It’s about growing the capability and capacity for change within a locality and for improvement techniques and innovation adaptive solutions to be implemented. Not simply implementing new technology and essentially running away.

“We can push out new ideas and innovations as much as we like,” continues Kathy, “but if you don’t have that culture of innovation and improvement there, it’s not going to stick.”

The ICS’s digital focus has also enabled significant work on pre-emptive care. For example, through the Yorkshire & Humber AHSN’s digital accelerator programme Propel@YH, the AHSN has worked with innovator DigiBete to support the adoption of their “one stop shop” app to help young people living with diabetes manage their treatment.

The app was clinically approved during the height of the pandemic, with extra funding provided from NHS England, and is now being used in 600 services across England. “This is an excellent example of how we can pre-emptively assess unmet need and streamline innovation into the system,” says Kathy.

Innovation as an antidote to health inequality

“Health inequalities are part of our design thinking from the get-go in any project,” says Aejaz, who points to the recent implementation of SkinVision, a tele dermatology app, as an example.

“The app was originally developed in the Netherlands, where predominantly you would have Caucasian skin that the AI would have been trained on,” he explains, “so, from the beginning, we have been mindful to capture more data on how well the app works on other skin types and feed that back to the company to improve their AI algorithms for wider populations.”

The Innovation Hub also works to ensure that implementing digital technology does not exacerbate inequality for less digitally mature users. “If somebody, for example, doesn’t have a smartphone that is able to run that app, there is always the non-digital pathway in parallel. So, it’s never either/or.”

An appetite for risk

“There is always a level of risk aversion when it comes to adopting something new in healthcare,” says Aejaz, “even with evidence backed solutions, we find there’s sometimes a level of reluctance. Staff want to know whether it’s going to work in their local context or not and whether introducing innovation would entail a significant ‘adoption’ curve. Building enthusiasm around a new idea and overcoming hesitancy to innovation is, therefore, central to the role of organisations such as the AHSN and, by extension, ICS innovation hubs.

“Building a culture of innovation is fundamentally about building a culture of increased risk appetite, where failure is most certainly an option.”

“Building a culture of innovation is fundamentally about building a culture of increased risk appetite, where failure is most certainly an option,” Aejaz continues. “We need to create systems which provide innovators with the necessary psychological safety that allows them to experiment.”

To help shift the mindset of NHS staff in favour of innovation, the Innovation Hub established a series of ‘exemplar projects’, designed to erode the fear of failure and capture learnings in the process. For example, for Population Health Management exemplars, one of the priority themes for the ICS, the hub called for providers to submit ideas to the Hub, all framed under high priority population health challenges such as cardiovascular health. Successful applicants with promising ideas received funding in the region of £25,000 as well as co-ordination support from the Hub towards their project.

The programme has enabled frontline innovators and has led to the development of a host of new services incorporating novel technologies, such as virtual wards and remote rehabilitation. The Hub is also working to transform dermatology pathways throughout the SYB region by introducing an app that allows patients to upload images of skin conditions and be processed more efficiently through the system. Funded by an NHSx Digital Partnerships award, this pilot project with Dermatology services in the Barnsley region will test out the use of this AI-enabled app to ascertain how well it can successfully identify low risk skin lesions which can be addressed in primary care. Thereby reducing demand on secondary care and speeding up access for higher risk patients. Each of these projects demonstrate the capacity for transformation when on the ground staff are given the freedom to innovate.

Interestingly, many of the ideas that the Hub works with are non-tech solutions. For example, primary care providers working with local football teams via a 12-week health coaching programme to engage with fans who may be at risk of cardiovascular disease, or introducing Cognitive Behaviour Therapy techniques to patients with severe respiratory conditions to help reduce anxiety when experiencing an episode of breathlessness.

To nurture a mentality more open to change, the Innovation Hub has developed learning networks across South Yorkshire. Through these networks, the Innovation Hub and AHSN teams have been reaching out to key leads from each of the provider organisations who are involved in innovation, improvement or research and invited them to become innovation ambassadors. “These ambassadors have become our eyes and ears on the ground across health providers, where they can start to introduce what we do and also help capture unmet needs from colleagues in their respective organisations,” explains Kathy.

Following in the footsteps of the first innovation hub established by the Yorkshire & Humber AHSN in South Yorkshire, other AHSNs across the country are now looking at setting up innovation hubs within their ICS by bringing leadership together, getting them out of their ‘comfort zone’ and giving them the space to innovate, and hoping to chip away at risk aversion and fear of experimentation. Introducing solutions outside of traditional domains will enable a culture of innovation and improvement. To streamline past bureaucratic and individualistic hurdles, ICS frameworks are key to facilitating transformational change in every region of the country.

If you would like to find out more about the Yorkshire & Humber AHSN, please contact info@yhahsn.com

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New digital maternity pathway goes live in Devon

By TPP UK

TPP SystmOne Maternity technology goes live at Torbay and South Devon NHS Foundation, digitising the entire maternity pathway, from ante to postnatal care.

This week, Torbay and South Devon NHS Foundation Trust have gone live with TPP SystmOne Maternity. The system has enabled the Trust to digitise their entire maternity pathway, from antenatal through to postnatal care. It is being used by all midwives in the region, including those based at the hospital and those working in the community. More than 2,500 women will benefit from the new system every year, with their maternity care now centred on a complete, integrated digital care record.

Following the go-live, midwives now have instant access to all of the maternity data they need. For example, midwives working in postnatal care can easily view all antenatal care and delivery details. All medical and nursing notes are captured in a single record. This provides staff with the information required to make the best clinical decisions and improve safety for mothers and babies. Advanced functionality in the system is also supporting staff with the management of more complex pregnancies, through enhanced clinical decision support, alerts, and a complete maternity timeline.

TPP maternity — TPP SystmOne Maternity in use at Torbay Hospital

There has been strong clinical engagement throughout the project, from midwives, doctors and nurses. The teams have used TPP’s powerful Clinical Development Kit (CDK) functionality to develop exactly the data entry templates and visualisations they wanted. All staff members can quickly capture the information they need for a complete antenatal, labour, delivery and postnatal record. The Trust have also used CDK functionality to create customised safeguarding content, helping to support and protect the most vulnerable families. Staff are also benefiting from interactive inpatient screens in the system, allowing them to manage bed capacity and perform safe, efficient handovers.

The go-live has also included providing TPP’s smartphone application, Airmid, to all women under the maternity service. This is putting women at the very centre of their pregnancy journey. Airmid allows women to access their maternity records, manage their upcoming appointments, complete questionnaires at home, and receive personalised advice and education material. Airmid supports better engagement and seamless communication between women and their maternity care team.

SystmOne also provides significant improvements to integrated care across the region and to multidisciplinary working. For example, maternity staff can immediately access any important information entered by GPs. This is significantly improving patient experience. Women only have to tell their story once, without having to repeat themselves. GPs can directly refer into the maternity unit, improving efficiency across both services. Additionally, all new births are now automatically registered with regional Child Health services, with no extra burden placed on NHS staff.

Tracy Moss, Head of Strategic Systems’ Software Development at the Trust, said: “We are excited to be working with TPP to introduce a new maternity IT system here at Torbay and South Devon NHS Foundation Trust. The new system is expected to bring a wealth of clinical as well as efficiency benefits for our maternity teams and the wider organisation. The families we care for will also benefit from the system, as the new associated Airmid patient app will allow them to view their records, access information and be more involved in their care. Moving forward, we would like to continue to work with TPP to deploy other SystmOne products, both within our maternity unit and across our wider Torbay and South Devon organisation.”

Charlotte Knowles, Managing Director at TPP, said that “maternity services will always hold a particular place in my heart. Having had three babies, I know, from personal experience, what a superb job they do. We are delighted that the Trust are already seeing significant benefits for staff and patients from TPP Maternity. The dedication of the staff here has been truly inspiring. We are looking forward to working together to continue to make better use of technology to improve the experience and outcomes for pregnant women and their families.”

Government failing on social care and health inequalities

By Kari Gerstheimer

The government’s failure to reform social care funding in the Health and Care Act is compounding regional health inequalities, writes Kari Gerstheimer, CEO and Founder of Access Social Care.

Speaking before a Cabinet meeting last month Boris Johnson stated that: “With household bills and living costs rising in the face of global challenges, easing the burden on the British people and growing our economy must be a team effort across Cabinet.” He added that “we will continue to do all we can to support people without letting Government spending and debt spiral, whilst continuing to help Brits to find good jobs and earn more, no matter where they live.”

However, the Prime Minister’s own assurances on protecting the British public from rising costs were set against the Government’s actions regarding the Health and Care Act, which has just been enshrined in law.

The Prime Minister continues to make promises to help the British people with the growing cost burden, while the Health and Care Act leaves those on the lowest income exposed to spending a greater proportion of their assets on care costs, during the worst financial crisis we have seen in generations.

The Government’s own amendment to the Bill, which was subject to a fierce debate in both chambers of Parliament before ultimately being voted through, means that the local authority support people receive to help them meet their care costs, will no longer count towards the proposed £86,000 cap.

This is all the while that the PM has continued to make promises to address the decades-long social care funding crisis and widening health inequalities. The £5 billion in extra money announced for social care over the next 3 years, is of course welcome. But there is no mathematical link between the amount of money and the level of need. The Health Foundation calculates that at least £8 billion are needed per year, just to deliver what councils are legally obliged to.

Failure on “levelling-up”

Research commissioned by Access Social Care, which provides free legal advice for those with care needs, shows that poorer areas with lower council tax and business rate yields have been worse affected by the reduction in the central Government grant for social care.

This means that people living in poorer areas where social care need is often the greatest, are already getting a bad deal compared to other parts of the country, which flies in the face of the much-vaunted concept of “levelling-up.”

Rather than addressing this unfairness, the Government’s amendment is compounding it, by leaving people living in ‘red wall’ areas having to spend a greater percentage of their total assets on care.

The Health and Care Act is a clear contradiction in the PM’s assurance to focus efforts on easing the burden for British people and protecting the public from rising costs. It will instead deepen the cost of living to the poorest of our society and widen long-standing health inequalities.

Access Social Care are already seeing cases where the cost of living crisis means that people cannot afford the social care they so desperately need. The Government urgently needs to do more to ensure that everyone can get the social care they need, at a price they can afford.

The UK must harness data and digital to revamp stroke aftercare – Mike Farrar

By Mike Farrar

Stroke is the single largest cause of complex disability and long-term thinking around stroke aftercare is critical in easing pressure on health and social care.

The NHS Long Term Plan places stroke aftercare as a key priority area for improvement. However, ongoing data shows that the promises to ensure the best performance in Europe for delivering clot-busting thrombolysis by 2025 and increasing the number of patients receiving reviews of their recovery needs (from 29 per cent to 90 per cent), is unlikely to be met.

The stroke pathway has seen significant improvements over the last decade. These include the introduction of hyperacute stroke units, improved brain-imaging, rapid thrombolysis and game-changing thrombectomy. However, it is likely that these interventions will be undermined by the failure to recognise the opportunities to help people return to productive lives after a stroke.

Stroke care is an area that has seen substantial improvement in the UK; while mortality rates have halved over the last 20 years, stroke remains the single largest cause of complex disability. Further to this, recent research from the Stroke Association five-year survival rates remains low.

The Stroke Association estimates that 100,000 people have a stroke in the UK every year, with two thirds of survivors leaving hospital with a disability. There are currently 1.2 million stroke survivors living in the UK, at an estimated cost to the health and care sector of £26 billion a year. This cost is expected to triple by 2035.

Missing parts of the stroke pathway

The provision of rehabilitation and aftercare is an essential element of the care pathway yet is often the least well supported and resourced, a situation not solely limited to stroke care.

This is not unique to the UK and clinicians in the USA are experiencing similar issues. Once a patient has left an acute situation, where the latest interventions, medications and technological advancements have been provided, the same level of attention just isn’t there post-discharge. There is often a marked deterioration in wellbeing with an undetermined longer-term impact.

Stroke aftercare: a faulty mindset

There is an underlying mindset within the system that the priority lies with acute care management and what happens after is less important. As a system, crisis response is generally exceptional, and innovation and resources tend to be focused on this stage of patient’s journey. But there is very little strategy – and the funding treadmill is perpetuated by continually focusing investment on acute interventions. But it is clear that the cost benefit is poor if a more strategic view of the whole care pathway is not taken.

The failure to provide effective rehabilitation immediately after an acute episode can lead to reduced functioning mobility and normal life for the individual. The consequence of this failure is an added cost for the health and care system, reduced economic productivity and can increase social care costs if it leads to patients losing their ability to live independently.

Masking the real data

The data currently collected typically identifies re-admitted patient episodes as a new case rather than allowing the system to recognise and then count it as a re-admission. This often masks the failure of the rehabilitation and ongoing support offered, which could have prevented further problems.

The link to co-morbidities is also missing, with more people dying in the first six months after a stroke from cardiac events, rather than consequences of a stroke – which means we are overlooking opportunities to influence outcomes in other ways.

The cost of high-quality rehabilitation may pay itself back over time but immediate cost pressures in the system can often mean that rehabilitation is not funded as a priority, in turn reducing patient outcomes.

Balancing the funding model

So, what should the path forward be from here? The key to achieving the right balance is to argue the need for a greater use of data and to provide the evidence to build up the business case. There are some professionals and clinicians leading the charge and looking for that evidence to balance the funding model.

The Mount Sinai health system in the USA recruited a randomly selected sample of people who were enrolled in a remote monitoring programme. Of the sample, 90 per cent of the sample had a crisis that the health system could have intervened on. Without the follow-up, these crises would never have been caught.

In Cardiff and Vale in Wales, they’re currently trialling a system that joins up the data to the patient – rather than the episode – to track the re-admissions and the patient’s entire journey through the health system. The data outcomes are providing interesting insights into chronic conditions and helping to modify care providers’ understanding of where they put their money.

The role of data and digital in stroke aftercare

There is also seeing a role for digital platforms to be used for virtual rehabilitation. There are many ways to do this and the growth of digital care technology in local authorities should be used to support and endorse these changes across the whole health and care system. As an example, Visionable’s platform allows any deterioration in health to be identified early to prevent serious problems occurring, including readmissions. As people wait longer for care, this early warning is crucial to avoid patient harm.

There’s a real opportunity to shift the way rehabilitation pathways are approached, and how outcomes are tracked. This dialogue should really appeal to the new integrated care systems and their integrated care boards as the NHS embark upon seismic structural shifts in 2022.

Through system-wide commissioning, there is the opportunity to balance the investment and provide transformation – and to deliver a genuine whole pathway, including more robust rehabilitation services. Enhancing data capture in real-time and making sure the money follows the patient could produce marked differences – not only for the public purse, but in the quality of people’s lives.

New IPPR report argues health is ‘holding back UK economy’

By Niamh Macdonald

The UK will suffer an £8 billion hit to economic activity this year due to lack of government action to improve the nation’s health, according to a report launching the new cross-party IPPR Health and Prosperity Commission.

The IPPR report published today marks the launch of a new Commission on Health and Prosperity. The report warns that health inequalities and ineffective policies are shortening life expectancy in the UK, coupled with more years spent in poor health.

New analysis by IPPR and health analytics company Lane, Clark & Peacock, reveals that the workforce is also being affected as people face barriers to staying in work.

The IPPR is calling for a ‘new post-pandemic approach’ to the nation’s health to ensure that people can live long healthy lives as well as to strengthen the UK’s suffering economy.

There are now more than a million workers missing from the workforce compared to pre-pandemic levels. About 400,000 of these individuals are no longer working due to health factors, including long Covid, disruption to healthcare and declining mental health. The researchers warn that without intervention, this will drag down economic activity this year by approximately £8 billion.

The report states that the relationship between health and the economy is a decisive factor in the UK’s low productivity, low growth and significant regional inequalities.

According to the report, local level analysis reveals that someone living in North East Lincolnshire can expect to fall into bad health eight years than the UK average, while the output of their work is also valued at £8 less than the average. The report argues that this is a vicious cycle and that factors like lack of job opportunities can harm people’s health.

To explore how good health can be the foundation for a fair and prosperous economy, IPPR is launching a new cross-party Health and Prosperity Commission. The cross-party commission will be chaired by Lord Ara Darzi and former Chief Medical Officer Dame Sally Davies.

The report argues that the UK’s poor health outcomes and stagnant economy are a result of poor policy choices. According to IPPR, policy makers must now ‘set about putting the building blocks of good health in place’, including ‘good work, quality housing, local public health services’ and a ‘well-funded and staffed NHS. ‘

Dame Sally Davies, former Chief Medical Officer and co-chair of the Commission on Health and Prosperity, said: “A fairer country is a healthier one, and a healthier country is a more prosperous one. While the restrictions have eased, the scars of the pandemic still remain deep on the nation’s health and our economy.

“Not only are we facing a severe cost of living crisis, driven in part by pandemic induced inflation, we’re also experiencing a workforce shortage driven by poor health that’s holding back the economy. It has never been more important to put good health at the heart of our society and economy – and our commission will bring forward a plan to do just that.”

Matthew Taylor, NHS Confederation chief executive and commission member said: “The pandemic has shown how deep health inequalities shape and cut across the lives and livelihoods of people across the country.

“Yet this is not new, disparities in health have not suddenly appeared, they have been part of the make-up of our society for decades. As millions of people now face the reality of a cost-of-living crisis there is an urgent need for a much bolder and more strident approach to tackling inequalities to create improved population health and stronger economic wellbeing.

“We are delighted to be part of the Commission on Health and Prosperity and look forward to reflecting member insight. ”

WHO reveals almost entire global population breathing unhealthy air

By Niamh Macdonald

Almost the entire global population (99 per cent) breathes air that exceeds World Health Organization (WHO) air quality limits, and threatens their health, according to the 2022 update of WHO air quality database.

The new air quality database, released on 4 April, is the most extensive yet in its coverage of air pollution exposure on the ground. The database now includes measurements of annual mean concentrations of nitrogen dioxide (NO2), a common urban pollutant and measurements of particulate matter with diameters equal or smaller than 10 μm (PM₁₀) or 2.5 μm (PM_2.5).

A record number of over 6,000 cities in 117 countries are now monitoring air quality, revealing how their populations are breathing unhealthy levels of fine particle matter and nitrogen dioxide. The data also shows that people in low and middle-income countries are suffering the highest exposures.

A worsening health emergency

The database demonstrates the threat of air pollution to human health. Particulate matter is capable of penetrating deep into the lungs and entering the bloodstream which can cause cardiovascular, stroke and respiratory impacts. There is also emerging evidence that particulate matter impacts other organs and causes other diseases.

Nitrogen dioxide is associated with respiratory diseases, particularly asthma, which lead to respiratory symptoms, such as coughing or difficulty breathing. This further leads to increased hospital admissions and visits to emergency rooms.

Dr Maria Neira, WHO Director, Department of Environment, Climate Change and Health, said: “After surviving a pandemic, it is unacceptable to still have 7 million preventable deaths and countless preventable lost years of good health due to air pollution. That’s what we’re saying when we look at the mountain of air pollution data, evidence, and solutions available. Yet too many investments are still being sunk into a polluted environment rather than in clean, healthy air.”

Last year, WHO responded to the growing evidence base for the significant harm caused by even low levels of many air pollutants by revising its Air Quality Guidelines. The guidelines were made more stringent, especially for Nitrogen dioxide and particulate matter, an action that was supported by the health community, medical associations and patient organisations.

Now, through the 2022 database WHO aims to monitor the state of the world’s air and feed into progress tracking of the Sustainable Development Goals.

Commenting on the report, Francesco Tamilia, Policy Analyst at Public Policy Projects and author of The climate crisis and its impacts report said: “The science and data are increasingly clear on the extreme threat air pollution poses on human health, damaging every organ in the human body. World Health Organization has done an incredible job revising its Air Quality Guidelines last year, making them more rigorous. The latest air quality database is another important step in measuring the damaging affects air pollution has on the population’s health.

“National governments have no excuses, either they implement those guidelines and avert millions of premature deaths, or they will knowingly neglect the health of their populations.”

More support needed for “fatigued” social care workforce

By Mary Brown

On the 16th March 2022, Public Policy Projects (PPP) hosted an evidence session entitled The Social Care Workforce: Averting a Crisis as part of its report series The Future of Social Care. PPP’s Social Care Network examines the most urgent issues facing social care and presents tangible solutions to address workforce challenges in the sector.

The crisis facing the social care sector is fundamentally a workforce one. The sector itself is a large employer in the UK, employing about 1.54 million people, equivalent to five per cent of the workforce. As one participant noted, “the sector itself is a huge contributor to the economy and to society”. Given that staff pay is the single biggest expenditure faced by care homes, workforce management should be front and centre whenever system finances are being considered.

Even before the pandemic, there were about 112,000 social care vacancies in England, with jobs paying only £8.50 an hour. Following the pandemic, the vacancy figures are assumed to be worse. Key issues driving individuals away from working in the social care sector include low pay, stressful working conditions and a low sense of worth.

A participant of the evidence session emphasised that the working conditions of the social care sector have led to 74 per cent of care professionals reporting that they regularly experience stress at work, an average number of sick days 25 per cent above the national average, and a staff turnover rate significantly higher than the national average.

As phrased by one participant, social care is suffering from a “fatigued workforce” not only due to the pressures of the pandemic, but issues which have existed within the sector for much longer. The problems within the social care workforce are chronic , and are considered by many to constitute a crisis. As one participant said, “clearly a workforce strategy is one of the absolute essentials that we need to have to make a success of the sector over the next decade or so”.

“The social care sector should work alongside recruitment organisations to recruit young, bright people into social care, and help them consider where a career may lead.”

One problem identified was narrow recruitment to the sector. It was stressed that within social care, “we should cast our nets wider in a recruitment approach… and recruit not only people with previous experience”. The social care sector should work alongside recruitment organisations to recruit young, bright people into social care, and help them consider where a career may lead.

It was also suggested that more effort must be made to recruit hard-to-reach and underemployed groups, including people living with disabilities, and immigrant workers. “What frustrates me is that there are individuals in these groups who can be wonderful, caring staff [but]are missed, because hiring managers are too narrow in their focus”, said one participant.

Staff retention rates in social care are low. Network members noted that social care workers often leave the sector for other, similarly paid jobs, such as retail roles, while few choose to leave and work for the NHS. One network member identified that “between care assistants in the NHS and the social care sector, there is around a 23 per cent deficit in social care. The terms and conditions are vastly better in the NHS. Pensions, sick pay, overtime and unsocial hours all contribute to that deficit.”

Essentially, social care workers are underpaid and undervalued. For both better recruitment and retention, social care workers must be appropriately paid and treated as though they are valued. Some network members identified low pay as the key driver for individuals choosing to leave the social care workforce, and yet, it was emphasised that social care is a both a skilled and psychologically demanding profession, and should be commensurately well-paid.

However, funding in the system is limited, and paying the workforce is the sector’s single biggest expense. One participant said “there is not a settlement from government or local government that actually meets the cost of care to enable us to pay a proper wage for the level of skill, ability, responsibility, dedication that [care workers] have”. Furthermore, a high proportion of social care workers are on zero-hours contracts; in London, this figure stands at 41 per cent of social care workers. Therefore, many social care workers have to deal with pay inconsistency and insecurity, on top of being low-paid.

“Network members were in agreement that social care is, and should be publicly regarded as, a skilled profession.”

While pay is regularly described as the most pressing issue in the workforce, one participant argued that in their experience of conducting exit interviews with workers, it is not low pay, but rather a low sense of worth which leads people to leave the profession. While higher pay is one way in which care workers can be practically appreciated, it was agreed that more must be done to value care work both by improving the public image of care workers and ensuring that internal structures provide support and give value to workers.

Network members were in agreement that social care is, and should be publicly regarded as, a skilled profession. “It is not the kind of job that everyone can do,” said one participant. “It is a skilled job, which requires the creation of quality human relationships and working with people who have complex care needs… it is a real skill and should be regarded as the same as working in health.”

Social work is challenging and worthy of respect, all participants agreed. One commented that “no two days in social care will be the same; you have to be agile and move with that, so it does take very special people to take those roles”. The public status of social care work must be elevated to reflect this, and the workforce to feel appropriately valued if these retention issues are to be effectively addressed.

Securing an integrated future

For a supported workforce, good leadership is essential. One participant noted that in the social care system “there is a varied approach to leadership”, and good leadership is not always evident in the system. Given the demanding nature of social care work, it is essential that carers feel well supported in their roles. One participant added that “workers do not stay because of a good job, they stay because of a good manager”, and therefore, proper leadership training must be a central goal of the workforce plan.

A practical solution suggested by one of the network members to combat low recruitment, retention and the poor image of the profession was a ‘social-care-first’ scheme, mirroring the successful teach-first scheme. Many other sectors have emulated the ‘teach-first’ template with great success. The aim of the scheme is to engage with young people to consider social care work as a career by espousing the value of a career in care. Such a scheme would emphasise how care work has the potential to transform the lives of dependent individuals, and the importance and value in building personal relationships with system users, improving the image of the profession. As part of the scheme, there should also be structured leadership, coaching and mentoring training, for the purpose of also transforming the quality of social care. This may serve to solve some of the leadership issues in the sector, as young and bright individuals will be well trained to manage and lead social care in the future.

Now that the NHS and social care are moving towards integration, participants noted that for a true and fair integration of the systems, employees should be paid and treated equally. One participant called for a joint recruitment scheme for the NHS and social care, with equal pay offered. It was also emphasised that NHS workers receive many ‘perks’, particularly since the start of the pandemic, which social care workers do not (including food and drinks discounts from certain companies).

Other suggestions to aid the integration of the NHS and social care workforce included social care placements and secondments for NHS staff, in which they are exposed to social care, and the richness and value of social care work. The status of care work must be elevated for proper integration of the two systems can occur, in order that social work and NHS work can be equally respected.

A large part of the discussion focused on the role of volunteers within the social care sector, and the value they bring to both paid carers and system users. Volunteers are an invaluable part of the social care workforce given that they reduce pressure on care workers, improve patient experiences, facilitate higher quality of care to drive better health outcomes, and strengthen community connections. One participant said that in the context of social care, “volunteering is a public health tool. There is a body of medical research which talks about the huge benefits for mental health and physical wellbeing for patients”. Volunteers also serve to raise the visibility of the social care sector.

Since the start of the Covid-19 pandemic, the UK has seen an unprecedented rise in the numbers of people volunteering in their local communities. During the pandemic, the UK had 12.4 million people volunteering in their local communities. 4.6 million of these were first-time volunteers. Currently, the UK has a window of opportunity to make the most of the interest in volunteering to reduce the immense pressure on care workers.

As part of the workforce strategy, there needs to be investment to drive the volunteer sector, for the wellbeing of the social care system and its users. However, time is undoubtedly of the essence; as one participant emphasised, “there is an urgency to the conversation we are having. As Covid dissipates, what we don’t want is for people to go back into the corners of their community and not come out again to contribute.”

How integrated care systems can improve digital inclusion

By Gabriel Blaazer

Sarah Boyd, Head of Digital Experience and Transformation at Norfolk & Waveney Health and Social Care Partnership (NWHSCP), explores how her integrated care system (ICS) is using digital health to improve patient inclusion and help reduce health inequalities.

Health inequality is a growing problem but is still too often discussed separately from the core business of the NHS. Patients are treated through siloed care pathways, with conversations about why some populations have poorer health outcomes often treated as an aside.

The pandemic brought this into greater focus, especially around digital inclusion. Technology rolled out across the NHS in response to Covid-19 often widened the gap between those who could access online services and those who couldn’t.

The benefits of ICSs

When it comes to digital inclusion, there is little doubt that ICSs offer a huge opportunity to deliver more equitable access to healthcare and improved health outcomes for those previously underserved by the health system.

NWHSCP is a new type of organisation, working as a system across the Norfolk and Waveney region. Operating across the public sector, along with health and social care, councils and with voluntary organisations, presents an opportunity tackle health inequality and exclusion in a person-centred way.

The ICS allows health leaders to work across organisational boundaries, to test assumptions about exclusion, and to leverage the work that happens at the level of individual places.

Fixing existing digital inequalities

At every stage, NWHSCP are ensuring that their digital projects address digital inequalities. By implementing a pan-public sector hub-and-spoke model that provides personalised support to excluded groups, their plan is to gain the wider benefits of digital inclusion by engaging people – not only in health services – but more broadly in society.

For example, if a GP detects that an elderly person in their care is socially isolated, they can refer them to a central digital inclusion service. From there, they may be passed to a library or volunteer service who are able to provide connectivity or a 5G-enabled device, along with the ongoing support to use it. This allows the patient to order repeat prescriptions, but also to food shop online or video call family and friends, with positive benefits for their wider health and wellbeing.

“Creating an environment in which every service is digitally inclusive offers benefits not just to individuals, but also to wider society”

Asking people to go to an appointment at an unfamiliar location can create unnecessary barriers. As it proceeds, the ambition of NWHSCP is to work towards using services that people already access to provide a trusted contact point. If patients are already known to a church group or domestic violence shelter, for example, they might receive support there.

Through community partnerships, ICSs can build a network of digital tools and skill provision. For example, if a partially-sighted person, or family member, needs a speech-to-text reader, NWHSCP can point them towards their trusted toolkit. Once a person has access to this network, they can then download tools freely, ahead of their health needs.

Building an inclusive service

Creating an environment in which every service is digitally inclusive offers benefits not just to individuals, but also to wider society. As the Good Things Foundation’s Widening Digital Participation report found in March 2020, digital inclusion pays for itself in better mental and physical health, and stronger participation in the economy. For every pound spent, £6.20 is made back.

With this in mind, ICSs can leverage skills found in the private sector to identify new ways to increase inclusivity. Companies in the space include ThriveByDesign and CardMedic, an award-winning digital tool that provides instant access to communications options to improve engagement with healthcare professionals.

CardMedic is designed to help patients with a language barrier, visual, hearing or cognitive impairment, or to communicate through PPE and is unique in its space.

One issue with digital inclusivity tools is that they’re often seen as only affecting excluded communities, but digital inclusivity applies to everyone. Many people often struggle to retain emotionally-sensitive medical information, such as details about a cancer diagnosis. Tools like CardMedic allow any patient to review the basics of a hospital procedure or consultation – helping them to feel more secure in their care.

Applying innovation

Through pulling together with public sector and voluntary organisations, NWHSCP has built a strong, interconnected and multi-disciplinary team to implement their digital transformation agenda. As ICSs move towards statutory footing, the hope is to build on their initial successes though good recruitment and the implementation of innovative technology.

But there is only so much one system organisation can achieve on its own. To maximise the potential of integrated care systems, the NHS will require a national system for picking up on digital innovation. It should not be up to individual ICSs to find products, such as CardMedic, themselves. Digital inclusivity should be available to all.