30 April 2021
An uneven playing field
In February 2020, just as the world reported its first cases of COVID-19, The Health Foundation published ‘Health equity in England: The Marmot Review 10 years on’. It revealed that life expectancy had stalled and the health gap had grown between wealthy and deprived areas.
We already knew that health inextricably links to wealth and that the deprivation gap between the South and the North of England is unacceptable. A strong, inclusive economy offers people good employment opportunities, which in turn help support and sustain good health. Likewise, good health leads to better productivity and therefore economic growth.
The challenges are significant. Across West Yorkshire and Harrogate, around one in five of the 2.7 million residents live in the 10 per cent most deprived areas of the country. Alongside this comes digital exclusion.
Last year in Leeds, for example, Healthwatch found that around 90,000 adults were without essential digital skills and 50,000 were not online at all. Neither were 40 per cent of council housing tenants.
Dealing with the pandemic inadvertently exacerbated this so-called ‘digital divide’ as so many health and care services moved online. If we thought digital inclusion was important before 2020, it has now shot to the top of our national, regional and local agendas.
The mother of invention
Yet the speed with which health and care services adapted to cope with the challenges of the pandemic was remarkable. We’ve seen amazing new levels of collaboration across organisational boundaries, creative thinking and fast adoption of digital and technological solutions. It’s shown us all that innovation isn’t something irrelevant happening in a remote laboratory somewhere that might one day mean something worthwhile. Innovation is happening now, in the workplace and it’s helping save lives.The sharp rise in the use of technology in the NHS has included remote hospital and primary care appointments. Digital tools, such as wearable devices producing vital, live information – or data – have
helped people manage their conditions at home. Millions of GP appointments have taken place via phone and video calls, text messages have provided important information to service users, and office-based work moved online.
These approaches can help people better manage their own health and health conditions, while relieving the pressure on, and the costs of, our precious health and care services.
This has started to catalyse the much-needed transformation from the healthcare model we’ve been working in since the NHS launched in 1948.
Leave no one behind
But how do we capture and evolve what has been learnt while ensuring an appropriate blend in how we provide care and, at the same time, reduce inequalities? And importantly, how do we evaluate that along the way? While technology will improve efficiency, it must be deployed appropriately, for the user.
In my former role as Chief Executive of the Innovation Agency, we rolled out a large number of highly technical and highly effective innovations. Conversely, one of the successful innovations we deployed was a tea towel, printed with advice on how to avoid falls.
One of our local councils introduced the idea. The towels were cheap to print and were deployed to an older population. Evaluation showed that, with supporting publicity and advice from appropriate agencies, this simple intervention reduced falls and kept people well.
Former NHS Confederation CEO Mike Farrar this month offered an interesting 12 top tips focusing on the technical, cultural, sustainable and equitable considerations for digital adoption. Beneath each is, of course, a lot of hard work and a willingness by all to embrace challenge and change.
Strengthening integration to improve care, as with our health and care partnership, must go hand-in-hand with unifying our health and care data, says Health Research UK CEO, Caroline Cake. It’s how we’ll make potentially life-saving advancements but it must be done in a transparent way and in an ‘ecosystem of trust’.
Our partnership is part of the award-winning Yorkshire and Humber Care Record, which is making great strides towards this, so that health and care staff have better and faster access to vital information and the public can be active participants in managing their own health and wellbeing.
Embrace the learning curve
Citizen inclusion and equal access to services depends on a workforce which is skilled in digital technology and understands how to overcome barriers to inclusion.
As with the digital divide, if developing skills in digital technology was considered important before 2020, it is now urgent. Education is the key to overcoming what is perhaps the biggest barrier to adopting digital technology in health and care.
In 2019, The Topol Review forecast that
Last year, Calderdale and Huddersfield NHS Foundation Trust, in a joint bid with Bradford Teaching Hospitals NHS Foundation Trust, was among the first 27 NHS trusts joining the NHSX Digital Aspirants programme. Another 32 additional Trusts joined last month, each receiving up to £6 million to help deliver their digital ambitions. Two more of our NHS Trusts (Airedale, Harrogate and District) were among this batch who received funding to develop their plans to join the programme.
Health Education England’s Topol digital health fellowships programme embeds digital into clinicians’ careers, giving participants up to 40 per cent of their salary for protected time to design digital health projects.
The Yorkshire and Humber Care Record Population Health Management Academy is enhancing the technical capabilities of NHS business intelligence analysts and strengthening leadership and collaboration across the NHS and local authority workforce. And the Leeds Health and Care Academy launched a new Data Analyst Apprenticeship last autumn
Industry, academia and economics
Topol also recognised that the NHS must collaborate with academia and industry and attract global technical talent.
The West Yorkshire and Harrogate Health and Care Partnership region has a thriving health and care business sector. We have 22% of the UK’s digital health jobs and our pre-pandemic economy contributed around £67 billion gross value added (GVA), or 5 per cent of the UK’s total.
More than 650 of our regional businesses are supplying products and services to our health and care sector and around 200 of these are digital. These businesses are a vital part of our region’s economic recovery. They are playing an increasingly important role as we accelerate innovation to transform health and care and address our own digital priorities.
Underpinning this is Leeds Academic Health Partnership’s new healthtech catalyst network which launches next month, part of our regional, cross-sector, healthtech partnership.
Through a series of events, workshops and direct introductions, we will offer access to expertise from industry, academia, the public sector, investor networks and entrepreneurs to stimulate innovation and commercialisation. This will catalyse healthcare innovation across the region and drive economic levelling up.
Grasp the nettle
Nationally, digital transformation is now a very fast moving issue.
In February, the Health and Care Bill White Paper detailed fundamental changes to primary legislation underpinning the health and care system. It outlines a framework to improve data access and better join up technological systems following the Covid pandemic.
Last month, the government set out its vision for putting digital and data at the heart of clinical research.
And this month, Dr Ben Goldacre is due to complete a government review into use of health data for research and analysis which, in turn, will underpin a new, national Health and Care Data Strategy.
The white paper’s proposal to strengthen integrated care through legislation confirms our vision and all of the hard work to date across West Yorkshire and Harrogate. But there is a lot more to do and none of this is easy.
Earlier this month I joined a Public Policy Projects national roundtable event to help inform legislation underpinning truly integrated health and care. We explored the barriers to integration and how to overcome them. The results of this roundtable will be reported to government to inform national policy.To catalyse and sustain new product development, research and innovation, and to deploy these into health and care practice requires deep and meaningful collaboration between partners. That means working together across different sectors, often involving different languages, cultures and ways of working.
We must continue to ‘take people with us’. To work hard, take time to listen and really hear and understand people’s views, most especially those who are typically less often heard or are underserved. This will ensure that we rollout the innovations that will support all our residents to live healthier lives.
This is a unique time for us all. The soil is fertile for new ideas. We must foster a culture of innovation and learning in which there are no wrong ideas or unwelcome questions. Vulnerability, psychological safety, risk-taking and learning from failure are essential for innovation to thrive.
This blog was first published by West Yorkshire and Harrogate Health and Care Partnership.
Dr Liz Mear is Managing Director for Leeds Academic Health Partnership and Senior Responsible Officer for the digital work stream of the country’s third largest integrated care partnership – the award-winning West Yorkshire and Harrogate Health and Care Partnership.
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