Moving Towards Care in the Community

Earlier this year the Prime Minister confirmed that £3.7 billion would be spent on 40 new hospitals in the biggest hospital building programme in a generation.

Yet recent developments in health and social care have seen the NHS take steps to significantly reduce the number of people who go to hospital for treatment and care. The NHS England’s Five Year Forward View, published last year as a blueprint for the future, sets out plans for the reconfiguration of health services towards care in the community and away from hospitals.

Why is this? As always, money matters. Hospital care is expensive, and currently accounts for more than half of all NHS spending. The NHS, like publicly-funded health services around the world, is struggling to meet growing demand while receiving less funding, in real terms. This is a trend that is unlikely to change in the post COVID-19 world.  Access to care in hospitals is another challenge. In the UK, many hospitals are in locations that are increasingly difficult to reach and far from where patients actually live and work.

Sir Simon Stevens, Chief Executive of NHS England, sees the traditional divide between primary care, community services, and hospitals – largely unaltered since the birth of the NHS – as a barrier to the personalised and coordinated health services patients need. Long-term conditions such as diabetes or cardiovascular disease are now a central task of the NHS; caring for these needs requires a partnership with patients over the long-term rather than providing single, unconnected episodes of care which traditionally were dealt with in hospital.

When it comes to shifting care from hospitals to the community, technology is an ally. This is a golden age for innovation in healthcare. It is becoming much easier for care to be delivered at home and in the community because healthcare technology is becoming cheaper, more effective and portable. Fewer patients need to go to hospital for chemotherapy, which can now be delivered safely in the comfort of one’s home. Pulmonary rehabilitation in the community can reduce the need for patients with COPD to receive treatment in hospital. Remote monitoring is helping older people to remain independent for longer, providing data that is more accurate and sensitive to change while being less intrusive for users.

Examples of good practice exist around the country. In Airedale, nursing and residential homes are linked by secure video to the hospital, allowing consultations with nurses and consultants around the clock for everything from cuts and bumps to diabetes management. Emergency admissions from these homes have been reduced by 35 per cent and A&E attendances by 53 per cent.  In Kent, 20 GPs and almost 150 staff operate from three modern sites providing many of the tests, investigations, minor injuries and minor surgery usually provided in hospital.

These approaches seem to improve the quality of care and patients’ experience. They also deliver better value for money; some may even cut costs. They need to become more widely available across the UK. The NHS is to find a funding model that enables care to thrive in the community while ensuring that hospitals maintain services. But perhaps the biggest challenge will be to persuade taxpayers that having a brand-new shiny hospital near you is not always the best option.

By Martin Barrow

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Taking Action to Reduce Health Inequalities

As a consequence of the pandemic, health inequalities across the UK are in sharp focus.

Recognising that we may now be at a watershed moment for change, this report from The Health Foundation offers a framework of action to help restore the nation to good health. It spans all aspects of citizen life. At its heart is a new social compact whereby government, businesses and wider society all have a role to play in giving everyone the opportunity to live a healthy life.

Will COVID-19 be a watershed moment for health inequalities? offers a contextual insight into how the pandemic has further exposed the extent of health inequalities across the country as well as seven proposals to be considered as part of a longer term, national cross-departmental health inequalities strategy.

Describing their vision for a new social compact, The Health Foundation propose:

  1. An enhanced role for the state in providing social protection
  2. Significantly increased public spending on prevention with targets set and preventative spending tracked
  3. Better quality of jobs for workers who have been undervalued and underpaid
  4. Measures to improve the quality, security and affordability of housing
  5. Action on the systemic barriers facing black, Asian and minority ethnic groups
  6. Sustained support for the voluntary and community sector
  7. Economic development to create the widespread conditions that enable people to live healthier lives

Together for Health asks how we can make this the decade for health equity.

To read the report in full please click here.

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Why is the COVID-19 Death Rate Disproportionately High in BAME Communities?

The COVID-19 pandemic has cast into stark relief the unacceptable health inequalities that BAME communities in the UK have experienced for decades. In a country with one of Europe’s worst death tolls, death rates from COVID-19 are highest among people of Black and Asian ethnic groups.

A review by Public Health England shows that people from ethnic minority backgrounds constitute 14 per cent of the population but account for 34 per cent of critically ill Covid-19 patients and a similar percentage of all Covid-19 cases. They also had between 10 and 50 per cent higher risk of death when compared to white British men and women.

The reasons for this are complex. People in BAME communities are more likely to be key workers, doing frontline jobs at a time when millions were keeping safe by working from home. They are more likely to have comorbidities, such as cardiovascular disease and diabetes, which make it more difficult to recover from COVID-19. Those from ethnic minority groups are more likely to be concentrated in poorer areas, live in overcrowded housing and in inter-generational households.

Many of these factors are driven by health inequalities that affect BAME communities disproportionately and have existed for many years. Sir Michael Marmot highlighted the lack of progress in his most recent review of health inequalities for the Health Foundation, published in February 2020. As Duncan Selbie, the then Chief Executive of Public Health England, explained, the impact of COVID-19 replicated existing health inequalities and, in some cases, increased them.

The PHE report makes a number of recommendations, including the mandatory collection of ethnicity data on death certificates and the development of ‘culturally competent’ risk assessment tools, which are particularly important for patient-facing roles such as nurses.

Clinical recommendations in the report include:

  • Strengthening targeted programmes for chronic disease prevention;
  • Culturally competent and targeted health promotion to prevent chronic diseases and multiple long-term conditions;
  • Targeting the health check programme to improve identification and management of [multiple long-term conditions] in BAME groups; and
  • Targeted messaging on smoking, obesity and improving management of common conditions including hypertension and diabetes.

However, many believe that these steps, although important, will only have a limited impact until society addresses the racism and discrimination experienced by communities and, more specifically, by BAME key workers as a root cause affecting health and the risk of disease. In its review, Public Health England said it was clear that many BAME groups lack “trust of NHS services and health care treatment”. As a result, they are less likely to seek care until their health has deteriorated.

Pharmacies have a critical role to play. Many are located at the heart of the most deprived communities with a high proportion of BAME families and are well placed to break down barriers in the way of timely access to healthcare. Prof Mahendra Patel, a member of the English Pharmacy Board, says: “Bigger factors such as poor housing, access to education and job opportunities are obviously central to affecting health. But beginning at ground level in our communities, we can really make a difference.”

By Martin Barrow

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3 Initiatives in 2020 to Improve Housing for a Healthier Population

The connections between health and housing are well understood, however, there remains much work to ensure that housing is a contributor to good health – for everyone. In this article, published by the National Housing Federation, a few statistics stand out:

  • A recent new YouGov survey found that nearly a third (31%) of adults in Britain – 15.9m people – have had mental or physical health problems because of the condition of, or lack of space in, their home during lockdown.
  • A recent review from Public Health England into why BAME people have been worst hit by the pandemic, found that issues of overcrowding and housing conditions contributed to the increased spread of coronavirus among these communities.
  • The main cause of these housing problems is the severe lack of housing in Britain, especially social housing. A shortage of homes means growing families have nowhere affordable to move to, leading to overcrowding. 
  • Meanwhile, rent in social homes is typically half the cost of privately rented homes, making them much more affordable for people on low incomes. On average, social homes are also of a better standard than those rented from private landlords.

The good news is that organisations including the National Housing Federation, the Town and Country Planning Institute, Homes England, NHS England & NHS Improvement and more are driving positive action for change.

3 Initiatives Bringing Together Housing & Health:

1. ‘Homes at the Heart’ campaign

Five leading housing organisations, backed by 60 businesses, ​banks, charities and think tanks, have now launched a campaign to warn that the country’s housing crisis is making lockdown even more unbearable for millions.

The ‘Homes at the Heart’ campaign is urging government to put funding for new and existing social homes at the heart of the country’s recovery from COVID-19.

To find out more about the campaign and the pandemic’s impact on poor housing and health, please click here.

2. The Healthy Homes Act

Good design, architecture, planning, place-making, housing and access to fresh air, green spaces and nature are all vital to our health and wellbeing. COVID-19 has highlighted as much.

The Healthy Homes Act is a collaborative campaign calling on government to adopt a Healthy Homes Bill which would require all new homes and neighbourhoods to be of decent quality, and effectively outlaw those which undermine residents’ health and wellbeing.

To find out more please click here.

3. Building for a Healthy Life guidance

New “healthy housing” guidance commissioned by NHS England & NHS Improvement was released in July 2020 to encourage healthier lifestyles to be planned into the design of new housing developments.

The design toolkit covers the priorities for creating healthier communities, including improved walking, cycling and public transport links, with reduced carbon emissions and better air quality. Master plans should be based on an assessment of local health and care needs with the creation of integrated neighbourhoods based on ‘tenure neutral’ housing and well-defined public spaces.

To find out more please click here

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Is Climate Change the Next Worldwide Health Emergency?

There is increasing evidence to support that climate change is affecting human health and wellbeing everywhere. Recent data from the Air Quality Life Index (AQLI) cites air pollution as the cause for a two-year reduction in global life expectancy.

As we reflect on how health communities have come together during a time of national crisis, health leaders are starting to ask if there a way to harness that same energy into tackling climate change, as the next big health issue.

Whilst health professionals have had a clear role to play in tackling the pandemic, it is more difficult to see how that same energy can make a real impact on climate change. There is also some way to go to change perceptions that climate change is a health crisis in a similar vein to COVID-19.

An article published in Integrated Care Journal emphasises the importance of the NHS and its role in tackling this health emergency. To help put it into context, did you know that the total carbon dioxide emissions attributable to the NHS in England is greater than the annual emissions from all aircraft departing from Heathrow?

Key takeaways:

  • In January 2020 an expert panel was launched “For a Greener NHS” with the objective to figure out how and when the NHS should reach net-zero.
  • NHS England have set a goal to reach net-zero carbon emissions ahead of 2050.
  • The World Health Organization (WHO) estimates that, between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year.
  • In terms of what health professionals can do about climate change, the WHO has a clear answer: advocate for health to be at the centre of all climate-change policies and plans.
  • The mistake that many make when talking about climate change is to consider it to be a future problem

Read the full article here with comments from Dr Nick Watts, Executive Director at The Lancet Countdown and Chair of the NHS Expert Panel, For a Greener NHS.

Find out more about the For a Greener NHS initiative here.

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Shining a Spotlight on Healthcare Data Analysts & Decision- Making

If you review the numerous definitions of Population Health Management being voiced by health organisations and leaders, one word that consistently stands out is ‘data’.

“Population Health Management is a patient-centric, data-driven approach to optimise the physical and mental health of populations over individual life spans and across generations”  

“Population Health Management is a data-driven approach that guides the planning, resource allocation and delivery of care to optimise population health”

“Population Health Management is the concept of gathering data and insights about population health and wellbeing across multiple care and service settings, with a view to identifying the main health care needs of the community and adapting services accordingly”

The need for connected health data that tells the right stories and provides actionable insights for decision-making will only be more important as we move forwards. Now is the time to put a stronger emphasis on our data resources, skills and requirements.

This theme is being championed by The Strategy Unit and its #AnalystRevolution. In this series of short videos, discover more about the future agenda for analysts and how to optimise their contribution to decision-making in the future:

  • How can we improve the relationship between analysts and decision-makers?
  • What are the skills, attributes and qualities needed to lead as an analyst?
  • How do we develop analysts as leaders?
  • Valuing the analytical workforce: A vision for career pathways and development opportunities?
  • What should we learn from COVID-19? Which ways of working should we retain?
  • Where next for the #AnalystRevolution?

All videos are under 15 mins, so perfect to digest in bite-sized chunks and include expert speaker contributions from a wide range of organisations including:

  • The Health Foundation
  • Imperial College Health Partners
  • Public Health England
  • NHS England & NHS Improvement
  • Nottinghamshire NHS Foundation Trust
  • Dudley CCG

Please click here to find out more.

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Behind the Scenes: Campaigning for Sugar Reduction During the Pandemic

With the focus back on national obesity levels, we asked Holly Gabriel, Nutrition Campaigner at Action on Sugar about the priorities during the early stages of the pandemic as well as a look to the future to what needs to happen next to make continued progress in the reduction of sugar.

How has Action on Sugar responded to the Covid-19 crisis?

Everyone staying safe and well has of course been the priority, but we were initially concerned at the shift away from important public health priorities. There seemed to be less focus on the importance of good nutrition, especially during lockdowns when people are potentially moving less, finding less food on the supermarket shelves and seeing a rise in delivery services promoting unhealthy options.

Action of Sugar placed a focus on monitoring emerging issues such as misleading claims on immunity in the media and food and drink companies taking advantage of the situation to sell products. When clear evidence emerged suggesting obesity and related health conditions are risk factors for worse outcomes for Covid-19, we saw some vital policies put back on the table as the Prime Minister took somewhat of a U-turn in light of his own experiences and growing evidence.

In April 2020 we put a call out to ban the marketing of food high in fat, salt or sugar during the pandemic. We ran a public focused social media campaign to give advice on healthy eating and to gather insight on habit changes during lock-down, and exposed irresponsible practices and breaches such as pringles advertising to children on Joe’s Wickes YouTube channel.  We wrote to the Prime Minister in response to the association between obesity and Covid-19, and the need for prevention policies plus immediate interventions on obesity for all, not just children.

What are the priority areas for your work over the next 6 months?

Reformulation programmes were omitted from recent obesity announcements by Government, and there is much uncertainty about the future of Public Health England. With that in mind we will be focussing on:

  • Ensuring that reformulation programmes such as the sugar and calorie reduction are kept high on the priority list during any restructure.
  • Continue to campaign for the soft drinks industry levy to be increased and extended to other categories of drinks such as milkshakes.
  • Ensuring the Government follows through with their commitment to implement a 9pm watershed.
  • Ensuring we respond to consultations on new measures announced.
  • Continue to monitor the food and drink industry, to highlight irresponsible product development and lack of progress towards reformulating products to improve their nutritional quality.

If you could change one thing to have the greatest impact on obesity levels in the UK, what would it be?

To have an impact on obesity levels, UK governments must act on previous commitments to address the obesity crisis that the nation faced prior to Covid-19, and will continue to face if government drag their feet. A whole systems approach is essential to reducing obesity and related conditions and to reduce widening inequalities which have been brought further to the fore in the wake of Covid-19. We provided the Government with ten evidence-based recommendations to support the nation to reach and maintain a healthy weight, without placing responsibility solely on the individual but rather by changing the environment we currently live in. These recommendations included increasing access and funding for evidence-based weight loss support, ensuring only healthy products are advertised and promoted, and adopting fiscal measures to promote healthy food (with income ringfenced to subsidise treatments).

A year from now, what do you hope we will have achieved in the reduction of sugar intake?

Sugar reduction policies in the UK which support the population in consuming no more than the recommended 5% of total energy from free sugars, will never be achieved if we continue to see food and drink companies producing products that contain 3 or 4 times the recommended maximum sugar intake for an adult, even more for a child, in one serving and often with no nutrition information available. We need comprehensive and mandatory reformulation programmes to reduce sugar AND calories that is robustly monitored by a new, independent and transparent food watchdog to ensure that sugar consumption is reduced on a population level.

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Reverse Worsening Trends in Children and Young People Health

In March 2020, The Royal College of Paediatrics and Child Health launched their child health report – the largest ever compilation of data on the health of babies, children and young people across the entire UK. State of Child Health 2020 brings together 28 measures of health outcomes, ranging from specific conditions, such as asthma, epilepsy and mental health problems, to risk factors for poor health such as poverty, low rates of breastfeeding and obesity. 

The report shows that, for many measures of children’s health and wellbeing, progress has stalled, or is in reverse – something rarely seen in high-income countries. There are parallels with the Marmot Review 10 Years On in that, across most indicators, health outcomes are worse for children who live in deprived areas while inequalities have widened since the last State of Child Health report published in 2017.

Taking practical actions now to reverse these trends

There is a lot of work ahead to get a grip of the state of child health in the UK. The report highlights the need for action in the following three areas:

  • Reduce child health inequalities: Action should be taken to tackle the causes of poverty and reduce variation in outcomes.
  • Prioritise public health, prevention and early intervention: Preventative measures will reverse current trends and ensure healthy children become healthy adults.
  • Build and strengthen local, cross-sector services: There should be equitable access to services, resources, advice and support within the local community.

Along with their recommendations, the RCPCH offers a number of specific, practical actions that health practitioners can take to improve matters for children and young people seen in clinical settings, including:

To read the report in full, please click here.

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Validating the Role of Social Prescribing Link Workers in Pandemic Conditions

Social prescribing aims to support people to stay healthy in ways which go beyond pills and medical procedures through better connections within their local communities. It works by referring people to a local Social Prescribing Link Worker, who then helps identify new opportunities for that individual, such as walking-football, walking clubs, dance classes, choirs and other local support services.

“Social prescribing, also sometimes known as community referral, is a means of enabling health professionals to refer people to a range of local, non-clinical services. The referrals generally, but not exclusively, come from professionals working in primary care settings, for example, GPs or practice nurses”

The Kings Fund

In this recent blog by Christiana Melam, CEO of the National Association of Link Workers there are signs that Social Prescribing Link Workers have had a positive impact during the pandemic. The blog describes the increasing engagement from GPs and nurses as they turn to this resource to support their patients’ welfare needs. Christiana describes Social Prescribing Link Workers as the glue between health, social and community services.

As we adjust to the new normal, there is an increasing need to build patient and community capabilities and resilience to take control of their mental and social wellbeing. Together for Health asks whether now is the time to seize the opportunity of social prescribing across health and social care.

Read the full blog here and find out more about:

  • What Social Prescribing Link Workers do
  • How Social Prescribing Link Workers are supporting Covid-19 response efforts
  • Mainstreaming Social Prescribing as an alternate care model

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Exploring the Principles of Population Health Management

The nationwide pandemic response has brought to the forefront the need for a data-driven approach to decision-making; the need to work together across organisational boundaries to deliver transformation; and the importance of focusing on good health and the underlying determinants that constitute health.

These same three themes sit at the heart of Population Health Management (PHM) – an approach to understanding current, and predicting future health and care needs with a view to designing and adapting services accordingly.

Similarly, these same underlying principles are highlighted in the NHS Clinical Commissioners report focused on Advancing Population Health Management. Through ten local stories the report demonstrates the progress and outcomes being derived from a Population Health approach. More importantly, it identifies a number of key learnings that need to be addressed as we look to embed PHM systems in 2021.

Together for Health Takeaways from this report include:

  • Finding a common definition for Population Health Management is a challenge, however, what is clearly important is that PHM is an approach to planning services based on the health needs of a population – even when that goes beyond the boundaries of traditional health and care systems.
  • A commonality across the stories is the importance of data and in particular, getting access to shared data and the associated information governance challenges.
  • Arming clinicians with the insights from this data and getting the right people from a range of stakeholder organisations around the table to talk about the needs of a particular cohort – that’s when radical transformation can really happen.
  • Transitioning to a local approach offers the opportunity to deliver meaningful and sustainable change – local teams understand their populations, and they’re very committed to the changes because they own them.
  • Clinical commissioners sit at the heart of Population Health Management as the bridge between primary and secondary care organisations, facilitating the right conversations and breaking down traditional silos

It is encouraging that whilst many describe themselves as being only at the beginning of their PHM journey, we can see that it is making a real difference to health outcomes.

Read the full report to gain insights from the following case studies:

  • Getting a grip on the data in North West London
  • Improving diabetes care for people in West Berkshire
  • Workforce empowerment in Dorset
  • Collaboration to improve mental healthcare in Sheffield
  • Building coalitions to provide even more targeted care in Leeds
  • Targeting need in Lewisham
  • The start of a journey in Suffolk
  • Clinical commissioners help to create the right conditions for PHM approaches in Lancashire
  • Encountering information governance challenges in Birmingham and Solihull
  • Merging towards strategic commissioning and population health management

Find out more about Population Health and Population Health Management here.

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Does COVID-19 Present an Opportunity to Embed Healthy Behaviours?

We are all familiar with the concept that supporting citizens and patients to adopt healthy lifestyles creates positive results for treatment and prevention of illness – helping people to live longer, healthier lives and reducing the demand for (plus delays in) treatment and care. Poor health lifestyles present a serious threat to population health, particularly for more disadvantaged groups.

Whilst health practitioners and leaders of public services can do their utmost to create the right environment for good health, this only goes so far. Getting people to change their behaviour is the difficult part.

As we face a ‘new normal’ where life has been upended and new daily routines created, there is an opportunity for people to form new habits and break old ones. Is now the time to help establish long-lasting health and wellbeing behaviours across our populations?

Does COVID-19 present a watershed moment to drive change?

The launch of the government’s ‘Better Health’ campaign was well-timed, acting quickly to capture a moment when many people had used the first national lockdown as an opportunity to change habits and adopt healthier behaviour. At the same time, research has shown that during this time over half the population found it harder to stay healthy, which may itself present an opportunity for change.

Analysis in this article shows a significant increase in downloads of the NHS-backed Public Health England fitness app From Couch to 5K during lockdown. NHS leaders who have backed the app say its widespread adoption could, alongside other similar fitness apps, help even more people to lead healthier lifestyles. While this is a step in the right direction, sustaining an increase in activity will be the next challenge.

And with smoking still being the biggest underlying cause of death in the UK, new analysis by Action on Smoking and Health (ASH) and UCL finds that over a million people in the UK have stopped smoking since the COVID-19 pandemic hit. A further 440,000 smokers tried to quit during this period. These are all positive changes towards achieving the 2030 smoke-free target as set by the UK Government.

In this short blog by The Behavioural Insights Team, you can explore three ideas for how behavioural science can help people maintain new habits as restrictions ease, and also drive broader positive changes post-lockdown. With 85% of Britons wanting to see at least some of the personal or social changes we have experienced to continue longer term, learn more about what they describe as the ‘Fresh Start’ phenomenon.

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