CSR – part one on health…

Our thoughts so far on what the #SR15 says on health and social care

A sustainable health and social care system

1.96 A fully funded NHS is only possible with a strong economy and strong public finances. The Spending Review announces the biggest ever investment in the healthcare system to ensure high quality and sustainable care for families across the country 7 days a week.

Of course it depends how you look at this – year on year 7.4% increases from 2002 to 2007 were larger proportionally. We concede if you add up the NHS budget from 2016 to 2021, that comes to the biggest ever spend on healthcare….

And in terms of “ensuring” care 7 days a week, well once we’ve paid off the £2.2bn debt and spent £0.6bn on mental health (1.99 below) that leaves £1bn in 2016/17 to fund rising demand, increased weekend working (government still wanting 7/7 increase in hospitals and primary care) and maybe some of the other targeted promises too, e.g. technology? This is a stop-gap. It does not address longer term funding questions – and we are now more than 2% behind GDP spending compared with the European average.

The Spending Review also puts more investment into social care and devolves greater power to local areas to make decisions about their health and social care services to drive forward an ambitious plan to integrate health and social care by 2020.

Read ‘make local decisions’ as ‘raise council taxes’… this is of real concern as the burden will fall on people on low incomes, living in poorer areas with a greater level of need. And PLEASE – we talk about integration until the cows come home but whilst social care remains means tested, we cannot achieve true integration.

A sustainable NHS ready for the future

1.97 The Spending Review confirms that the NHS will receive £10 billion more in real terms by 2020-21 than in 2014-15, with £6 billion available by the first year of the Spending Review (£2bn had previously been announced and given to NHS england and devolved administrations) so that the government fully funds the NHS’s own Five Year Forward View. By taking the difficult decisions required elsewhere, the government is able to increase NHS spending in England from £101 billion in 2015-16 (the front-line budget – not the total healthcare spend) to £120 billion by 2020.

This is £2 billion more than the NHS asked for in its Five Year Forward View. Alongside this, the government expects the NHS to deliver £22 billion of the efficiency savings it said it can find (it said it needed to find, as long as several big “IF”s could be met) in the Five Year Forward View, to deliver the best value from NHS resources.

1.98 The government’s investment will ensure that everyone will be able to access services in hospitals 7 days a week and GP services in the evenings and at the weekend (Sounds like flexibility has been conceded for primary care – most GPs already offer some evening and Saturday morning opening). By 2020-21 the NHS will be funded to provide:

  • 800,000 more elective admissions to hospital for procedures such as operations
  • 5.5 million more outpatient appointments
  • 2 million more diagnostic tests
  • over 100 million more free prescriptions every year

I’m surprised they have listed the items above – it’s what journalists usually do when trying to convey what a certain amount of money would buy – so is this a pledge, what will be in the mandate, or a public-friendly menu of what the money could buy?

  • new hospitals in Brighton, West Birmingham and Cambridge (another one? They’ve just got a new Papworth!! And what about the Peterborough  PFI millstone next door?) over the next 5 years

1.99 This investment will result in faster diagnosis, more effective treatment and greater choice of services, and provide greater funding for new clinical strategies such as cancer and mental health, including:

  • • implementing the recommendations of the Independent Cancer Taskforce so that by 2020 patients referred for testing by a GP should be diagnosed for cancer, or given the all clear, within 4 weeks. This will be delivered by investing up to £300 million a year by 2020 to fund new diagnostic equipment and additional staff capacity, including 200 additional staff trained to perform endoscopies by 2018. More endoscopies has been called for by many, including John Barron MP, Chair of the APPG on Cancer, at 2020health’s 2011 discussion event.  
  • investing an additional £600 million in mental health services. Additional investment will mean that significantly more people will have access to talking therapies every year by 2020. NHS England’s Mental Health Taskforce will report in early 2016 and the government will work with them to set out transformative plans, including for perinatal mental health and coverage of crisis care.

Sounds good – and is welcome – but the reality is that following disinvestment, this just returns funding to previous levels and mental illness prevention and early intervention, IAPT and services for acute mental illness require significantly greater funding. We highlighted some of these inequalities in our report on depression

1.100 The Spending Review reforms the funding system for health students by replacing grants with student loans and abolishing the cap on the number of student places for nursing, midwifery and allied health subjects. The current grant system means that there is a cap on student nurses and over half of all applicants to nursing courses are turned away. This reform will enable universities to provide up to 10,000 additional nursing and other health professional training places this Parliament. This will ensure that there are enough nurses for the NHS while cutting the current reliance on expensive agency staff. The move to loans will also mean access to 25% more financial support for health students during their studies. The government will work with key stakeholders to implement the reforms.

Sounds sensible to us when everyone else in health and life sciences has had to pay their way since grants and were abolished and fees introduced.

1.101 The government will invest £1 billion in new technology over the next 5 years to deliver better connected services for patients and ensure that doctors and nurses have the information they need at their fingertips. By September 2018, 80% of clinicians in primary, urgent and emergency care will have digital access to key patient information. By 2020 integrated care records will give every health and care professional concerned with an individual’s care the information they need to provide safe and prompt care.

We wish the wording was better here – it has been in the past – the records are about us, they should belong to us and be shared by us. Shared care, self-care, information, understanding and confidence will only happen when we have healthcare records with which we can read and write.

The government will invest £10 million in expanding the Healthcare Innovation Test Bed programme. This is fine, but it’s adoption and spread that are the issues – another one for the Mandate?!

This facilitates partnerships between industry and the NHS to make healthcare more effective and efficient by testing combinations of new digital technologies and innovations in NHS services. The Test Bed programme will fund a testing site in every region. YES – the potential is there, but our list of innovation that has been transformational in some areas, in the devolved nations, in other EU countries yet is NOT commissioned or copied here is getting ever longer. Incentives, regulation, funding flows HAVE to change if we are going to reap the rewards of innovation.


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Wearable Tech Gets Intimate!

A lot has happened since we last caught up with British startup Chiaro. After winning both Best R&D Product award at the AXA PPP Health Tech & You Awards and Best Startup at the Wearables Technology Show 2015 in the same week, expectations were high. In October their award winning product Elvie finally became available to the world… And the world said thank you!

It’s not often you come across a tech product designed specifically for women, let alone being designed women too. Elvie is paving the way to women taking full control of their health, learning to listen to their bodies and build inner strength.

Screen Shot 2015-11-24 at 22.25.28Elvie is a kegel exercise tracker that was designed to help women track and improve their pelvic floor strength and is clearly already striking a fancy to a number of women, with pre-orders selling out a month before its launch.

Only two weeks into launch, Elvie had already gained an impressive amount of press coverage, with articles in some of the web’s biggest sites (TechCrunch, Forbes, Elle, etc). Despite having a number of competitors who have launched similar products, Elvie’s sophisticated software and beautiful design is undoubtedly contributing to its overwhelmingly positive reception.

Here are just a few of the quotes that are coming out of the launch:

“What intrigued me most was the promise of regular ‘me-time’ with my vagina” Elle

“For the added bonus that it helps with women enjoy their sex lives, it really is priceless!” Viral Thread

It’s not hyperbole to say Elvie is a new breed of connected device…. The product design is thoughtful and discreet” TechCrunch

“…the Elvie makes pelvic floor exercise surprisingly simple” Forbes

Screen Shot 2015-11-24 at 22.31.19A number of events are set to take place over the coming months to accompany their online coverage, including partnering with brands such as Grace of Belgravia and Lomax Gyms. It’s clear that Elvie is gearing up to start a revolution in how women look after their pelvic floors, and so far it seems to be working.

To keep up to date with the Elvie launch and upcoming events, follow them on Facebook, Twitter and Instagram. A new era in women’s tech has arrived!

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No Silver Bullet for Obesity

Nadiya Hussain was recently crowned queen of a relatively new British institution: the Great British Bake-off – and a few weeks later was a star guest at the Women of the Year lunch on Park Lane. Yet in the same week on the other side of Green Park, a key ingredient of her success was being demonised as successive ‘witnesses’ at Parliament’s Health Select Committee inquiry into Childhood Obesity told of the evils of sugar and repeated the long-established statistic that people with lower incomes were those most at risk of becominScreen Shot 2015-11-03 at 22.07.24g obese . Forty years ago, warnings on the rise in prevalence of obesity began to emerge from the National Institutes for Health in the USA. By 1985 they had raised the stakes and were referring to obesity as a ‘killer disease’ (Gomez, 2014). In 1991 the UK government acknowledged that obesity represented a national threat to public health but there was no accompanying strong policy. Early in 2001 the UK’s National Audit Office produced a report warning government that if nothing changed, a quarter of the population would be obese by 2010; their prediction was almost exact, and today over 26% of the UK population are clinically obese.

But can the solution to the ‘obesity crisis’ be as simple as one ingredient (essential to our beloved bake-off cakes), and is it still true to say that it is the poor and deprived who are most at risk of obesity?

2020health have looked afresh at the evidence from the past 10 years in our report:
Fat fatchancethumbnailChance? Exploring the evidence on who becomes obese. The answers are not simple but complex. We found it wasn’t simply about those who are poor; it was younger, socially deprived women most at risk of obesity. Living in an environment that has a high density of fast food outlets, poor pavements, insufficient green space and a perceived fear of crime all correlated with an increase in obesity in girls. For men, they are more likely to be obese if their place of work has a high density of surrounding fast food outlets. Economic instability is now associated with some of the most rapidly rising rates of obesity in the UK , which constitutes a massive challenge as we anticipate greater automation of workplace and fewer middle class jobs. Again this is gendered, as for the stable poor, obesity is much higher in women. For the stable wealthy, obesity is higher for men, and for the economically mobile, obesity rises for both men and women. Obesity has been associated with certain ethnicities too, but you are at greater risk if your parents are obese, especially if it’s your mother.

Obesity is a problem with multiple drivers, many of them outside of the health sector. It has grown over the past decades to be a problem that, it is estimated by Management Consultants McKinsey, to now cost our economy £47bn per year (in direct costs to NHS including associated disease, loss of productivity in the workplace, welfare support for those of working age and through the burden of early retirement). It is therefore hard to understand the reticence of successive policy makers to respond to the economic and social crisis that obesity represents.

We are hoping that this study will serve as a valuable contribution to the evidence base on obesity to inform intelligent health interventions and workable solutions. A new children’s obesity strategy has been promised after Christmas and the government has the chance to this time do something significant. What our report emphasises is that we cannot take the same approach as before and expect outcomes to improve. Nor is there a silver bullet such as increasing the cost of donuts which will change our ever-fattening trajectory.

We now know that we have to understand exactly who we are targeting. We have to understand the complexity of the problem and that this requires a cross-departmental, Cabinet-level high-status commitment to a strategy. We have to insist on some environmental changes if people are ever to stand a chance of making healthy choices. We need to acknowledge that schools are the most significant place outside of the home where habits are formed and crucially, government has to decide on what is no longer an optional but a necessary intervention. Our children deserve nothing less.

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‘Who exactly becomes obese?’

Jack Nicholson once said, with my sunglasses on I am Jack Nicholson; without them I am fat and 60! With or without sunglasses, more than half of the UK adult population are now overweight or obese. ‘So what?’ cry the libertarians as they lick the icing off their lips from their Krispy Kreme donut. ‘It’s my free choice to eat what I like and when I like now my nanny (real or imagined) has her P45’.

Thus, cowed by taunts of ‘nanny state’, oblivious of the tsunami of obstacles shaping our ‘free’ choices which have turned our daily lives into an obesogenic environment survival race, and ignorant of the detailed analysis of evidence of who gets fat and why, piecemeal solutions have been trotted out over the years that have had precisely zero impact on our status as the ‘fat man of Europe’.

Last year McKinsey produced a report putting a figure of £47Bn cost to the economy on why obesity matters to the UK, more than the cost of war and terror threats. To say therefore that obesity represents an economic crisis is not an overstatement, and logically everyone of us who becomes obese adds to our nation’s burden.

2020health’s 2014 report ‘Careless eating costs lives’ highlighted that no individual obesitythumbnailsector or solution can solve the problem. There are so many actors around us shaping our choices that simply to talk about personal responsibility is naive, lthough of course our own behavior is a critical element. We highlighted actions for 13 different agencies, from the treasury to health, education to Ofcom, schools and industry to local government. Nothing less than a cross-departmental, coordinated, holistic national and local strategy will work. But we still don’t have the whole picture.

What is still lacking is an analysis of detailed, changing trends and factors. For instance which women, in what circumstances, why some and not others, and how have changes over the years come about?  Above all if policy is going to be effective, we need to know, apart from libertarians, who exactly gets fat? If it were simply those living in poverty, there would be a natural cap. But numbers of obese rise year on year – it has to be more nuanced than this.

With this challenge in mind 2020health is carrying out research which examines and compiles the wealth of current knowledge and statistics on obesity in England in order to address one crucial question: ‘Who exactly becomes obese?’ By looking at changing trends, the structural and choice architecture of people’s lives this research aims to inform the gaps in knowledge of obesity research that must be filled in order to begin to intelligently and meaningfully address the ways in which individuals, organisations and policy makers in both the public and private sectors can address UK obesity.

There are some interesting early findings. Men have caught up with women in the fat league tables, but while country-wide demographics show obesity as an epidemic that is equal among sexes, some research suggests that obesity, correlated with a range of other socio-demographics data, is highly gendered.  In other words, for a given socio-economic or demographic factor, gender becomes highly informative in understanding trends in obesity.  Whilst we’ve known that neighbourhood characteristics share correlation towards obesity rates, research that simply links obesity to deprivation has the potential to overlook complexity in neighbourhood poverty influences.  One of these characteristics is fast food density in a given area, and recent literature suggests that, for men especially, it is food options in the vicinity of their employment which have the highest correlations to body Mass index (BMI).

The evidence that links poverty, deprivation, and lower socioeconomic positions to obesity remains overwhelming, but what has emerged in recent research on obesity is that obesity rates are now rising fairly rapidly among other economic groups.  This, too, is gendered.  For middle and upper financial classes, men are becoming far more affected by obesity, but this trend is mitigated for women.  Additionally, both upwardly and downwardly mobile groups are correlated with higher rates of obesity than the stable rich or poor, with the downwardly mobile currently sharing the highest rates and rises of obesity. Again, these rates are gendered.  For the stable poor, obesity is much higher in women, for the stable wealthy, obesity is higher for men, and for the economically mobile, it rises for both men and women.

For children, the rates of obesity are more alarming.  Childhood obesity is still associated with poverty and parents’ education and habits.  However, in many cities and towns, researchers have found ‘hotspots’ of childhood obesity that are not associated with health.  These hotspots tend to overlap with both the poorest and wealthiest neighbourhoods.

Clinical depression and anxiety are also positively correlated with higher BMIs, but evidence suggests that, outside the clinic, more subtle ownership of depression and anxiety is deeply linked with obesity.  One very large study found that, especially for men, it is the ‘anxious’ middle class that is currently experiencing the largest rise in obesity rates.

The final report will explore and discuss these themes and others in more detail, with the aim of directly informing decisions on how we reverse UK obesity trends and our unenviable status as nutritional overachievers. If it was as easy as naming and shaming a particular food ingredient, we would have nailed this problem decades ago. Our hope is that this research will give a deeper understanding of this national crisis, and that we will have politicians and agencies bold and wise enough to understand that their duty to protect society from obesogenic harm actually increases, not decreases our freedoms.

Listen to the Spectator & 2020health podcast special: exploring obesity

Blog by Julia Manning, Chief Executive, 2020health, for Spectator Health

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Dementia is one of the most significant health crises of the 21st century

Guest Blog from Alzheimer’s Disease International

Every 3 seconds, someone in the world develops dementia. Today, more than 46 million people are living with the disease. This number is set to almost double every 20 years, making the dementia one of the most significant health crises of the 21st century.

Dementia is a collective name for degenerative brain syndromes which affect memory, thinking, behaviour and emotion. Although each person will experience dementia in their own way, after a period of time people living with dementia are unable to care for themselves and need help with all aspects of daily life.

Many people around the world are now living for longer. Over the past century, successes in improving standards of health and social care means the world population now has more older people than ever before.

As a result, much of the increase in dementia’s global prevalence will take place in low and middle income countries (LMICs). Today, over half of all people with dementia live in LMICs. By 2050, this will rise to 68%, so it is vital we are able to help these countries provide services and support.

In 2015, the global cost of dementia care is estimated at $818 billion. If global dementia care were a company, it would be the world’s largest by annual revenue exceeding Apple (US$ 742 billion) and Google (US$ 368 billion). In just three years’ time, dementia is set to become a trillion dollar disease.

Across the globe, there is a growing awareness about dementia, but stigma and misinformation remain significant barriers to making the world a better place for people living with the disease.

2 out of 3 people globally believe there is little or no understanding of dementia in their countries, so it’s essential we work together to educate ourselves and our communities to dispel lingering myths about dementia.


September is World Alzheimer’s Month™, an international campaign to raise awareness and challenge stigma. During September, Alzheimer associations around the world focus campaigns on advocacy and public awareness with a packed month of activities including information provision, Memory Walks and media appearances. Each year, more and more countries are participating in World Alzheimer’s Month events and in many areas, dementia awareness is growing.

ADI is the umbrella organisation of over 80 Alzheimer’s associations around the globe. It’s thanks to the hard work and dedication of these national Alzheimer associations that the impact of World Alzheimer’s Month is felt at both a national and global level.

World Alzheimer’s Month is a time for action, a global movement united by its call for change, but it is also a time to reflect on the impact of dementia, a disease that will affect more and more people as the years pass.

Dementia is a global issue that demands a global solution. By educating ourselves about dementia and campaigning for better health and social care provision we can help people living with dementia both now and in the future. By joining us this September and helping to spread the word you can help us make this a reality.

Find out how you can get involved and find events in your country by visiting www.worldalzmonth.org and following Alzheimer’s Disease International on Twitter and Facebook.

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Bad for your health: What can be done about Britain’s long hours’ culture?

Guest Blog from Working Families

Recent research by Working Families shows that parents are having to work longer than
their contracted hours on a regular basis¹, with fathers putting in the longest hours.  This is despite fathers wanting to play a greater part in their children’s lives², by for example dropping them off at school, and despite successive governments introducing more family friendly policies such as Shared Parental Leave (SPL) and the right to request flexible working for all, ensuring that parents and those without children have the same flexible working opportunities.

Other research by scientists at University College London, who conducted the largest study ever commissioned on the issue of stress and long hours culture, found that those who worked more than 55 hours a week have a 33% increased risk of stroke compared to those who work a 35-40 hour week, as well as a 13% risk of coronary heart disease³.

So a toxic combination of parents feeling stretched and stressed mixed with the physical demonstration of overwork is a clear demonstration that a long hours working culture is harming the nation’s health.

Screen Shot 2015-09-13 at 22.52.35So what can be done about it – what can we do as employees and employers to stop this madness? Fortunately, there are some employers who are leading the way in showing how flexible working can be made to work for both employees and employers.  Deloitte, the professional services company, has introduced their Time Out initiative, which allows employees to take an additional four week block of leave each year, helping employees to achieve a better balance between their careers and other commitments.  As Emma Codd, a Deloitte HR manager commented, “Our people say they love the policy”.

American Express, the banking and financial services company, has policies which encourage managers to initiate flexible working conversations with their employees, to ensure that they have the working hours which are right for their particular situation, including promoting home working along with providing technology to facilitate this.

At the employee end of the spectrum, there are high profile standard bearers for flexible working such as Thomasina Myers, co-founder of the Mexican food chain Wahaca, who works 3-4 days a week, and Nicola Mendelsohn of Karmarama, the TV company which makes the popular TV drama Last Tango in Halifax.  But there are also less well known flexible working role models, in organisations as diverse as financial institutions and government agencies.  Simon, who works part-time for a government agency in Scotland, says that working three days a week means he has to be super-efficient, but because he works reduced hours, he doesn’t get stressed.  And Lee, a mother of two working for an investment bank, is ambitiously keen to keep climbing the corporate ladder and feels able to do so in her working environment despite working flexibly.

Working Families, the leading work life balance organisation, campaigns for better work life balance, and is running National Work Life Week from 21-15 September 2015, which aims to highlight the difficulties faced by employees as they struggle with finding the balance that’s right for them.

Screen Shot 2015-09-06 at 23.45.09And during that week, a day has been designated as Go Home on Time Day, on Wednesday 23 September, a day when workers are encouraged to leave work on time rather than stay late, and demonstrating that productive work can and should be achieved within working hours, and that the free time spent out of office hours benefits the employee’s health and wellbeing and ultimately the employer, whose workers are healthier and more productive.

So it doesn’t have to be this way and on a positive note, more and more companies are recognising that they will not achieve higher levels of productivity by promoting long hours’ culture, in fact, quite the opposite.

To find out more about Working Families’ National Work Life Week, visit www.workingfamilies.org.uk/campaigns/national-work-life-week-2015/ and for Go Home on Time Day UK visit www.gohomeontimeday.com

¹Modern Families Index, 2015
²Modern Families Index, 2015
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The biggest cancer you’ve never heard of

Guest Blog by Chris West, Head of Media & Public Affairs at Bloodwise

Being given the news you have cancer is one of the most devastating things you can hear.  People who have gone through it talk about the shock, about not knowing if they’ll live beyond it, and wondering how to go about telling their family.

Now imagine that in addition to all that, you have the added confusion and fear of being told you have a cancer you’ve never heard of.  You don’t know anything about this kind of cancer, or know anyone who’s ever had it.  You don’t understand what the disease is, what the treatment options are, or where to go for information and support.

This is too often the experience of patients who are diagnosed with a blood cancer.  It’s a complex disease area comprising of 137 individual diseases, some of which affect thousands of people, others only a handful.  Combined, blood cancer is the fifth most common cancer in the UK, accounting for 38,000 new cases and 14,000 deaths each year, yet many people have never heard of it, let alone the charities that exist to help.

To address this, our charity is taking two big steps this month.

Firstly, we’re changing our name.  As the charity has grown over recent years, we’ve started to do more and more for patients.  The name Leukaemia & Lymphoma Research obviously covered our world leading research, but didn’t include our growing patient support services, our campaigning and advocacy work or our fundraising.  In addition, our vision is to beat all blood cancers, not just lekaemia and lymphoma.  Our name was no longer representing who we are or what we do, and starting to hold us back.

The name Bloodwise embraces all blood cancers.  It’s simple, short, and crucially, easy to remember, particularly important to someone who’s life has just been turned upside down by news of a diagnosis.

Screen Shot 2015-09-06 at 23.35.02
The second big step we’re taking is to embark on the UK’s biggest blood cancer awareness raising campaign this month, to coincide with Blood Cancer Awareness Month.

Early this year, we published the results of our research into what patients need.  We asked 2,000 people affected by blood cancer what patients and their families needed most.  They came up with many areas of need from right across the patient pathway, including diagnosis, treatment, and care once treatment had ended.

One major issue of need they raised was low public awareness.  Low awareness added significantly to feelings of worry, confusion and isolation for patients.  Being diagnosed with a cancer you’ve never heard of, one that contains many long and complicated words can often make patients feel like there’s nowhere they can turn to for support – low awareness of the disease equals low awareness of charities that can help.  In addition, patients felt that increasing awareness of blood cancer would be a starting point in addressing all the other areas of need they identified.

Screen Shot 2015-09-09 at 11.07.403,000 billboards will be going up across Britain this month for the “137 campaign”, raising awareness of blood cancer and the diseases it includes.  We hope this will help to raise awareness of one of the biggest cancers in the UK – and starting to demystify blood cancer can only help to support and reassure patients and their families.

Screen Shot 2015-09-06 at 23.41.17

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