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Extra Early Support Hubs funding welcome, but more needed, warns Royal College of Nursing

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The government is providing an extra £3 million to expand the number of Early Support Hubs across the country and reduce pressure on NHS services.


The Royal College of Nursing (RCN) has cautiously welcomed an extra £3 million of funding to expand access to Early Support Hubs for children and young people in England.

The 24 drop-in hubs will provide psychological therapies and specialist advice to children and young people, on issues such as mental health, sexual health, employment, drugs and alcohol and financial worries.

Following the government’s initial investment of £4.2 million in October 2023 to support 10 Early support hubs, the additional funding will see a further 14 hubs increase their service offering to children and young people. A network of 70 Early Support Hubs already operates across the country, run by a combination of volunteer organisations, NHS trusts and local authorities.

However, while welcoming the additional investment, the RCN has warned that the government needs to go further in supporting the mental health of young people and is urging the government to make similar commitments to improving workforce recruitment and retention.

The RCN’s Head of Nursing Practice and Professional Lead for Mental Health, Stephen Jones, said: “The RCN has repeatedly pushed the government to invest in early mental health intervention and we’re pleased to see these calls recognised with additional funding for early support hubs. But as demand continues to rise, this must be one step of many.

“Across England’s NHS mental health services, there are over 13,000 unfilled nursing posts, accounting for nearly 1-in-3 of all nurse vacancies. Shortages like this have real-world consequences, leaving staff unable to meet the needs of all patients suffering a mental health crisis.” Jones urged government ministers “not to become complacent and invest in the nursing workforce which delivers these vital interventions.”

The Deputy Chief Executive of NHS Providers, Saffron Cordery, has likewise urged the government to go further, saying: “Too many children and young people and their families face long waits for mental health and community health services vital for their wellbeing and development.

“We need a more joined-up, cross-government approach with equal national focus on community and mental health services to support children and young people as early as possible.”

The government says that it has increased spending on NHS mental health services from almost £11 billion annually in 2015/16 to almost £16 billion in 2022/23. It has pledged an additional £2.3 billion of funding a year but March 2024, aiming to extend mental health support to a further 345,000 children and young people, “regardless of [their] background or location”.

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Care England publish new “roadmap to a sustainable future for adult social care”

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“Pragmatic and deliverable” new plan makes recommendations to next incoming government and has received wide cross-sector backing.


Care England, the largest representative body for independent adult social care providers, has today launched Care For Our Future: The roadmap to a sustainable future for adult social care. The report, which has received backing from major representative groups from across the adult social care sector, sets out the sector’s priorities across three themes: workforce, funding and integration.

The publication issues a series of “pragmatic and deliverable” policy recommendations it describes for the next government to implement within 100 days, two years and five years of entering office. Care England describe these recommendations as striking “a balance between addressing the urgent needs of the adult social care sector and remaining pragmatic and deliverable amid a challenging economic and political landscape.” Key among these is the recommendation for the government to mandate direct adult social care representation at all ICS levels in England, a position long advocated by Public Policy Projects.

Care For Our Future makes the following recommendations:

Within 100 days of the next government taking office:

  • Mandate the professional registration of adult social care staff in England.
  • Zero-rate VAT for welfare services in England.
  • Mandate direct adult social care representation at all ICS levels in England

Within two years of the next Government taking office:

  • Implement a fully-funded £15 minimum care wage and develop parity of esteem with NHS staff.
  • Close the Fair Cost of Care funding gap and repeat the exercise at a sector-wide level.
  • Publish a strategy for hospital discharge which introduces a national tariff of £1,500 per week.

 Within five years of the next Government taking office:

  • Consolidate reforms within a fully-funded, long-term adult social care workforce plan.
  • Deliver a long-term adult social care funding settlement, with a £10bn annual funding boost.
  • Deliver a fully mapped prevention and integration plan.

The full Care For Our Future report can be accessed here.

The recommendations have been backed by a wide swathe of sector stakeholders, including Steve Brine MP, Chair of the Health and Social Care Committee, who said: “I fully support Care England’s call for a long-term workforce strategy for the adult social care sector. I hope that Ministers read the report carefully and provide a full response in due course.”

Speaking in support of direct adult social care representation at all ICS levels, Ian Smith, Chair of NHS Surrey Heartlands ICB, said: “At Surrey Heartlands ICS, the involvement of adult social care representatives on our Integrated Care Partnership and Integrated Care Board has been critical in ensuring the diversity of the entire sector is accounted for and heard. We encourage the Government and ICS colleagues to acknowledge the importance of such representation and commit to its facilitation through the measures outlined in Care For Our Future.”

Professor Martin Green OBE, Chief Executive of Care England, commented: “Adult social care affects all of us. From the vital care and support delivered to our loved ones to the £51.5bn contributed to the English economy every year, all our futures depend on a well-resourced and resilient sector. This roadmap harnesses the sector’s talent and enthusiasm to provide a blueprint for the next Government to move us towards the sustainable future our sector and society so desperately needs.”

“The recommendations are pragmatic, realistic and would deliver meaningful impact. This includes a multi-billion pound boost to the economy, shorter NHS waiting times and care work becoming a valued and rewarded career. It is incumbent upon the incoming Government, whatever their political persuasion, to put the future of adult social care at the heart of its vision for the country and this roadmap represents the foundations on which to do so.”

 

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‘7 in 10’ doctors see no end in sight for strikes

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A survey of GMC-registered doctors conducted by Doctors.net.uk finds that majority believe strikes to continue at least until next general election, with little optimism for near-term compromise.


Most doctors see no immediate end to strike action in England, and do not think their support will wane over time, according to a survey of more than 7,000 doctors.

Doctors.net.uk surveyed members across the UK for their views on what might happen next in the long-running dispute with the government over pay. The questionnaire listed five possible scenarios and doctors were asked how likely they thought each one was.

The scenarios are listed below in order of most likely to least likely, as predicted by respondents.

Scenario 1: Strikes continue indefinitely, or at least until the next general election

Nearly 7 in 10 doctors (69 per cent) predict this is either ‘very likely’ or ‘probably’ going to be the case, compared with just over 1 in 4 (26 per cent) who think this is ‘unlikely’ or ‘very unlikely’.

Yet, the health commentator and former NHS trust Chairman, Roy Lilley, thinks the longer the strikes go on for, and the more patients are impacted by postponed appointments, the more likely public opinion will come into play. “When push comes to shove, junior doctors will lose public support,” he said.

Scenario 2: The government agrees to negotiate, despite saying its last offer was ‘final’

More than half of doctors (58 per cent) think there is a good chance that negotiations will resume, but just over a third (37 per cent) are less optimistic. One doctor responding to the survey said: “Unfortunately both parties have taken extreme positions making it difficult to find a just compromise.”

Scenario 3: Strikes will stop but other action, such as working-to-rule, will be used

Professor Gregor Gall, an industrial relations researcher, thinks other forms of action are likely to be used but not as an alternative to walkouts, which he said “generate more pressure and a higher visibility for the action”. However, 46 per cent of doctors anticipate that this scenario could happen.

Scenario 4: The mandate for industrial action expires and is not renewed because of a lack of support from union members

Overall, doctors are confident that unions will be able to maintain sufficient support from their members to sustain prolonged strike action. About a third (32 per cent) think there is a chance support could dwindle, but the majority (61 per cent) think that is doubtful.

Scenario 5: The BMA backs down

More than 7 in 10 (72 per cent) do not see this happening. This view is supported by Professor Gall who thinks after trainees in Scotland voted to accept a pay offer, which includes a 12.4 per cent uplift for 2023-24, the BMA is unlikely to stop its campaign in England.


Current support for strike action

Nearly 4 in 5 (78 per cent) said they currently support strike action, with most saying their support would not diminish even if strikes were to continue. Just over 1 in 5 (22 per cent) said they do not support it.

Doctors typically lose pay when they go on strike, so the survey asked if financial reasons could impact how they feel. It also asked if moral or ethical issues could erode their support. Nearly 6 in 10 said both aspects would be unlikely to affect how they feel, but more than a third (37 per cent) do think those pressures could change their position.

Chance of fresh negotiations?

In July, the Prime Minister said the 6 per cent pay rise offer (an average uplift of 8.8 per cent for trainees) for 2023-24 was “final” and the government would “not negotiate again on this year’s settlements”.

However, Lilley told Doctors.net.uk that he predicts there will be movement on discussions. He said: “I would be surprised if a conduit hadn’t been opened and there weren’t talks happening probably about a three-year pay deal.”

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New framework agreement eases squeeze on hospital beds ahead of winter

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Agreement of free-to-access framework expected to help hospitals and providers to improve patient pathways from acute care to appropriate care settings.


Corporate services provider, NHS Shared Business Services (NHS SBS), has released a new framework agreement, Patient Discharge and Mental Health Step Down Beds Services, to support hospitals when discharging patients, and free up beds for those waiting to be admitted.

The procurement framework, Patient Discharge and Mental Health Step Down Beds Services, comes after NHS England set out its plans to mitigate winter pressures and improve care ahead of what it anticipates to be a “difficult” winter for the health service.

These plans include the creation of care “traffic control” centres to speed up discharge, increase ambulance hours and provide extra bed capacity. The “traffic control” hubs will act as a single place for staff to co-ordinate the best and quickest discharge options for patients, either at home or into social or community care settings.

Delayed discharge has long been a serious problem for the NHS, limiting its ability to provide care to new patients and driving waiting times to record levels. In June alone, the number of patients who no longer met the criteria to reside, but remained in hospital, was in excess of 12,000 daily, and analysis by The Health Foundation shows the NHS was forced to cut admissions by over half a million due to lack of beds.


Medically fit, ward confined

“Delays in discharge processes and limited capacity in social and community care, are making it challenging for NHS hospitals and mental health services to discharge patients appropriately,” said Elaine Alsop, Head of Category – Health, at NHS SBS.

“They remain inpatients, placing further strain on hospital resources, reducing the number of hospital beds available for new admissions, and at higher risk of hospital-acquired infections, loss of mobility, independence and re-admission.”


Streamlining the transition from hospital care, adding extra capacity

NHS SBS’s framework agreement enables NHS hospitals and health and care providers to use services like Virtual Ward support, Brokerage, and Discharge to Assess services – all of which can help them improve patient pathways from acute care to an appropriate care setting.

Uniquely, it also supports additional care in mental health settings with a Mental Health Step Down Care Beds Services offer – the provision of temporary care for those who need it until more permanent arrangements can be made.

Supported placements must provide safe, rapid assessments with an outcome of accommodation for patients aged 18 and over, currently experiencing mental ill-health, and being discharged from an acute ward for up to six months.

Elaine Alsop, added: “Free to access, our Patient Discharge and Mental Health Step Down Beds Services framework agreement is designed to support the transition of patients from hospital, reducing instances of pressure on acute hospital beds, Social Services and re-admissions. In turn, this enables health and care providers free up capacity to deal with other patients. improve quality of care and health outcomes.

“It provides a convenient, compliant and cost-effective means for NHS health and care providers, hospital trusts and Integrated Care Systems to use 12 carefully vetted suppliers at pace, ready for winter and beyond.”


For more information about the ‘Patient Discharge and Mental Health Step Down Beds Services’ framework agreement, contact the NHS SBS team at: sbs@hello.nhs.net.

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E-zec and ERS Medical merger announced

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The merger creates the UK’s largest provider of non-emergency patient transport services.


A merger has been announced between E-zec Medical Transport Services (E-zec) and ERS Transition Limited (trading as ERS Medical), creating the UK’s largest provider of specialist transport services to the NHS and local authorities. Together, the merged businesses will serve more than 50 commissioning bodies with the support of over 2,500 employees, from 55 operational sites nationwide. In 2022, the businesses generated a combined revenue in excess of £100m.

ERS Medical provides patient transport, medical courier and GP out of hours services to over 40 NHS and healthcare customers across the UK. In 2022, it completed approximately 700,000 patient journeys and transported over 10 million pathology samples. E-zec provides patient transport, mental health and specialist transport services to local authorities and in 2022, delivered over 720,000 patient journeys.

This partnership is strategically important to both companies and the breadth of service expertise is hoped to create a highly complementary merger. It delivers considerable geographical expansion, with near national coverage, and creates the unequivocal industry leader. This offers a unique opportunity to drive innovation and future growth. By combining operational best practice, expertise and high standards, the enlarged business will deliver enhanced benefits for employees, customers and better support for those in its communities.

Andrew Pooley, ERS’ owner and Chief Executive leaves the business to pursue other interests. Jeroen van Os, remains with the business and is appointed as Group Chief Commercial Officer, working with Craig Smith, Group Chief Executive Officer, and the wider executive team to integrate the two businesses and focus on growth potential.

Jeroen van Os, who becomes the group’s Chief Commercial Officer, said, “the team at ERS Medical set out to be the leading healthcare transport provider in the UK and have achieved significant growth over the last 5 years. To help unlock our future potential, we have taken the decision to partner with E-zec. Both businesses are specialists in non-emergency transport services and share a commitment to deliver high quality, people-oriented services. This naturally creates the foundations for a strong partnership, enabling the delivery of best-in-class services to our customers, patients and provides further opportunities for all colleagues. I look forward to joining the executive team and delivering our next phase of growth.”

Craig Smith, E-zec’s Chief Executive Officer added, “We are delighted to welcome ERS to our family. The health and social care sectors are undergoing rapid change and our partnership will truly help us to better support those in our communities who need us the most. We have much in common with a shared ethos and culture of care. This is an obvious partnership that strengthens our offering to our employees, customers and patients, while also giving us a platform for further growth. We have much to learn from each other and are excited about the next phase of our growth.”


For further information, please contact Katherine Ritchie on 020 8347 6183 or 07941 040021.

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Fujifilm unveils expanded pulmonology solutions portfolio with addition of new scope

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Fujifilm has unveiled its expanding pulmonology solutions portfolio at the European Respiratory Society (ERS) International Congress in Barcelona with the addition of a new slim bronchoscope.


Fujifilm, while known for its pioneering endoscope systems, is also an active manufacturer of bronchoscopes and other pulmonology solutions. Through the addition of its latest scope, the EB-710P, Fujifilm can now deliver its most powerful and comprehensive portfolio of pulmonology and bronchoscopy solutions to improve patient outcomes and early diagnosis.

Healthcare professionals continuously face the challenge to do more with less: less funding and less time. A lack of capacity in lung cancer screening can cause delays to diagnosis; early diagnosis is vital to support better patient outcomes. Fujifilm’s expanded product portfolio means the ability to support enhanced diagnostic pathways and treatment planning for patients suffering with their lung health, helping healthcare practitioners to improve patient care.

The suite of pulmonology solutions includes a broad product offering that a pulmonologist could need for the entire diagnostic patient care pathway – from screening solutions such as X-ray and CT, diagnostic solutions such as endoscopic systems, bronchoscopes, ultrasound mini-probes, and bronchoscopic navigation planning, all the way to cutting edge AI software and surgical planning software.

The expanded product portfolio includes the FDR Nano X-ray system, which is a lightweight, compact, and highly portable digital X-ray machine utilising Fujifilm’s patented imaging technologies. In addition, the FDR Xair X-ray system provides unique portability and operability which means that it can be used inside patients’ homes, nursing homes, and emergency medical care, allowing physicians time to provide optimal care to patients efficiently.

The expanded product portfolio was unveiled at the ERS International Congress in Barcelona, where respiratory experts came together to present and discuss the latest scientific and clinical advances across the entire field of respiratory medicine.

At the event, delegates were able to view the broad pulmonology portfolio at the Fujifilm exhibition booth, while also being invited to hands on training at Fujifilm’s Skills Lab Sessions.

Delegates could also visit the EndoRunner, a mobile training hub with Fujifilm equipment which travels to hospitals and conferences and offers physicians the opportunity to use their bronchoscopy solutions. Find out more about the EndoRunner at fujifilm-endoscopy.com/endorunner.

Samiran Dey, European Business Development Manager at Fujifilm Europe, said: “Fujifilm is a broad pulmonology solutions provider supporting clinicians from screening to treatment planning. With our expanding portfolio and a wide range of medical equipment we are focused on improving patient outcomes and innovating for a healthier world. By choosing Fujifilm, you can rely on one partner for your diagnostic pulmonology needs, while driving fast diagnoses through innovative products. As a trusted partner to healthcare practitioners in pulmonology, we are proudly by your side.”

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Hospital workers say that almost half of their patients are unnecessarily residing on wards, despite record high waiting times

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discharge

A newly published survey of hospital and social care workers shines new light on the underlying issues causing delayed discharge, with thousands of patients left stuck in hospital for an estimated average of 12 days despite record high waiting times for patients requiring care.


Conducted by CHS Healthcare UK, the survey reveals that almost half (43 per cent) of patients on hospital wards across the UK meet the NHS’ criteria for hospital discharge, meaning they are well enough to leave hospital. With the NHS facing unprecedented pressures – from the COVID-19 pandemic to a workforce crisis – almost one in five hospital workers (17 per cent) reported patient flow as the biggest problem they face.

Findings from the survey include:

  • Hospital workers saying 43 per cent of patients still residing on their ward meet the criteria to be discharged
  • 17 per cent of hospital workers believing patient flow as the biggest challenge in the NHS, with 67 per cent reporting it as a problem
  • Social care workers reporting better discharge planning would benefit 75 per cent of those who are transferred to additional care

“Collaborative planning is the key to unlocking patient flow” says CHS Healthcare

Hospital workers went on to report that the top three reasons for these delays are complexity of patients’ needs (77 per cent), no aftercare support available (55 per cent) and resistance from patient’s family/carers on the discharge decision (50 per cent). Almost half of hospital workers (49 per cent) also reported that paperwork, admin and bureaucracy cause delays to discharge.1

To avoid delayed discharge, government guidance states that ‘early discharge planning from admission is required’.2 However, the survey reveals that that in 31 per cent of cases, hospital discharge is not discussed until treatment nears completion or once the patient is medically optimised.1 The survey also reveals that two in five hospital workers (40 per cent) are unaware of the government’s ‘Discharge to Assess, Home First’ guidance, which is designed to avoid delays in care discharge.2

Care home staff and managers responding to the survey reported that the top three factors contributing to delays in discharge from their perspective are paperwork, admin and bureaucracy (54 per cent), no clear discharge planning pathway (48 per cent), and delays in agreeing funding (47 per cent). Staff also added that better discharge planning prior to patients being medically optimised would benefit those who are transferred to additional care (75 per cent).3

Commenting on the survey’s findings, Matt Currall, Managing Director at CHS Healthcare, said: “with unrelenting pressures felt across the system, accelerating patient flow is the immediate and glaring opportunity to protect patient outcomes and create sustainably in the NHS. Our new insight shines a light on the issues faced by hardworking health and social care staff, and the urgent need to re-engineer processes and drive greater co-ordinated collaboration in order to create a system that truly meets the needs of patients.

“A system that works for patients needs hospital teams, social care services, families and providers working and planning together. Achieving this will increase capability through resource and scale, giving everyone the tools they need to make significant change.”

Liz Bruce, Joint Executive Director of Adult Social Care & Integrated Commissioning at Surrey Council and Surrey ICS, said: “Discharge is everybody’s business. It’s not just a section of the staff in the hospital or the discharge team in social care, it’s all our business. It can be challenging to take a whole system view and say to ourselves ‘where are the interventions that will make the greatest changes and what can we do together?’ It’s got to be done in collaboration and we all have to care about that patient journey.”

Chief executive Officer at Chelsea and Westminster Hospital NHS Foundation Trust, Lesley Watts, added: “We need strategic planning from ICBs for complex cases, such as for people with mental health or physical rehabilitation needs or need social care support. We’ve seen that when systems work together it can have a significant benefit for patients.

“It also ensures that every part of the system is as productive as possible. Where you do not have partners committed to ensuring patients are looked after in the most therapeutic setting, then patient outcomes can be compromised.”


1 CHS Healthcare Hospital Discharge Survey May 2022

2 GOV-UK: Hospital discharge service guidance – https://www.gov.uk/government/collections/hospital-discharge-service-guidance

3 NHS England hospital discharge data – https://www.england.nhs.uk/statistics/statistical-work-areas/hospital-discharge-data/

Heatwaves are killing thousands every year – it will get worse

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Heatwaves

The damage of heatwaves to human health, productivity and lifestyles is growing. This is primarily because of the increasing likelihood of heatwaves caused by climate change. What are the impacts of this silent killer and what can be done about it?


Seventy thousand people died during the 2003 heatwave in Europe – a fact that should pose frightening questions if scientific projections that suggest climate change will increase the frequency of heatwaves turn out to be correct. Yet, because the death toll and drastic impacts of heatwaves are not always so immediate and obvious, they rarely received adequate attention from policymakers and the public.

“When hot days come, people think it’s just time to go to the beach. They don’t think about the fact that heat can make people sick, it can kill them. Maybe it’s just human nature, but why doesn’t it spur public attention?” asks Kathy Baughman McLeod, founding member of the Extreme Heat Resilience Alliance (EHRA) and SVP and Director of the Adrienne Arsht–Rockefeller Foundation Resilience Center at the Atlantic Council. The EHRA, formed by more than 30 global organisations, seeks “to tackle the growing threat of extreme urban heat for vulnerable people worldwide”.

Of the impacts of climate change, heatwaves are considered to have one of the deadliest health impacts. According to The Lancet Countdown on Health and Climate Change 2020 report, “from 2000 to 2018, heat-related mortality in people older than 65 years increased by 57 per cent and, in 2018, reached 296,000 deaths. The majority of these occurred in Japan, Eastern China, Northern India and Central Europe.”

What exactly defines a heatwave? Because they can vary significantly depending on a range of factors such as humidity, heatwaves do not have a universally accepted definition. One of the most common definitions that is attributed to them relates to an intensity that exceeds a certain threshold (there is no worldwide accepted threshold) and a duration that lasts a certain length of time.


How heatwaves impact human health, and who is most at risk?

Experts in the UK and US have concluded that extreme heat can cause a variety of negative health impacts depending on the intensity and duration of the heatwave. Some research shows direct correlations between increasing heat and an increasing number of excess deaths, which often double on particularly hot days. The main causes of illness or death during a heatwave are cardiovascular, respiratory disease and heatstroke.

Other heat-related illnesses:

  • Heat exhaustion – the most common. It occurs as a result of water or sodium depletion, with no-specific features of malaise, vomiting and circulatory collapse, and is present when the core temperature is between 37°C and 40°C. Left untreated, it may evolve into heatstroke
  • Heat cramps – caused by dehydration and loss of electrolytes, often following exercise
  • Heat rash – small, red itchy papules
  • Heat oedema – dizziness and fainting, due to vasodilation and retention of fluid
  • Heatstroke – can become a point of no return whereby the body’s thermoregulation mechanism fails. This leads to a medical emergency, with symptoms of confusion; disorientation; convulsions; unconsciousness; hot dry skin; and core body temperature exceeding 40°C for between 45 minutes and eight hours. It can result in cell death, organ failure, brain damage or death

(Source: Heatwave Advice, Department of Health)

People most at risk are those over the age of 65, people with disabilities or pre-existing medical conditions and those working outdoors for long hours in non-cooled environments. Other factors that can increase risk include; limited access to green spaces, living in cities with high population density, living on a top floor and being homeless. Nowhere is immune to extreme heat but populations in the Europe and Eastern Mediterranean regions have been the most vulnerable of all the WHO regions, the 2020 Lancet report found.

People with chronic or severe illness are likely to be at particular risk, including the following conditions:

  • Respiratory disease
  • Cardiovascular and cerebrovascular conditions
  • Diabetes and obesity
  • Severe mental illness
  • Parkinson’s disease and difficulties with mobility
  • Renal insufficiency
  • Peripheral vascular conditions
  • Alzheimer’s or related diseases

(Source: Heatwave Advice, Department of Health)

2003 heatwave in Europe. Image courtesy of Reto Stockli and Robert Simmon, based upon data provided by the MODIS Land Science Team.

Other impacts of heatwaves

The impacts of heatwaves extend beyond people’s health; experts estimate that by 2030, lost productivity from heat stress at work, particularly in developing countries, will cost $4.2 trillion USD per year.

“Across the globe, a potential 302 billion work hours were lost in 2019, which is 103 billion hours more than were lost in 2000. Thirteen countries represented 80.7 per cent of the 302,4 billion global work hours lost in 2019,” The Lancet 2020 report found.

The 2003 heatwave was estimated to have cost £41 million in health-related costs and productivity losses in the UK alone. In the US, a 2014 study by economists Tatyana Deryugina and Solomon Hsiang looked at annual income data and daily weather data from 1969 to 2011 and found that years with more days above 59 F (15 C) are associated with significantly lower income per person: average per-day income declines by 1.5 per cent for each 1.8 F (1 C) increase in daily average temperature beyond 15 C (59 F).

Several studies have also found links between extremely hot days and the worsening of people’s mental health conditions. A study in Toronto associated the increased rates of emergency visits for mental health conditions to temperatures rising above 28 C (82 F).


Yet another equality issue

Like many public health issues, heatwaves do not impact everyone equally – they affect people of colour and lower socioeconomic status more than anybody else.

“The people contributing to it least are suffering the most. There’s a link between hot communities and trees. Low-income communities don’t have trees whereas suburbs do. Trees help keep the temperature down and, more importantly, they absorb pollution,” says Ms Baughman McLeod.

“By contrast, people of lower economic status and of colour are more likely to be living next to industrial complexes that are emitting pollution. Most of the time in those areas there are no trees that can absorb pollution and heat is a key component of that.”

This was confirmed by a 2018 paper in the US that found people living in less vegetated areas had a five per cent higher risk of death compared to those living in more vegetated areas. Scientists at the University of California in 2017 mapped racial divides in the US by proximity to trees. Results were clear: black people were 52 per cent more likely than white people to live in areas of unnatural “heat risk-related land cover,” while Asian people were 32 per cent more likely and Hispanics 21 per cent.


Heatwaves and climate change: a sign of what is to come

There are fingerprints of climate change all over the recent heatwaves. An overwhelming amount of scientific evidence suggests that climate change is already making heatwaves and extremely hot days more frequent and severe. The evidence also suggests that if immediate actions to reduce emissions are not taken, extreme weather events will become the norm. A 2019 report by the World Weather Attribution (WWA) found that the 2019 heatwave in western Europe “would have been extremely unlikely without climate change”.

More recently in 2020, Siberia hit a record-breaking temperature of 38 degrees celsius. Again, WWA found “with high confidence” that the January to June 2020 prolonged heat “was made at least 600 times more likely as a result of human-induced climate change.”


We must raise awareness

When Ms Baughman McLeod, along with international partners, decided to establish the Extreme Heat Resilience Alliance in summer 2020, their first priority was clear: raising awareness among decision-makers. “We found that heat was the place where there was not enough attention. I think it’s ironic that in 60 or 70 years of climate discussions, and we call it global warming, we’re not talking about heat. It’s killing more people than any other impact of climate change,” she says.

A report published in 2021 by the WHO concluded that public awareness of the health risk is relatively high in places that are regularly affected by hot spells. However, it also found that “the risk perception of heat among healthcare providers may be significantly lower than it should be, given the objective risks faced by their patients.”

Worryingly, the report also revealed poor levels of awareness of heat warnings among health professionals, including nurses in care homes, as well as a lack of knowledge of existing heat–health plans among hospital front-line staff.

Heatwaves are a silent killer, how can you solve a problem people don’t know about? In a landscape of crises, if something is not burning, people are not going to address it.

– Kathy Baughman McLeod, SVP and Director of the Adrienne Arsht–Rockefeller Foundation Resilience Center at the Atlantic Council.

How should we go about raising awareness and saving lives? The Extreme Heat Resilience Alliance believes that naming heatwaves can make a difference. Although Ms Baughman McLeod admits that this may not be as straightforward as naming hurricanes, she believes this can help save lives.

“We’re trying to build a framework that can be adapted at a local met service and the existing heat health warning systems,” she told Integrated Care Journal. “We’re piloting heatwave naming and we’ve put a science team together to help inform it. We’re also building a ‘how to name heatwaves policy’ toolkit for countries that we will take to the COP26 in Glasgow,” she adds.

Courtesy of Arsht–Rockefeller Foundation Resilience Center

It is now crystal clear that heatwaves are an international issue that is bound to worsen in the years ahead, causing tens of thousands of deaths. While heatwaves impact certain countries more than others, nowhere is immune. Policymakers and health professionals must close the current knowledge gap and put into place policies that safely protect the most vulnerable in our societies. As the chances of altering the global CO2 emissions fall year after year, more resources should also be dedicated to adaptation rather than mitigation.

It is now crystal clear that heatwaves are an international issue that is bound to worsen in the years ahead, causing tens of thousands of deaths. While heatwaves impact certain countries more than others, nowhere is immune. Policymakers and health professionals must close the current knowledge gap and put into place policies that safely protect the most vulnerable in our societies. As the chances of altering the global CO2 emissions fall year after year, more resources should also be dedicated to adaptation rather than mitigation.

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Aligning value and incentives to make digital health really work

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How can we bridge the gap between health and technology companies and the NHS? Professor Terry Young and Jacqueline Mallender ask what barriers need to be overcome to facilitate transformation in healthcare.


Why do Digital Health Technology (DHT) companies experience financial and operational barriers when launching their solutions to the NHS? After all, the National Institute for Health and Care Excellence (NICE) has made the UK a global leader in health value, while the NHS itself should be able to think and purchase as a single system.

The NICE Evidence Standards classify technologies into three tiers of evidence according to their use, the highest burden of proof being required those which directly impact patient care, with the lowest being required for those focused on operational efficiency, as shown in Figure 1.

In reality, healthcare providers face operational and budgetary constraints which limit their ability to adopt solutions despite evidence of clinical effectiveness or economic benefit.

  • NHS Finance Directors ask: “Can we afford this investment at this time for our organisation?”
  • NHS Managers ask: “Can we manage and adapt our processes to fit this DHT into our operating procedures?”

Providers might understand the economic value and clinical benefits of a DHT, but this value may not resonate for a busy department with tough in-year efficiency targets and tight financial control totals to adhere to.

For example, there may be a strong economic case for investing in a DHT which improves the management of a chronic illness. The longer-term savings in treatment costs and the positive QALY (quality-adjusted life year) impact of better disease management, usually outweigh any additional input costs which might be incurred. However, if short-term investment is required and the department responsible for the relevant budget faces savings targets or in-year performance targets for existing processes, it may have neither the financial headroom nor the operational space to justify cuts elsewhere or to shift resources, even if this will improve clinical outcomes eventually.

Similarly, an investment may make financial sense for the hospital as a whole, but the clash between economic and business value may still prevent a finance director from cutting one departmental budget to invest in another. Moreover, the clash between clinical value and current operations may also stall DHT adoption, especially where there are competing demands on management time; and implementation may feel like one task too many.

Where an investment only makes financial sense for an entire health system, the problem is sharper still; cutting payments to one provider to create a new pathway in another is a big risk and faces considerable opposition from the “losing” provider, especially if the legacy assets and infrastructure still need to be paid for by someone. The alternative of securing extra short-term cash to fund the launch of new DHT can simply be too challenging.

A technology may cost more than the current standard of care but still be worth doing because of the positive impact on clinical outcomes. In such cases, the cost per QALY using that technology might be lower than the NICE implied threshold – and therefore good value for money. However, for DHTs which do not save money but provide much better health, it is pretty much “game over” for adoption unless the new technology is mandated.


What can be done?

At the national payer level, NHSX and NICE should continue to promote methods that highlight the benefits from all perspectives and provide national mandates for high-value DHT solutions which impact operational and clinical workflows respectively.

At the health system level, the move to integrated care systems (ICSs), integrated care providers (ICPs) and primary care networks (PCNs) and the new financial frameworks being applied, provides potential space for system-wide contracting advances. This is critical in the case of new DHTs where the benefits to the whole system are evident but no individual actor has the right financial incentive or operational space to move forward.

We would strongly encourage those supporting the establishment of these new systems to ensure the frameworks for making decisions have the sophistication and flexibility to identify such value propositions.

At the coal face, finance and management teams need to be rewarded rather than punished for taking business and operational decisions which improve whole system effectiveness and efficiency.

The impact of these clashes is easy to understand but reconciling the perspectives to make better decisions is very difficult and new methods need to be developed to make consistent decisions. Then, it will take courage to change things for the better.


About the authors

Jacque Mallender is an Economist and co-founder at Economics by Design. She is a respected international health and public policy economist and health evaluation practitioner. Over the last 35 years, Jacque has worked across health and social care with a focus on evaluation and health economics in UK, Europe, North America and more recently the Middle East and North Africa. She was a founding convenor of the joint Campbell and Cochrane Economics Methods Group and for 15 years was a committee member. In addition to her work at Economics By Design, Jacque is a Member of the Executive Committee of the Economic Research Council and an Associate of the Oxford Centre for Triple Value Healthcare.

Professor Terry Young worked in industrial R&D before becoming an academic and is now Director of Datchet Consulting. With over 30 years’ experience in technology development and strategy, health systems, and methods to ensure value for money, his current focus lies in designing services using computer models and he set up the Cumberland Initiative to support healthcare organisations wishing to develop their services more systematically.

Three of his downloadable papers are:

Using industrial processes to improve patient care (2004, with Brailsford et al., British Medical Journal)

Performing or not performing: what’s in a target? (2017, with Eatock & Cooke, Future Hospital Journal)

Systems, design and value-for-money in the NHS: mission impossible? (2018, with Morton and Soorapanth, Future Hospital Journal)