The Covid-19 knock-on: public health and the impact of delays in non-urgent treatment and diagnosis

Since the beginning of the pandemic, concerns have been raised about the wider public health impacts of coronavirus. In addition to strains on acute NHS care services on the frontline, there are warnings about the additional public health impacts of delays to preventative healthcare measures like screening and routine medical care in the form of pre-planned operations for long-term chronic and non-urgent conditions.

At the outbreak of the pandemic many hospitals took the decision to delay or stop entirely routine pre-planned surgeries and preventative screening and diagnostics. Some even suspended treatment for more urgent care like cancer treatment on a short term basis. While many of these services have resumed since the beginning of the pandemic, albeit with a backlog of patients now to be seen, significant strain on the NHS as we come into the winter months because of  coronavirus is still anticipated. As a result, many hospitals are not working at full capacity in order to prepare for potential increases in admissions due to coronavirus or staff shortages over the winter.

In many areas this has led to a backlog of care, both for those patients already in the system awaiting routine surgeries, as well as those who are yet to be diagnosed but would have been through preventative screening programmes run by the NHS.

Delays in healthcare and routine screening programmes 

Even before the coronavirus pandemic took hold, many NHS hospital trusts were under criticism because of the significant length of waiting times for people who required routine operations, which in some parts of the UK can be as long as three years. Doctors across the UK are now warning that these delays could be increased further unless the NHS receives additional support to increase capacity across all areas of care  not just urgent care in the coming months.

Data released by NHS England in October 2020 showed the numbers waiting over a year for hospital treatment have hit a 12-year high, with almost 2 million patients waiting more than the target time of 18 weeks for routine care.

It has been suggested that delays in diagnosis and routine treatments could lead to an increased number of hospitalisations further down the line, requiring higher levels of care, longer lengths of stay, and increased hospital readmissions.

A reluctance to visit hospitals and use primary care services

Government messages to ‘protect the NHS’ may have had the unintended consequence of discouraging people from seeking urgent medical care when it was required for fear of using services unnecessarily or for fear of contracting the virus when attending hospital or primary care settings.

Research from the Health Foundation found that there had been a significant reduction in the number of GP consultations since the start of the pandemic which has led to concerns about the care of non-covid patients, patients with long term health conditions and also the potential for delayed diagnosis. Primary care consultations also reduced and have remained low consistently since the beginning of lockdown.

Figures have also shown a reduction in the number of referrals, medical tests, new prescriptions and immunisations. While some of these reductions are the result of advice to delay routine referrals to free up capacity for hospitals to deal with the potentially large number of cases of Covid-19, routine referrals have still not recovered to pre-lockdown levels.

 

A potential future crisis for the NHS and a ticking time bomb for public health

Doctors are now warning that the treatment backlog which has been caused by the coronavirus pandemic, in addition to diagnostic delays and screening programmes, may lead to a future crisis of care or significant delays in care for people waiting to receive more routine treatment.

Delays in care have not only been reported in cases of physical health. There have also been significant delays in referrals for those seeking treatment for a mental health condition, an area of the NHS which was already facing significant delays in referral and transfer of care even before the pandemic. Research suggests that incidence of mental illness during the coronavirus pandemic increased. However, the numbers of people accessing services and being referred for treatment have not increased proportionate to this. People with mental health conditions may have been unable to access appropriate support through primary care pathways, which could potentially impact on their long term health and care.

Finally, concerns have been raised about the wider social determinants of health such as employment and poverty. Public Health England (PHE) published a monitoring tool which looks at the wider impacts of the Covid-19 pandemic on population health, and it is likely that the knock-on impact of the virus could have far reaching consequences for public health in the future as the health implications of lockdown, lack of social interaction and rising unemployment could be significant. 

Where next?

While the challenges of the coronavirus pandemic for the NHS will not be going away anytime soon, it is clear that it will be necessary for the NHS and other supporting services to act now to prevent a longer term public health crisis. It is critical that we not only focus on the acute care of Covid-19 patients, but also proactively manage patients without Covid-19, particularly those with time-sensitive, complex and long term conditions who are postponing their care. We must also consider the knock-on impacts of delayed diagnosis for those people who missed out on routine screening or who were unable or too afraid to visit their GP or hospital. This is important not only to sustain health and life, but to preserve hospital and NHS capacity in the future.


If you enjoyed this article you may also be interested in reading:

Follow us on Twitter to find out what topic areas are interesting our research team.

How the COVID-19 homelessness response shows opportunities for future progress

Before the UK entered lockdown in March 2020, there were already discussions around how the spread of COVID-19 would impact some of the most vulnerable people in our society. There was an acute awareness not only of the significant levels of homelessness in our towns and cities but that the number of people who needed support was growing at an alarming rate. Strategies for prevention and outreach programmes to help break the cycle of homelessness through a network of support systems for homeless people were helping to a certain extent in some areas, but the problem was (is) chronic and the concern among people who worked in, and had experience of, the sector in relation to the potential impact of COVID-19 was growing.

Homelessness during the COVID-19 pandemic

Surprisingly though, in many areas the response to support the UK’s homeless populations was swift, definitive and all encompassing. Partnerships were formed with local hotel chains – the GLA partnership with multiple hotel groups as part of the Pan London Placement scheme is probably the best publicised but individual arrangements have sprung up across the country and people were moved from the street into accommodation which was self-contained and would allow them to effectively isolate if they showed any symptoms of COVID-19.

In March, minister Robert Jennick announced £3.2 million of funding for councils to help them protect local rough sleepers from the pandemic and MHCLG, councils, the voluntary sector and those who work within homelessness outreach specifically have all mobilised to form an effective network of support for many people who had previously been sleeping on the streets.

The response to moving those who were sleeping rough off the streets has been unprecedented, as is the volume of people who have been helped. Many people have been accommodated regardless of their “local connection” or their “recourse to public funds”, something which previously was a significant barrier to many people being housed in temporary accommodation by their local authority.

A new wave of homelessness?

However despite the significant progress made, there are growing concerns about a “second wave of homelessness”- people who become homeless off the back of the stagnation and collapse of some areas of the economy, particularly those in low paid and precarious work i.e. hospitality and retail sector. Additionally, there are signs that some especially vulnerable groups have not engaged with the process or that some people have became homeless after the initial offer of support was rolled out. These include people from migrant backgrounds, and people with acute and severe mental ill health.

Things can’t go back to the way they were

One thing is clear, according to professionals, things can’t be allowed to return to the way they were. In some instances this is for practical reasons, and in other instances because we have been able to see what it is possible to achieve when people co-operate and there is a collective will to progress.

The use of communal shelters, one of the main ways of delivering emergency accommodation for many years may have to stop, or at least be re-organised to avoid multiple people sharing facilities like bathrooms or sleeping in rooms with multiple beds. A move towards more “pod style” contained living may be a way forward, but it will take a shift in design to accommodate people safely in the future.

The response has shown that it is vital to develop links between housing and health, and that the integration of services with public health to create wrap-around care (which is something which is currently being co-ordinated in response to the pandemic) should be maintained going forward.

The pandemic response has also shown that multiple organisations can work well effectively together and that the red tape, perceived layers of bureaucracy and challenges of different ways of working can be overcome if there is collective understanding and will. These barriers can be overcome to create really effective and much needed services and support for some of our most vulnerable citizens.

Concerns have been raised around future funding, and in particular the risks of funding being stopped abruptly or the supply being removed at short notice, for example if hotels re-open and councils then struggle to identify appropriate accommodation for people to transition into. The sector has stressed that councils should be planning for this transition phase to prevent people returning to the streets and dis-engaging with services.

Opportunities to learn lessons

At an online event hosted by the Centre for London, which brought together professionals from within the sector in London to reflect on the response to COVID-19, somewhat surprisingly, the atmosphere was one of optimism that this could be the start of a new way of working. There is hope that a “can do” and “get things done attitude” which had been catalysed by the need for urgency because of the spread of COVID-19 can be harnessed and that this mindset should be embedded into practice going forward.

One of the main questions that appears to be raised is, if we can do it now, with such urgency, why couldn’t we do it before, and what steps need to be taken to ensure that the collective will and the government support doesn’t disappear post COVID-19? This is something local authorities, homeless outreach groups and other partners will have to grapple with over the coming weeks and months.

The response to the pandemic has been unprecedented. It has shown that with understanding, flexibility and effective partnership working to deliver coordinated services (as well as appropriate supply and funding) that tackling homelessness, or at least offering more to our homeless communities in terms of effective long term support, can be achieved.

There is a collective sense within the sector that the steps forward taken as a result of this pandemic should not be allowed to regress in the future, but should be strengthened and built upon to provide more effective support going forward for homeless communities across the UK.


Follow us on Twitter to see which topics are interesting our research team.

Read some of our other blogs on housing and homelessness:

An app a day … how m-health could revolutionise our engagement with the NHS

It seems like almost every day now we see in the news and read in newspapers about the increasing pressures on our NHS, strains on resources and the daily challenges facing already overworked GP staff.

Mobile health applications (m-health apps) are increasingly being integrated into practice and are now being used to perform some tasks which would have traditionally been performed by general practitioners (GPs), such as those involved in promoting health, preventing disease, diagnosis, treatment, monitoring, and signposting to other health and support services.

How m-health is transforming patient interactions with the NHS

In 2015 International Longevity Centre research found some distinct demographic divides on health information seeking behaviour. While 50% of those aged 25-34 preferred to receive health information online, only 15% of those aged 65 and over preferred the internet. The internet remained the favourite source of health information for all age groups younger than 55. And while not specifically referring to apps, the fact that many people in this research expressed a preference to seek health information online indicates that there is potential for wider use of effective, and NHS approved health apps.

A report published in 2019 by Reform highlighted the unique opportunity that m-health offered in the treatment and management of mental health conditions. The report found that in the short to medium-term, much of the potential of apps and m-health lies in relieving the pressure on frontline mental health services by giving practitioners more time to spend on direct patient care and providing new ways to deliver low-intensity, ongoing support. In the long-term, the report suggests, data-driven technologies could lead to more preventative and precise care by allowing for new types of data-collection and analysis to enhance understandings of mental health.

M-health, e-health and telecare are also potentially important tools in the delivery of rural care, particularly to those who are elderly or who live in remote parts of the UK. This enables them to submit relevant readings to a GP or hospital consultant without having to travel to see them in person and allowing them to receive updates, information and advice on their condition without having to travel to consult a doctor or nurse face-to-face. However, some have highlighted that this removal of personal contact could leave some patients feeling isolated, unable to ask questions and impact on the likelihood of carrying out treatment, particularly among older people, if they feel it has been prescribed by a “machine” and not a doctor.

Supporting people to take ownership of their own health

Research has suggested that wearable technologies, not just m-health apps, but across-the-board, including devices like “fitbits”, are acting as incentives to help people self-regulate and promote healthier activities such as more walking or drinking more water. One study found that different tracking and monitoring tools that collect and analyse health and wellness data over time can inform consumers of their baseline activity level, encourage personal engagement in health and wellbeing, and ultimately lead to positive behavioural change. Another report from the International Longevity Centre also highlights the potential impact of apps on preventative healthcare; promoting behaviour change and encouraging people to make healthier choices such as stopping smoking or reducing alcohol intake.

Home testing kits for conditions such as bowel cancer and remote sensors to monitor blood sugar levels in type 1 diabetics are also becoming more commonplace as methods to help people take control of monitoring their own health. Roll-outs of blood pressure and heart rhythm monitors enable doctors to see results through an integrated tablet, monitor a patient’s condition remotely, make suggestions on changes to medication or pass comments on to patients directly through an email or integrated chat system, without the patient having to attend a clinic in person.

Individual test kits from private sector firms, including “Monitor My Health” are now also increasingly available for people to purchase. People purchase and complete the kits, which usually include instructions on home blood testing for conditions like diabetes, high cholesterol and vitamin D deficiency. The collected samples are then returned via post, analysed in a laboratory and the results communicated to the patient via an app, with no information about the test stored on their personal medical records. While the app results will recommend if a trip to see a GP is necessary, there is no obligation on the part of the company involved or the patient to act on the results if they choose not to. The kits are aimed at “time-poor” people over the age of 16, who want to “take control of their own healthcare”, according to the kit’s creator, but some have suggested that instead of improving the patient journey by making testing more convenient, lack of regulation could dilute the quality of testing Removing the “human element”, they warn, particularly from initial diagnosis consultations, could lead to errors.

But what about privacy?

Patient-driven healthcare which is supported and facilitated by the use of e-health technologies and m-health apps is designed to support an increased level of information flow, transparency, customisation, collaboration and patient choice and responsibility-taking, as well as quantitative, predictive and preventive aspects for each user. However, it’s not all positive, and concerns are already being raised about the collection and storage of data, its use and the security of potentially very sensitive personal data.

Data theft or loss is one of the major security concerns when it comes to using m-health apps. However, another challenge is the unwitting sharing of data by users, which despite GDPR requirements can happen when people accept terms and conditions or cookie notices without fully reading or understanding the consequences for their data. Some apps, for example, collect and anonymise data to feed into further research or analytics about the use of the app or sell it on to third parties for use in advertising.

Final thoughts

The integration of mobile technologies and the internet into medical diagnosis and treatment has significant potential to improve the delivery of health and care across the UK, easing pressure on frontline staff and services and providing more efficient care, particularly for those people who are living with long-term conditions which require monitoring and management.

However, clinicians and researchers have been quick to emphasise that while there are significant benefits to both the doctor and the patient, care must be taken to ensure that the integrity and trust within the doctor-patient relationship is maintained, and that people are not forced into m-health approaches without feeling supported to use the technology properly and manage their conditions effectively. If training, support and confidence of users in the apps is not there, there is the potential for the roll-out of apps to have the opposite effect, and lead to more staff answering questions on using the technology than providing frontline care.


Follow us on Twitter to see which topics are interesting our Research Officers this week.

If you enjoyed this article you may also like to read:

Figuring it out: five issues emerging from the Scottish draft budget

The week before Christmas might not seem an ideal time to be mulling over the minutiae of economic forecasts and the implications of tax changes. But on Monday morning, the Fraser of Allander Institute (FAI) review of last week’s Scottish draft budget attracted a big turnout, and helped make sense of the numbers announced by Scotland’s Finance Secretary, Derek Mackay.

Here are some of the key issues to emerge from yesterday morning’s presentations.

  1. Growth: degrees of pessimism

Last month, the UK Office for Budget Responsibility revised downwards its growth forecast for the UK economy to less than 2%. The FAI, meanwhile, has forecast a slightly lower growth rate for the Scottish economy of between 1% and 1.5%. However, the independent Scottish Fiscal Commission (SFC) is much more pessimistic, forecasting growth in the Scottish economy of less than 1% up to 2021. If the SFC’s forecast turns out to be accurate, this would mean the longest run of growth below 1% in Scotland for 60 years.

Dr Graeme Roy, director of the FAI, suggested that the SFC’s gloomy outlook is based on the view that the Scottish working-age population is projected to decline over the next decade. In addition, the SFC also believes that the slowdown in productivity, which has been a blight on the Scottish economy since the 2008 financial crisis, will continue.

  1. Income tax rises: reality v perception

Mr Mackay proposed big changes in Scotland’s tax system, with five income tax bands stretching from 19p to 46p. While these measures attracted the biggest headlines for the budget, the FAI believes that most people will see little meaningful impact in their overall tax bill (relative to income). Charlotte Barbour, director of taxation at the Institute of Chartered Accountants of Scotland, also suggested that the tax changes are unlikely to result in any significant behavioural changes in the way people pay tax in Scotland. And, as has been noted elsewhere, high taxation does not necessarily lead to unsuccessful economies.

However, as the FAI highlighted, perception is important, and if Scotland comes to be seen as the most highly taxed part of the UK, this could have serious implications for business start-ups and inward investment.

  1. Taxation: two systems, multiple implications

Charlotte Barbour also highlighted some of the implications of the tax changes in Scotland that haven’t featured widely in press coverage. How the changes interact with areas such as Gift Aid, pensions, the married couple’s tax allowance, Universal Credit and tax credits will need careful examination in the coming weeks.

  1. Public spending: additional resources, but constrained settlements

The FAI’s David Eiser noted that Mr Mackay was able to meet his government’s commitments to maintain real terms spending on the police and provide £180m for the Attainment Fund. He also announced an additional £400m resource spending on the NHS. But these settlements are constrained in the context of the Scottish Government’s pay policy,

Mr Mackay’s plan offers public sector workers such as nurses, firefighters and teachers earning less than £30,000 pounds a year a 3% pay rise, and those earning more than that a 2% rise. For the NHS alone, this could cost as much as £170m.

In addition, analysis published yesterday by the Scottish Parliament Information Centre (SPICE) has estimated that, if local authorities were to match the Scottish Government’s pay policy, this would cost around £150m in 2018-19.

  1. The budget’s impact on poverty

If the growth forecasts are correct, even by 2022 real household incomes in Scotland will be below 2007 levels. Dr Jim McCormick, Associate Director Scotland to the Joseph Rowntree Foundation, looked at the Scottish budget in the context of poverty, and suggested that three principles need to be addressed before the budget can be finalised: there are opportunities both to increase participation by minority groups in employment and to improve progression in low-wage sectors, such as hospitality and retail; energy efficiency is one important way of lowering household bills and improving housing quality in the private rented sector; and options such as topping up child tax credits and more generous Council Tax rebates are better at reducing poverty than cutting income tax.

Finalising the budget

As all of the speakers noted, the Scottish draft budget is not a done deal. The minority Scottish National Party government in the Scottish Parliament needs the support of at least one other party to ensure its measures are adopted. The most likely partner is the Scottish Green Party, which has indicated that the budget cannot pass as it stands, but could support the government if an additional £150m is committed to local government.

It took until February this year before the Scottish Government’s 2016 draft budget could be passed. Time will tell whether a budget announced shortly before Christmas 2017 can finally be agreed before Valentine’s Day 2018.

The complete collection of slides presented at the Fraser of Allander Institute’s Scottish budget review are available to download here.


Our blog post on the Fraser of Allander Institute’s review of the Chancellor of the Exchequer’s 2017 Autumn Budget is available here.

Joining up housing and mental health

The role of housing goes far beyond physical shelter and safety. It introduces people to a community to which they can belong, a space which is their own, a communal setting where they can make friends, form relationships and a place where they can go for support, social interaction and reduce feelings of loneliness and anxiety. Housing  stable, safe housing  also provides a springboard for people to begin to re-integrate with society. An address allows them to register with services, including claiming benefits, registering at a local job centre, registering with a GP, and applying for jobs.

Housing and health, both physical and mental, are inextricably linked. A 2015 blog from the Mental Health Foundation put the relationship between housing and health in some of the clearest terms:

“Homelessness and mental health often go hand in hand, and can be a self-fulfilling prophecy. Having a mental health problem can create the circumstances which can cause a person to become homeless in the first place. Yet poor housing or homelessness can also increase the chances of developing a mental health problem, or exacerbate an existing condition.”

Single homeless people are significantly more likely to suffer from mental illness than the general population. And as a result of being homeless they are also far more likely to rely on A&E services, only visiting when they reach crisis point, rather than being treated in a local setting by a GP. They are also more likely to be re-admitted. This high usage is also costly, and increasingly calls are being made for services to be delivered in a more interconnected way, ensuring that housing is high on the list of priorities for those teams helping people to transition from hospital back into the community.

Not just those who are homeless being failed

However, transitioning from hospital into suitable housing after a mental health hospital admission is not just a challenge for homeless people. It is also the case that people are being discharged from hospital to go back into settings that are unsuitable. Housing which is unsafe, in poor condition, in unsafe locations or in locations away from family and social networks can also have a significant impact on the ability of people to recover and prevent readmission.

Councils are facing an almost constant struggle to house people in appropriate accommodation. However, finding a solution to safe, affordable and suitable housing is vital. Reinvesting in social housing is a core strategy councils are considering going forward to try and relieve some of the pressure and demand. Gender and age specific approaches, which consider the specific needs of women, potentially with children, or old and young people and their specific needs would also go a long way to creating long term secure housing solutions which would then also impact on the use of frontline NHS services (by reducing the need for them because more could be treated in the community). Suitable housing also has the potential to improve employment prospects or increase the uptake of education or training among younger people with a mental illness. It would also provide stability and security, long term, to allow people  to make significant lifestyle changes and reduce their risk of homelessness in the future.

A new relationship for housing and health

A number of recommendations have been made for services. Many have called for the introduction of multi-disciplinary teams within the NHS, recruited from different backgrounds, not only to create partnerships with non-NHS teams, but also to act as a transitional care team, to ensure that care is transferred and dealt with in a community setting in an appropriate way, and to ensure housing is both adequate and reflects the needs of those who are most vulnerable.

In June 2017 the King’s Fund held an online seminar to discuss how greater integration between housing and mental health services could help accelerate discharge from hospital and reduce the rates of readmission for people suffering from mental illness. The panel included Claire Murdoch, National Mental Health Director at NHS England and Rachael Byrne, Executive Director, New Models of Care at Home Group.

Final thoughts

Increasingly the important link between housing and health is being recognised and developments are being made in acknowledging that both effective treatment and a stable environment are vital to helping people with mental illness recover and re-integrate back into their community, improving their life chances and reducing the potential for relapse.

Housing can be an area of life which can have a significant impact on mental health. It can cause stress, and the financial burden, possibility of being made homeless, or being placed in temporary accommodation can have a significant and lasting negative effect on people’s mental health. However, safe and stable housing can also have a significant positive impact on mental health, providing stability, privacy, dignity and a sense of belonging.


Follow us on Twitter to see what developments health, social and community care are interesting our research team.

If you enjoyed this blog, you may also be interested in our other articles on health care and reablement care

Why a holistic approach to public health and social care needs a wider evidence base … and how Social Policy and Practice can help

SPP screenshot2016 has been described as “make or break time for the NHS”, and with pressures on finances increasing, social care and public health are in the spotlight. Around £1 in every £5 of NHS spending is estimated to be the result of ill health attributable to the big five risk factors of smoking, alcohol, poor diet, obesity and inactivity. Investing in prevention, and understanding the complex wider community and social factors that lead to poor health, is therefore important. In cash-strapped local authorities however, investment in preventative projects can be sidelined in the face of tackling acute issues.

Prevention and behaviour change are linked

Recent health policy has included an expectation that individuals should take greater responsibility for their own health. But where we are talking about behaviour change, there is no quick fix. Glib use of the term ‘nudge’ to promote change can suggest that laziness is the only issue. However, research such as that by the King’s Fund has highlighted that motivation and confidence are essential if people are to successfully modify their health behaviours.

Practitioners within the field of both public health and social care need help understanding what works – but as two great recent blogs from the Alliance for Useful Evidence noted, change can be achieved in multiple ways and evidence shouldn’t be used to prove a service works but as part of a journey of improvement and learning.

We talk about the “caring professions”, but it seems that it can be difficult to maintain a focus on the ‘person not the patient’ when budgets are being cut. Well-reported issues such as the rise in the use of 15-minute home care appointments are just one symptom of this. More generally, making time to consider alternative approaches or learn from good practice elsewhere can be hard. That is where having access to a trusted database can help.

Trusted source of research and ideas

The Alliance for Useful Evidence, most recently in its practice guide to using research evidence, has highlighted the importance of using trusted sources rather than “haphazard online searches”. One of these resources is Social Policy and Practice, a database which we have contributed to for twelve years.

“SPP is useful for any professional working in the field of social care or social work who can’t get easy access to a university library.” Alliance for Useful Evidence, 2016

The partners who contribute to the database – Centre for Policy on Ageing, Idox Information Service, National Children’s Bureau, the NSPCC and the Social Care Institute for Excellence – are all committed to sharing their focused collections with the wider world of researchers and to influence policy and practice.

Social Policy and Practice is the UK’s only national social science database embracing social care, social policy, social services, and public policy. It boasts over 400,000 references to papers, books and reports and about 30% of the total content is grey literature.

Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care. And importantly, it supports the ability to take a holistic approach to improving outcomes, by covering social issues such as poor housing, regeneration, active ageing, resilience and capacity building.


Find out more about the development of the Social Policy and Practice database in this article from CILIP Update. Update is the leading publication for the library, information and knowledge management community and they’ve given us permission to share this article.

If you are interested in using the Social Policy and Practice (SPP) database for evidence and research in health and social care, please visit www.spandp.net for more information and to request a free trial.

Read some of our other blogs on evidence use in public policy:

Should the UK introduce a tax on sugar?

An assortment of liquorice allsorts sweets.

by Stacey Dingwall

Recent months have seen two enquiries to our Ask a Researcher service for evidence on sugar consumption in the UK. Namely: should this be taxed?

Sugar has become somewhat of a villain in the UK, with magazine articles, research and governments all telling us that we should be greatly reducing, or even eradicating completely, our consumption of added sugars in particular. The week beginning 30th of November even saw the first National Sugar Awareness Week, part of a campaign to encourage the government to establish a sugar reduction programme in the UK. However, is a ‘sugar tax’ really necessary?

Sugar consumption: a public health issue?

According to the Royal Society for Public Health (RSPH), absolutely. Last month, they published a review of how to tackle obesity in the UK, which included the introduction of a sugar tax. The report notes that, according to the latest forecasts, half of all adults in the UK are expected to be classed as obese by 2050. Key to reversing this trend, it is argued, is to tackle issues around diet and nutrition among children, who are now spending double the amount of time per day in front of screens than children in 1995 (something that has been shown to increase cravings for food and drink, but not for nutritionally sound items). Alongside other developed nations, the UK is also seeing an ever increasing rate of consumption of high-sugar carbonated drinks.

While the RSPH recommends placing restrictions, or ending, the use of advertising and sponsorship by junk food and drinks companies around family and sporting events, it also argues that this is not enough to tackle the country’s obesity problem. The RSPH supports the introduction of a tax on sugary drinks of 20%, or 20p per litre. Their report highlights evidence which suggests that this could prevent or delay around 200,000 cases of obesity per year, and points to the experience of Mexico, who introduced a tax of 10% at the start of 2014. During that year, sales of sugary drinks declined by 6% overall, and by 9% among those living in the most deprived areas of the country (the demographic group most likely to be obese).

What does the government think?

After a delay, the UK government published Public Health England’s (PHE) review of the evidence for action with regards to sugar reduction in October. The report:

  • agrees that too much sugar is consumed in the UK
  • favours a reduction in advertising to children
  • recommends the introduction of a tax on full sugar soft drinks of 10-20%

This, combined with a range of other measures, it is argued, could save the NHS £500 million per year. The PHE recommendation was also supported by the House of Commons Health Committee, in their recently published Childhood obesity – brave and bold action report. Having heard evidence from parties including Sustain and Jamie Oliver, a key figure in the campaign for the introduction of a sugar tax, the Committee recommended that such a levy should be introduced at 20%, in order to achieve maximum impact.

The Prime Minister, however, is still not convinced, stating that he believes there are “more effective” ways of tackling obesity. The government is due to publish a strategy on childhood obesity in the New Year.

What does the evidence say?

A number of countries have implemented a form of taxation on sugar or saturated fats. These include:

  • a tax on saturated fats in Denmark
  • Finland’s tax on sweets, ice cream and soft drinks
  • Hungary’s public health product tax
  • France’s tax on sugar- and artificially-sweetened beverages

According to a review of using price policies such as these to promote healthier diets by the World Health Organization, food pricing policies are feasible, and can influence consumption and purchasing patterns as intended, with a significant impact on important dietary and health-related behaviour. Crucially, however, the same review notes a lack of formal evaluation in this area.

A report published earlier this year by the activist group Taxpayers’ Union of New Zealand, Fizzed out: why a sugar tax won’t curb obesity,  questioned the validity of nutrition related taxes. Reviewing the experience of Mexico, they suggested that the reduction in consumption of sugary drinks following the introduction of an excise tax of one peso per litre in January 2014 had been overplayed.

It’s also the case that the Danish tax on saturated fats was repealed by the government after only one year. This was due to a number of economic impacts that quickly became apparent after the tax was implemented, and resulted in plans for similar taxes to be abandoned. In fact, fat consumption in Denmark has been on a downward trend for some time now, therefore no tax incentive was required. And according to the Danish minister of finance, “to tax food for public health reasons [is] misguided at best and may be counter‐productive at worst”.

Whether the UK Prime Minister will be swayed on this matter remains to be seen. It’s likely that a ‘sugar tax’ will continue to be deemed too politically sensitive to introduce, especially as one in five people continue to live below the poverty line.


Related reading
Child obesity: public health or child protection issue?

Our popular Ask-a-Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

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

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

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:

Become a member of the Idox Information Service now, to access a wealth of further information on health and social care including best practice and commentary. Contact us for more details.

What’s preventing health and social care from going digital?

Two women using a tablet computer.

Image by Innovate 360. Licensed for reuse under Creative Commons.

By Steven McGinty

In the first of two articles focusing on technology in health and social care, I will be looking at some of the barriers organisations face in adopting digital technologies. Financial pressures such as the reduction in public spending, as well as an ageing society, mean that health and social care will be expected to meet greater levels of demand with fewer resources.

The UK Government believes that the implementation of technology is the solution to helping the health and social care system become more efficient and more effective at delivering patient care. However, before health and social care can reap the benefits of technology, a number of barriers have to be broken down.

Information sharing challenges

Integration has been a main focus of health and social care in England, as well as the devolved administrations. If integration is to work successfully, different organisations must be able to share data securely. At the moment, data is recorded in a variety of ways across a number of different IT systems. We also have a situation where the main method for sharing data securely in local authorities, the Public Services Network (PSN), is not fully integrated with either the NHS in Scotland or England. Eddie Copeland, of the Policy Exchange, suggests that full integration of the NHS with the PSN should be seen as a priority.

Financial costs

The financial costs of rolling out new technology within an organisation can be significant. These costs can include the procurement of hardware and software, internet connections, and the training of staff. For organisations which are undergoing major budgets cuts, it may seem very difficult to justify the investment in technologies, even if there is the potential for savings in the future.

Management issues

The importance of technology in organisations can be underestimated by decision-makers. For example, according to Martin Ferguson, Director of the Society of IT Management (Socitm), the ICT challenges involved in introducing the new Care Act in England are not being given enough priority. He highlights that if organisations are unable to share information safely by April 2015, they risk failing to comply with new reporting regulations.

Local authorities can also have policies that restrict the use of technology. A recent Skills for Care report into the digital capabilities of social care found that local authorities are still wary of certain technologies, including cloud based systems, which can offer low-cost solutions, and social media, which can lead to savings for local authorities if used correctly.

The health and social care workforce

The Skills for Care report highlights that over 95% of staff feel they are confident in basic online skills. However less than a quarter of managers believe that they have staff with enough skills to make use of digital technology. This mismatch means that managers may be hesitant to introduce new technologies over fears that staff may have difficulties in using the technology, as well as the costs associated with staff training.

There is also a suggestion that social care staff may be resistant to the introduction of new technologies, due to concerns that introducing technology may over-complicate things and move the focus away from the patient. As we noted in a recent article on digital services within government, a key part of introducing any new technology is changing the mindset of staff and having effective leadership in place to champion it.

These are just some of the challenges associated with introducing digital technologies into health and social care. In a future article, we will look more at how technologies can be used within health and social care and the benefits they can bring to organisations. We also look at a case study of an innovative technology partnership between Calderdale Council and Idox, which is addressing the shared services agenda in social care.


Further reading:

 

Public Health Information Network for Scotland (PHINS) – 14th Seminar

Image of outside of the Glasgow Royal Concert Hall.

Image by Neil Turner under Creative Commons License, via Flickr

By Steven McGinty

On the 10th October I attended an annual event organised by the Scottish Public Health Observatory (ScotPHO) in the Royal Concert Hall in Glasgow. The event focused on health inequalities and the factors driving them. It brought together individuals from a variety of areas, including academia, public health organisations, local and central government, and the voluntary sector to review current evidence, highlight upcoming research and debate key issues with fellow professionals. Continue reading