Tag Archives: hospitals

Creating sustainability in health and social care

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The question of the sustainability of funding for health and social care services has been in the spotlight recently. The Conservative Party manifesto contained proposals around making individuals pay for more of their social care costs, to deal with the “challenges of an ageing society”. Meanwhile, figures suggest that NHS Trusts in England overspent by £770m last year despite a focus on efficiency savings.

However, creating and maintaining sustainability in health and social care is much broader than financial sustainability. It means considering other factors, including environmental, training and project management issues. This takes planning, commitment and an understanding of the aims and expectations of staff and senior management.

A research symposium earlier this year (hosted by Healthcare Improvement Scotland and partners) explored these issues further, looking at the evidence underpinning ways to create sustainable health and care systems.

Environmental sustainability

Environmental sustainability is something which all organisations are being asked to address and improve. The issue of climate change has led to a focus on behaviour change and a more sustainable use of resources.

  • Buildings – This includes the planning of new healthcare buildings, as well as adaptations to existing structures to make them more energy-efficient. Alternative building materials and designs have been used in new projects to improve energy efficiency, with some buildings even incorporating wind turbines, solar panels and geothermal capture centres. Reducing waste water and improving temperature regulation through heat capture and insulation techniques are also being adopted. While these may be costly initial spends for many, the long-term cost savings are also significant, as well as ensuring that the buildings meet minimum national requirements for energy efficiency and contribute to emissions reduction targets.
  • Resource, waste and recycling management – In many offices and clinical centres, individuals are encouraged to be personally responsible for their own reduction in waste and improved use of recycling facilities; however, this must also be facilitated at an organisational level. Clearly labelled recycling bins, promoting reduction in of the use of disposable water and coffee cups, and encouraging employees to use less paper when report writing (printing double sided for example, or going paperless where possible) are all simple ways in which environmental sustainability can be promoted in health and social care settings. Innovative techniques such as reusing water in internal plumbing, or creating bespoke recycling facilities to help reduce the amount of clinical waste incinerated, are being developed.
  • Remote monitoring and the use of technology – There have been major advances in the use of remote technology to host meetings, video-conferences, follow up appointments and assessments for those in receipt of reablement care via tele-health. Remote monitoring of patients, as well as the use of tele-health and other digital platforms can allow consultations and routine check-ups to take place without either party having to leave the house or office, thereby reducing vehicle emissions used in transport. In social care, remote meetings and cloud-based reporting can allow front-line social workers to remain out on visits instead of having to return to the office to fill out reports, again reducing vehicle emissions.

Sustainable resource management

In the face of more limited funding, joint working between health and social care is being heralded as a new way of cost saving, making the most of ever-depleting resources in the face of ever-greater demands. Being efficient with resources, through effective planning and management is one of the key ways to ensure resource sustainability in the long term, especially for the NHS and local authority social care teams.

Approaches include:

  • Making full use of the entire health and care ecosystem – This means using the entirety of the health and social care ecosystem, its capacity, expertise, resources and the end-to-end care it can provide. It means engaging carers, GPs, nurses, and pharmacists to improve efficiency, make better use of resources, spread the workload and improve satisfaction levels and outcomes for service users.
  • Using careful and well-managed commissioning models – This means making good decisions about commissioning and outsourcing to make best use of funding and other available resources. It also means allocating to appropriate projects, being mindful of the possible consequences of payment by result frameworks, and getting the best value possible.

Sustainability in practice

The final level of sustainability in relation to health and social care practice involves the sustainable implementation of programmes. This means finding ways to ensure that implementation is carried out in ways that ensure long term success and positive outcomes. It involves understanding context, and the culture of the organisation and makes reference to something discussed previously in our blog on implementation science.

Ensuring sustainability in practice requires multiple efforts including:

  • Making sure that practice becomes embedded into everyday work
  • Sharing best practice
  • Maintaining motivation among your workforce
  • Using robust, local evidence in a way that is clear and concise.

Understanding what kind of evidence leads to sustainable programme implementation is also important: economists prefer cost-based strategies, chief executives want one-page summaries, professionals want examples of other organisational based programmes and what was required to implement effectively, and councillors want case studies based around the positive impact on services users. Case studies can at times actually be the least helpful because even in a failing programme there is usually one example you can use to find positives.

Another issue with evidence is the reluctance to report on issues or challenges, or failed projects, when actually some of the greatest insight can be gained from this. All of the learning that can be gained from failures could be useful when trying to make programmes more resilient so they can be more sustainable.



Final thoughts

The concept of sustainability in health and social care cuts across many areas of organisational management and personal practice and behaviour. Encouraging and participating in sustainable practice can mean anything from being more environmentally friendly by digitising reports, recycling paper or changing to energy saving lightbulbs to promoting sustainability of resources through efficient and effective management, utilising the skills, expertise and resources of the entire health and social care ecosystem.

These approaches to sustainability should not only help health and social care as a profession to be less impactful on the environment but will also allow organisations to save money, improve efficiency and ultimately improve outcomes for patients and service users as a result.

* The 5th Annual Research Symposium: Evidence for sustainability – exploring the current evidence underpinning ways to create sustainable health and care systems was held on 16 March 2017. It was jointly hosted by Healthcare Improvement Scotland, Health Services Research Unit and the Health Economics Research Unit at the University of Aberdeen, and the Nursing, Midwifery and Allied Health Professions Research Unit at the Chief Scientist Office.

If you enjoyed this blog, you may also be interested in other articles on implementation theory and commissioning in health and social care.

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Going through the roof: could building upwards address London’s housing problem?

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The Ter Meulen Building, Rotterdam: 21st century residential apartments built on top of a post-war shopping centre

The housing challenges facing London are well documented::

  • London needs around 50,000 new homes a year, but housebuilding is running at around half that.
  • Between 2005 and 2015, private rents in London rose by an average of 35%.
  • Future projections suggest there will be 9m people in London by 2020, 10m by 2030 and 11m by 2050.

There are now serious concerns that the lack of affordable housing and rising rents risk driving key workers out of London, and may cause businesses to think twice about locating in the capital. But as well as triggering dire warnings about the future of London and the UK economy, the housing crisis has also prompted increasingly creative ideas on how to solve it.

Going up

Last year, Darren Johnson, who represented the Green Party on the Greater London Assembly, proposed five ideas to secure land for affordable homes. One of his proposals was to build additional storeys on top of existing buildings.

Johnson suggested that this approach has many advantages over demolishing existing properties and building new homes, including:

  • a shorter period of disruption for residents;
  • more environmentally friendly than demolition and rebuilding
  • an opportunity to refurbish the existing homes

He offered the example of the Ducane Housing Association in Hammersmith, which built 44 new homes on top of two 1970s buildings. Based on data from London’s Borough Councils, Johnson estimated that almost 50,000 new homes could be built using Ducane’s example.

One potential stumbling block is the difficulty of getting planning permission for intensive construction projects in the heart of active communities. However, in July 2015, the Treasury signalled the government’s intent to end the need to obtain planning permission for upwards extensions in London.

Building on public buildings

Another approach, on similar lines, is the idea of building new homes on top of publically owned buildings. In 2015, WSP professional services consultants conducted a survey to gauge interest in the idea. Among their findings:

  • 61% of respondents supported the idea of allowing private developers to refurbish government buildings, allowing them to make their money back by building additional housing on top of the refurbished building, which they could sell for profit.
  • Over 60% of Londoners would happily live above a library, while 44% would be willing to live above a government administration building, and around a quarter of Londoners would be willing to live above a school or hospital.

The WSP report went on to suggest that developing all available sites by building apartments above all available public buildings in London could provide over 630,000 residential units.

“Of course we acknowledge that not every building will be able to be redeveloped in this way, but even targeting one in every two municipal buildings could go a long way in solving the housing crisis, providing 315,000 homes.”

These homes, the report argued, would be most suitable for key workers employed by these facilities, or by students, older people and young professionals. Some may even house those working in the facilities below.

One landlord is already exploring the idea with several London councils. Apex Housing Group has experience of converting airspace above properties into luxury penthouse apartments. Managing director Arshad Bhatti believes the principle could be applied to affordable homes:

“We are working with a number of local authorities across London and expect airspace development projects will help bridge the gap between demand and supply of new homes in London – crucially with minimum lead times, and offering maximum value for property owners.”

The view from overseas

The idea of building up may be relatively new to London, but other densely populated cities have already been exploring its possibilities.

  • In Rotterdam, developers have been combining ultra-lightweight materials to build apartments on top of a 1940s shopping centre.
  • In New York, a developer is planning to construct a nine-storey condominium on top of apartments dating from the 1950s.
  • In Paris, three prefab dwellings attached to the rooftops of existing buildings were completed in January 2016.

The architects of the Paris project believe it has multiple benefits:

“Building on top of the roofs is not only an ecological and economical solution, it’s working against the urban sprawl that kills the social link. It’s also a contemporary way to discover new perspectives of the city, a new Paris above the horizon.”

But not everyone is happy with the idea. Residents in the existing apartments beneath the proposed New York condominium are concerned that the wear and tear of construction could damage their properties. And they’re also worried about the stability of the columns supporting the new building.

The only way is up?

Clearly, building on existing properties is not without its problems. But as the housing crisis in London intensifies, and spreads to other parts of the UK, it’s an idea that may no longer be regarded as pie in the sky.

If you liked this post, you may also be interested in other blog posts on suggestions for tackling the UK housing crisis:

Social prescribing – just what the doctor ordered?

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blue toned, focus point on metal part of stethoscope

By Heather Cameron

It is widely acknowledged that wider social, economic and environmental factors have a significant influence on health and wellbeing. According to recent research only 20% of health outcomes are attributable to clinical care and the quality of care while socioeconomic factors account for 40%.

With increasing pressures on GPs and lengthy waiting times a real issue for many, particularly those with mental health conditions, social prescribing could represent a real way forward.

The government clearly recognised the importance of social prescribing in its new deal for GPs announced earlier this year, which made a commitment to make social prescribing a normal part of the job.

In response to a recent Ask-a-Researcher request for information on different approaches in social prescribing and evidence of what works in the UK, it was interesting to find that despite the recognition of potential value, there has been little evaluation of social prescribing schemes to date.

Much of the material found focused on specific interventions and small-scale pilots and discussion around implementation. A new review of community referral schemes published by University College London (UCL) is therefore a welcome addition to the evidence base as it provides definitions, models and notable examples of social prescribing schemes and assesses the means by which and the extent to which these schemes have been evaluated.

So what is social prescribing?

Social prescribing means linking patients with non-medical treatment, whether it is social or physical, within their community.

A number of schemes already exist and have included a variety of prescribed activities such as arts and creative activities, physical activity, learning and volunteering opportunities, self-care and support with finance, benefits, housing and employment.

Often these schemes are delivered by voluntary, community and faith sector organisations with detailed knowledge of local communities and how best to meet the needs of certain groups.

Social and economic benefits

Despite a lack of robust evidence, our investigation uncovered a number of documents looking at the social prescribing model and the outcomes it can lead to. Positive outcomes repeatedly highlighted include:

  • improved health and wellbeing;
  • reduced demand on hospital resources;
  • cost savings; and
  • reduced social isolation.

According to the UCL report, the benefits have been particularly pronounced for marginalised groups such as mental health service-users and older adults at risk of social isolation.

A recent evaluation of the social and economic impact of the Rotherham Social Prescribing Pilot found that after 3-4 months, 83% of patients had experienced positive change in at least one outcome area. These outcomes included improved mental and physical health, feeling less lonely and socially isolated, becoming more independent, and accessing a wider range of welfare benefit entitlements.

The evaluation also reported that there were reductions in patients’ use of hospital services, including reductions of up to a fifth in the number of outpatient stays, accident and emergency attendances and outpatient appointments. The return on investment for the NHS was 50 pence for each pound invested.

Similarly, the Institute for Public Policy Research (IPPR) has recently argued that empowering patients improves their health outcomes and could save money by supporting them to manage their condition themselves.

IPPR suggests that if empowering care models such as social prescribing were adopted much more widely throughout the NHS we would have a system that focused on the social determinants of health not just the symptoms, providing people with personalised and integrated care, that focused on capabilities not just needs, and that strengthened people’s relationships with one another.

Partnership working

With a continued policy focus on integrated services and increased personalisation, social prescribing would seem to make sense. In addition to providing a means to alternative support, it could also be instrumental in strengthening community-professional partnerships and cross-collaboration among health, social and other services.

The New Local Government Network (NLGN) recently examined good practice in collaboration between local authorities, housing associations and the health sector, with Doncaster Social Prescribing highlighted as an example of successful partnership working. Of the 200 referrals made through this project, only 3 were known to local authority and health and wellbeing officers, showing that the work of social prescribing identified individuals who had otherwise slipped through the net.

And with the prospect of an ageing population and the health challenges this brings, a growing number of people could benefit from community-based support.

As Chair of Arts Council England, Sir Peter Bazalgette, notes “social prescribing is an idea whose time has come”.

Follow us on Twitter to see what developments in policy and practice are interesting our research team.

Further reading: if you liked this blog post, you might also want to read Heather’s earlier post on the health and wellbeing benefits of investing in public art.

What’s happening to make big data use a reality in health and social care?

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data-stream-shutterstock_croppedBy Steven McGinty

At the beginning of the year, NHS Director Tim Kelsey described the adoption of new technologies in the NHS as a ‘moral obligation’. He argued that the gaps in knowledge are so wide and so dangerous that they were putting lives at stake.  It’s therefore no surprise that the UK Government, the NHS, and local governments have all been looking at ways to better understand the health and social care environment.

The effective use of ‘big data’ techniques is said to be key to this understanding. Big data has many definitions but industry analysts Gartner define it as:

“high-volume, high-velocity and high-variety information assets that demand cost-effective, innovative forms of information processing for enhanced insight and decision making”

However, if health and social care is to make better use of its data, it’s important that an effective infrastructure is in place. As a result, changes have been made to legislation and a number of initiatives introduced.

Why is it important to know about big data in health and social care?

The effective use of data in health and social care is a key policy aim of the current government (and will most likely continue under future governments).  The changes that have been made so far have had a significant impact on the policies and practices of health and social care organisations. The vast majority focus on information sharing, in particular how organisations share data and who they share data with.

What changes have been made to support big data?

Care.data

This was the most ambitious programme introduced by NHS England. It was developed by the Social Care Information Centre (HSCIC) and set out to link the medical records of GP practices with hospitals at a national level. It was expected that datasets from GPs’ records and hospital records would be linked using an identifier such as an NHS number or a person’s date of birth. However, due to concerns raised by the public, particularly in regards to privacy, the programme was delayed. The programme has now resumed but new safeguards have been introduced, such as the commissioning of an advisory board and the ‘opt out’ provision, where patients can opt out from having their data used for anything other than their direct care.

The Health and Social Care Act 2012 and the Care Act 2014

The Acts have both introduced provisions that impact on data. For instance, the Health and Social Care Act enshrines in law the ability of the Health and Social Care Information Centre (HSCIC) to collect and process confidential personal data. In addition, the Care Act clarifies the position of the Health and Social Care Act by ensuring that the HSCIC doesn’t distribute data unless it’s part of the provision of health and social care or the promotion of health.

Centre of Excellence for Information Sharing

This initiative came from the ‘Improving Information Sharing and Management (IISaM) project’, a joint initiative between Bradford Metropolitan District Council, Leicestershire County Council and the 10 local authorities in Greater Manchester. The centre has been set up to help understand the barriers to information sharing and influence national policy. They hope to achieve these goals through the use of case studies, blogs, the development of toolkits, and any other forms of shared learning. The centre has already published some interesting case studies including the Hampshire Health Record (HHR) and Leicestershire County Council’s Children and Young People’s Service (CYPS) approach to communicating how they deal with data.

These are just some of the steps that have been taken to make sure 2015 is the year of big data. However, if real progress is to be made it’s going to require more than top down leadership and headline grabbing statements. It’s going to require all health and social care organisations to take responsibility and work through their barriers to information sharing.

Further reading

Read our other recent blogs on health and social care:

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