Workplaces should accommodate people suffering from long term health conditions

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Freya Thompson, knowledge and research executive, North England Chamber of Commerce latest column for the Journal.

New analysis has revealed a massive increase in the number of people in the UK with long-term illnesses over the past two years, primarily due to Post-Covid conditions such as breathing difficulties, mental health problems, and long Covid.

My heart goes out to the 1.2 million people out there with a newfound chronic condition. This must be devastating.

The increase comes not just at the time of a cost-of-living crisis, in which disabled people are twice as likely to live in a cold house and three times as likely to not be able to afford food, but also when regional health inequalities are worsening.

Now that a third of working-age people suffer from a long-term health condition, it is clear we should be thinking about how we can make workplaces more accommodating.

Many of these conditions are invisible, so you don’t always know who in your organisation might benefit from adjustments.

I myself have suffered from chronic pain, fatigue, and dysautonomia since childhood as a result of Ehlers Danlos Syndrome and Postural Tachycardia Syndrome. The latter is also a common diagnosis for those suffering from long Covid, and before I started understanding my condition and adapting my lifestyle around it, it was possible for me to pass out in the street. I continue to struggle with standing, but you wouldn’t know if I didn’t tell you!

Full-time work was an intimidating prospect for me, and I felt locked out of many entry-level job opportunities. I am lucky here at the Chamber, however, where something that has really helped me is the ability to work from home. Being able to work without too much physical exertion most days means I have time to recover from the days I have to be out and about. For some, flexible hours will be useful, as symptoms and their severity can be unpredictable. Workplace culture also makes a massive impact, and it is helpful to promote a healthy work-life balance instead of overworking. These are considerations that I’m sure will benefit employees regardless of health status. I also encourage people to learn from their openly chronically ill colleagues so they can support them with their personal needs.

Even if there comes a day when this pandemic becomes a distant memory for most, it is likely it will deeply affect many people’s health for the rest of their lives. Being inclusive means you won’t miss out on talent, and will help employees to achieve their full potential.

Levelling Up Health and Wellbeing in the North East

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In the Government’s outline for Levelling Up the United Kingdom, two of the twelve ‘missions’ concern health and wellbeing. In this post I summarise the missions, their policy programmes, and what they could mean for the North East.

 

Health

The Government has stated that the gap in Healthy Life Expectancy (HLE) between local areas where it is highest and lowest will have narrowed by 2030, and that HLE will rise by 5 years in 2035.

The motivation behind this mission is that there are stark disparities in health outcomes across the UK, and that people deserve to have the opportunity to live long, healthy lives wherever they live. Better health will also improve productivity and wellbeing.

People living in the most deprived communities in England have up to 18 years less of their lives in good general health than the least deprived. The North East has the lowest life expectancy in the country and, in its most deprived areas, life expectancy has been decreasing. This is driven by a variety of factors, including smoking rates, alcohol intake, poor diet, quality of housing, and access to healthier food. Access to and quality of health services are also an issue which can vary by area.

Covid-19 has made these disparities even more stark, with hospital admission, mortality rates, and ‘long covid’ higher among more deprived groups. Access to healthcare has also widened in deprived areas, with waiting lists in England having increased by 55% in the most deprived areas. This is compared to only 36% in the most affluent. Ethnic minorities and people with disabilities have also been disproportionately impacted.

The government’s policy programme to improve health focuses on:

  • Improving public health
  • Supporting people to change their food and diet
  • Tackling diagnostic backlogs

 

Improving public health

The key points:

  • Recent launch of the Office for Health Improvement and Disparities
  • A new White Paper on Health Disparities in England will be released this year
  • The 2019 NHS Long Term Plan
  • The Core20PLUS5 Initiative
  • Rollout of social prescribing
  • A new 10-year Drugs Strategy was published late last year
  • A new Tobacco Control Plan for England is due to be published later this year
  • The Government is investing £75m in weight management services and support in England in 2021-22

A closer look:

The new White Paper on Health Disparities in England that will be released later this year will set out a strategy to tackle the core drivers of inequalities in health outcomes. It will have a strong focus on prevention and disparities by ethnicity, socioeconomic background, and geography. It will also include new ways to ensure that business plays a part in improving health.

The 2019 NHS Long Term Plan and the Core20PLUS5 initiative each look to level up healthcare. The latter focuses on improving cardiovascular disease, cancer, respiratory, maternity and mental health outcomes in the poorest 20% of the population, as well as ethnic minorities. In the North East, this will particularly benefit Middlesbrough.

In rolling out social prescribing, the aim is for at least 900,000 people to be referred to social prescribing by 2023-24. Social prescribing promotes a holistic approach to people’s health and wellbeing. NHS England has also commissioned an evaluation of this rollout to ensure that it meets people’s needs. There are several social prescribing projects across the North East region, including Ways to Wellness and Zone West. More specifically, the Government has invested in a £5.77m cross-government project aimed at preventing and tackling mental illness through ‘green’ social prescribing. This will look at how to increase connection to the natural environment and will be focusing particularly on communities most affected by health disparities.

Finally, a new 10-year Drugs Strategy was published late last year and outlines a whole-system approach. The most deprived areas in England face the highest prevalence of drug-driven crime and health harms associated with drug use. The Government has stated that they will invest £780m to create a treatment and recovery system to break the cycle of problem drug use. As of 2020, the North East has had the highest rate of drug misuse of any English region for 8 consecutive years. We also have the highest rate of drug misuse deaths.

 

Food and diet

The key points:

  • Upcoming Food Strategy White Paper
  • New approach will be launched to assure compliance with school food standards (in collaboration with the Department for Education and the Food Standards Agency)
  • Government to invest £5m in ‘school cooking revolution’
  • Government to invest up to £200,000 to pilot new training for school governors and academy trusts on a whole-school approach to food
  • Aim for every child leaving secondary school to know at least six basic recipes
  • 3-year pilot of a Community Eatwell programme (GPs will be able to prescribe fruit and vegetables and food-related education)

A closer look:

The Government states that their upcoming Food Strategy White Paper will attempt to ensure that everyone can access, understand, and enjoy the benefits of a healthy and sustainable diet. This includes looking at how consumers access information about food. It will support eligible children and families in some of the most disadvantaged areas to learn and improve their knowledge of health and nutrition.

While the project launched between the Department for Education and the Food Standards Agency will engage with multiple local authorities, it does not appear that any will be in the North East. The project aims to promote accountability and transparency of school food arrangements by encouraging schools to complete a statement on their school websites. It is the Government’s intention that this will become mandatory when schools can do this effectively.

 

Tackling diagnostic backlogs

The key points:

  • £2.3bn of Government investment to improve access to vital diagnostic services and tackle the diagnostic backlog
  • At least 100 Community Diagnostic Centres to be established in England by 2025
  • The People at the Heart of Care White Paper published late last year outlines planned reforms to adult social care in England

A closer look:

The majority of the Community Diagnostic Centres will be based outside of London and the South East, boosting diagnostic capacity in areas that need it most and offering a range of services tailored to local needs. The centres may include imaging, cardio-respiratory, pathology, endoscopy and general consulting equipment to allow several tests in one visit, improving the accuracy of diagnosis and overall patient experience. It is said that the Community Diagnostic Centres rolled out this year will deliver nearly three million additional scans in the first full year of operations. Over the next three years, they are projected to increase scans by an additional eight million tests each year, providing the equivalent of 23,000 years of improved quality of life.

As part of the Government’s commitment to build 40 new hospitals by 2030, Two hospitals are to be delivered in the North East by the end of the decade. These include the rebuild of Northgate hospital and a new hospital to replace Shotley Bridge Hospital. It is also said that 725 more doctors and 1,552 more nurses will be working in hospitals in the North East between September 2019 and September 2021.

 

Wellbeing

The Government has stated that, by 2030, wellbeing will have improved in every area of the UK, with the gap between top performing and other areas closing.

This ‘mission’ is considered an overarching, outcomes-based measure of success for levelling up. The report states that wellbeing captures the extent to which people across the UK lead happy and fulfilling lives, and consider it the very essence of levelling up.

Wellbeing is affected by a multitude of things, from physical and mental health, jobs, community relationships, quality of housing, and the environment. The report found that even the most productive and prosperous of places have some of the lowest levels of life satisfaction, which persisted even after controlling for personal and economic characteristics. They considered this a powerful illustration that wellbeing goes beyond income and that other factors are just as, if not more, important.

While the North East had the most significant deteriorations in happiness and life satisfaction from April 2019 to March 2020, the most recent investigation on personal wellbeing from the ONS found that the North East was an exception to increases in anxiety and decreases in happiness the feeling that the things done in life are worthwhile.

The Government states that, over time, it will be able to expand its use of new and administrative data through the ONS and the Integrated Data Services Platform, and that this will improve estimates of factors such as wellbeing.

 

Freya Thompson

Knowledge and Research Executive

@NEEChamberFreya

 

Photo by Andrew Tanglao on Unsplash

The North East’s ‘Left Behind’ Neighbourhoods

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A devastating new report by the All-Parliamentary Party Group (APPG) for ‘left behind’ neighbourhoods and the Northern Health Science Alliance (NHSA) explores the health inequalities of our most deprived neighbourhoods and how these could be overcome.

This summary will highlight the North East stats and impact on work, the economy, and businesses.

 

What are ‘left behind’ neighbourhoods?

‘Left behind’ neighbourhoods are identified as being within the top 10% most deprived of the Index of Multiple Deprivation and the top 10% of areas most in need as measured by the Community Needs Index. They lack the transport, digital connectivity, and social infrastructure that would transform a place into a community where people would want to live and businesses would want to trade.

Of England’s 225 ‘left behind’ neighbourhoods, nine of the 20 most vulnerable are in the North East, with six of them being in County Durham specifically.

Areas that are identified as ‘left behind’ have among the worst health outcomes in England, and these disparities between them and the rest of the country are continuing to grow. People who live in these areas are more likely to self-report their health to be ‘bad’ or ‘very bad’ (9.1%) than other deprived areas (8.1%) and England as a whole (5.5%). As a result of these worse health outcomes, people in ‘left behind’ neighbourhoods also live shorter lives and live 7.5 fewer years in good health.

The report has also shown that those living in ‘left behind’ neighbourhoods have been particularly vulnerable to COVID-19, with them being a devastating 46% more likely to die from it when compared to the national average. These COVID-19 mortality rates were particularly high in ‘left behind’ neighbourhoods in the North East. Seven of the 10 areas with the highest mortality rates are in this region, with the highest recorded rate in Hemlington in Middlesbrough.

 

Work and the Economy

It is apparent that these health inequalities have an impact on work. ‘Left behind’ neighbourhoods have nearly twice the proportion of people out of work due to sickness than the England average. Residents are also more likely to be out of employment due to mental health conditions. Despite this, people in these neighbourhoods also work more hours on average than those in the rest of England, but the nature of the jobs in these areas means that average wages are lower, as is productivity, which is falling even further behind the rest of England.

This poor health therefore also translates into poor economic outcomes. However, reducing health inequalities and bringing ‘left behind’ neighbourhoods up to England’s average would add an extra £29.8 billion to the country’s economy each year.

 

Policy Recommendations

The report emphasises that investment in the social infrastructure that ‘left behind’ neighbourhoods lack is a key policy solution. This would transform the physical and social environment in these neighbourhoods and strengthen residents’ capacity to address the health disparities and other poor outcomes that they experience. To achieve this would require consistent and longterm financial support.

The report also suggests that the government’s national ‘levelling up’ strategy must include reducing regional health disparities trough targeting multiple neighbourhood, community and healthcare factors. The authors stress that levelling up cannot be done without working together with these communities and their residents. Residents must be listened to and be able to take an active role in safeguarding their health and improving the quality of their lives and their community.

Community public health budgets must also be safeguarded and more longterm funding is needed for effective delivery of resources and for targeted heath inequalities programmes, such as Healthy New Towns.

Healthy New Towns was a three-year NHS England initiative that took place between 2016 and 2019 in ten housing development sites across England. One of these sites was Darlington. The initiative provided resources to these housing development sites with the aim to shape the health of communities and rethink how healthcare services could be planned more effectively and from a more integrated approach, which could, in turn, promote health and wellbeing and prevent illness.

Despite challenges which included a delayed implementation and funding uncertainty, Darlington’s Healthy New Towns programme was successfully piloted. It resulted in a cultural shift among GP practices to work in more integrated ways, a successful delivery of e-consulting across the area, and more suitable serviced being accessed by patients, which led to an estimated 985 GP appointments being saved in 2019 and reduced incidences of non-attendance.

 

Overall, the report shows the severity of regional health inequalities in this country (which has been further exposed by the Covid-19 pandemic) and the importance of taking an ultra-local approach to solving health issues and engaging the local community in these efforts. If these inequalities can be addressed, not only will the lives of millions of citizens be improved, but entire communities and the economy as a whole.

 

Read the whole Overcoming Health Inequalities in ‘Left Behind’ Neighbourhoods report here, and their summary here.

Read my summary of a previous NHSA report, Child of the North, here.

 

Freya Thompson

Knowledge and Research Executive

@NEEChamberFreya

Photo by Tim Mossholder on Unsplash