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Lord Mann review on antisemitism and other forms of racism in the NHS - June 2026

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Lord Mann review on antisemitism and other forms of racism in the NHS - June 2026

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Lord Mann review on antisemitism and other forms of racism in the NHS

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An urgent review led by Lord John Mann examining how the NHS, including employers and UK health regulators, identify, report and respond to antisemitism and other forms of racism.

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The emerging role of emotional intelligence in healthcare leadership: a scoping review - Leadership in Health Services, 2026

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The emerging role of emotional intelligence in healthcare leadership: a scoping review - Leadership in Health Services, 2026

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To recieve any of the following current awareness bulletins complete our form and we will add you to the mailing list.

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Ten Tasters - Medicine

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Free Webinar: Understanding the NHS Management and Leadership Framework in Practice

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Free Webinar: Understanding the NHS Management and Leadership Framework in Practice

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Tuesday 28 April 2026, 11am-12pm

This session is designed for NHS managers and leaders, as well as HR, organisational development, workforce and learning professionals looking to understand how the framework will shape leadership development across the system.

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Webinar - Understanding the NHS Management and Leadership Framework in Practice

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Webinar - Understanding the NHS Management and Leadership Framework in Practice

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Enrol your OpenAthens account on Imprivata

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Enrol your OpenAthens account on Imprivata

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What do I need to do?

On a Trust PC go to www.openathens.net - select Login - then select Login to MyAthens

Once you have done this your OpenAthens account will have been enrolled on Imprivata. This will make accessing the e-resources more streamlined for you as login should now be automatic.

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Some of the articles are open access - for others you will need to select the Use Token option.

Leadership in Health Services provides international examples of theory and best practice to improve healthcare practices, organizations and services worldwide by recognizing and developing effective leaders and leadership models.

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Briefing - NHS Staff Survey analysis - Nuffield Trust

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Briefing - NHS Staff Survey analysis - Nuffield Trust

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What does the NHS staff survey tell us about the changing behaviours and motivation of health care staff?

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Over the past decade younger NHS staff have reported lower job satisfaction, higher stress levels, and greater dissatisfaction with pay than their older colleagues, according to this new analysis of over a million NHS staff survey responses. Do these trends reflect changing generational attitudes to work, or are they in fact shaped by wider workforce and societal pressures? This long read explores the relationship between age and staff experience and what it means for workforce retention and policy.

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Virtual drop-ins on the Green Plan Guidance will be held in March 2025 - visit the Sustainability Network on FutureNHS for more information.

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Introduction In 2020, the NHS became the world’s first health system to commit to reaching net zero emissions. The Delivering a Net Zero National Health Service report set out the scale of ambition. The Health and Care Act 2022 reinforced this commitment, placing new duties on integrated care boards (ICBs), NHS trusts and foundation trusts […]

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2025/26 priorities and operational planning guidance

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2025/26 priorities and operational planning guidance

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NHS England » 2025/26 priorities and operational planning guidance

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Foreword from the NHS Chief Executive Our 76-year history is one of progress and transformation – as society, technology and medicine have changed, so has our health service. But the NHS currently faces twin challenges, managing today’s very real pressures – a legacy of the historic context set out by the Darzi Review – while […]

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Policy paper - Road to recovery: the government's 2025 mandate to NHS England

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Policy paper - Road to recovery: the government's 2025 mandate to NHS England

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Presented to Parliament pursuant to section 13A of the National Health Service Act 2006.

Foreword from the Secretary of State for Health and Social Care

The government was elected with a mandate to get our NHS back on its feet and to build an NHS fit for the future. Together, we will deliver.

On day one, I was honest with the country that the NHS is broken, because the first step to rebuilding public trust and confidence in the service is to be completely honest about its failings.

The promise that the NHS will be there for us when we need it has been broken for almost a decade. Patients are waiting too long for appointments, treatment and ambulances. Cancer care lags behind other countries. Care for cardiovascular conditions is going in the wrong direction. The NHS budget is not being spent where it should be - far too concentrated in hospitals, too little in the community, and productivity is too low. Patients and staff alike are confronted with these failures, and they are counting on us to act.

Nothing I have experienced in my first months as your Secretary of State has shaken my conviction that, while the NHS may be broken, it's not beaten. The NHS has extraordinary depth of clinical talent. Staff across every function in every part of the NHS are dedicated to their patients, have an unshakeable commitment to the NHS's values, and are passionate about bringing about the change we all want to see.

This new mandate for reform of the NHS reflects patients' priorities:

cut waiting times

improve access to primary care

improve urgent and emergency care

With so many pressures on people's pockets and the public purse, the NHS must learn to live within its means. We recognise that this will mean tough decisions need to be made and local systems should feel empowered to make them. The government's investment in the NHS against a challenging economic and fiscal backdrop must be matched with reform to the operating model, with a sharp focus on improving efficiency and productivity. We have a shared responsibility to make sure that every pound is well spent. The public welcomed the Chancellor's decision to prioritise the NHS, but they remain sceptical about whether the money will be well spent. It is our responsibility to make sure that it is. I will be closely monitoring performance against the budget. The culture of routine overspending without consequences is over.

Our 10 Year Health Plan, to be published in the spring, will deliver the 3 big shifts our NHS needs to be fit for the future: from hospital to community, from analogue to digital, and from sickness to prevention. It will deliver power to the patient and more freedom to the frontline. It will meet the Prime Minister's challenge, set out in the Plan for Change, for us to deliver the biggest reimagining of the NHS since its birth.

This mandate puts the NHS on the road to recovery. The last Labour government delivered the shortest waiting times and the highest patient satisfaction on record. It won't be easy, but together we'll do it again.

The Rt Hon Wes Streeting MP

Secretary of State for Health and Social Care

Introduction

This mandate represents a critical step in responding to the issues identified by the Darzi investigation and addressing the urgent challenges facing the NHS. The government is committed to ensuring that every individual receives timely, high-quality care, and this requires swift, decisive action now.

In addition to addressing the immediate challenges, the mandate lays the foundation for longer-term reform as part of our health mission, focusing on bringing care closer to communities, prioritising prevention over treatment, embracing digital transformation, and embedding financial discipline within the system.

Ahead of the broad and extensive engagement planned through the 10 Year Health Plan process, it is important to put a new mandate in place to formally communicate the key priorities on which the new government was elected, and signal to NHS England and the NHS the immediate actions needed. Integrated care boards ( ICBs) and NHS England need to engage with patients, carers and the public as they discharge their functions, both in relation to clinical and wider commissioning decisions.

In the financial year 2025 to 2026 we will take the first steps to reform the service, so that it delivers the new model of care that the NHS will be working towards over the next decade. Following the publication of the 10 Year Health Plan the government will publish an updated mandate, to support longer-term planning in the NHS aligned with a long-term vision for health.

Through the 10 Year Health Plan, the government will focus on 3 strategic shifts, moving care from:

hospital to community

sickness to prevention

analogue to digital

These shifts will help to:

cut waiting times for care

reduce the amount of time spent in ill health

tackle health inequalities

reduce the lives lost to the biggest killers - cancer, cardiovascular disease and suicide

make the NHS sustainable in the long term

Alongside our health mission, our ability to achieve the government's growth mission is dependent on a healthy, productive workforce. At the start of this year, 2.8 million people were economically inactive due to long-term illness. We know that 4.1 million people are in employment with a work-limiting health condition - an increase of 300,000 in the last year. The NHS plays a vital role in keeping people healthy and in work. Further, the NHS also plays a vital role in delivering our opportunity mission, including through training the staff we need (including health visitors) and the provision of health services to provide babies and children the best start in life.

There are many positive examples of local organisations and systems working effectively to successfully drive progress towards the 3 shifts. Scaling examples of best practice, promoting innovation in delivery and tackling unwarranted variation will be critical as we collectively transform the NHS. The NHS has more pilots than the Royal Air Force (RAF). We need to do more to adopt and scale new approaches, to take the best of the NHS to the rest of the NHS. This applies especially strongly in addressing the stark health inequalities that mean shorter lives in poorer health for far too many people.

Objective 1: reform to cut waiting times

High-quality elective care, delivered in a timely way is a top priority for patients and the government. It is simply unacceptable that waiting lists are at record highs and that some patients are waiting over a year for care. We expect the NHS to make progress towards delivering shorter waiting times and to improve performance against the constitutional standards. Patients should be empowered and given more choice and control, and their experience of planned NHS care should be as smooth, supportive and convenient as possible.

The government will prioritise reducing waiting times for elective care and improving experience of care by empowering patients with greater choice and autonomy over their treatment. We will need to shift culture in the NHS to focus as much on experience as outcomes and safety, making the most of patient voice and involvement in co-design solutions. Making progress will require judicious use of public resources and wide-ranging reforms to delivery by working more productively, consistently and differently. These reforms will be successfully delivered by aligning finance, performance oversight and delivery standards with clear responsibilities and incentives for reform, robust and regular oversight of performance, and clear expectations for how elective care will be delivered at a local level. As part of delivering our Elective Reform Plan, NHS England should:

support the NHS to ensure that trusts make progress towards the 18-week standard over the financial year 2024 to 2025 and 2025 to 2026 in line with the 2025 Elective Reform Plan, by continuing to maximise elective activity, increasing diagnostic and theatre capacity, and introducing the reforms it outlines

empower patients with choice and control over where they receive treatment, including from the independent sector

work with patients and carers to understand their expectations and co-design solutions to improve experience of care

drive expansion of the NHS App as a key part of the drive to improve communication with patients so that individual needs are better met and patients exercise greater control over their health and care

continue to support the NHS to maximise performance against the cancer waiting time standards and improve cancer outcomes

support the NHS to maximise performance on the waits patients experience for mental health services

continue to reduce the number of long-waiters, including reducing the proportion of people waiting over 65 weeks in the financial year 2024 to 2025 and waiting over 52 weeks in the financial year 2025 to 2026

Objective 2: reform to improve primary care access

Primary care services are the front door to the health service for most people and the key to earlier diagnosis, but too often it is not possible to get a timely appointment, or one at all. Improving primary care access is essential to support a move to a neighbourhood health service, with more care delivered in local communities to identify and manage problems earlier. Bringing care closer to home is important for preventing hospital attendances and admissions, so reducing waiting lists. This will be a focus of the 10 Year Health Plan.

NHS England should:

enable patients to access general practice appointments in a more timely way

enable commissioners to tackle unwarranted variation and support improvement in general practice services, including by increased investment to deliver upgrades to GP surgeries

ensure investment in data and digital to build a more modern and productive primary and community care sector

ensure a focus on patient access to urgent NHS dental care, including access to urgent care appointments

develop approaches with relevant partners to improve financial flows within health and social care to provide more co-ordinated services to patients as a step towards building a new neighbourhood health service

work through the 10 Year Health Plan process to deliver an expansion in primary and community services including dental practices and pharmacies

Objective 3: reform to improve urgent and emergency care

The NHS has been struggling to provide the level of urgent and emergency care the public needs. Ambulance response times and waiting times in A&E are unacceptable. It will take time and transformation for these services to be fit for the future, but a start must be made.

NHS England should:

support the NHS to reduce long wait times in urgent and emergency care settings with the aim of improving patient safety, experience and outcomes

improve patient flow through mental health crisis and acute pathways by providing new infrastructure for mental health crisis support to improve patient experience, outcomes and contribute to the avoidance of unnecessary A&E attendance

make progress towards reducing hospital admissions, especially with respect to emergency bed use, by taking the first steps to building neighbourhood health services

ensure close working with local government, community partners and social care services to improve discharge in a timely manner with appropriate support

develop new approaches to financial incentives to support urgent and emergency care performance and improve the use of resources by tackling unwarranted variation in performance

work with the Department of Health and Social Care (DHSC) to develop a new strategy for transforming urgent and emergency care for publication in early 2025

Objective 4: reform to the operating model

To support delivery of these reforms and to improve performance, changes must also be made to the operating model of the NHS. The top down centralised model of control will, over time, need to give way to a more devolved system where ICBs and trusts have greater freedom and flexibility and where patients have more choice and control.

NHS England should:

develop an updated NHS Oversight and Assessment Framework

develop a differentiated approach to supporting ICB and trust delivery, empowering those performing well with a package of freedoms, flexibilities and financial rewards while improving support for those in the middle and offering intensive and focused intervention for the most challenged local systems

reward the best performing NHS organisations by rewarding them with financial incentives, for example flexibilities such as more capital resources

get ICBs focused on developing the new neighbourhood health service of the future, with stronger primary and community care services closer to home, through a renewed focus on strategic commissioning

Objective 5: reform to drive efficiency and productivity

The financial position facing the NHS is not easy. The Darzi investigation spoke of a system under huge pressure. The public welcome the Chancellor's decision to prioritise the NHS in the Budget but want funds to be spent wisely. This will require the NHS to revisit how they can further improve efficiency and productivity in all parts of the system and the choices being made about which services to prioritise.

While NHS England needs to continue to comply with its existing duties and deliver financial balance, the overarching financial objective for the NHS has to focus on ensuring that the right spending decisions are made to deliver the services patients require.

NHS England should:

work closely with DHSC to monitor the delivery of spending plans and expected outcomes against jointly agreed metrics, across both revenue and capital funding, including with the aim of delivering a 2% productivity improvement across the NHS

contribute to a zero-based review of spending, including in NHS England's resources with a view to making real terms cash-releasing savings

prioritise digital integration to promote greater efficiency within the system by allowing systems to co-ordinate more effectively to deliver better outcomes for patients

ensure the right financial management and control frameworks are in place to support the delivery of mandate objectives within the parameters set out in the financial directions, delegated spending authorities and controls issued by the department

ensure that ICBs and partner trusts exercise their functions with a view to managing within agreed plans, to deliver financial balance across their systems. Where deficits occur, NHS England should work with DHSC to identify potential measures to address systems and trusts with persistent financial issues

This mandate will apply from 30 January 2025 until a new mandate is published, following the publication of the 10 Year Health Plan. NHS England has a duty to seek to achieve the objectives in the mandate. The Secretary of State keeps progress against the mandate under review, setting out his views in an annual assessment which is laid in Parliament and published. The government will agree with NHS England how it should report on overall progress against the mandate to support the Secretary of State in keeping this under review.

In seeking to meet the objectives set out above, NHS England will need to act in accordance with the principles and guidance set out in Managing public money, and continue to comply with its delegated authorities agreed by DHSC, and its framework document with the department, which will be published on GOV.UK and sets out how it and the government will work together. NHS England's statutory obligations under the NHS Act 2006 and other legislation also apply.

The Education Outcomes Framework, as published on GOV.UK ( The government's 2023 mandate to NHS England), remains in place pursuant to Section 100(2) of the Care Act 2014.

As required by the NHS Act 2006, the government has consulted NHS England and Healthwatch England on the objectives set in this mandate.

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Road to recovery: the government's 2025 mandate to NHS England

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Presented to Parliament pursuant to section 13A of the National Health Service Act 2006. The government was elected with a mandate to get our NHS back on its feet and to build an NHS fit for the future. Together, we will deliver.

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Now available to borrow from the library.

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New Perspectives in Health Promotion pic

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Population Health & Health Inequalities - resources

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Population Health & Health Inequalities - resources

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HSSIB - Safety management: accountability across organisational boundaries

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HSSIB - Safety management: accountability across organisational boundaries

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This investigation considers how safety management is coordinated and integrated across the healthcare system. This will be achieved by ensuring that the patient voice is represented and that challenges to safety management are understood by hearing from patients that may have been harmed and those working within the system. The investigation will report on pathways of care for the health needs of patients that require multiple contacts across different healthcare settings and providers. Contacts with the healthcare system will be mapped with a detailed account of organisational patient safety accountabilities. We will explore recurring risks when patients receive care from multiple services, and we will consider vulnerable patients.

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What does the plan for reforming elective care mean for patient-initiated follow-up? Nuffield Trust

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What does the plan for reforming elective care mean for patient-initiated follow-up? Nuffield Trust

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What does the plan for reforming elective care mean for patient-initiated follow-up?

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One important part of the recent plan to reform elective care is the role of patient-initiated follow-up (PIFU), which is a way of organising care that gives patients more flexibility over the timing of their follow-up appointments. After a recent evaluation of PIFU by the NIHR Rapid Service Evaluation Team revealed important lessons for the NHS, Rachel Hutchings takes a closer look at what the new plan could mean for PIFU.

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Population and Person Insight (PaPI) dashboards - NHS England

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Population and Person Insight (PaPI) dashboards - NHS England

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You will need to register to access the data - sign up for an Okta account

This dashboard is intended to support decision making in Health and Care. It provides users with a range of insights on population groups, their health acuity, their associated use and costs of services and their outcomes. However, it often uses very large, complex, specialised and novel data that should be considered experimental. It is highly recommended that this dashboard is used in conjunction with local knowledge and other faces of local intelligence.

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For a selection of some of the books held in the library click on the following links.

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For a selection of some of the books held in the library click on the following links.

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Leadership

Change Management

Teams

Project Management

Coaching

Mentoring

Communication Skills

People Management

Sustainability

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Evidence-based practice for effective decision-making | Factsheets | CIPD

Building an evidence-based people profession | CIPD

Evidence-based HR: Make better decisions and step up your influence | CIPD

figure-3--the-six-steps-to-evidence-based-practice-v2.png (1001×1001)

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NHS Horizons - The School for Change Agents

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NHS Horizons - The School for Change Agents

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A free, online, self-paced course designed for health and care staff at any level to build the confidence, knowledge & skills to unleash your inner change agent!

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The November 2023 run of School Is now Closed!
Thank you to everyone who has taken part!

Stay tuned for more updates for the next run of School or you can register your interest for the next run here: Register your interest

In the meantime - check out the magic of School below....

On this page - please click on any of the links below to go directly to that item

Build your network

The lively community of fellow learners on FutureLearn (as well as on Twitter, and in the Facebook group) means that you not only gain a wealth of useful knowledge, you can also build your networks and learn from each other as you reflect on how you can use the skills you've gained to take action.

The School for Change Agents Celebration Report!

We are delighted to share the #S4CA celebration report 2022: Celebrating 9 years of a social movement.

Discover the global impact of the School and hear from the Alumni who were inspired

Listen to our podcast

If you enjoyed School, you may also appreciate our podcast, which goes "behind the scenes" with the team who are responsible for School. You can also access transcripts of the podcast.

What you will learn

The School for Change Agents by NHS Horizons is a free, online, self-paced course designed for health and care staff at any level to build the confidence and community to unleash their inner change agent!

The School for Change Agents takes place on FutureLearn. There are five interactive sessions to complete:

1. Change starts with me

2. Resourcefulness

3. Using power to make a difference

4. Using stories to create change

5. Making sense of complexity

Each session includes a range of articles and videos that feature people like you talking about their own experiences of creating change.

How to take part

School is free to join, and to take part in. All you need is an internet connection. The sessions are arranged into 'bite-sized' chunks so that you can complete them in your own time, and in your own way. You can take part on a computer, tablet or mobile device. School is currently closed but you can register your interest for the next run here: Register your interest

Live sessions

Alongside the FutureLearn sessions, we held three live webinars. These were optional and were a way to interact with concepts and themes covered in the FutureLearn sessions. They have been recorded and you can watch them via YouTube on the link below.

To upgrade you need to:

Engagement Pack
Spread the word and help promote the School For Change Agents with your networks!

Images, copy and downloads available here: https://horizonsnhs.com/the-school-for-change-agents-engagement-pack/

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The School for Change AgentsA free, online, self-paced course designed for health and care staff at any level to build the confidence and community to unleash their inner change agent! The November...

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The Knowledge and Library Hub gives access to many resources all in one place.

Access HERE - Click on the yellow bar at the top of the screen then login using your OpenAthens account.

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NHS Knowledge and Library Hub on your desktop

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NHS Knowledge and Library Hub on your desktop

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You'll find this icon on the desktop of all DGT Trust computers, giving you quick and easy access to the Hub and the information you need.

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A blue and white icon representing the Knowledge and Library Hub. The upper part resembles the symbol for WiFi or signal strength. The lower part is formed of diagonal lines which resemble an open book.

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How life has changed in Dartford: Census 2021

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How life has changed in Dartford: Census 2021

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How life has changed in Dartford: Census 2021

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Find out how life changed in Dartford between Census 2011 to Census 2021, including data on ageing, ethnicity, health, housing and more.

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HCS Leadership Journal - The Academy For Healthcare Science

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An overarching body for whole healthcare science profession

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Public health and population health: leading together

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Public health and population health: leading together

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Public Health And Population Health: Leading Together | The King’s Fund

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The new government has made a commitment to halving gaps in health life expectancy and delivering a 10-year plan for health. To achieve this, ministers must call on and support the expertise of the existing public health family and the new emphasis on population health taking root in ICSs.

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What would 2 million more operations, scans and appointments do to the NHS waiting list?

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What would 2 million more operations, scans and appointments do to the NHS waiting list?

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What would 2 million more operations, scans and appointments do to the NHS waiting list?

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With waiting times in the NHS struggling, one pledge made by Labour ahead of the summer election was that, under their leadership, there would be an extra 2 million NHS operations, scans and appointments every year. Sarah Scobie and Theo Georghiou assess what that would mean for waiting times in the health service.

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NHS hospital care: who is waiting and what are they waiting for?

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NHS hospital care: who is waiting and what are they waiting for?

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NHS hospital care: Who is waiting and what are they waiting for?

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Backlogs in NHS care and long waiting times in England are widespread, and politicians, policymakers and the public are well aware of this. But headline numbers obscure important distinctions, and questions remain unanswered about who is bearing the brunt of delays. This new QualityWatch analysis uses urgent and emergency care and planned care data alongside an ONS patient survey to understand how waiting times vary by age, sex, ethnicity, and level of deprivation, and how waits for specific conditions differ.

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Tackling health inequalities: seven priorities for the NHS

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Tackling health inequalities: seven priorities for the NHS

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Tackling Health Inequalities | Seven Priorities For The NHS | The King’s Fund

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Drawing on our five-year programme of work on health inequalities, we outline what we think the anticipated 10-year health plan should focus on.

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www.linkedin.com/in/dgtlibrary

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750 million+ members | Manage your professional identity. Build and engage with your professional network. Access knowledge, insights and opportunities.

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If you would like to be added to the monthly mailing list, you can sign up at https://www.theqihub.com/latest

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Working with Uptimize, we have produced this report which makes the case that neuroinclusion should be part of your EDI strategy and that it is vital to the future of work.

Why does neuroinclusion matter?

There is a strong business case for neuroinclusive workplaces, relating to talent and underuse of skills, but also pursuing equality of outcomes for all is simply the right thing to do. Facing skills shortages, organisations need to think more inclusively about how they recruit and retain talented people. In addition, the business case for EDI has highlighted the importance of 'diversity of thought'. When we're talking about neurodiversity, we're talking about the fact that people literally think differently. And to realise the benefits of diversity of thought, a neuroinclusive workplace is essential as well as action to ensure equality of opportunity and outcomes for all types of thinkers.

How can this report help you?

This report discusses the findings from an employer and an employee survey to examine the importance of having a neuroinclusive workplace. We look at what employers are currently doing in this area as well as offer insight from employees themselves about their working experiences.

We consider the extent to which employers are considering neuroinclusion and the impact of their work on organisation outcomes. In the employee survey, as well as examining the working experiences of respondents overall, we consider the experiences of neurodivergent and of neurotypical people separately, in order to explore and understand the often hidden neurodivergent experience at work.

The findings provide a clear rationale for neuroinclusion to be a key part of an organisation's equality, diversity and inclusion efforts as well as its wellbeing approach. At the end of this report, we also provide seven key principles for creating a neuroinclusive organisation, and you can find more information on how to be neuroinclusive in our guide.

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CIPD | Neuroinclusion at work report 2024

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Working with Uptimize, we have produced this report which makes the case that neuroinclusion should be part of your EDI strategy and that it is vital to the future of work. There is a strong business case for neuroinclusive workplaces, relating to talent and underuse of skills, but also pursuing equality of outcomes for all is simply the right thing to do.

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What do virtual wards look like in England?

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What do virtual wards look like in England?

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Unfortunately, your browser is too old to work on this website. Please upgrade your browser

The Improvement Analytics Unit (IAU) is a partnership between the Health Foundation and NHS England. In this working paper, the IAU uses aggregate national data to explore what virtual wards currently look like across England and their effects on patients, staff and hospital capacity.

Virtual wards provide hospital-level care to patients in their own homes. There are many different models of virtual wards. Some cover specific conditions, while others provide care for a much broader range of patients.

Virtual wards have the potential to improve outcomes for both patients and the health care system. But we need high-quality data, careful monitoring and robust evaluations to understand if this is the case - and for which patients and in what contexts. This will provide learning and drive improvement.

In April 2022, NHS England launched its national virtual ward programme with the long-term aim of providing 40 to 50 virtual ward beds per 100,000 people in England. So far, every integrated care board in England has introduced virtual wards. Further aims of this programme include improving patient choice and experience, avoiding risks associated with inpatients stays and improving hospital flow by reducing lengths of stay and freeing up beds.

In this working paper, the IAU analyses aggregate national data on virtual wards to describe what virtual wards currently look like across England and discuss the effects of virtual wards on patients, staff and hospital capacity, as well as the gaps in the evidence.

It is not yet clear if virtual wards reduce pressure on hospital beds. We do not know how many of the patients cared for on virtual wards would have been in hospital if they were not in a virtual ward bed. Better data will help with this.

Virtual wards may benefit some patients, but more research is needed, including on equity. They also may benefit patients with certain demographics or conditions more than others. Moving resources to virtual wards might also have unintended consequences for other services and their patients.

To enable better evaluation and improvement of virtual wards, we need good data. Current national virtual wards data only provide limited patient information. NHS England is developing a national minimum dataset for virtual wards that will allow better analyses.

Cite this publication

Chappell P, Co M, Hardie T, Lloyd T, Tallack C, Gerhold M, Mayers C. What do virtual wards look like in England? (Working Paper). Health Foundation; 2024 (https://www.health.org.uk/publications/what-do-virtual-wards-look-like-in-england).

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What do virtual wards look like in England?

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This paper explores what virtual wards currently look like across England and their effects on patients, staff and hospital capacity.

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Making care closer to home a reality: refocusing the system to primary and community care

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Making care closer to home a reality: refocusing the system to primary and community care

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What next?

Because the health and care system is complex, so are the solutions. Although, in this report, we identify some specific actions that are required - for example, changes to training or to financial and incentive systems - it will not be enough to selectively implement only a few changes; a wholesale shift is needed, which helps to explain why the vision has not been achieved thus far. This wholesale shift in focus requires the following.

Leaders need to be clear about why a change in focus is needed: which is to deliver improved care and improved outcomes, and to ensure the health and care system is sustainable for the future, rather than to deliver cost savings in the short term.

All policies, including investment, workforce, financial architecture and performance management policies, must be aligned to the vision. If the focus remains on hospital performance, eg, waiting times and elective care targets, until performance recovers, this will reinforce the status quo and mean that the wholesale changes required will not be delivered.

The vision must be maintained over the long term - shifting focus will be an ongoing process and will need a consistent vision and dedicated investment that matches demand in the long term.

There will need to be differential funding growth. In a cash-limited system, and to avoid destabilising services, the solution is likely to be differential growth for each part of the health and care system, and a longer-term strategy for investing growth monies into primary and community health and care services.

The workforce needs to be equipped to deliver the vision. The health and care system is currently hospital centric, with increasing specialism and subspecialism of health and care. However, people are having increasingly complex health and care needs, which require an integrated, holistic response.

The system needs to increase generalism and multidisciplinary integrated teamworking, with practitioners able to hold risk and to enable people to live healthily in their communities. This will require pay and reward systems, workforce planning, education and training, and regulatory bodies to reflect the nature of this work.

Training for both practitioners and managers should focus as much on primary and community-based care as it currently does on hospitals, with most system and national leaders having expertise in, and experience of, primary and community-based care.

National leaders need to devolve responsibility and allow local areas to focus on what will meet the needs of their communities - a community-focused health and care system needs to reflect local need and circumstances. If integrated care boards (ICBs) focus on population health as originally intended, they have the potential to be able to deliver this change. In the main, ICBs should be held to account for their achievements in growing primary and community health and care services, rather than for the performance management of the hospital system.

We also identified some actions that should not be taken.

Only partially implementing the vision: individual policies, levers or initiatives will not miraculously unlock change. A total change in focus is needed to finally realise the vision.

Structural reorganisation: restructuring the current system is not necessary and risks reinforcing a hospital-centric health and care system.

Expecting short-term financial savings as a result of moving activity away from hospitals and abandoning plans if they do not materialise; given England's already low acute-bed base, it is unlikely that money will be released from acute hospital closure, even if some activity moves from hospital to community.

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Making Care Closer To Home A Reality | The King's Fund

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Our new report explores the factors that have prevented successive governments from achieving this vision so far and proposes several steps to begin this shift.

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A selection of tools and resources to help you use evidence and knowledge to inform NHS policy and practice

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A selection of tools and resources to help you use evidence and knowledge to inform NHS policy and practice

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Additional resources about the learning before section of the Knowledge Mobilisation Framework.

Appreciative Inquiry

Before Action Review

Peer Assist

Self-Assessment

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Workforce, training and education | Knowledge and Library Services

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Additional resources about the learning before section of the Knowledge Mobilisation Framework.

If you want to know more about any of these techniques please contact your local NHS Knowledge and Library Service or have a conversation with the HEE Knowledge for Healthcare team.

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Learning before resources | Workforce, training and education

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Additional resources about the learning before section of the Knowledge Mobilisation Framework.

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Additional resources about the learning during tools section of the Knowledge Mobilisation Framework.

Action Learning Sets

After Action Review

Communities of practice

Fishbowl

Knowledge assets

Knowledge Cafe

Randomised Coffee Trials

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Workforce, training and education | Knowledge and Library Services

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Additional resources about the learning during tools section of the Knowledge Mobilisation Framework.

If you want to know more about any of these techniques, contact your local NHS Knowledge and Library Service or have a conversation with a Regional Library Lead on [email protected] .

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Learning During resources | Workforce, training and education

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Additional resources about the learning during tools section of the Knowledge Mobilisation Framework.

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Additional resources about the learning after element of the Knowledge Mobilisation Framework.

Knowledge harvesting

Retrospect

Storytelling

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Workforce, training and education | Knowledge and Library Services

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Additional resources about the learning after element of the Knowledge Mobilisation Framework.

If you want to know more about any of these techniques please contact your local NHS knowledge and library service or have a conversation with a regional library lead on [email protected] .

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Learning after resources | Workforce, training and education

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Additional resources about the learning after element of the Knowledge Mobilisation Framework.

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Knowledge retention and transfer toolkit

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Knowledge retention and transfer toolkit

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Use this template to help elicit information from a colleague on a specific area of knowledge which they have gained through their experiences.

Knowledge Retention Toolkit for Leavers

Question template for facilitated session

Knowledge prioritisation plan template

Contact list template

Useful resources template

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Workforce, training and education | Knowledge and Library Services

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Use this template to help elicit information from a colleague on a specific area of knowledge which they have gained through their experiences

Getting Started

Start thinking about your knowledge transfer as early as possible and get dates for activities/events in diaries with colleagues early on.

1. identify what you think are the key knowledge areas you are taking with you when you leave

2. ask team/colleagues what they think they would like to know from you before you go - it may be different!

3. agree with line manager the priorities to focus on

4. agree with line manager reasonable actions for each priority. These activities may include a combination from the toolbox below

5. identify a key colleague to help and to facilitate your knowledge transfer activities

6. create your 'legacy' and capture output from the activities and store in a central area accessible to all the team

A toolbox of knowledge transfer activities:

Below are a selection of activities to help with the transfer of knowledge. They are not a checklist, but a toolbox from which to select the most appropriate.

What do others need to know about my job?

Create a table of the key priorities relating to your job and identify who needs to know this information and how you are going to give it to them.

Go to the knowledge prioritisation plan template.

Create a physical handover folder

You can put a copy of all key documents (with file path added in the footer) and a printed copy of any of the documents you created from the list below.

Collate vital emails

75% of organisational knowledge is transferred via email and is lost when your email account is deleted when you leave. Go through your mailbox thoroughly and collate the ones you know will be useful to colleagues, save as actual document.

Key contact lists

Draft a key contacts list, who you use to get your job done, internally, externally. Annotate with useful background/context.

Go to the knowledge retention and transfer contacts list template.

Calendar of my job

Create table of activities/events that take place during a standard year and note what must happen when and who is involved etc.

Go to the calendar of events template.

Organise your files to be transfered into the shared drive

Prune and organise your electronic documents and files and transfer them into your team's shared drive.

You could also leave colleagues a guide to your unique file structure. The guide could be added to your prioritisation plan.

'Work in hand' statements

Draft a brief position statement for each on going/ unfinished area of work. The position statement could be added to your prioritisation plan.

Useful resources

Draft a list (not too long) of the resources you use to get your job done (favourite databases, websites, books, etc.)

Go to a template for recording your useful resources.

Handover guides

Write up 'how to', 'best practice', and procedure guides.

My FAQs

Write up the top 5 questions you are repeatedly asked by collegues.

Elicitation interview

1:1 with line manager or other appropriate colleague on specific area of knowledge to draw out tacit knowledge (what's in your head).

Go to the knowledge and retention transfer questions template.

'Audience with...'

this is a Q&A session with your immediate (and sometimes wider) team, and can be linked to a last team meeting.

Colleagues get to ask you anything they want to know. Prepare the team in advance to think of questions. Works best if made an informal social event - i.e. over tea & cakes.

Knowledge exchange

A quick transfer of essential knowledge. You and the team, in a room, for an hour. Team draft 'top 10 things we want to know about X'.

You simultaneously draft 'Top 10 things you need to know about X'. Bring lists together, work through and answer questions there and then.

Ensures the crucial knowledge is exchanged in a short space of time, no lengthy documenting. Team members are responsible for capturing their own notes.

Masterclass

In-depth training for a group of people in a specific area of knowledge. Prepare an annotated PowerPoint presentation to leave for colleagues reference after the event.

Coaching or Baton passing

Arrange 1:1 sessions with key colleague.

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Knowledge retention and transfer toolkit | Workforce, training and education

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Use this template to help elicit information from a colleague on a specific area of knowledge which they have gained through their experiences

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Challenge and change: what does 2024 hold for the health and care system?

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Challenge and change: what does 2024 hold for the health and care system?

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There's no escaping the severe pressures the health and care system is facing and consequent waning levels of public satisfaction.

Yet there is cause for optimism too, and with an imminent election, key debates about how we keep our population healthy, how health and care services can best meet people's needs and how to develop a sustainable social care system will need to be addressed. My hope is that the election will be a catalyst for tackling issues that have been kicked into the long grass for too long. We can't wait much longer.

2024 in focus

As 2024 gets under way, immediate winter pressures loom large. Stephen Powis, National Medical Director at NHS England, has warned that the NHS is facing one of its most difficult starts to the year. Junior doctors began 2024 with an unprecedented six-day strike, as part of a dispute that could rumble on well into the year. While the strain on NHS services will grab many headlines, social care is under pressure too. A report by the Association of Directors of Adult Social Services published last autumn found that 470,000 people in England were waiting for care, a direct payment or for their care needs to be assessed.

These pressures in the NHS and social care are compounded by uncertainty and instability. NHS planning guidance expected in December has been delayed until later this month meaning health service priorities have not yet been confirmed for 2024/25 and integrated care systems are unable to make firm plans despite the challenging financial and performance context. Local authorities are also still awaiting details of the upcoming year's public health grant. A growing number of local authorities have effectively declared bankruptcy in recent years. A Local Government Association survey found one in five council leaders and chief executives in England think it is very or fairly likely their council will issue a section 114 notice (effectively declare bankruptcy) in 2024/25.

Throughout the year ahead, the government is set to implement several new policies that will have an impact on the health and care workforce. We can expect ministers to press ahead with a plan to mandate a minimum level of service in the NHS during strike action, and take steps towards regulating NHS managers following the murder and attempted murder of babies by Lucy Letby. The migration debate will continue to heat up as the government grapples with migration targets amid severe workforce shortages in many areas of public service, not least social care.

In spring, the government has committed to publishing its major conditions strategy, laying out next steps to tackle the major causes of ill health and mortality, and beginning to grapple with the issues faced by the one in four people living with more than one long-term condition, who too often experience fragmented care. The major conditions strategy is also an opportunity to think about how to better address mental and physical health together.

Also in spring, the Covid-19 Inquiry turns its attention to the impact of the pandemic on the health care system. NHS decision-making, service provision, staffing, infection control and more will all be under the microscope when the public hearings for module three get under way. The hope is experts will learn practical lessons to equip the country for future pandemics.

Health care remains in the top three issues of concern to the public as the UK heads into an election year. Flash points in debates are likely to include NHS productivity, already a topic of much scrutiny, immigration and, of course, the long waits people face to access care. It's easy to become cynical of the politicking in the run up to polling day, but what gets said in the campaign does matter. It sets the tone - and mandate - for whoever forms the next government.

Reasons to be cheerful?

The government's bold plan to introduce a phased ban on smoking is welcome news. If implemented effectively it will save lives, reduce inequalities and save future generations the scourge of tobacco addiction. The ban has cross-party support but is not yet a done deal. Ministers and parliament will need to act fast to pass this legislation before the election.

For all the talk of division in the run up to the election, there's a good deal of political consensus about the need to move more care into the community, with a greater role for community pharmacy and integrated primary care, ensuring services are more personalised, joined up and appropriate to need. There is also a growing drumbeat of support for more preventive health measures across the political spectrum.

Developments in the life sciences industry also provide some cause for optimism in 2024. Thanks to a new deal for access to medicines, which includes commitments to improve uptake and support clinical research, the life sciences sector should feel more optimistic about its ability to operate effectively. And perhaps the most consequential development for global health in 2024 will be the rollout of malaria vaccines. This is incredibly significant as the disease kills more than 600,000 people a year worldwide.

2024 has undoubtedly got off to a rocky start. It will be a year when health and care staff, services, systems, and policies will be under intense scrutiny. Amid the uncertainty, 2024 will be a year of change for health and care services and the people who rely on them.

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Challenge and change: what does 2024 hold for the health and care system?

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Sarah Woolnough considers the challenges facing the health and care system in 2024 - but, she says, there are also reasons to be cheerful.

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Developing a competency framework for integrated care working across healthcare, social care and allied professions

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Developing a competency framework for integrated care working across healthcare, social care and allied professions

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OpenAthens login may be required

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We work with social care data, including social services and safeguarding data, to produce data sets that are used to monitor spending and quality of care and plan and provide services. We collect and publish a wide range of information on social care activity. This data gives us an insight into how much money is spent on social care and what it is spent on. The data we collect is used to help plan, deliver and monitor services.

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Social care data is collected by councils responsible for adult social care through council administration systems. This data is submitted to us by the 152 councils with adult social services responsibilities in England and used to monitor spending and quality of care and plan and provide services.

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home; analysis; evidence; starting well; living well; knowledge

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Welcome to the Kent Public Health Observatory website. Home to the Kent Joint Strategic Needs Assessment

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Compassionate leadership: how to do hard things in a human way

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Compassionate leadership: how to do hard things in a human way

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Access this e-book HERE then login using OpenAthens

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Essential facts and figures to understand how the NHS works

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Patient experience is still not prioritised

One of the key principles of the Understanding integration guide was that if listening to and working with people and communities are to become central to the work of health and care, then they cannot be the preserve of patient experience and public engagement teams only. They need to be everyone's business and everyone has a role to play, whether that is in listening to people and patients or acting on what is learnt. Working with the heads of patient experience, we heard there is still a long way to go before this is the case in the NHS.
I think if you were to ask the leaders in my organisation, they would say 'patient experience is front and centre'. But I think for them, that means I crack on and do it... They're not that aware of where their responsibility sits around the patient experience agenda.
Those working on the projects had tried to engage colleagues from across the local system with mixed success. Where there were pre-existing relationships, the work was easier to put in place, but there were still challenges around the additional resources required. Project leads were often asking busy people to take part who did not have time to devote to ICS activities. Currently, cross-system working often relies on goodwill rather than dedicated capacity, and trying to encourage ownership is difficult when people do not have the time, permission or resource to take on more work. Although partners saw the benefit in working this way, there were challenges around capacity (for example, admin support, data analysis and project management) and making resources available.

Our sites reported that clinical support is key to progress, but there was a feeling that in the NHS, patient experience is still seen predominantly as a nursing function, and it lacks buy-in from doctors. Medical directors at one site were interested and engaged but this was the exception rather than the rule.
There are medical colleagues who are more and more aware that they need to be listening to people - both patients and their staff... My hope is that there are things happening now... but it's a really slow, long journey.
The heads of patient experience recognised that they needed leaders to acknowledge and champion the patient experience agenda, but this was still not happening in a way that would ensure that more people sat up and took notice of what patients were telling them.

We discussed how to frame the patient experience agenda in a way that would encourage key players to support and promote the work - in particular how to align it with other key priorities. One site was linking work on patient experience to the patient safety agenda, showing the link between good patient experience and patient safety. In another site, it was about linking work on patient experience with quality improvement. The rationale was that issues around safety and effectiveness were less likely to be deprioritised, so tying patient experience to these concerns could prevent it slipping further down the agenda.

One frustration that sites raised was the false distinction often made by people in the NHS between patient and public engagement, and patient experience functions. Some misrepresented patient experience as being about quantitative data from surveys, while engagement was seen as being about qualitative data. In reality, patient and public engagement and patient experience both rely on a range of different sources - from stories to surveys - to understand how people and communities experience services. There needs to be more effort to bring these different functions together, recognising what can be learnt from both and what can be done as a result.

ICSs need to provide clarity about where responsibility for patient experience sits

The sites we worked with had very different experiences of working with colleagues across their ICSs. At one site, a clear partnership model was in place. The integrated care board (ICB) had a designated lead for quality and patient experience, and the team at the trust was working closely with the lead to share and implement the findings from their project.

In another site, the ICB recognised that engagement and patient experience were linked, and there was collaboration between the teams. There was a clear sense that the ICB was prioritising this area of work, and colleagues working on the project felt supported as a result. However, even in this otherwise positive example, progress was limited as a result of staff turnover caused by the reorganisation of the ICS.

It was notable that this experience contrasted sharply with some of the other sites. In a number of cases, staff working on patient experience at NHS provider organisations were unsure who to contact within ICSs to progress their work, and they reported being given conflicting information about where responsibility for patient experience lies at ICS level. One participant had been told to reach out to the quality lead but could not establish who that was, leading them to question how high patient experience was on the ICB's agenda.

This type of experience limits progress, as work being done below ICS level will lack the advantages that come from scaling up or from accessing the resources of the ICB and the knowledge from colleagues on integrated care partnerships.

Insight from patient experience is still not on an equal footing with other data

In Understanding integration, we argued that patient experience work should be placed on an equal footing with other data and information gathered at a system level. This would both demonstrate the importance of patient experience and recognise how it can add understanding and meaning to other collected data and information, rather than them being treated separately.

The learning from our work with the HOPE network suggests there is still a long way to go. This was particularly true of the qualitative insights being collected. One reason why patient experience struggles to get to the top of ICS agendas relates to culture. The old maxim of 'what gets measured gets done' reflects the existing bias across the public sector to prioritise quantitative metrics and view dashboard numbers as the best measures of quality. Understanding patient experience needs qualitative data and individual stories to make sense of the data from surveys of users - things that the NHS has a harder time processing and accepting as meaningful.

As a result, those working on patient experience can find themselves feeling isolated within the system; some of those we worked with described their role as 'lonely'. Their work means listening to stories of increasingly difficult experiences for patients, as a system under strain fails to deliver minimum standards of care. Yet despite holding these stories, as well as data from other sources, they are often left feeling powerless to make a difference.

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The King's Fund has been working with the Heads of Patient Experience (HOPE) network to better understand the experiences of people using health and care services.

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BMJ Leader showcases original research and reviews, interpretations of the evidence base, and reflections and debate by practitioners on the key themes of leadership. It is the place to find and contribute evidence, reflection and discussion on the many disciplines that drive leadership in health and care.

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Introduction

Before you read this explainer, we invite you to ask yourself two questions...

What do I hope to learn from reading this?

What assumptions have I made before I start?

Compassion can be defined as 'a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it' ( Gilbert 2013). We can experience compassion in different ways: we can feel compassion for other people; we can experience compassion from others; and there is also the compassion we can direct towards ourselves.

Compassionate leadership involves a focus on relationships through careful listening to, understanding, empathising with and supporting other people, enabling those we lead to feel valued, respected and cared for, so they can reach their potential and do their best work. There is clear evidence that compassionate leadership results in more engaged and motivated staff with high levels of wellbeing, which in turn results in high-quality care ( West 2021).

How do compassionate leaders behave? They empathise with their colleagues and seek to understand the challenges they face; they are committed to supporting others to cope with and respond successfully to work challenges; and they are focused on enabling those they lead to be effective and thrive in their work. Compassionate leaders don't have all the answers and don't simply tell people what to do, instead they engage with the people they work with to find shared solutions to problems.

For leadership to be compassionate, it must also be inclusive. Compassion blurs the boundaries between self and other, promoting belonging, trust, understanding, mutual support and, by definition, inclusion ( West 2021). This creates an inclusive, psychologically safe environment in which diversity in all forms is valued and team members can contribute creatively and enthusiastically to team performance.

It is evident that the NHS has struggled over many years to sustain inclusive, people-centred cultures and our research suggests that it is local action in teams, departments and organisations (big and small), where the work to create these types of cultures is most effective, because that is where the people are ( Ross et al 2020). Developing compassionate leadership approaches helps leaders hold crucial conversations about inclusion, ensuring they hear and reflect deeply on what staff are telling them and then take necessary action to help address inequities and discrimination in the workplace.

Attending

This means being present with and focusing on others - 'listening with fascination' ( Kline 2002). Listening is probably the most important leadership skill and compassionate leaders take time to listen to the challenges, obstacles, frustrations and harms colleagues experience as well as listening to accounts of their successes and joys ( West 2021).

Understanding

This involves taking time to properly explore and understand the situations people are struggling with. It implies valuing and exploring conflicting perspectives rather than leaders simply imposing their own understanding ( Gallo 2017).

Empathising

This involves mirroring and feeling colleagues' distress, frustration, joy, etc, without being overwhelmed by the emotion and becoming unable to help (West and Chowla 2017).

Helping

This involves taking thoughtful and intelligent action to support individuals and teams. Removing obstacles that get in the way of people doing their work (eg, chronic excessive workloads, conflicts between departments) and providing the resources people and services need (eg, staff, equipment, training) are the most important tasks for leaders ( McCauley and Fick-Cooper 2020).

Research shows that compassionate leadership has wide-ranging benefits for both staff and organisations.

For staff

People who work in supportive teams with clear goals and good team leadership, have dramatically lower levels of stress ( West et al 2015). Compassionate leadership increases staff engagement and satisfaction, resulting in better outcomes for organisations including improved financial performance ( Dawson and West 2018).

In NHS trusts where staff report the absence of such leadership, staff also report higher levels of work overload and less influence over decision-making ( West et al 2022) and organisations have poorer outcomes ( West and Dawson 2012; West et al 2011).

For patients

Staff who are treated with compassion are better able to direct their support and care giving to others ( Goetz et al 2010). This results in higher-quality care and higher levels of patient satisfaction ( West and Dawson 2012; West et al 2011). Where staff generally report the absence of such leadership there are lower levels of patient satisfaction ( West et al 2022), there is poorer-quality care and (in the acute sector) higher patient mortality ( West and Dawson 2012; West et al 2011)

Meeting people's core needs at work is important in supporting their wellbeing and motivation. Compassionate leaders constantly strive to understand and meet the core needs of the people they work with ( West 2021).

The Health and Care Select Committee recently conducted an inquiry on workforce burnout and resilience in the NHS and social care ( House of Commons Health and Social Care Committee 2021). It concluded that burnout is a widespread reality in today's NHS and has negative consequences for the mental health of individual staff, which has an impact on their colleagues and the patients and service users they care for.

Recent studies on doctors ( West and Coia 2019) and nurses and midwives ( West et al 2020), including those in training, have shown that the wellbeing, flourishing and work engagement of health and care staff, is affected by eight key factors that can be organised into three core needs (see figure below). Meeting the core needs of health and care staff can help transform their work lives and in turn, the safety and quality of the care that they deliver.

An introduction to leading with kindness and compassion in health and social care

Develop your understanding of how to lead with compassion and kindness within the health and social care sectors on this free online course delivered in partnership with FutureLearn.

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Research shows that compassionate leadership has wide-ranging benefits for both staff and organisations. Learn more in this explainer.

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How-to guide: Measuring and improving your engagement with staff in major change

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How-to guide: Measuring and improving your engagement with staff in major change

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10 collaboratively developed principles for how to engage staff well in major change.

Guidance on the key considerations underpinning a good measurement approach.

A collaboratively developed survey of staff tool.

A collaboratively developed planning and reflection tool.

Guidance on moving from data to analysis and action.

Equity, diversity and inclusion (EDI) considerations when measuring engagement in change.

Who is this resource for?
This guide is designed to support anyone responsible for understanding, measuring, and improving major change across health and care.
How has it been developed?
Developed by Q, working with Thiscovery - an online platform for collaboration, innovation and improvement - the guide has been co-created with more than 300 people working across the health and care sector; a wide range of people who saw the importance of sharing their experiences to support us to collectively improve our approaches to major change.

Our fuller insight report, launching later this year, will provide details of our methodology and findings.
How should it be used?
The resources will help you to understand the 10 principles that underpin how you engage staff well in change and provide flexible tools that you can use to measure engagement in the major change projects you're delivering. Refer to the how-to guide for wider information on the generation of the tools, how to use them and supporting content on topics that research participants found valuable.

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How-to guide: Measuring and improving your engagement with staff in major change | Q Community

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This resource provides you with: 10 collaboratively developed principles for how to engage staff well in major change. Guidance on the key considerations underpinning a good measurement approach. A collaboratively developed survey of staff tool. A collaboratively developed planning and reflection tool. Guidance on moving from data to analysis and action.

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Waste not, want not: Strategies to improve the supply of clinical staff to the NHS - September 2023

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Waste not, want not: Strategies to improve the supply of clinical staff to the NHS - September 2023

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Third of people in England lack confidence they can access critical NHS services

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Third of people in England lack confidence they can access critical NHS services

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A record-breaking 5.7 million people are waiting for hospital care. In response, the Government is spending an extra £5.9 billion to tackle the problem. Our latest research looks at how the backlog is impacting the lives of those waiting.

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Third of people in England lack confidence they can access critical NHS services

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Our new research shows worryingly low public confidence in being able to access NHS services. A third of adults in England lack confidence that they can access timely care, including GP services, mental health support and hospital care. Read the findings and our calls to action.

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September 7, 2023

Stay informed

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Martha’s Rule: A new policy to amplify patient voice and improve safety in hospitals

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Martha’s Rule: A new policy to amplify patient voice and improve safety in hospitals

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Martha Mills died aged 13 in the summer of 2021 after sustaining a pancreatic injury from an everyday bike accident while on holiday with her family. The inquest into her death heard that she would likely have survived the sepsis that killed her had consultants made a decision to move her to intensive care sooner.

Her mother, Merope, later wrote about the failures in Martha's care, and how she trusted the clinicians against her own instincts - they didn't listen to her concerns and instead "managed" her. "We had such trust; we feel such fools," she wrote. The piece prompted a huge reaction across the NHS and beyond. Many hospital trusts wrote to Martha's parents, asking them to come and speak to their leadership teams about their experience, in order to help them improve patient safety in their hospitals.

This report is a response to that call from Martha Mills's parents to rebalance the power between patients and medics with one purpose only: to improve patient safety. It comes amidst significant evidence that shows that failing to properly listen to patients and their families contributes to safety problems in the NHS, along with public awareness among citizens that the NHS can feel unresponsive at times.

Fundamentally, this is about culture change and improving the relationship between medics and patients. In the report we explore one specific policy change designed to redress the balance of power and nudge the culture change that is required: Martha's Rule.

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Martha's Rule: A new policy to amplify patient voice and improve safety in hospitals

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Demos is Britain's leading cross-party think-tank. We produce original research, publish innovative thinkers and host thought-provoking events.

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A review of the Vaccine Taskforce (updated 31 August 2023)

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A review of the Vaccine Taskforce (updated 31 August 2023)

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Introduction to the Vaccine Taskforce

On 11 March 2020, the World Health Organization ( WHO) declared the spread of the COVID-19 virus a pandemic. The UK government had at this point already been active in funding research into the disease. In early April 2020, the Vaccine Taskforce ( VTF) was set up in the Department for Business, Energy and Industrial Strategy ( BEIS) to gather together the collective efforts of government, academia and industry to help find a vaccine against COVID-19, to protect and save the lives of UK citizens.

The VTF's formal objectives were originally formulated between May and June 2020 and have been slightly refined over time. This review seeks to measure the taskforce's performance against the final objectives in place at the end of the VTF in September 2022. All data in this document is correct as of 30 September 2022 unless otherwise indicated.

Objective 1: secure access to promising vaccine(s) for the UK population and achieve lasting immunity.

Objective 2: make provision for international distribution of vaccines.

Objective 3: strengthen the UK's onshore capacity and capability in vaccine development, manufacturing and supply chain to provide resilience for this and future pandemics.

The VTF was established in BEIS with a steering group comprising both external experts and senior civil servants, initially chaired by Dame Kate Bingham until December 2020 and subsequently by Sir Richard Sykes. The team consisted of:

a strategy directorate

an international directorate

a commercial directorate (to lead negotiations with suppliers)

a programmes directorate (to oversee the day-to-day delivery of the agreements the VTF made)

The VTF mobilised and recruited staff from across the Civil Service, private sector and academia. This provided a breadth of expertise, ranging from clinical and scientific knowledge, through to supply, programme management, delivery and commercial.

The VTF 's formal accountability was through the usual Civil Service procedures. A ministerial panel took all key spending decisions. The panel was made up of the:

Day-to-day ministerial decisions were taken by the Health and/or Business Secretary, with assurances sought and provided in the usual way, by permanent secretaries and/or accounting officers. The Director General of the VTF was the senior responsible owner of the programme throughout.

The VTF became a joint unit between BEIS and the Department for Health and Social Care ( DHSC) from August 2021. Accountability for vaccine supply and international distribution moved to DHSC, and BEIS retained accountability for the VTF's work to support onshoring of vaccine capability. DHSC was responsible for vaccine deployment throughout and the vaccine deployment programme was separate to the VTF.

The VTF continued to support the UK's vaccine programme throughout all its phases: from the early days of the pandemic and the global pursuit of a safe and effective vaccine, to the need to boost all adults, the introduction of an under-18s programme, and the roll-out of updated bivalent vaccines. This review sets out those phases in greater detail and explains how the VTF evolved its objectives to meet them.

Achievements: objective 1

Secure access to promising vaccine(s) for the UK population and achieve lasting immunity.

Following its establishment, the VTF secured access to a portfolio of 7 vaccines for the UK:

Pfizer-BioNTech has been part of the UK's vaccine deployment programme throughout (from December 2020 to current), Oxford-AstraZeneca from January 2021 to August 2022, Moderna from April 2021 onwards and Novavax from September 2022.

By the time the Vaccine Taskforce closed in September 2022, over 150 million doses of Oxford-AstraZeneca, Pfizer-BioNTech and Moderna had been used in the UK.

The UK was the first country in the world to procure, regulate and deploy the Pfizer-BioNTech and Oxford-AstraZeneca vaccines (first deployed 8 December 2020 and 4 January 2021 respectively). It also procured, regulated and deployed the Moderna vaccine (first deployed in April 2021). These 3 vaccines now account for the most used vaccines in the world by number of countries to deploy them (see figure 1).

Figure 1: most used COVID-19 vaccines in the world, by number of countries to deploy

Source: Our world in data - Which vaccines have been administered in each country?

The VTF invested in trials to analyse the effect of different combinations of vaccines as a first, second and third dose to help inform deployment decisions (made by the Joint Committee on Vaccination and Immunisation ( JCVI)). The UK's COV-BOOST trial, for example, which tested 7 different vaccines as a booster dose following an Oxford-AstraZeneca or Pfizer-BioNTech primary course, was the first of its kind in the world.

Achievements: objective 2

Make provision for international distribution of vaccines.

In addition to securing access to vaccines for the UK, the VTF has been at the forefront of the UK government's commitment to help the global fight against COVID-19.

The UK championed setting up COVID-19 Vaccines Global Access ( COVAX) as a global initiative to support research, manufacturing, procurement and equitable distribution of COVID-19 vaccines for the benefit of all countries. COVAX's initial aim was to make available 2 billion doses by the end of 2021, enough to enable participating countries to protect high risk and vulnerable people as well as healthcare workers. COVAX established a fund to support 92 lower income countries in getting equal access to vaccines. The UK provided £548 million through the Foreign, Commonwealth and Development Office ( FCDO) aid budget to support this objective. By September 2022, COVAX had delivered over 1.7 billion doses to 146 countries.

COVAX additionally established a joint procurement pool for higher income countries intended to enable them to share the costs and risks of investing in a diverse vaccine portfolio. The UK joined this but procured very few vaccines through this route because of the success of the UK procurement programme.

The UK backed the Oxford-AstraZeneca vaccine with government funding. The UK government played a key role in the licensing of the Oxford University vaccine which made the vaccine available to developing countries at cost. The vaccine was crucial in the global fight against COVID-19. Around 2.5 billion doses had been distributed, at cost, to more than 170 countries by January 2022.

At the G7 Summit in June 2021, the then Prime Minister, Boris Johnson, announced that the UK would donate 100 million surplus COVID-19 vaccines, as part of a G7 commitment to make available at least 1 billion doses in support of WHO's call to vaccinate at least 70% of the world's population by the end of 2022. The VTF established a programme with the FCDO to deliver this.

The UK was able to offer 100 million doses for donation and to deliver 84.4 million doses by June 2022. In 2022, delivery of donations was constrained by lack of demand from COVAX and lower income countries. Of the 84.4 million doses delivered, over 75 million were delivered to COVAX, and 7.9 million were delivered directly by the UK to countries in need. These donations benefitted 42 countries.

Achievements: objective 3

Strengthen the UK's onshore capacity and capability in vaccine development, manufacturing and supply chain to provide resilience for this and future pandemics.

The VTF invested over £405 million to secure and scale up the UK's vaccine manufacturing capabilities to respond effectively to the pandemic.

This included immediate action to support the pandemic response, including investment in a rapid deployment facility at Oxford Biomedica by temporarily locating new bioreactors in an existing vaccine manufacturing facility and securing 'fill and finish' capacity from Wockhardt in North Wales. Both sites went on to prove vital to the UK supply chain of the Oxford-AstraZeneca vaccine, with Oxford Biomedica producing drug substance for over 76 million doses and Wockhardt providing fill and finish for over 87 million doses.

Other investments that were intended as a pandemic response have been transitioned to their longer-term resilience objectives since it became clear they were no longer needed for the initial response. Most notably, this included the government's investment in:

the Vaccines Manufacturing and Innovation Centre (VMIC) in Oxfordshire

support for the Centre for Process Innovation (CPI) in Darlington to develop messenger ribonucleic acid (mRNA) manufacturing capability

the Cell and Gene Therapy Catapult (CGTC) facility in Braintree

In March 2022, the government awarded a grant of £15.9 million to Croda to increase the UK's manufacturing capacity of speciality lipids, an essential ingredient in mRNA vaccines, and in October 2022 announced £10.65 million additional funding for the RNA Centre of Excellence in Darlington.

In June 2022, the government announced a long-term strategic partnership with Moderna to open a vaccines research and manufacturing centre in the UK, which will provide the UK population with access to the company's COVID-19 and other respiratory disease products in future.

Purpose and scope of this review

This review considers the extent to which the VTF achieved its 3 strategic objectives, and the factors which contributed to it doing so. It seeks to draw out learning that can be applied to future government programmes, both in emergency circumstances, such as those in which the VTF was formed, and to business-as-usual activity.

It assesses the VTF 's success against its first 2 objectives.

The objectives have evolved over time, and this review explains when and why. The review sets out the investment approach that the VTF took through its original programme business case (July 2020) and updated programme business case, to include the winter 2021 booster campaign (May 2021). The second objective was delivered in close collaboration with the FCDO which has published information on its programmes to support lower income countries on the UK Development Tracker.

Phases of the VTF

Timing: the review splits the taskforce's existence into 3 periods:

Phase 1: the period to secure a safe and effective vaccine as soon as possible

This phase consisted of:

the early procurement activity of the VTF (2020)

the original NHS first and second dose campaign (winter 2020 to spring 2021)

Phase 2: ensuring ongoing protection

This phase consisted of:

planning for and supporting the first booster campaign for adults (January 2021 to January 2022)

preparing for and responding to variants of concern

Phase 3: continued protection

This phase consisted of:

Questions for the first 2 objectives

For the first 2 objectives, the review considers the following questions:

1. To what extent has the VTF achieved the intended outcomes?

2. What were the causal factors resulting in the outcomes?

3. Were there any unintended consequences?

4. What other factors have influenced outcomes?

5. How effective has the VTF been compared with other countries?

How the VTF's objectives evolved over time

In May 2020, the then Prime Minister, Boris Johnson, appointed Dame Kate Bingham to be the VTF 's first chair. In her formal appointment letter of June 2020, he set her the following 2 objectives for the taskforce to deliver:

to ensure the whole UK population, or relevant subpopulations, can be vaccinated against COVID-19 as soon as is practicable

to ensure adequate global distribution of vaccines to bring the quickest possible end to the pandemic and the economic damage it inflicts

The introduction of a formal international objective reflected the extensive efforts of the UK government in the early part of the pandemic to support the global fight against the disease. In addition, the PM put a focus on ensuring long-term capacity for the UK by asking the VTF to "help to develop and agree a wider UK long-term vaccine strategy, to include a broad '[UK]' biotherapeutic and vaccine manufacturing capacity so the UK is prepared for future potential pandemics".

These were brought together into 3 formal objectives to:

Later in the VTF 's lifespan, objective 1 was modified, to reflect the growing need to boost all adults.

Key facts and figures

Figure 2: infographic of key COVID-19 related facts and figures

Sources: Coronavirus (COVID-19) in the UK; VTF as at 30 September 2022; PHE- UKHSA COVID-19 surveillance reports.

Figure 2 gives a visual representation of the key COVID-19 facts, dates and figures set out below.

The key dates shown in figure 2 are:

11 March 2020: WHO declared COVID-19 a global pandemic

23 March 2020: the UK entered lockdown

17 May 2020: the UK became the first country in the world to procure a COVID-19 vaccine (Oxford-AstraZeneca)

2 December 2020: the first COVID-19 vaccine in the world received regulatory approval (Pfizer-BioNTech in the UK)

8 December 2020: the first person in the world received a regulated vaccine outside of a clinical trial (Pfizer-BioNTech in the UK)

UK COVID-19 health data

UK health data (cumulative at 30 September 2020) for COVID-19 cases, hospital admissions and deaths with COVID-19 on the death certificate was as follows:

COVID-19 doses

The number of COVID-19 doses (all doses) given to people of all ages (at 30 September 2022) was:

UK vaccine portfolio

The original and current UK vaccine portfolio (at 30 September 2022) was as follows:

Oxford-AstraZeneca (original: 100 million doses, current: 100 million doses), deployed and donated

Pfizer-BioNTech (original: 40 million doses, current: 189 million doses), deployed

Moderna (original: 17 million doses, current: 77 million doses), deployed

Sanofi-GSK (original: 60 million doses, current: 7.5 million doses), reduced order

Novavax (original: 60 million doses, current: 1 to 16 million doses conditional purchase), donated and reduced order

Janssen (original: 20 million doses, current: none), donated

Valneva (original: 60 million doses, current: none), cancelled

Lives saved and hospitalisations prevented

The number of lives saved and hospitalisations prevented from COVID-19 vaccines was as follows:

123,100 lives saved (in all ages in England, to 17 September 2020)

178,900 hospitalisations prevented (in over 65s in England, to 21 September 2020)

Review of progress against VTF objective 1

Objective 1: secure access to promising vaccine(s) for the UK population and achieve lasting immunity.

Question 1: to what extent has the VTF achieved the intended outcomes?

To enable delivery of its first objective, the VTF secured 3 funding agreements with HM Treasury:

a £5.2 billion programme business case in 2020

a £6.1 billion amended programme business case in September 2021 (to take account of both the contracts the VTF had entered into in the summer of 2020 and to anticipate the possible future need for boosters)

the Spending Review of 2021, which set vaccines budgets through to 2025

How the VTF went about securing its vaccine portfolio

In the early days of the pandemic there were believed to be approximately 200 COVID-19 vaccines in early development stage across the world. The chances of any one vaccine candidate being effective and safe were remote, owing to the traditionally lengthy and trial and error approach to the activity in 'normal' times, which various estimates suggest can take 10 years from the early research and development (R&D) to regulatory approval and mass manufacture of a successful vaccine. The VTF's own programme business case quantified the likelihood of any individual vaccine being safe and effective as between 5% (pessimistic scenario) and 10% (optimistic scenario). This range was based on advice from the VTF's specialists in vaccine development. The VTF 's early priority was therefore to set out to secure a portfolio of promising vaccine candidates, increasing the overall likelihood of finding at least one safe and effective vaccine.

VTF's direct approach was to evaluate the around 200 global candidates and secure access to a portfolio from these. The VTF assembled a vaccines due diligence team, made up of clinical, scientific and industry experts, to narrow down this large field. The first step was to rule out any vaccine that had no realistic chance of entering clinical trials in 2020, as its route to deployment, if safe and effective, would simply be too long.

The method to securing these contracts was based on treating each as a bespoke deal, rather than approaching each as a standardised procurement activity. This recognised that every developer had a unique product that was potentially the only successful vaccine and allowed the UK to tailor each deal accordingly.

This speed and quality of analysis, supported by a commercial mindset to deal-making, allowed the UK government to move at speed to secure its vaccine portfolio, and heads of terms agreements for all 7 deals were signed by mid-November 2020.

Table 1: original UK vaccine portfolio (December 2020)

Vaccine

Date deal struck

Original doses secured bilaterally (millions)

MHRA approved

Deployed in the UK

Additional information

Sanofi-GSK

29 July 2020

60

Not applicable

Order reduced to 7.5 million doses November 2021

Novavax

14 August 2020

60

Yes (3 February 2022)

Yes

Further 14.7 million doses ordered through COVAX donated. Bilateral 60 million dose order reduced to 1 to 16 million doses in July 2022

Pfizer-BioNTech

20 July 2020

40

Yes (2 December 2020)

Yes

Further 500,000 doses ordered through COVAX. 60 million extra doses secured April 2021 for primary and booster campaigns. 35 million extra doses secured in August 2021 for autumn booster campaign. 54 million extra doses secured December 2021, for 2022 and 2023 deployment

Note: UK supply agreement (signed 28 August 2020) with AstraZeneca reflected the agreement between AstraZeneca and Oxford University in April 2020, which included commitment to supply the UK and the license signed in May 2020.

The portfolio included what are now the 3 most used vaccines in the world, by number of countries to deploy:

Pfizer-BioNTech was the first COVID-19 vaccine to be regulated and deployed (both of which happened in the UK) anywhere in the world, with MHRA approval secured on 2 December 2020 and the first vaccine administered in the UK on 8 December 2020. As of July 2022, 164 countries have used this vaccine in their deployment programme.

Oxford-AstraZeneca became the second COVID-19 vaccine to enter deployment in the UK when it was introduced into the vaccine programme on 4 January 2021. As of July 2022, 185 countries have used the Oxford-AstraZeneca vaccine in their programme. The UK was the first country to procure and deploy this vaccine. The UK government also supported the cost of the original phase 1, 2 and 3 clinical trials for the vaccine. The UK procured 100 million doses of this vaccine, of which approximately half have been used in the domestic vaccination programme, and half offered for donation.

Moderna is the third most widely used COVID-19 vaccine in the world, having been deployed in 108 countries. In addition to its original 7 million dose order, the VTF signed deals for a further 10 million doses for the original UK vaccination campaign, and 60 million more doses to support vaccination in 2022 and 2023.

On 15 August 2022, JCVI advised that the Novavax vaccine could be used in the UK in exceptional circumstances. The Novavax vaccine is being deployed in 32 countries. It received UK regulatory approval as a primary course in 2022, when most of the UK population had received their first and second dose of COVID-19 vaccine.

Figure 3: COVID-19 vaccines deployed in the UK

Source: COVID-19: the green book, chapter 14a

Figure 3 shows that, at September 2022, 4 COVID-19 vaccines had been deployed in the UK over the following dates:

The UK's original vaccine portfolio also consisted of 3 other vaccines:

The Janssen vaccine is being used in 98 countries, making it the fourth most widely deployed vaccine globally. The UK reduced its original 30 million dose order to 20 million doses and donated it in full in October 2021, via COVAX.

The UK terminated its contract with Valneva in September 2021. The vaccine received regulatory approval as a primary course in the UK in April 2022. It is being used in the deployment programme in Bahrain.

After the conclusion of the original UK vaccine portfolio, and as part of the UK's strategy to respond to variants of concern, the UK government announced a heads of terms agreement with the developer CureVac in February 2021. This was intended to specifically develop vaccines targeted at new variants quickly and anticipated an initial order of 50 million doses of vaccine for the UK (no pre-payment was made on this order). However, CureVac withdrew its vaccine from regulatory approval later in 2021 following clinical trial data read-outs and, as a consequence, the VTF did not proceed to a final contract.

The UK also joined the collaborative vaccine procurement platform set up by COVAX for higher income countries. VTF paid a £65 million deposit towards procurement of up to 27 million doses (enough for up to 20% of the UK population). COVAX did not secure contracts with vaccine manufacturers as quickly as the UK. COVAX offered the opportunity to procure Oxford-AstraZeneca, Sanofi-GSK and Pfizer-BioNTech in November 2020. The UK opted to procure only Pfizer-BioNTech and was allocated 500 thousand doses. These were delivered to the UK in June 2021 and deployed as part of the domestic programme. In February 2021, the UK decided to take up the offer to procure Novavax through COVAX and was allocated 14.7 million doses. In May 2022, the UK donated these doses to COVAX. The UK did not procure other vaccines offered by COVAX later in the pandemic as these were not needed.

Table 2: table of vaccine purchase opportunities from COVAX to VTF and decisions

Note that the Sanofi-GSK vaccine has subsequently been granted regulatory approval in the UK on 21 December 2022.

How the VTF has supported the revaccination of adults through the extension of its portfolio to meet boosting needs

As well as supporting the original COVID-19 UK vaccination programme, the VTF 's further procurement of COVID-19 vaccines has allowed the UK to roll out 3 booster campaigns to date:

The VTF anticipated the potential need for boosting immunity of those already vaccinated with their original primary course of COVID-19 vaccine by developing a booster strategy in 2021. Activity to support the strategy included:

The VTF worked with DHSC and the National Institute for Health and Care Research ( NIHR) to design a series of studies looking at the effect of different vaccines in combination with each other - both as a mixed dose primary course, and as a heterologous booster dose.

The mRNA vaccines have proved to be an effective option for protecting people from the worst effects of COVID-19 disease, including through boosting them with a third dose of vaccine. The VTF 's decision to place the platform as one of the 4 modalities in its portfolio has proved pivotal, as has its decision to ensure security of supply by making an early decision to procure from the 2 developers using the platform: Pfizer-BioNTech and Moderna.

To enable the continued supply of mRNA vaccines across the autumn to winter campaign, the VTF exercised its option to increase its Pfizer-BioNTech order from 40 million to 100 million doses in April 2021, and placed an additional order of 35 million doses in August 2021, followed by a further order in November 2021 for a total of 114 million doses of Pfizer-BioNTech and Moderna vaccine over 2022 and 2023.

Timetable of actions in 2021 to support the adult booster campaign:

28 April 2021: secures a further 60 million does of Pfizer-BioNTech vaccine

Mid August 2021 (interim internal read-out): COV-BOOST results

23 August 2021: signs deal with Pfizer for 35 million additional doses

14 September 2021: JCVI advice to Secretary of State and start of booster campaign

Taken together, the VTF 's actions on its portfolio meant that 150 million doses of COVID-19 vaccine were administered to those aged 12 and over throughout the UK, its Crown Dependencies and Overseas Territories, up to September 2022.

How the VTF has managed its portfolio to avoid wastage

Particularly in 2021, the vaccines had short shelf life. It was critical to manage deliveries effectively to avoid wastage and ensure efficient use of such a critical resource.

Figure 4: the National Audit Office's analysis of how cumulative administered vaccines compared with stocks available in England December 2020 to October 2021

Source: National Audit Office - The rollout of the COVID-19 vaccination programme in England

Figure 4 shows how cumulative administered vaccine numbers compared with stocks available in England between December 2020 and October 2021. The UK made sure the stock available at any one time through the COVID-19 vaccine deployment period was never greatly above what was needed to meet the demand of that programme.

In addition to the close working with the NHS to minimise the time from delivery to deployment, specific actions taken by the UK to manage its portfolio included:

reprofiling of delivery schedules with suppliers wherever possible to best match supply and expected demand

donation of surplus vaccines, including:

the donation of approximately 50 million doses of Oxford-AstraZeneca

the donation to COVAX of 20 million doses of Janssen

the donation of the 14.7 million doses of Novavax that the UK had secured through COVAX

optimising the supply of doses with other countries, allowing vaccines to be used where and when they were needed

the reduction of other contracts. These decisions were taken on a case-by-case basis as the VTF assessed the portfolio and ongoing needs:

Sanofi-GSK, from 60 million to 7.5 million doses

Novavax, from 60 million to between one and 16 million doses

Valneva, terminating the full contract

The active management of supply helped to ensure vaccines were used where most needed. As the National Audit Office report of February 2022 states, up to the end of October 2021, in England, overall wastage rates had been 4%

How the VTF has ensured all 4 nations of the UK have access to vaccines

Procurement of medicines is usually a devolved competency under current devolution agreements, meaning Scotland, Wales and Northern Ireland buy their own medical supplies, such as vaccines for seasonal flu. For COVID-19, however, the UK led all 4 nations in the search for a safe and effective vaccine. The UK government and the devolved governments of Scotland, Wales and Northern Ireland reached agreement early in the pandemic that the VTF would act on behalf of all 4 nations in its pursuit of a vaccine.

On a day-to-day basis, supply colleagues across all 4 nations have worked closely to ensure that health services across the UK are working from the same set of information and assumptions. Examples of the VTF's contribution to this collaboration include the sharing of short- and medium-term supply projections from suppliers, to enable health services across the UK to plan for the supply arriving to them. The Barnett formula has been applied to UK dose numbers, to ensure the 4 nations have access to a population-based proportion of the VTF 's portfolio.

How the VTF has helped to support the UK's vaccination campaigns for 2022 and future years

Through the VTF's original contracts and relationships with developers, it has been able to ensure a continued supply of vaccine to the NHS to meet the needs of booster campaigns in light of evolving JCVI advice.

In December 2021, the government announced the purchase of a further 114 million doses of mRNA vaccines (from Pfizer and Moderna) to support future campaigns in 2022 and 2023. Campaigns supported so far (at 30 September 2022) from this have been:

In June 2022, the government also announced that it had entered into a non-binding heads of terms agreement with Moderna for the company to establish a vaccine manufacturing facility and R&D Centre of Excellence in the UK, creating the UK's first developer-owned end-to-end mRNA vaccine manufacturing facility. The centre will give NHS patients guaranteed access to COVID-19 vaccines, future-proofing the UK against emerging health threats. A final deal with Moderna was agreed in late 2022.

How the VTF invested in domestic manufacturing capacity to support access to a vaccine

The VTF took early steps to invest in domestic vaccine capacity, with the aim of supporting objective 1 by speeding up production and helping guarantee security of supply.

Funding from the VTF temporarily placed new, larger bioreactors at an existing vaccine manufacturing facility, Oxford Biomedica, in Oxfordshire, while longer term solutions were being built. This increased the speed at which the Oxford-AstraZeneca vaccine was manufactured, allowing for faster deployment of the vaccine.

In May 2022, the UK received final deliveries of its 100 million dose order from Oxford-AstraZeneca; it is estimated that 76.3 million of these doses were manufactured at the Oxford Biomedica site.

In May 2020, the government also announced that it was investing a further £93 million in the VMIC in Oxfordshire, to broaden its capacity as a vaccine manufacturing centre, and accelerate its opening. This was followed by further government investment of £48 million in March 2021. In April 2022, VMIC 's board took the decision to sell the facility to Catalent, a multinational company with plans to invest approximately £120 million to develop the site into a state-of-the-art manufacturing facility for therapeutics and vaccines.

The VTF also secured domestic fill and finish capacity in the UK through an agreement with the company Wockhardt in Wales. This was used in the manufacturing process for the AstraZeneca vaccine.

Since the start of the pandemic, developers have increasingly seen the UK as an attractive place to invest, with over £500 million of private sector investment in vaccine manufacturing confirmed so far, including:

How the UK has invested in trials and research to support the understanding of vaccine effectiveness against COVID-19

The UK has hosted a number of important trials of COVID-19 vaccines through the UK's world-leading health research infrastructure. Four of the developers in the UK's original vaccine portfolio conducted some of their studies into the safety and efficacy of their product in the UK:

In addition, some developers have conducted other studies in the UK, including:

Moderna's COVID-19 Omicron variant study

Pfizer-BioNTech's study in expectant mothers

To support this, the VTF invested in the NHS clinical registry, working with NHS Digital and the devolved nations in the world's first national citizen database where members of the public could volunteer to take part in clinical trials. As of 31 August 2022, volunteer numbers stood at over 540,000. This supported the clinical trials of vaccines such as Oxford-AstraZeneca and Novavax.

The VTF also helped develop and fund the Human Challenge project. This study was a partnership between VTF, the NHS, academia and the private sector to develop a greater understanding of the COVID-19 disease itself, and to aid the pandemic response with vaccine and treatment development. Initial government funding for the programme was £33.6 million and funded the trials in full. The first Human Challenge Programme clinical paper was published on the pre-print server Research Square in January 2022. It details the outcomes in 36 young, healthy participants with no immunity to the virus and shows that experimental infection of volunteers is reproducible and resulted in no severe symptoms in healthy young adult participants, laying the groundwork for future studies to test new vaccines and medicines against COVID-19.

Question 2: what were the causal factors resulting in the outcomes?

Ability to draw together expertise from the Civil Service, private sector and academia to expedite and co-ordinate the research and procure successful COVID-19 vaccines

The VTF has utilised the collective expertise of an array of specialists, including from within the Civil Service and wider public sector to achieve its objectives. Examples include:

private sector expertise: senior leaders from industry were recruited to the VTF Steering Group, including Dame Kate Bingham as Chair in 2020, and Sir Richard Sykes, Chair from 2021 to 2022

commercial: deal-making expertise was mobilised from elsewhere in government to lead the negotiations and commercial strategy

programme delivery: experienced leaders with extensive delivery expertise garnered in the public and private sectors were mobilised to the VTF

manufacturing: working closely with industry experts, both in an advisory capacity, and through formal secondment to working level teams, the VTF developed an early manufacturing strategy

clinical trials: alongside DHSC, NIHR and the MHRA, the VTF was able to deliver on the priority to support the rapid delivery of clinical trials through, for example, making the UK an attractive place for vaccine developers to trial their products, and manufacturing these products, where applicable

science in decision-making: the VTF has drawn on expertise across government (including UKHSA,DHSC and JCVI) and in academia to ensure its decision-making on procurement is always informed by the latest scientific and clinical advice. For instance, on issues such as vaccine effectiveness and durability, and the evolution of the disease (including variants of concern)

Dealing with suppliers in a different, more collaborative way to identify and quickly solve problems

The UK's vaccination programme has involved complex supply chains across multiple borders, at a time when vaccines were a scarce global commodity, and during a period of intense geopolitical uncertainty.

The VTF worked hand-in-hand with developers, proactively managing the journey from manufacturing through to deployment by the NHS. Vital to the success here was the nature of the relationship, with senior VTF leaders working very closely with senior leadership at vaccine developers.

Examples of this novel way of working include:

Creating effective processes that support proper oversight and risk assessment, but also facilitate swift decision-making

The VTF has operated in an agile way, ensuring no delays to key decisions being taken when they were needed. A steering group was established comprised of:

chair

director general and 5 directors covering the VTF's strategy, commercial, vaccine supply, onshoring and international functions

scientific adviser

manufacturing adviser

clinical and public health adviser (deputy chief medical officer)

Together the group provided strategic oversight of the VTF 's work and considered and agreed recommendations to go to ministers. It acted as an escalation point for decisions on strategy and for managing programme-level risks and issues.

Speed of decision-making was also enabled by having a ministerial panel (the list of the ministerial panel members appears in the introduction of this publication).

The ministerial panel provided commercial and financial approvals for:

Investment in world-leading studies, for example COV-BOOST, to supplement developer data and inform JCVI recommendations

The COV-B study, which looked at different vaccines (Oxford-AstraZeneca, Pfizer-BioNTech, Moderna, Janssen, Novavax, Valneva and CureVac) as a booster dose to a double dose primary course of Oxford-AstraZeneca or Pfizer-BioNTech, was the first such study in the world, and informed the JCVI's decision-making on the 2021 autumn adult booster campaign, which saw all adults recommended for a boost of an mRNA vaccine.

Engagement led from the top

This approach reflected the priority given to the vaccine programme given its centrality to both the public health and economic objectives of the government. During the pandemic, weekly meetings were held with the Prime Minister to brief him on key developments in supply and deployment, as well as daily meetings chaired by the Health Secretary with senior leaders of the vaccine programme in the Civil Service and the NHS, alongside senior clinical advisers.

Question 3: were there any unintended consequences?

The UK secured more successful vaccines than originally expected

Vaccine success of an individual vaccine was estimated at 5 to 10% in the VTF 's programme business case - written when many vaccines were in clinical trials and none had read out on efficacy and safety. This relatively slim chance of success for an individual vaccine was a key assumption for the UK's portfolio approach.

As it turned out, of the 7 vaccines in the UK's original portfolio, 6 (Oxford-AstraZeneca and Pfizer-BioNTech in December 2020, Moderna and Janssen in the first half of 2021 and Novavax and Valneva in 2022) have now secured regulatory approval from the MHRA, with the seventh (Sanofi-GSK) currently being considered by the MHRA.

The unexpected success of the vaccines in the UK portfolio has had a number of benefits:

the UK had access to successful vaccines, but the portfolio approach meant that the UK also had access to the earliest available vaccines that provided material health and economic benefits

providing optionality between vaccines. This has been especially important for the autumn 2021, spring 2022 and autumn 2022 booster campaigns, where the JCVI indicated a preference for mRNA vaccines, of which the UK has 2 maintained in its portfolio (Pfizer-BioNTech and Moderna). This decision was informed by data both from manufacturers and from the studies funded by the VTF, which provided comparisons between the different vaccines as a booster dose

accelerating overall deployment by providing a greater total quantity of vaccine doses more rapidly, allowing the UK to move more rapidly away from non-pharmaceutical interventions and the associated economic consequences

having a number of successful vaccines within its portfolio allowed for flexibility for the UK to respond to clinical advice and changes in the disease. For example, the availability of the Oxford-AstraZeneca vaccine in the autumn 2021 and spring 2022 campaigns provided an alternative for those who should not receive an mRNA vaccine

enabling the UK to donate surplus vaccines to lower income countries, delivering against the VTF's second objective to contribute to the global effort to end the pandemic

the active management of supply, including close monitoring of deliveries, reprofiling of delivery schedules, donation of excess vaccine supply, supply optimisation with other countries and reduction of contracts, helped to ensure vaccines were used where most needed to reduce excess stocks

Question 4: what other factors have influenced outcomes?

Willingness to invest at risk

The VTF invested in manufacturing of vaccines before data on their safety and efficacy was available. This meant that when they were approved by the MHRA for use, supply was available to the NHS quickly.

Huge incentives for companies to develop an effective vaccine

Many pharmaceutical companies across the world moved quickly to refocus their efforts onto COVID-19 vaccines, therapeutics and other drugs. Given the clear commercial opportunities for those able to develop and manufacture successful vaccines, many companies were willing to invest in development and begin manufacture at risk, prior to regulatory approval or signing of commercial contracts with governments, helping to accelerate availability of vaccines worldwide.

Question 5: how effective has the VTF, and the UK, been compared with other countries?

The UK has now deployed over 150 million doses of Pfizer-BioNTech, Moderna and Oxford-AstraZeneca across its vaccination campaigns. As stated above, these are now the 3 most used vaccines in the world, by number of countries using them. The UK was the first country to buy the Oxford-AstraZeneca and Pfizer-BioNTech vaccines.

Table 3: dates that comparator countries signed with Pfizer-BioNTech, Moderna and Oxford-AstraZeneca

In selecting the 7 original candidates for its portfolio, the UK included the 4 vaccines currently being used in deployment. All 4 of these are being widely used in comparator countries.

The speed at which the VTF was able to act meant the UK's vaccination programme began ahead of any other. On 8 December 2020, the UK administered the first COVID-19 approved vaccine outside of a clinical trial, anywhere in the western world.

Conclusion

The VTF procured a portfolio of safe and effective vaccines, enabling the UK to start its deployment programme in 2020. In doing so, the UK became the first country in the world to secure key deals and to deploy a regulated COVID-19 vaccine outside of clinical trials with the Pfizer-BioNTech vaccine. This was followed shortly after by the UK becoming the first country to deploy the Oxford-AstraZeneca vaccine.

The original vaccination programme and the first (and subsequent) booster campaign in autumn to winter 2021 were further strengthened by the availability of the Moderna vaccine, which the UK placed its first order for in late 2020.

The VTF's proactive approach to its strategy for revaccination, including through its investment in the world-leading COV-BOOST study, and its further purchases of the Pfizer-BioNTech vaccine in April and August 2021, ensured that the NHS's booster programme began on time in September 2021, and that all adults were able to be offered a booster dose in line with JCVI advice.

Review of progress against VTF objective 2

Objective 2: make provision for international distribution of vaccines.

Question 1: to what extent has the VTF achieved the intended outcomes?

Supporting global access to the Oxford-AstraZeneca vaccine

The UK government invested early in Oxford University's vaccine development work, supporting their vaccine technology since 2016 and their COVID-19 vaccine since March 2020, with more than £88 million to help research, develop and manufacture the vaccine. The government saw the potential for the vaccine to play a critical part of the global response to the pandemic and supported Oxford University to secure a commercial partner for further development, large-scale manufacturing and licencing and distribution of the vaccine.

On 30 April 2020, Oxford University and AstraZeneca announced an agreement which provided both for the UK population to have access to the vaccine if it proved successful, and for the vaccine to be produced on a not-for-profit basis for the duration of the pandemic. It also enabled manufacturing licencing so that the vaccine could be made available quickly across the globe. The NIHR helped recruit thousands of volunteers from across the UK for the phase 3 clinical trials and supported the researchers, which paved the way for approval by the MHRA.

The Oxford-AstraZeneca vaccine proved crucial in the global fight against COVID-19. By January 2022, around 2.5 billion doses had been distributed at cost to more than 170 countries.

Establishing COVAX

The UK was an early champion of a global initiative to support research, manufacturing, procurement and equitable distribution of COVID-19 vaccines for the benefit of all countries. On 4 June 2020, the UK hosted the Global Vaccine Summit at which a proposal for a global vaccine procurement initiative was launched and the UK announced £48 million to support the initiative. This soon became COVAX and, with the aim of providing equitable global access to safe and effective COVID-19 vaccines as quickly as possible, brought together the expertise and resources of 4 key international organisations:

Gavi, the Vaccine Alliance

the Coalition for Epidemic Preparedness Innovation (CEPI)

United Nations Children's Fund (UNICEF)

Donation of surplus vaccines

In June 2021, the then Prime Minister, Boris Johnson, called upon G7 leaders to set a goal for the world to be fully vaccinated against COVID-19 by the end of 2022. At the G7 summit, hosted by the UK, G7 leaders collectively pledged to donate at least 870 million doses and a total of 1 billion doses over the year to June 2022 (including previous commitments). The Prime Minister announced that the UK would donate 100 million surplus COVID-19 vaccines. The UK committed to make available 5 million doses by September 2021, a further 25 million by the end of 2021, and the remaining 70 million doses by June 2022. Of the total 100 million doses, 80% would be donated via COVAX and the remainder shared bilaterally.

The VTF worked with FCDO to set up a programme to deliver on the 100 million commitment.

The UK met its commitment to donate 30 million doses by the end of 2021. At this stage global demand for vaccines far outstripped supply and there was extreme competition for doses. The UK's donated doses therefore helped meet urgent demands to protect the most vulnerable populations.

In October 2021, the UK announced further donations of 20 million doses of Oxford-AstraZeneca and all 20 million Janssen doses through COVAX.

In 2022, the balance between global demand and supply of vaccines began to shift. Global vaccine manufacturing capacity was increasing quickly and higher income countries were making progress on vaccinating their populations and increasing delivery of vaccine donation commitments. Demand from lower income countries was also lower than anticipated as the new Omicron variant caused less severe disease and many lower income countries were struggling with high levels of vaccine hesitancy, challenging vaccine deployment logistics and competing urgent healthcare priorities.

In May 2022, the UK donated all 14.7 million doses of Novavax procured through COVAX.

The VTF continued to identify and offer further donations of surplus vaccines and was able to make offers totalling 100 million, including donations of Pfizer-BioNTech and Moderna vaccines. By the end of June 2022, the UK had donated and delivered 84.4 million doses. This included 76.5 million (91%) via COVAX and 7.9 million (9%) donated bilaterally to 42 low and middle income countries.

Figure 5: doses offered and donated to other countries by the UK by end June 2022

Source: VTF internal management information.

Figure 5 shows the doses offered and donated to other countries by the UK. By June 2022 the UK had offered 100.2 million doses of COVID-19 vaccine for donation:

By June 2022, the UK had donated 84.4 million doses of COVID-19 vaccine:

76.5 million doses through COVAX

7.9 million doses bilaterally

Vaccine optimisation with other countries

In September 2021, the UK government announced initiatives to share 4 million Pfizer-BioNTech vaccine doses with Australia, and 1 million doses with the Republic of Korea. This arrangement was mutually beneficial and ensured that these Pfizer-BioNTech doses, which were not immediately required in the UK, were used to support international vaccination efforts. The same volume of doses was returned later in the year. Sharing doses meant those countries had immediate access to vaccines they could use in their domestic campaigns and enabled the UK to better align timings of its own supply with UK requirements.

Question 2: what were the causal factors resulting in the outcomes?

The UK government's early support was critical for the rapid development of the Oxford-AstraZeneca vaccine.

Question 4: what other factors have influenced outcomes?

Constraint on supply in 2020 and 2021 meant that countries that had secured deals early got earliest access to vaccines. The UK's ability to donate vaccines offered for donation was limited by lack of demand from COVAX and lower income countries in 2022. Global supply increased as more vaccine candidates proved safe and effective, manufacturers scaled up production capacity, and other countries scaled up vaccine donations. Global demand was also lower than expected as the Omicron variant spread rapidly and was perceived to cause less severe disease.

Question 5: how effective has the VTF been compared with other countries?

Like for like comparisons between countries are complicated because there are many variables in play. For example, over-ordering for domestic use leaves a country with more capacity to donate and donations delivered may be different from commitments. The following table is presented as a factual summary.

Table 4: vaccine donation commitments of G7 countries

Country or area

Donation commitment (million)

Per capita

Per $m GDP

Per dose administered domestically

Conclusion

The UK played a leading role in championing the establishment of COVAX as a global initiative to support both higher and lower income countries secure equitable access to safe and effective COVID-19 vaccines as quickly as possible.

The UK was also a strong advocate, including in the G7, for the donation of surplus COVID-19 vaccines as a short-term response to global supply constraints with intention of improving vaccine access particularly in low and middle income countries around the world.

The VTF was able to identify sufficient surplus vaccine doses to be able to offer to donate 100 million doses in line with the UK's G7 commitment.

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On 11 March 2020, the World Health Organization ( WHO) declared the spread of the COVID-19 virus a pandemic. The UK government had at this point already been active in funding research into the disease.

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Office for Health Improvement and Disparities - Wider Impacts of COVID-19 on health (WICH) monitoring tool

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Office for Health Improvement and Disparities - Wider Impacts of COVID-19 on health (WICH) monitoring tool

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Please be advised that the web tool will be temporarily unavailable due to scheduled maintenance on 13 July 2023, 3pm-5pm. We apologise for any inconvenience this may cause.
Updates to the WICH are paused pending the results of a review of the content and presentation of data within the tool. The tool has not been updated since the 16 March 2023. Please send any questions or comments to PHA-OHID@dhsc.gov.uk

The Wider Impacts of COVID-19 on Health (WICH) monitoring tool is designed to allow you to explore the indirect effects of the COVID-19 pandemic on the population's health and wellbeing. WICH presents a range of health and wellbeing metrics in interactive plots that can be broken down to show differences between groups - for example, you can explore grocery purchasing habits by region or social class. WICH is updated quarterly and may include the addition of new metrics as they become available. A summary has been included for WICH and is available to read.

Application development: World Health Organisation (WHO) framework

The WICH tool is currently being redeveloped so that it continues to be a responsive resource which meets the needs of its users for the recovery phase of the COVID-19 pandemic. Specifically, in response to an evaluation conducted in 2021, the indicator themes are being restructured so that they are consistent with a WHO pandemic framework. This framework consists of five main pathways through which the pandemic and related containment measures can have an impact on population health. The first two themes are included in the December 2022 update: Impact of COVID measures, Impact on healthcare. Please see the table below to find out which metrics have been grouped into these new themes.

Metrics

Office for Health Improvement and Disparities (OHID) Health Intelligence teams have collated a range of metrics and grouped them into nine themes. Click the rows in the table below to expand groups and subgroups. The link column will take you to the relevant theme within the tool. You can search through metrics using the search bar on the right.

What's new?

Updated 16/03/2023.

Other resources

On the 5 November 2020, we published a report which provided an in-depth commentary on the impact of the COVID-19 pandemic on grocery shopping behaviours during March to June 2020.

Feedback

We are interested in your feedback on the tool. If you have any comments or suggested changes, please email PHA-OHID@dhsc.gov.uk.

Wider Impacts of COVID-19 on Health (WICH) summary, 16 March 2023

This Office for Health Improvement and Disparities (OHID) monitoring tool looks at the wider impacts of the coronavirus (COVID-19) pandemic on population health. This report briefly highlights the main findings.

This resource is updated quarterly, with new data for existing metrics and new metrics covering relevant themes added when data become available. In some cases, a metric is from a single time point data collection and therefore figures will not be updated. This will be continually reviewed and the resource will be updated as appropriate for relevance and timeliness.

Overview

This summary provides the main messages for some of the metrics updated in this release. It will cover employment indicators, such as number of job vacancies and redundancy rates, child physical activity, wellbeing and breast screening.

Main messages

Social determinants of health

Number of job vacancies in the UK

There is a strong evidence base showing that work is generally good for physical and mental health and wellbeing. Figure 1 shows the number of job vacancies has continued to decrease to 1,134,000 for the quarter November 2022 to January 2023, from a recent peak of 1,294,000 in the quarter February to April 2022.

Figure 1: Quarterly average of number of job vacancies in the UK (thousands) (seasonally adjusted), United Kingdom, November 2018 to January 2023
Source: Vacancy Survey, Office for National Statistics
Redundancy rate

Figure 2 shows the redundancy rate for all persons has continued to increase to 3.5 per 1,000 employees for the quarter October to December 2022, from 1.9 for the quarter April to June 2022. This remains below levels from a peak during the pandemic where the redundancy rate reached 12.8 per 1,000 employees for the quarter October to December 2020.

For the same period a larger increase in redundancy rate is observed for males. For the quarter October to December 2022 the redundancy rate reached 4.5 per 1,000 employees, an increase from 2.1 for the quarter April to June 2022. This figure is below the redundancy rate at the peak of the pandemic (14.7 per 1,000 employees for the quarter October to December 2020).

Figure 2: The ratio of redundancy level to the number of employees by sex, January 2018 to December 2022, England
Source: Labour Force Survey, Office for National Statistics
Wellbeing

Low life satisfaction

This data enables us to explore whether the pandemic has had an impact on the percentage of people experiencing low levels of life satisfaction.

Figure 3 shows the percentage of respondents with a low life satisfaction score. This percentage has been increasing since December 2021. The November 2022 figure (10.3%) was higher than both the 2019 baseline (5.7%) and October 2021 (8.4%). However, it was 0.1 percentage points lower than the November 2020 (10.4%) when the second lockdown came into force in England.

Figure 3: The percentage of survey respondents with low life satisfaction (score 0-4) in England, June 2020 to November 2022
Source: PHE/OHID analysis of Opinions and Lifestyle Survey data from Office for National Statistics
Behavioural risk factors

Child physical activity - Active Lives survey

Figure 4 shows that for all three school terms of the 2021 to 2022 academic year the percentage of physically active children (aged 5 to 16 years) was higher than the respective terms of the 2020 to 2021 academic year and have returned to pre-pandemic levels. The UK Chief Medical Officers (CMO) currently recommend that children and young people (5 to 18 years) are physically active for an average of at least 60 minutes per day across the week.

Figure 4: Percentage of children and young people aged 5-16 years that met the UK Chief Medical Officers' recommendations for physical activity, England, Autumn 2018 to Summer 2022
Source: Active Lives Children and Young People Survey, Sport England
Impact on healthcare

Breast screening round length

Breast screening is offered to women aged 50 to 71 years of age every 3 years to maximise the chances of finding breast cancers at an early stage when they are too small to see or feel. This indicator aims to show the restoration of breast screening services following a pause in invitations between April and June 2020.

Figure 5 shows the proportion of women aged 50 to 73 years who were offered a subsequent appointment for breast screening within 36 months of their last attended appointment or date of first offered appointment for women who did not attend. The proportion has continued to increase to 54.3% in Quarter 1 2022/23, from 45.7% in Quarter 4 of 2021/22. Breast cancer screening services have been negatively affected by the COVID-19 pandemic and this proportion remains below pre-pandemic levels of 81.8% (Quarter 4 2019/20) and below the 'acceptable level' for this standard 90% and over.

Figure 5: Proportion of women eligible for breast screening whose date of first offered appointment is less than or equal to 36 months of their previous episode, England, Q2 2017/18 to Q1 2022/23

Chart note:

Gap in line indicates where data have been withdrawn due to poor data quality during the pandemic and the change in the IT reporting system.
Source: Screening key performance indicators, NHS England and NHS Improvement
Breast screening uptake

This indicator shows the proportion of women offered screening who have a technically adequate screen within 6 months of the date of first offered appointment. As shown in figure 6 the proportion has remained stable at 55.5% for Quarter 1 2022/23, compared to 53.3% in Quarter 4 2021/22. This proportion remains below the 'acceptable level' of 70%.

Figure 6: Proportion of women eligible for breast screening who have a technically adequate screen less than or equal to 6 months of date of first offered appointment, England, Q2 2017/18 to Q1 2022/23

Chart note:

Gap in line indicates where data have been withdrawn due to poor data quality during the pandemic and the change in the IT reporting system.
Source: Screening key performance indicators, NHS England and NHS Improvement
WICH Summary for download
WICH Summary Mar 2023 WICH Summary Dec 2022 WICH Summary Sept 2022 WICH Summary July 2022 WICH Summary June 2022
If you are interested in a summary from an earlier release, please email PHA-OHID@dhsc.gov.uk.

National lockdown restrictions in England from March 2020 to date

January
6 Jan - third national lockdown

February

15 Feb - hotel quarantine for travellers arriving in England from 33 high-risk countries

March

20 Mar - schools close, all cafes, pubs and restaurants close except for take-away
23 Mar - first national lockdown begins 'stay at home'

8 Mar - schools, colleges and practical university courses open
29 Mar outdoor gatherings of either 6 people or 2 households allowed. Outdoor sports facilities reopen. Stay at home rule ends

April

12 Apr - non-essential retail, personal care premises (e.g. hairdressers), public buildings, gyms and outdoor hospitality reopen

May

13 May - outdoor exervise with one other houeshold allowed

17 May - outdoor gatherings of up to 30 people allowed. Indoor rule of 6 or 2 households applies (social distancing to remain). Indoor locations such as cinemas, play centres and hotels to reopen

June

1 Jun - fatherings of up to 6 people outdoors and phased reopening of schools
15 Jun - non-essential retail and secondary schools reopen
23 Jun - 2m social distancing rule relaxed

21 Jun - wedding guests no longer limited to 30, care home residents do not necessarily have to self-isolate if they go on a trip out of the home, children can go on overnight trips in groups of 30, large events pilots continue. Those in areas with high levels of Delta variant advised to meet outside, keep 2m apart from those you don't live or bubble with, minimise travel in/out of the area

July

4 Jul - pubs, restauraunts, hotels and hairdressers open. Two households can meet indoors and social distancing relaxed to at least one metre

19 Jul - all legal limits on social contact removed

August

14 Aug - indoor activities such as theatres, bowling alleys and soft play, resume

September

14 Sep - indoor and outdoor social gatherings of more than 6 banned
22 Sep - return to working from home and hospitality curfew of 10pm

October

14 Oct - 3 tier system of restrictions introduced

November

5 Nov - second national lockdown

December

2 Dec - second lockdown ends, return to 3 tier system
21 Dec - tier 4 alert introduced (stay at home)
26 Dec - more areas enter tier 4

How to use this Tool

Use the tabs at the top of the screen to move between the different metric groups.

Each tab provides a visualisation of the selected metric by different breakdowns and the trends over time for the metrics available.

1. Select the metric to display in the 'Indicator' drop down. The dashboard will populate with the selected data.

2. Select the breakdown you would like to display from the 'Breakdown' drop down.

3. Navigate between viewing charts, data tables and metadata using the tabs in each theme.

4. To see a single variable on a chart click on the variable name in the legend.

5. View data from previous releases using the 'Release Date' drop down.

Accessibility statement for Wider Impacts of COVID-19 on Health (WICH) monitoring tool

This accessibility statement applies to https://analytics.phe.gov.uk/apps/covid-19-indirect-effects/

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* The graphs require colour vision to interpret, failing Use of Color
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What we're doing to improve accessibility

Most of the issues above will be reviewed with the development team and be resolved within 6 months.

The graphs are created using a library, and it has not been possible to find an accessible alternative. The data tables associated with each graph will be updated to ensure they include the same information as the graph.

Preparation of this accessibility statement

This statement was prepared on 23rd September 2021. It was last reviewed on 23rd September.

This website was last tested on 22nd September 2021. The test was carried out by Nomensa. A selection of 10 pages across the site were selected for testing, covering the main templates and types of content (graphs) that are available.

COVID-19 Health Inequalities Monitoring for England (CHIME)

The COVID-19 Health Inequalities Monitoring for England (CHIME) tool brings together data relating to the direct impacts of COVID-19, such as on mortality rates and hospital admissions.

By presenting inequality breakdowns, including by age, sex, ethnic group, level of deprivation and region, the tool provides a single point of access to:

show how inequalities have changed during the course of the pandemic and what the current cumulative picture is

bring together data in one tool to enable users to access and utilise the intelligence more easily

provide indicators with a consistent methodology across different datasets to facilitate understanding

support users to identify and address inequalities within their areas and identify priority areas for recovery

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Please be advised that the web tool will be temporarily unavailable due to scheduled maintenance on 13 July 2023, 3pm-5pm. We apologise for any inconvenience this may cause. Updates to the WICH are paused pending the results of a review of the content and presentation of data within the tool.

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This guidance outlines how NHS England intends to exercise its enforcement powers for both integrated care boards (ICBs) and providers, by setting out how it would use these powers to direct an ICB and the licence enforcement mechanisms that apply to foundation trusts, NHS trusts, licensed independent providers of NHS services and licensed NHS controlled providers.

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Broken trust: making patient safety more than just a promise

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Broken trust: making patient safety more than just a promise

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How do the public and NHS staff feel about virtual wards?

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How do the public and NHS staff feel about virtual wards?

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Key points

NHS England's Delivery plan for recovering urgent and emergency services commits to an expansion of virtual wards (also known as 'hospital at home'), and there are similar commitments in Scotland, Wales and Northern Ireland. In March 2023, the Health Foundation commissioned a survey of 7,100 nationally representative members of the public (aged 16 years and older) and 1,251 NHS staff members to explore what people think about virtual wards and what factors will be important for making sure they work well.

The UK public is, overall, supportive of virtual wards (by 45% to 36%). But this support is finely balanced - with a further 19% unsure whether they are supportive or not. So there is further to go in raising awareness and in understanding and addressing the public's concerns as this model of care is developed.

Support for virtual wards is higher among disabled people and those with a carer - groups that typically have greater health needs and who might therefore be expected to be more intensive users of virtual wards.

Those in socioeconomic groups D and E are on balance unsupportive of virtual wards, so it will be important to understand and address needs and concerns here. Notably, survey respondents in these socioeconomic groups who said that they would not want to be treated through a virtual ward were also more likely to say that their home would not be suitable for a virtual ward compared with those in other socioeconomic groups.

Nearly three-quarters of the UK public (71%) are open to being treated through a virtual ward under the right circumstances, while 27% said they would not be - suggesting that, if implemented well, virtual wards should be acceptable to a large majority of service users.

Interestingly, a higher proportion of the public, 78%, told us that they would be happy 'to monitor their own health at home using technologies, instead of in a hospital' - describing a scenario often seen as part of a broader virtual ward service, but avoiding the term 'virtual ward' - with only 13% saying they would not. This raises the question of whether using different terminology or providing more explanation could help alleviate concerns and build wider support.

NHS staff in our survey were, on balance, clearly supportive of virtual wards (by 63% to 31%). When asked what will matter for making sure virtual wards work well, their top two factors were the ability to admit people to hospital quickly if their condition changes, and the ability for people to talk to a health professional if they need help.

In January 2023, NHS England's Delivery plan for recovering urgent and emergency services committed the health service to ease the growing pressure on hospitals by scaling up the use of 'virtual wards'. Also known as 'hospital at home', virtual wards allow people to receive treatment and care where they live, rather than as a hospital inpatient, while still being in regular contact with health professionals. Virtual wards can be used to avoid a hospital admission or to support early discharge from hospital. In some cases, virtual wards are supported by technologies that help people monitor their health at home and send information back to health care professionals, such as devices to track pulse, blood pressure or oxygen levels.

NHS England is aiming for more than 10,000 virtual ward beds to be available in England by winter 2023. Current NHS England guidance is also driving the digitisation of virtual wards, with a view to soon have all virtual wards enhanced by the use of technologies, such as for remote monitoring. There are similar commitments in Scotland, Wales and Northern Ireland.

Understanding what people think about new ways of delivering care and new uses of technology is important for ensuring these new approaches command the confidence of patients and staff, for implementing them successfully and for maximising their benefits.Where the public and staff are less supportive, innovation and transformation can be significantly constrained.

So how do NHS staff and the UK general public feel about the use of virtual wards? To understand this, in March 2023 we commissioned a survey of 7,100 nationally representative members of the public (age 16 years and older) and 1,251 NHS staff members to find out how supportive they are of virtual wards and what they think is important for making sure they work well.

Box 1: Describing virtual wards

How virtual wards operate can vary significantly between the different care pathways, services and organisations they are deployed in. In some cases they can include face-to-face care delivered outside of the hospital; in other cases they do not (though all involve clinical assessment). And while some are 'technologically enabled' - allowing people to communicate digitally with health professionals or monitor their health - others are not. Therefore, to capture the essence of a virtual ward for the purposes of our survey, we described them as below:

'Patients on "virtual wards" are looked after at home rather than in a hospital. They are in regular contact with health professionals, like a doctor or nurse, and sometimes given technologies to help them monitor their health from home. These might include devices they can wear to measure things like their pulse, blood pressure, or the amount of oxygen in their blood.'

Are people supportive or unsupportive of virtual wards?

To explore how the UK general public and NHS staff feel about the idea of virtual wards, we asked our survey respondents to tell us how supportive or unsupportive they were of their use. As shown in Figure 1 below, on balance both the general public and NHS staff were supportive, with 45% of the public and 63% of NHS staff either 'very' or 'quite' supportive. But public support is delicately balanced. Around a third of the general public are 'not very' or 'not at all' supportive of virtual wards, and nearly 1 in 5 (19%) do not know whether they are supportive or not. There were no significant differences in this pattern across the four UK nations.

Through Censuswide, we commissioned an online survey of 7,100 members of the UK general public aged 16 years and older and 1,251 NHS staff members, which ran from 1-23March 2023. Our survey also included a booster sample of 100 UK adults at risk of digital exclusion through computer-assisted telephone interviewing. Those in our booster sample met a minimum of two of the following three criteria: age 65 years and older; household income under £25,000 per annum; or no post-18 qualifications.

Our total sample of 7,100 members of the UK public was representative by age, gender, ethnicity, region and socioeconomic group as per 2011 UK Census data. Our NHS sample contained at least 125 respondents in each of the following occupational groups: medical and dental; nursing and midwifery; health care scientists/additional professional scientific and technical; other clinical services; admin and clerical; and allied health professional.

As shown in Table 1 below, disabled people, people with a carer and carers themselves are significantly more likely to support the use of virtual wards when compared with the population as a whole (50%, 58%, and 55% respectively, compared with 45% among the population as a whole).

Table 1: Support for virtual wards is higher among disabled people, people with a carer and carers themselves

General public (n=7,100)

Disabled people (n=1,457)

People with a carer (n=767)

Carers (n=1,198)

Supportive

45%

50%

58%

55%

Unsupportive

36%

34%

35%

31%

Don't know

19%

17%

8%

13%

Although the general public is on balance supportive, this support varies by socioeconomic group (determined by the occupation type of the primary income earner in a household). As shown in Figure 2 below, those in socioeconomic groups D and E, are more unsupportive than supportive (by 38% to 36%). As people in these socioeconomic groups may be more likely to face barriers both to accessing health care and using technology, it will be important for policymakers and providers to understand what lies behind the drop in support for virtual wards among this group, so that their concerns and any barriers they face can be addressed.

Support for virtual wards also varies with how much someone knows about how the NHS is using technology. As shown in Figure 3 below, there is a clear relationship between the level of self-assessed knowledge about how the NHS is using technologies and support for virtual wards. Those who know 'a great deal' or 'some' about how the NHS is using technology are significantly more likely to be supportive of virtual wards compared with those who know 'very little' or 'nothing at all' (70% and 53% compared with 36% and 24%). And as awareness reduces, the percentage of people choosing 'don't know' increases. So the more people know, the more likely they are to support virtual wards.

This finding is consistent with previous Health Foundation research showing that confidence in technologies rises when people feel they have more knowledge of them. And while further research is needed to understand the relationship between support for health care technologies and self-reported knowledge, it suggests the importance of ensuring that the public is well informed about virtual wards and associated technologies.

Are people happy to use a virtual ward themselves?

We also asked members of the general public whether they would personally be happy to be treated through a virtual ward instead of hospital. The results are shown in Figure 4 below. Nearly three-quarters (71%) said they would personally be happy to be treated through a virtual ward, as long as their concerns and conditions were addressed (discussed in more detail below), while 1 in 4 (27%) said they would not.

Age is sometimes cited as a factor affecting attitudes to technology enabled care, with the assumption that those in older age groups will be less comfortable using technology and therefore less supportive than younger age groups. However, our analysis shows that the proportion saying they would not want to be treated through a virtual ward declines with age, as illustrated in Figure 5 below, with a corresponding rise in conditional support ('It depends') from a low of 32% among 25-34 year-olds to a high of 50% among those 65 years and older. This suggests that older age groups are potentially more open to using virtual wards under the right conditions.

What factors lie behind attitudes to virtual wards?

To delve deeper into the reasons why people selected 'It depends' or 'No' when asked if they would be happy to be treated through a virtual ward, relevant participants were given a list of reasons and asked to pick up to three.

For those who told us 'It depends' (42% of our sample), over three-quarters (77%) said whether they would be happy to be treated through a virtual ward would depend on what their illness or condition was (see Figure 6). To date, virtual wards have primarily been used in specific pathways such as acute respiratory infection and frailty, but with an ambition to expand the model to a greater range of conditions. In addition to considering which pathways are suitable for treatment through a virtual ward model, our survey findings suggest it will also be important to engage with the public to understand how they feel about using this model of care for different conditions.

As shown in Figure 7, nearly half (47%) of those who said they would not be happy to be treated through a virtual ward said it was because they would prefer being face to face with those taking care of them, and 43% said it was because they did not think the quality of care would be as good. Over a third (34%) said it was because they might not be able to access a health professional quickly if they needed it (a factor that was also important for those saying 'It depends', where it was the second most highly ranked reason).

Although fewer of these respondents chose the reasons that they 'wouldn't be able to care for themselves at home' (17%), that their 'home wouldn't be suitable' (16%) or that they 'don't have reliable phone or internet access' (9%), this nevertheless suggests that a small yet significant number of people may lack the infrastructure or support needed to take advantage of virtual wards. These factors raise questions over equity of access and underscore the importance of considering the barriers some households will face, when deciding if this model of care will be suitable.

Given our findings show that support for virtual wards can vary by socioeconomic group and age (see Figure 9 and Figure 10), we sought to understand if the reasons people gave for saying that they would not want to be treated through a virtual ward also varied by these characteristics. As shown in Figure 9 below, the top three reasons given by those saying they would not want to be treated through a virtual ward remained consistent across socioeconomic groups.

However, the number of people selecting 'Because my home wouldn't be suitable for a virtual ward' rises consistently, from 13% of households in socioeconomic groups A and B, to 19% in socioeconomic groups D and E - once again, raising questions about equity of access to this model of care.

If we look at the reasons given by those who would not want to be treated through a virtual ward and how this varies with age, shown in Figure 9, the order of the top three reasons does not change. But the preference for face-to-face care rises steeply, cited by 38% of 16-34 year olds, but 59% of those age 55 years and older. So while older people as a whole are more supportive of virtual wards than younger people (see Figure 5), those older people who say they would not want to be treated through a virtual ward are much more likely to cite a preference for face-to-face care as the reason.

Another factor that may affect how people feel about virtual wards is the terminology used. This could be because of a lack of understanding of the concept, a general dislike of the idea of hospital wards, or negative views of related concepts such as 'virtual consultations'.

Our survey also included a question asking people whether they would or would not 'be happy to monitor, with help if you needed it, your own health at home, using technologies like a blood pressure monitor, instead of in a hospital'. This describes a typical scenario in a virtual ward service, but avoids the term 'virtual ward'. As shown in Figure 10, 78% of the public told us they would be happy to do this, whereas only 13% would not; a more positive picture than when asked specifically about virtual wards.

These results, alongside those discussed earlier, indicating that support for virtual wards is higher for those with more awareness of how the NHS is using technology, suggest that the term 'virtual ward' may need rethinking, or at least further explanation and clarification. For example, it may be failing to convey that virtual wards can include face-to-face care delivered outside of hospital - something that may provide reassurance to a significant number of those who said they would not want to be treated through a virtual ward.

What do NHS staff think is needed for virtual wards to be successful?

We asked NHS staff what they think the most important factors are for making sure virtual wards work well. As shown in Figure 11, the highest ranked factor was 'People can get admitted quickly to hospital if their condition changes', chosen by 40% of NHS staff. This was closely followed by 'People can still talk to a health professional if they need help', chosen by 36% of staff. Interestingly, this echoes one of the main concerns of those members of the public who only expressed conditional support for the idea of using a virtual ward - namely, that they would want to know they could get help quickly if they needed it (see Figure 6).

Implications for policymakers and those overseeing the development of virtual wards

Our findings suggest that there is an existing base of support for virtual wards among the public on which to build as this model of care is developed and spread, but also that there is further to go to secure buy-in across the population as a whole. The finding that those who know more about how the NHS is using technology are more supportive of the model suggests that awareness raising could play an important role in building support. There may also be a need to consider the terminology of 'virtual wards' and explore whether using alternative descriptions or providing supporting information could strengthen support for this model of care.

But steps to build awareness and offer reassurance are only one part of what is needed. It will also be critical to continue to monitor and evaluate virtual wards as they are rolled out, ensuring they deliver high-quality and safe care in practice. For example, the Health Foundation's Improvement Analytics Unit will be working closely with NHS England and a number of frailty virtual wards to explore how frailty virtual wards are operating, and assess equity, safety and effectiveness.

Proponents of virtual wards will be encouraged to see support is stronger among certain groups with greater care needs, including older people, disabled people and those with a carer. These groups might be expected to be more intensive users of virtual wards, as well as among carers themselves, who will play an important role in making virtual wards work well in practice. Nevertheless, it is notable that those in socioeconomic groups D and E are less supportive of virtual wards. It will therefore be important to understand the issues here and address concerns, including the suitability of people's homes for virtual wards and whether or not they have the necessary support available. In seeking to expand the virtual wards model, providers will need to work closely with other services and agencies, such as social care and local authority housing teams, to ensure people have the support they need.

Our findings suggest that support for virtual wards depends for many people on the specific condition or illness for which they are being used. As the NHS seeks to expand this care model to more conditions, it will therefore be important to consider not just which conditions are amenable to treatment through virtual wards, but also whether patients are comfortable with the model in these situations.

Finally, our NHS staff survey contains useful intelligence about what staff think will be important for making virtual wards work well, including ensuring people can be admitted to hospital quickly if their condition changes, and that they can still talk to a health professional if they need help. Our public survey also suggests that getting these factors right will play an important role in offering greater reassurance about virtual wards to those who are not already convinced.

Further reading

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How do the public and NHS staff feel about virtual wards?

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This long read looks at our polling on what the public and NHS staff think of virtual wards, and what policymakers can do to increase support for their rollout.

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Six findings on how the public views the NHS at 75 and perceptions of what the future may bring.

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A picture of health? Examining the state of leadership and management in healthcare

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A picture of health? Examining the state of leadership and management in healthcare

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The UK's healthcare system lags behind those of many comparable countries, despite signs of slow improvement in some areas in the years before the pandemic. In this report, we examine the role that better leadership and management can play in both lifting up the tail of under-performing healthcare providers and fostering more "outstanding" healthcare providers, so that healthcare outcomes in this country are much closer those of the best systems in the world.

UK healthcare provision lags behind many other comparable countries on key indicators such as cancer and heart attack survival. The aftermath of the pandemic has made the situation worse. Getting to the international frontier on healthcare will require action by politicians, policymakers and the NHS, to:

support improvements among the tail of under-performers, especially among acute care providers

increase significantly the proportion of healthcare providers rated "outstanding" in CQC inspections.

Central to tackling both these problems is improving leadership and management in healthcare providers. Mounting evidence shows these factors make an important difference to healthcare delivery. Our survey findings suggest that, while two-thirds (65%) believe leadership across the NHS is effective, there is a significant minority that do not (27%), indicating room for improvement.

Performance benchmarks linked to an organisation's overall ambitions are an example of management best practice. Yet the results from the survey found that 19% of managers did not have performance targets relevant to their role in place. Even among those who did, less than two-thirds (62%) had targets that aligned with the goals of the healthcare organisation they worked in.

Even when leaders and managers already employ best practice approaches, their impact is maximised when the environment is conducive. 62% of leaders and managers surveyed said that they faced obstacles that hindered their ability to do their job as effectively as they might otherwise be able to. Obstacles cited by respondents included human resource challenges, organisational problems and internal red tape.

In order to help improve leadership and management and, in turn, boost the quality of healthcare delivery across the entire country, we propose a number of reforms, including:

expanding the degree of oversight of and support for leaders and managers by the CQC

offering more training in leadership and management skills to those working in healthcare

pushing for the take-up of best practice measures in underperforming hospitals, to help improve workplace culture.

The government should:

broaden the CQC's "well-led" category for inspections so that it includes a detailed review of the management practices, training and leadership pipelines of the organisations it inspects

establish a set of benchmarks for judging good leadership and management that the CQC can use in its assessment of whether or not an organisation is "well‑led"

mandate in‑work leadership and management training requirements across the NHS. including primary care, for managers and leaders

mandate NHS England to establish a compulsory national excellence framework for the minimum in‑work leadership and management training requirements

pilot workplace democracy in the NHS in under‑performing trusts.

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A picture of health? Examining the state of leadership and management in healthcare - Social Market Foundation.

# data[].attributes.attachment_link.description
The UK's healthcare system lags behind those of many comparable countries, despite signs of slow improvement in some areas, in the years before the pandemic. In this report, we examine the role that better leadership and management can play in both lifting up the tail of under-performing healthcare providers and fostering more "outstanding" healthcare providers, so that healthcare outcomes in this country are much closer those of the best systems in the world.

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Effective people managers: Evidence review - Research exploring how to develop people managers who drive organisational success

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Effective people managers: Evidence review - Research exploring how to develop people managers who drive organisational success

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CIPD | Effective people managers: Evidence review

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People managers are an indispensable link between an organisation's top management and its employees. However, their impact is affected by several moderating factors, such as leadership style, management skills and organisational support. This evidence review draws together the best available evidence to explore why people managers are important, what a good people manager looks like, and how to develop effective people managers.

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STRETCHED TO THE LIMIT: TACKLING THE NHS PRODUCTIVITY CHALLENGE

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STRETCHED TO THE LIMIT: TACKLING THE NHS PRODUCTIVITY CHALLENGE

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Stretched to the limit: tackling the NHS productivity challenge

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NHS Long Term Plan » The NHS in England at 75 (NHS@75)

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Ahead of the NHS’s 75th birthday, the NHS Assembly has developed an independent report: The NHS in England at 75: priorities for the future. This will help the NHS, nationally and locally, respond to long term opportunities and challenges.

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75 years of the NHS: how does it compare to international health systems?

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75 years of the NHS: how does it compare to international health systems?

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Join us as we mark the 75th anniversary of the NHS. In this episode, Jo Vigor chats with fellow colleagues from The King's Fund, Danielle Jefferies and Siva Anandaciva, about how the NHS has changed in its history, and what we can learn from other health systems around the world.

Related resources

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75 years of the NHS: how does it compare to international health systems?

# data[].attributes.attachment_link.description
In this episode, Jo Vigor chats with fellow colleagues from The King's Fund, Danielle Jefferies and Siva Anandaciva, about how the NHS has changed in its history, and what we can learn from other health systems around the world.

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Year one of integrated care systems has been tough – here's what they need in year two

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Year one of integrated care systems has been tough – here's what they need in year two

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It's been a challenging first 12 months for fledgling integrated care systems (ICSs) which were placed on a statutory footing on 1 July last year.

With more challenges on the horizon, it's time to take stock of trusts' experiences as key budget holders and employers within those health and care systems, and central to driving the collaborative, population health focused change we all want to see.

The pace of change has been variable according to trust leaders. For many real focus on some of the ambitions of ICSs to improve outcomes in population health, tackle inequalities and help the NHS support broader social and economic development - feels a long way off. Integrated care boards (ICBs) have understandably been occupied with establishment issues, system governance and the huge organisational and structural change required to make the transition to this new way of working.

Despite welcome efforts by NHS England to clarify roles and responsibilities, trusts still tell us that greater clarity about the role of ICBs is needed.

Julian Hartley Chief Executive

These challenges have been compounded by sustained, severe pressures facing the whole health and care system. Energy spent on operational 'fire fighting' - on waiting lists, urgent care and industrial action - has reduced leadership capacity to lay the groundwork for serious improvement on population health and inequalities. Year two of ICSs is likely to see more of the same.

While many trust leaders have seen a real evolution in relationships over the last year, and statutory system working has given collaboration greater impetus and credibility, this isn't universal yet and will take time to build. We still hear that old patterns of 'commissioning' behaviour and contractual or transactional approaches continue in some systems.

And with a target to deliver a 30% reduction in ICB running costs by 2025/26 there is a clear risk that ICBs' focus will be diverted.

Effective system working is underpinned by strong relationships and consistent collaboration. This requires buy-in at every level of each organisation, and for many partners - including trusts - a profound cultural shift. Working with partners is something I had a positive experience of in my former role as a trust leader.

Despite welcome efforts by NHS England to clarify roles and responsibilities, trusts still tell us that greater clarity about the role of ICBs is needed. Expecting ICBs to be both a convenor and performance manager of their system is an uncomfortable fit for many and stretches already-limited capacity. An additional tier of management and regulation will add little value: trust leaders want to work with ICBs as equal partners in pursuit of shared goals, and are keen to see far greater focus on trust and system level improvement approaches instead of top down performance management.

For some systems, provider collaboratives have played a key role in managing operational pressures such as reducing elective waiting lists and cutting delayed discharges.

Julian Hartley Chief Executive

Trust leaders are particularly positive about the work taking place through provider collaboratives and place-based partnerships even where they report challenges in their systems. In some cases they are flourishing even where the ICB is severely challenged, demonstrating the leadership that trust leaders bring to every level of system working.

Provider collaboratives at scale or at place are developing to serve communities and join up services, delivering benefits such as reducing waste, managing workforce capacity and improving quality of care. For some systems, provider collaboratives have played a key role in managing operational pressures such as reducing elective waiting lists and cutting delayed discharges.

Local authorities too have essential expertise in tackling the wider determinants of health and health inequalities and are key to unlocking the potential of ICSs. At a 'place' level and in the day-to-day delivery of services, local authority and NHS colleagues are working ever more closely together which is something we need to see more of. And at the strategic level, integrated care plans have now been submitted by systems.

While this does not overcome challenges relating to different NHS and local authority funding and accountability structures, it is an important first step in creating a shared vision for wider services within the scope of ICSs. It is not clear yet whether these plans will lead to progress in collaborating towards shared goals of preventing ill health and reducing inequalities, but they are necessary to begin that work.

So, what are the next steps? Big cultural shifts and organisational changes take time but there are some key enablers to support the next phase of ICSs. It is clear that further structural change would be damaging to the health and care system, making it all the more important to support ICSs to succeed in a challenging environment to deliver for populations.

With a concerted effort, the longer-term ambitions of system working are within reach.

Julian Hartley Chief Executive

First, greater clarity about the roles and responsibilities at every level of system working will help leaders to focus on the long-term. For instance, ICBs' energies will best be spent not on quasi-regulatory activity, but on strategy and brokering relationships within systems to add real value to collective ambitions to improve population health.

Likewise, a balance between central control and system level autonomy is important, including through a slimmed down set of national targets (as recommended by Patricia Hewitt's review of ICSs), aligned financial incentives which don't pull against collaboration in times of pressure making good on the more mature behaviours set out in NHS England's operating framework. There remains a strong role for regional teams in bridging these gaps.

Looking ahead, with a slimmed down ICB on the horizon through cuts to running costs, place-based partnerships and provider collaboratives will have an essential role in delivering on the core ambitions of ICSs. There is already significant optimism here, and with further time and space to navigate new relationships, governance structures and financial arrangements, the potential is huge.

With a concerted effort, the longer-term ambitions of system working are within reach. Trusts are ready to play their part as equal partners in systems.

This opinion piece was first published by HSJ.

About the author

Julian Hartley
Chief Executive

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Year one of integrated care systems has been tough - here's what they need in year two

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To mark the one-year anniversary of integrated care systems, Sir Julian Hartley discusses the challenges, progress and next steps needed to meet the long-term ambitions of systems in the coming years.

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From Inception to Implementation: A Year of Integrated Care Systems

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From Inception to Implementation: A Year of Integrated Care Systems

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This study seeks to investigate how Integrated Care Systems have developed since July 2022, with a specific focus on how they have managed and overcome pressures associated with the planning, coordination and commissioning of health and care services. Understanding these systems and their key pressure points will allow wider system partners to steer improvement across regions through best practices and partnerships across both short and long-term pressures.

Please use this page to navigate to the various section of the report. The Executive Summary and Bibliography can be found below. You can locate a full pdf version of the report here.

Executive Summary

Integrated Care Systems (ICSs) are the latest initiative to plan and deliver joined-up health and care services and improve the quality of life for individuals who live within their designated areas.

On 1 July 2022, 42 ICSs were formed across England, with the statutory powers of Clinical Commissioning Groups (CCGs) being transferred to the Integrated Care Boards (ICBs) and the statutory ascendancy of the Integrated Care Partnerships (ICPs) coming online. The function of an ICS is to deliver four core objectives:

* Improve outcomes in population health and healthcare
* Tackle inequalities in outcomes, experience, and access
* Enhance productivity and value for money
* Help the NHS support broader social and economic development.

As we approach the end of the first year since their inception, Care England looked to understand how these ICSs sought to establish themselves, particularly through the lens of the adult social care sector, and the progress made in integrating their local health and social care system. The core focus of this report is to identify: what is working well, why it's working well, and how we can accelerate the implementation of integrated care which recognises the value of the adult social care sector.

To inform this report, Care England conducted a series of qualitative interviews with ICS leaders from across England to understand how their system has developed over
this period. The report aims to improve the national understanding of how systems have managed the transition from CCGs to ICSs and how they have addressed systemic barriers to delivering on their four core objectives. To achieve this, the report addresses four topics:

* New structures and managing the change
* Identifying and overcoming the pressure points
* The priorities and ambitions
* Where do we go next?

The report provides a summary of the key discussions and concludes with a set of tangible recommendations that seek to further accelerate the integration between health and social care, whilst overcoming barriers.

Recommendations

New structures and managing the change

* ICS leaders should seek to include an adult social care representative (either a care provider, a Care Association, or a representative body) on the ICP or the ICB to represent the views of adult social care providers. ICSs must take pragmatic steps to build appropriate, additional and transparent vehicles that feed directly to the ICP or ICB, to enable all elements of the care sector to provide valuable insight at a strategic level to aid decisions that work across their local health and social care sectors.

Identifying and overcoming the pressure points

* The Government should legislate ringfenced national funding for ICSs across multiple years to enable systems to plan, build, and execute long-term plans effectively to support a sustainable health and social care sector.

* The Government should look to adopt a consistent investment basis for ICSs wherein systems are given greater autonomy on how funding should be used to sustain health and social care.

The priorities and ambitions

* ICSs should undertake an exercise to gain a complete understanding of their adult social care sector market to ensure they are properly addressing needs and effectively utilising the strengths that exist within the system. The market assessment should be overseen by the Department of Health and Social Care and NHS England, who should be empowered to hold ICSs to account to ensure systems are taking appropriate measures to build a comprehensive knowledge base of their local health and social care market under the scrutiny of the Care Quality Commission.

* The Government should develop a national, long-term 'Adult Social Care Workforce Strategy', which includes and proposes solutions to improving workforce pay. This should be adopted by ICSs for their locality, characterised by a variety of different methods to support the recruitment and retention of the workforce. The strategy should encompass measures for success, with a comprehensive understanding of what such success looks like, to ensure ICSs are meeting workforce targets appropriately within their regions.

* NHS England should strive to ensure national oversight of each ICSs' digital make up to ascertain where funding must be allocated to create a standardised consistent digital foundation that ICSs can build. This would include interoperable data systems that integrate with both health and social care IT systems.

Where do we go next?

* Regional and national shared learning platforms must be developed for adult social care, NHS England, and system leaders to promote, ascertain, and develop shared learning, to improve the efficiency and effectiveness of integrated systems. These platforms must not be designed to exclude or diminish non-NHS system partners.

* ICSs should look to consult with representative bodies on strategic decisions for feedback and information to ensure that developed policies and ambitions set by the system reflect underrepresented areas within their ICS.

Bibliography
* Care Quality Commission (2022). The state of health care and adult social care in England 2021/22.
* Department of Health and Social Care (2022). 'Joining up care for people, places and populations. The government's proposals for health and care integration.' Open Government License.
* Dixon-Woods, M. (2011). 'Using framework-based synthesis for conducting reviews of qualitative studies.' BMC Medicine. 9:39.
* Flick, U. (2008). Designing Qualitative Research. London: SAGE Publishing.
* Galdas, P. (2017). 'Revisiting bias in qualitative research: Reflections on its relationship with funding and impact.' International Journal of Qualitative Methods. 16: 1-2.
* Gale, N., Heath, G., Cameron, E., Rashid, S., and Redwood, S. (2013). 'Using the framework method for the analysis of qualitative data in multi-disciplinary health research.' BMC Medical Research Methodology. 13: 117-124.
* Hammarberg, K. and de Lacy, S. (2016). 'Qualitative research methods: when to use them and how to judge them.' Human Reproduction. 31(3): 498-501
* Novick, G. (2008). 'Is there a bias against telephone interviews in qualitative research?' Research in Nursing and Health. 31: 391- 398.
* Ritchie, J. and Spencer, L. (1994). 'Qualitative data analysis for applied policy research'. In: Bryman, A. and Burgess, R. (eds). Analysing qualitative data. London: Routledge.
* Roulston, K. (2010). Reflective Interviewing: A Guide to Theory and Practice. Los Angeles, California: SAGE.
* Weiss, R. (1995). Learning from Strangers: The Art and Method of Qualitative Interview Studies. New York: The Free Press.
* World Health Organization (2016). Framework on integrated, people-centred health services. [Google Scholar].
* Knight, A. and Burdett, T., 2021. Achieving integrated care: the need for digital empowerment. Perspectives in Public Health, 141(1), pp.15-16.

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From Inception to Implementation: A Year of Integrated Care Systems - Care England

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This study seeks to investigate how Integrated Care Systems have developed since July 2022, with a specific focus on how they have managed and overcome

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Getting the fundamentals right: how to better prepare for discharge pressures next winter

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Getting the fundamentals right: how to better prepare for discharge pressures next winter

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The good news is that most ICS areas have made strides over recent years towards putting in place initiatives to better handle winter pressures. These include the development of that bring together system partners to better coordinate services to better support timely discharge, and that allow people to receive hospital-level care in their own home. Social care has also seen some slight positive development in its ability to hire staff, with an additional 60,000 staff recruited internationally into the sector since last year.

(the government's data roadmap for adult social care) has created opportunities to improve streamlining and collecting data that can support discharge planning. ICS leaders have pointed to positive developments in their local area, such as expanding shared care records to include social care providers or developing common dashboards.

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Getting the fundamentals right: how to better prepare for discharge pressures next winter

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Delayed discharges, where a patient is medically fit to leave hospital but is not discharged, were a particular problem in England last winter. In this long read, Camille Oung highlights some possible solutions to help better prepare health and care services for discharge pressures next winter.

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This jargon buster aims to demystify and clarify some of the concepts and terms that are frequently used in health and care policy. We will be updating it on a regular basis to reflect changes in the health and care system and we’d like to hear from you on what needs defining.

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Financial regulation
Financial regulation is the process by which the financial performance of NHS organisations is monitored and managed. In England, the measures that organisations need to meet are set out by NHS England and NHS Improvement. Based on these measures, and other measures including care quality, national regulators can take action or provide targeted support to organisations to improve their financial performance and use of resources.

Joint strategic needs assessment (JSNA)
This is a process by which local authorities and partner organisations assess the current and future health, care and wellbeing needs of the local community to inform local decision-making. JSNAs usually contain information about the health and wellbeing status of the local population, identify inequalities and illustrate trends. They may also outline local community views and highlight suggested areas for focus for collective action to improve the lives of people locally. Health and Wellbeing Boards and clinical commissioning groups are under a statutory duty to produce a JSNA.

Mental Capacity Act 2005 (MCA)
This law applies to everyone involved in the care, treatment and support of people aged 16 and over living in England and Wales who are unable to make some or any decisions for themselves. The primary purpose of the MCA is to promote and safeguard decision-making within a legal framework. It does this by empowering people to make decisions by themselves and protecting those who lack capacity by ensuring decisions are guided by a set of principles, such as ensuring all decisions are in the best interests of the person. It also allows for people to plan for their future when they might lack capacity.

Mental Health Act 1983
This act is the law in England and Wales that covers the assessment, care and treatment of people with a mental disorder and the rights of the person and their family.

Out-of-area placement (OAP)
An OAP occurs when a person is assessed as requiring inpatient care or treatment and is admitted to a unit that is not part of the usual local network of services. Out-of-area placements are a particular issue in the care of people with acute mental health problems, learning disability and autism. OAPs can harm patients and set back recovery, and the government has set a target to eliminate inappropriate use of OAPs by 2020/21.

Reablement
Reablement is one of a range of short-term services for people whose health has deteriorated and/or who need support to relearn skills to keep them safe and independent at home. It is categorised as a type of intermediate care, most commonly delivered by social care staff. These services can be provided to anyone who would benefit but often in practice it is arranged as someone leaves hospital, with the aim of preventing them being readmitted.

Reflective practice
An approach taken by professionals in various fields to learn from their experiences. It means considering your thoughts and actions in a particular situation, understanding what happened and why, and what you might learn to inform your future practice.

Resource departmental expenditure limit (RDEL)
departmental expenditure limit (DEL).

Tri-morbidity
The simultaneous presence of physical ill health, mental ill health and drug or alcohol misuse. The term is used in some health care settings; in the homelessness sector, this combination is more likely to be referred to as 'high and complex needs'.

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Our jargon buster includes common terms used in the health and sector. You can also submit requests for terms to be added in the next revision.

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All is not well: Sickness absence in the NHS in England

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All is not well: Sickness absence in the NHS in England

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Monthly sickness absence rates over the last calendar year never once fell below even the peak in the pre-pandemic year and, on average, the reported rate for NHS staff across 2022 was 29% higher than in 2019 (5.6% v 4.3%).

The reported level of sickness absence - some 27 million days across 2022 - equates, on average, to around 74,500 full-time equivalent staff, including 20,400 nurses and 2,900 doctors. This is likely to be a significant underestimate due to various causes of under-recording of the sickness absence rate.

Over the course of 2022, some 6 million days were recorded for staff being sick due to mental health and wellbeing related reasons. The number of reported days of absences related to anxiety, stress, depression and other psychiatric illnesses increased by 26% between 2019 and 2022.

High sickness absence is bad for NHS staff, bad for providers of health care in terms of costs and disruption to patient care, and expensive for the taxpayer. Sickness absence is also associated with a higher likelihood of staff leaving the NHS.

What are the levels of sickness absence in the NHS?

Over the course of the last calendar year, from January to December 2022, we saw an unprecedented and sustained high average level of sickness absence for the NHS in England. The reported sickness absence rate for NHS staff across 2022 (5.6%) was substantially higher than in the year before the pandemic (4.3% in 2019). In fact, the monthly sickness absence rate across 2022 never once fell below even the peak for 2019 (4.9% in December 2019).

The reported sickness absence rates in 2022 were equivalent to 74,500 additional full-time staff, including 2,900 doctors and 20,400 nurses. In reality, the scale of absences could be substantially greater as not all sickness absence days are thought to be recorded, particularly for some staff groups. The rise in reported sickness absence rates between 2019 and 2022 alone is equivalent to 16,900 full-time staff. Separate data suggest that there were 122,501 staff reported as absent from work through sickness or self-isolation at the peak across health care providers in 2022 (on 6 January during the Omicron wave).

Is this trend consistent across England?

While the directions of the trends are fairly consistent across the English regions, the absolute reported sickness absence levels are substantially higher in some areas (Figure 1). By the end of 2022, the reported sickness absence rate stood at 7.4% in the North West compared to 5.4% in London.

All types of NHS trust - from small to large and from acute to community - have, on average, seen a substantial increase. That said, reported levels across mental health and learning disabilities have been less affected overall. However, there is significant variation at a provider level. Sixteen trusts had their sickness absence rates increase by over half between 2019 and 2022, and three ambulance trusts saw their rates soar to 10% across 2022 (Figure 2).

The absolute level of absences is vast for some providers. For example, in the first week of 2022 - during the Omicron wave - 30 NHS trusts reported having, at some point, more than 1,000 staff absent on a given day from work through sickness or self-isolation (with six of these providers having more than 2,000 absent on at least one day over that week). Fast forward to the last week of 2022, and a sizeable number (11) of trusts were still reporting over 1,000 absences.

What are the reported reasons for sickness absences?

There has been a large rise in absences related to anxiety, stress, depression and other psychiatric illnesses which account for around a quarter (23%) of sick days (Figure 3). In fact, across 2022 there were around 6 million reported sick days for these mental health and wellbeing related reasons. The data available suggest that sickness absence days due to these reasons increased by around a quarter (26%) between 2019 and 2022, substantially outstripping the growth in staff numbers of that period (around 13%).

Across 2022, around one in six (18%) of sickness days were reported as specifically due to Covid-19. However, looking at the detailed reasons for sickness absence (which does not identify Covid-19 separately), it appears that Covid-19 and similar conditions (chest & respiratory; cold, cough or flu; infectious diseases) account for much of the increased levels compared to 2019 (27% in 2022 compared to 10% in 2019).

Have some staff groups been particularly affected?

Comparing sickness absence rates between staff groups can be problematic as, for example, some professions are less likely to actually record absences. In addition, the nature of the roles of different staff groups affects the degree to which staff can work with certain conditions - including the extent to which they are patient-facing or, for example, involve physical tasks - and the ability to work remotely or when self-isolating.

Compared to 2019, most staff groups saw a reported increase in sickness absence of broadly around 1 percentage point in 2022. However, some had no or low increase (managers, central functions, and for some categories of largely locally employed doctors) while other professions, including ambulance staff (2.3 percentage points), support to ambulance staff (3.2) and midwives (1.9), saw larger increases. The rates for foundation doctors (medics in their first two years after graduating) more than doubled, but this was from a comparatively low pre-pandemic level (Figure 4).

The reported reasons for absences vary by staff group. Prior to the pandemic in 2019, midwives for example were more likely to have reported sickness absence for mental health reasons (28% of all absences) than doctors (24%). Moreover, around twice the proportion of reported sickness days for ambulance staff and clinical support staff related to musculoskeletal conditions than for doctors (17% compared to 9%). And in the last three years, some groups have been disproportionately affected by certain reasons for sickness absence. For example, reasons for absence relating to influenza, chest and respiratory problems, and infectious disease (i.e. those that could relate to Covid-19) for ambulance staff alone rose from equivalent to a 0.3% sickness absence rate to 1.9% (for all staff the sickness absence rate for those reasons alone increased from 0.4% to 1.5%).

Is this increase unique to the NHS in England?

Differences between sectors and settings in the way sickness absence rates are defined and recorded makes such comparisons difficult. However, the increase in overall public sector sickness absence between 2019 and 2022 was similar to the NHS in England. That said, the sickness absence rates remain well above the public sector average (3.6% in 2022, albeit measured in a different way to that of the NHS) despite a target from the NHS Long Term Plan to get them down to those levels.

Increased levels of sickness absence in 2022 not only affected the health service in England, with surges too in the NHS in Wales and Scotland (the latter despite the data excluding Covid-19 absences, which in part explains the different apparent trend in that nation). While this analysis focuses on the NHS, the recent spike in sickness absence for teachers is also notable (Figure 5). Prior to the pandemic - between 2015 and 2019 - sickness absence rates had been fairly stable in the NHS in England and for teachers too, while reported rates had fallen on average across the public sector.

These increases coincide with more people leaving the labour market due to long-term sickness. Staff employed in "human health and social work" have - compared to some other sectors - relatively high retention issues due to long-term sickness (7.8 former workers economically inactive because of long-term sickness per 1,000 current staff, 2021/22) which, for example, was above the education sector (4.7 per 1,000) but below wholesale and retail services staff (10.4 per 1,000). Again, such comparisons need to be treated with some caution due to the nature of the roles in different sectors and, for example, the ability to work remotely including when self-isolating.

Discussion

Sickness absence levels tell us about the physical and psychological health and wellbeing of a workforce. And this analysis is not the first, by any means, to highlight health and wellbeing issues for the NHS workforce. The annual staff survey for NHS staff in England showed, for instance, a higher proportion of staff feeling unwell as a result of work-related stress in 2022 (45%) relative to three years prior (41%). Not only this, but over half (57%) of staff reported going into work despite not feeling well enough. While the proportion dipped in 2020 due to Covid-19 self-isolation requirements, this has gone back to levels seen in 2018.

Where staff sickness cannot be adequately covered by temporary staffing, then this could have a direct impact on those receiving care and - as the ability to clear the backlog would be hindered - those yet to receive care. It can also have indirect effects on other staff working in stretched services. Around a sixth (16%) of the total temporary (bank and agency) nurse and midwife use is to cover long-term sickness. While we do not know the exact cost of this, a sixth of the spend on agency nurses in 2020/21 equates to around £130 million.

Health reasons are also increasingly a cause for staff to leave the NHS. The number of NHS staff pointing to health as the reasons for leaving their role has more than tripled in the decade to 2022, including increasing by 52% since 2019. Of nurses, midwives and nursing associates leaving the professional register in 2022, physical and mental health is the second most commonly cited main reason and burnout or exhaustion the third, both behind retirement. Across these professionals leaving, of those that were educated in the UK, nearly one in three (31%) reported physical or mental health as a reason for leaving, with one in seven (14%) suggesting it as the main reason.

Sophisticated recent analysis highlighted a strong association between probability of leaving the NHS acute sector and sickness absences for both physical and (particularly) mental health reasons. For instance, compared to those that have not had absences, an NHS consultant missing three days of work for mental health reasons is 58% more likely to leave three months later. Given high sickness absence levels and poor retention are both causes of and caused by increased pressure of services, the NHS risks being stuck in a vicious cycle.

Sickness absence rates are known to relate to a huge array of factors. In particular, previous work has highlighted its relationship with season, infectious disease outbreaks, job satisfaction and employee engagement, workload over previous years, effort-reward imbalance, socioeconomic status, and gender. The solutions needed to solve the current high levels of sickness absence are, therefore, likely to be manyfold. However, there is an array of UK and international experience on interventions to address, for example, long-term sickness absence and reduce risks of recurrence.

In any case, the concern is that, despite emerging from the peaks of Covid-19, the levels of NHS sickness absence are still stubbornly higher than what was observed before the pandemic. But the NHS has a moral duty to protect the physical and mental health of its staff and, in doing so, can benefit the entire workforce and current and future patients. And, for this reason, understanding and ameliorating sickness absence levels are something that we hope will feature centrally in the highly anticipated NHS long-term workforce plan.

*We have calculated the NHS's sickness absence rate by dividing the total sickness absence days (including non-working days) reported by the sum total days available per month for each member of staff (also including non-working days), while the BBC (for whom we carried out this analysis) have calculated annual sickness absence rates taken as an average of the monthly sickness absence rates in a given year.

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All is not well: Sickness absence in the NHS in England

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Billy Palmer and Lucina Rolewicz draw on published data to explore the trends in, reasons for, and impact of sickness absence in the NHS. The briefing primarily focuses on hospital and community services in England, since this is where most is known, although we do compare to trends in other sectors and health services in the other UK nations, where data permits.

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Improvements to the apprenticeship system - Government changes to make it easier for employers and apprentices to access opportunities. 20 July 2023

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Improvements to the apprenticeship system - Government changes to make it easier for employers and apprentices to access opportunities. 20 July 2023

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The government has announced a set of enhancements to the apprenticeship system. These improvements aim to simplify the process for employers to acquire apprenticeships and for learners, parents, and employers to discover suitable skill opportunities.

Employers need to know about upcoming improvements in the apprenticeship system, which include getting rid of unnecessary burdens when hiring apprentices:

Ensuring that apprenticeships continue to meet employers' needs:

Helping learners and employers find the skills and opportunities that they need:

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Improvements to the apprenticeship system

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Government changes to make it easier for employers and apprentices to access opportunities.

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The practice of collaborative leadership: Across health and care services

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The practice of collaborative leadership: Across health and care services

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Why we did this work

In England, integrated care systems (ICSs) aim to realise collaborative working across health and care services, but this will require staff to employ different behaviours, skills and practices both in and outside their own organisations. Effective working across organisations means adopting new practices to navigate challenges such as conflicting organisational goals, competing institutional norms and rules, and any perceived loss of power or resource.

Learning to collaborate well is possible but few people working in health and care organisations have ever received substantial development in this area. Government policies over the past 50 years have focused on the structures and governance arrangements rather than the behaviours, skills and processes. This report shares the learning and insights from health and care leaders about what nurtures more effective collaborative working. The report combines three data sources:

contemporaneous notes collected while the authors worked with various leadership groups over the past decade

data from interviews with 15 senior leaders working in ICBs, NHS providers and local government

data from a short online survey with 53 health and care leaders.

The report shares insights and evidence about how to collaborate well to build a stronger collaborative ethos across health and care services.

What is collaborative leadership?

Collaborative leadership is grounded in the belief that a shared model of leadership is more creative and effective than a leader or group of staff working alone. Sometimes leaders will adopt a collaborative leadership approach when working with their peers; in other instances, a leader focuses on creating the conditions that mean others can collaborate well.

A true collaboration values difference and prevents any one organisation or group from dominating. This may be difficult to achieve in health care systems that have traditionally valued some organisations or professional groups above others but if done well collaboration will promote staff engagement and accelerate service transformations that will benefit patients, staff and communities.

What we found

Health and care staff are beginning to successfully work collaboratively across organisational and professional boundaries. However, after many years of government policies promoting organisational independence in the NHS, the switch to working together is proving challenging even within the new organising framework of an ICS.

Our research shows health and care leaders at all levels have a critical role in modelling and rewarding collaborative behaviours but this is insufficient on its own, attention also needs to be given to six key leadership practices.

The six leadership practices are:

creating a safe, inclusive and trusting environment in which everyone can contribute fully - leaders need to look at problems from perspectives beyond their own. This means leaders need to be open and trusting, to connect with others and create different spaces in which people feel safe to contribute and be heard; to listen to and value others' contributions and ensure others do the same.

building healthy relationships - this requires sustained effort but adopting a more relational way of working based on humility, respect and trust strengthens connections between organisations and individuals leading to increased staff engagement and more co-ordinated services.

developing a shared purpose and shared group identity. It is important to clearly set out the shared purpose around why organisations or/and professional groups are working together and create a shared group identity to promote engagement across the collaboration and to address any power differentials (see below).

actively managing any power dynamics - so no organisation or professional group dominates. Introducing processes that create a more open and participatory environment can also be useful to enable individuals to think differently.

surfacing and managing any conflict - in collaborations you are working with different views and ideas, sometimes these will turn into conflict. It is important to approach any conflict with an open and curious mind, rather than turning away from it.

developing shared decision-making processes - designing transparent processes that enable all key organisations or groups to contribute to a decision produces a range of benefits, although it takes longer. Benefits include greater ownership over the decisions adopted and strengthening trust across a collaborating group.

Given the pace of change and disruption needed to solve many of the problems facing our health and care system, The King's Fund recommends health and care leaders extend the practise of collaborative leadership more widely with working more closely with local organisations, people and communities.

This more 'civic' style of collaborative leadership will give health and care leaders a key role in mobilising local assets and communities. This approach will place less emphasis on producing plans and give more attention to demonstrating the values and behaviours associated with shared stewardship.

Leadership development programmes

Explore our range of development courses, with each one specifically designed for every step in your professional development.

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The practice of collaborative leadership

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Our report shares insights and evidence about how to collaborate well to build a stronger collaborative ethos across health and care services.

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Building capacity and capability for quality improvement: developing an organisational approach

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Building capacity and capability for quality improvement: developing an organisational approach

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OpenAthens login may be required

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Increasing joy in work in UK healthcare teams: a national quality improvement collaborative

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Increasing joy in work in UK healthcare teams: a national quality improvement collaborative

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OpenAthens login may be required

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Longer hospital stays and fewer admissions - How NHS hospital care changed in England between 2019 and 2022

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Longer hospital stays and fewer admissions - How NHS hospital care changed in England between 2019 and 2022

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Falling hospital admissions in context

Since the start of the COVID-19 pandemic, some long-term trends in hospital care have been reversed (see Box 1). Most notably, between 2019 and 2022, the total number of hospital admissions in England fell - the first sustained reduction in hospital admissions since the early 2000s. This is despite increases in the number of staff working in NHS hospitals over the same period and a substantial backlog of people waiting for routine hospital care - currently standing at 7.3 million people.

Although hospitals are still dealing with many effects of the pandemic, national policymakers are focused on increasing activity and restoring NHS services - including a headline ambition to deliver 30% more elective activity in 2024/25 than before the pandemic, and to reach 76% of A&E patients being seen within 4 hours by March 2024 (from 72.4% in January 2023). The first target to eliminate elective waits longer than 18 months by April 2023 was missed.

If policymakers want more patients to be seen in NHS hospitals, they first need to understand why hospital admissions have fallen since 2019. Yet analysis of these changes and what may be driving them is limited. In this analysis, we explore patterns in hospital admissions between 2019 and 2022, drivers of recent falls in admission numbers and implications for policy. We analyse data from Hospital Episode Statistics (HES), which include information on all NHS-funded hospital admissions in England. We compare 2019 and 2022, using data on patients aged 18 and older. Our analysis focuses on trends in the number of admissions, total bed days and mean length of stay, including variation by NHS region, patient age and area-level deprivation (see Box 2 for more detail on our analytical approach).

Over the two decades before the pandemic, the NHS saw sustained year-on-year increases in hospital admissions, with inpatient admissions per person rising by 33% in England between 1998/99 and 2016/17. Growth in hospital admissions was driven by a mix of factors, including an ageing population with increasingly complex health needs.

At the same time, the total number of NHS hospital beds in England more than halved since the late 1980s, with overnight general and acute beds falling from 136,000 in 2000/01 to 101,000 in 2018/19. The NHS was able to treat more patients while reducing bed numbers partly because of substantial falls in the average length of time each patient stayed in hospital - facilitated by improvements in the delivery of care, changes in policy and a mix of other factors. Length of stay in the UK fell by 22% between 2008 and 2018 - one of the fastest falls among OECD countries. Reducing reliance on hospital care and cutting hospital beds in some parts of the country were explicit national policy objectives, and a range of initiatives were introduced to make best use of hospital capacity, such as the expansion of NHS 111 and new care models.

By the late 2010s, it was clear that constrained hospital capacity was holding back NHS performance. Bed occupancy in hospitals had increased above 90%, exceeding levels considered safe and much higher than many other European health systems ( Germany's bed occupancy, for instance, was 77% in 2019). National waiting time targets for emergency and elective care were routinely being missed, and many patients faced delays being discharged from hospital. In 2019, Simon Stevens, then Chief Executive of NHS England, warned that NHS hospitals were 'overly pressurised' and cautioned against local plans to further reduce hospital bed numbers. Going into the pandemic, the NHS hospitals in England had shorter length of stay than most comparable countries, as well as fewer acute hospital beds per capita and higher bed occupancy.

Box 2: Data, approach and limitations

Data source

We used data from Hospital Episode Statistics (HES), which include information on all hospital admissions to NHS hospitals in England. We included admissions among patients aged 18 years and older at the time of their admission, with a discharge from hospital in 2019 and/or 2022.

Approach

We compared the number of completed hospital admissions in each year for: emergency admissions, elective admissions, as well as day cases, maternity admissions and regular day/night attenders. Emergency admissions account for over 80% of bed days, so we focused the main analysis on these admissions. We report the percentage of zero-day emergency admissions (where the patient was admitted and discharged on the same day) and mean length of stay (for emergency admissions lasting at least 1 day), excluding day cases. We excluded zero-day admissions from our calculation of length of stay because of variability in reporting these across NHS trusts. We calculated total hospital bed days by summing the length of stay for emergency admissions in each group, assuming 0.5 bed days for zero-day admissions.

We described the change in length of stay for emergency admissions between 2019 and 2022, including the absolute and percentage change in number of admissions by length of stay, as well as the absolute change in number of bed days.

We compared changes in admissions and mean length of stay by age, region and area-level deprivation. We did so to identify which groups of patients were most affected by changes in length of stay. Variation between trusts reporting data in 2019 and 2022 was also described; we included only 105 hospital providers with at least 1,000 admissions in both years, and whose number of emergency admissions did not change by more than 50%. Specialist mental health and learning disability hospitals were not included.

Limitations

We were unable to look at the contribution of discharge delays to changes in length of stay, because information on the date at which each patient was considered ready for discharge was inconsistently recorded before April 2023. In addition, we were unable to tell from national hospital data what caused the observed trends in admissions numbers or length of stay, or how. Finally, national- and regional-level results mask important variation in trends at the local level. For these reasons, we encourage local research to better understand drivers and potential solutions to improve hospital capacity and flow.

Trends in admissions and average length of stay

Hospital admissions decreased while length of stay increased between 2019 and 2022

In England, there were 800,000 (12%) fewer emergency and elective hospital admissions, excluding day cases, in 2022 than 2019 (Table 1). This is a major reversal of trends from before the COVID-19 pandemic. The percentage reduction was greater among elective admissions at 21%, than emergency admissions (9%).

Also reversing pre-COVID trends, average length of stay rose from 7.3 days in 2019 to 8.3 days in 2022 overall. This pattern differed between emergency and elective admissions, with only emergency admissions seeing an increase in average length of stay (Table 1, Figure 1). Mean length of stay among admissions with at least 1 night in hospital decreased slightly from 5.2 days in 2019 to 5.1 days in 2022 for elective admissions (3% decrease). Emergency admissions, alternatively, saw an increase from 7.9 to 9.1 days (a 15% increase) in average length of stay. Median length of stay remained stable for both emergency and elective admissions.

Overall, the total number of bed days recorded across all hospital stays decreased from 36.2 million in 2019 to 35.3 million in 2022, a reduction of 2.5%. This aggregate figure masks trends in opposite directions for elective and emergency admissions: bed days used for elective admissions decreased by 21%, while they increased by 1% among emergency admissions, meaning that emergency care took up an increased share of total hospital bed days in 2022. Moreover, the 2.5% decrease may partly be the result of a shift to treatment elsewhere in hospitals, where they are not counted as admissions, eg in Same Day Emergency Care settings, and these no longer being recorded in HES.

Table 1: Number of elective and emergency hospital admissions, mean length of stay and total bed days in 2019 and 2022, patients aged 18 years and older at admission

2019

2022

Change between 2019 and 2022

All admissions* (N)

Mean length of stay** (days)

Total bed days***

All admissions* (N)

Mean length of stay** (days

Total bed days***

All admissions* (N, %)

Mean length of stay** (N, %)

Total bed days (N, %)***

Elective admissions

1,309,000

5.2

5,610,000

1,030,000

5.1

4,460,000

-279,000
(-21.3%)

-0.1
(-2.7%)

-1,150,000 (-20.5%)

Emergency admissions

5,538,000

7.9

30,624,000

5,017,000

9.1

30,882,000

-521,000
(-9.4%)

1.1
(14.8%)

258,000
(0.8%)

Total admissions (elective plus emergency)

6,846,000

7.3

36,233,000

6,047,000

8.3

35,343,000

-799,999
(-11.7%)

1.0
(12.7%)

-890,000
(-2.5%)

*All admissions excluding day cases; **Mean length of stay is reported among admissions lasting at least 1 day, excluding day cases; ***Admissions where patients are admitted and discharged on the same day are counted as 0.5 bed days.

Note: mean length of stay is calculated among hospital admissions lasting at least 1 day.

Numbers of day cases, maternity admissions and regular day/night attenders also decreased between 2019 and 2022, as well as corresponding bed days, indicating that decreased emergency and elective admissions were not offset by an increase in other hospital activity.

Drivers of changes in length of stay and emergency admissions

Among emergency admissions, which account for over 80% of bed days, striking changes in length of stay took place between 2019 and 2022. There were around 562,000 (11%) fewer emergency admissions lasting 14 days or less in 2022 than in 2019 (Figure 2, Figure 3). In contrast, there were an additional 41,000 (8%) admissions lasting more than 14 days took place. The percentage of zero-day admissions - where patients are admitted and discharged on the same day - remained at around one-third of emergency admissions (1.7-1.8 million) in both years.

The increase in length of stay was therefore driven by fewer shorter admissions and, to a lesser extent, by more longer admissions. This is also evidenced by changes in the total number of bed days: in 2022, admissions with stays up to 14 days accounted for fewer bed days overall than in 2019. But there were almost as many additional bed days for admissions with stays longer than 14 days, suggesting that fewer bed days for shorter admissions compensated for more bed days used for longer admissions. Patients with emergency admissions lasting longer than 14 days required an extra 1.5 million bed days compared with 2019 - bed days that were therefore not available for other admissions, including those with more minor needs or undergoing planned hospital care. 1.2 million fewer bed days were used for admissions lasting up to 14 days in 2022 compared with 2019.

Although the available data do not establish causality, it is likely that increasing length of stay in turn contributed to the decrease in the number of admissions. Emergency patients staying longer in hospital likely added more pressure in hospitals, which already had high levels of bed occupancy. Without enough beds and unable to increase capacity by adding more beds, hospitals were forced to change admissions thresholds - ie not admitting some patients for shorter admissions who would have been admitted in 2019. High bed occupancy has previously been shown to reduce the likelihood of hospital admission.

Changes in length of stay for emergency admissions differed across age groups, regions and deprivation

Age

The number of emergency admissions decreased in all age groups (Figure 4). In contrast, average length of stay increased across age groups - and most substantially for older people. For patients aged 85 years and older, it increased from 10.8 to 12.5 days on average, compared with an increase from 4.7 to 5.1 days among patients aged 16-44 years. 18-44-year-olds occupied 11% fewer total beds than in 2019, while older age groups occupied more total beds This may indicate factors particularly relevant to older patients are contributing to longer hospital stays, such as higher health care needs (eg from COVID-19 or delayed care during the pandemic), and challenges discharging patients with further need for support.

Region

Similarly, the number of emergency admissions decreased while the mean length of stay increased in all regions of England (Figure 5). However, there was considerable variation and some regions experienced much greater increases in length of stay than others. The South West saw a 26% increase in length of stay, from 7.6 to 9.5 days on average, while the smallest increases were observed in the Midlands (from 7.9 to 8.5 days). The change in total hospital bed days over time also varied across regions: the greatest increase between 2019 and 2022 was in the South West (8%) and East of England (5%), while most other regions saw total bed days hold steady or fall. The extent of the increase in the South West is surprising, because this region already had higher bed occupancy levels than most other regions in 2019-20. Data quality issues could play a role in these differences, but regional variations may also reflect differences in local needs, previous service capacity and service configurations.

Deprivation level

Patients living in more deprived areas experienced a greater fall in admissions than those in wealthier areas (Figure 6). However, changes in mean length of stay were similar across deprivation levels, with an increase of around 14% across all deciles (although mean length of stay remained lower in 2022 among the most deprived deciles). Overall, total bed days decreased by up to 3% among patients living in the three most deprived deciles, but increased by up to 3% among less deprived deciles.

These patterns by deprivation are not explained by people of different ages living in areas with different deprivation levels: we see the same trend of more pronounced decreases in emergency admissions and bed days within each age group. In addition, greater reductions in emergency care among people living in more deprived areas were not offset by smaller reductions in elective care. Although the patterns by deprivation are less clear than for emergency admissions, the largest reductions in number of elective admissions and elective bed days occurred in the most deprived decile.

NHS trusts

Variation in length of stay between trusts widened over time, with mean length of stay ranging from 6-50 days in 2019 compared with 6-48 days in 2022. Figure 7 shows 85 of 105 NHS trusts (81%) reported an increase in mean length of stay (by >0.5 days between the 2 years), while it decreased (<-0.5 days) or remained stable in 19% of trusts.

Note: hospital trusts are pseudonymised in HES, so we were unable to include provider names.

What might explain these trends?

Further reading

The data analytics team delve into the range of factors that can cause delays in discharging...

The data analytics team examine the role of independent sector providers in delivering elective...

Longer hospital stays and fewer admissions

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Longer hospital stays and fewer admissions

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In this analysis, we explore patterns in hospital admissions between 2019 and 2022, drivers of recent falls in admission numbers and implications for policy.

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NHS equality, diversity and inclusion (EDI) improvement plan

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NHS equality, diversity and inclusion (EDI) improvement plan

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NHS equality, diversity and inclusion (EDI) improvement plan

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This improvement plan sets out targeted actions to address the prejudice and discrimination - direct and indirect - that exists through behaviour, policies, practices and cultures against certain groups and individuals across the NHS workforce.

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NHS Leadership Academy - Inspiration Library

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NHS Leadership Academy - Inspiration Library

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Short snippets of learning ranging from videos, podcasts, blogs, links to Ted Talks and much more…

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In the first of three YouTube videos on psychological safety featuring Leadership expert Amy Edmondson, she explains how humility, transparency and urgency are the keys to successfully steering an organisation - big or small - through the challenges that come your way and breaks this down into a 4 step model.

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The structure of the NHS in England - 10 July 2023

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The structure of the NHS in England - 10 July 2023

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This briefing provides an overview of funding and accountability arrangements within the NHS in England. It also highlights issues including patient safety, NHS funding and performance.

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Improving patient safety culture – a practical guide

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Improving patient safety culture – a practical guide

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Improving patient safety culture - a practical guide

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This guide brings together existing approaches to shifting safety culture as a resource to support teams to understand their safety culture and how to approach improving it.

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CIPD - Preparing your organisation for AI use

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CIPD - Preparing your organisation for AI use

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Guidance on how to prepare a user policy on generative AI for your workplace and how this technology can be used to support HR functions

This guide focuses on the use of generative artificial intelligence tools - the personal, publicly available AI technology like ChatGPT, Google Bard and similar which have become increasingly popular and widely used. HR needs to lean into the technology, ensure responsible and ethical use of AI, and support their people in adopting and using these tools.

This guide covers two critical elements:

how HR can create a policy or approach for the use of AI in their organisation

how HR can embrace AI tools in its work and apply them throughout the employee lifecycle.

Generative AI

While AI is already established and present in some HR information systems, spreadsheet software, learning platforms, as well as in search engines and social media apps, the recent shift puts hugely powerful, transformative tools directly into the hands of the end user. This is distinct from AI within those enterprise-level tools that are usually deployed as major projects in an organisation, with testing, risk and security assessments, robust governance and controlled access. By contrast, personal AI tools are unsupervised and unguided, with broad and largely unrestricted access.

Sensational headlines have warned about the potential for cheating, destruction of jobs and even human extinction. This means that people experimenting with generative AI often do so in secret for fear of getting into trouble, or else are avoiding it altogether.

This is a fast moving area. At the time of writing, other new apps like Microsoft Copilot are preparing to launch, and that is likely to bring the power of generative AI to internal data. Some examples we discuss below explore how use could be extended as these new apps become available.

Shaping an AI-use policy

The rapid emergence of generative AI requires 'road rules' or a use policy to be made clear for employees in any organisation.

Many of the risks of AI may already be covered by existing HR policies. But a specific AI policy will provide needed clarity and help avoid wrong assumptions. Such new policy or approach should also reflect the landscape and culture of your organisation. There are three core stages:

1. Determining your position and philosophy

2. Using this to outline your policy

3. Communicating and implementing the policy.

Consider your organisational culture. If you have values or behaviours that encourage initiative, curiosity and experimentation, then your AI policy should reflect these. If the environment is more tightly controlled or regulated, then your policy may need to reflect that.

Determine why you want an AI policy. Consider the areas of risk management for the organisation, particularly regarding data security (eg ensuring the organisation's data is not inadvertently placed into the public sphere), accuracy and quality assurance (eg ensuring employees don't solely rely on outputs from AI tools, but validate the generated information), control (agreeing what is and isn't reasonable use), and fairness (eg ensuring that use of tools guards against bias).

Articulate the benefits that you want to achieve. Is the aim to increase productivity, improve quality, reduce time spent on activities, or possibly to accelerate learning? Articulating desired benefits guides usage and reduces fear about elimination of jobs.

Understand current use in your organisation. This may be difficult if there is low trust at present. People who are already using AI may worry they will get into trouble. But it is important to get at least some sense of where, when and how people are using the tools.

Consider where AI may be deployed in different roles. Some of this will be driven by the approach of senior leaders but will also be influenced by the nature of role. AI tools can support research, planning documents, writing business papers and policies, assessing data for errors, writing code and beyond.

Maintain compliance with obligations and requirements. These can include aspects such as data security and GDPR obligations, local legislation, or requirements from industry regulators. It is also critical to identify how the organisation will guard against algorithm bias. Determine whether there are new legal requirements driven by AI, or whether your existing policies already cover them sufficiently or should be revised. The new policy may need to articulate the connection to the ones already in place, reminding employees of their existing responsibilities.
In the round, these elements of the organisational culture, structure, current usage, along with matters such as legislative requirements will guide the development of your policy.

Explain the need for policy. This is a combination of enabling people and providing guidelines. With such a wide range of potential uses, helping people make good decisions is critical.

Open the policy with a statement of how you expect people to behave. This should be grounded in your culture, values, or behavioural expectations. If you seek to be empowering, then emphasise the need for judgement and accountability with AI use. Highlight that AI is a tool - a very sophisticated tool, but a tool nonetheless. Individuals remain responsible for their own work and for the outputs they deliver. For example:

"All employees are expected to apply our core values when accessing, interpreting, and acting on AI-generated outputs. We are all responsible for our own work and ensuring that the use of AI aligns with our mission, values, and behavioural expectations."

Be clear that AI is a tool, not a replacement for human decision-making. For example:

"AI should only be used as a tool to aid judgement, not replace it. All employees are expected to use their expertise, judgement and empathy when using AI tools. We all have a duty to guard against inherent biases when using AI."

Emphasise transparency. It's vital to be clear where AI is being used and where it has or needs to stop. For example:

"We expect all employees to be transparent about their use of AI. Explaining where AI has been used, where it has been tested and with what data inputs, how outputs are validated. This enables us to make the best possible decisions, and to continue to build our expertise and confidence in the use of AI tools."

Fairness and bias. Recognise machine limitations and imperfections. AI is trained on information it is given, and users should be warned of the risk of bias being fed in and propagated, and should be taking measures to mitigate that risk. For example:

"We are committed as an organisation to mitigate the risk of bias in datasets or AI algorithms. Employees are expected to review and evaluate their models regularly to minimise risk of discrimination."

Data protection. Outline connection with relevant data protection requirements, and ensure users do not share confidential information or hand over ownership of data in breach of those obligations or safeguards inadvertently. For example:

"Refer to our existing policies in relation to data use and protection. These policies remain in place when using personal AI tools. Employees must treat all data with the same level of security and care and should not place confidential organisational data into open-source tools. In addition, employees must ensure they do not pass ownership of proprietary data to organisations that own the AI tools. Take all due precaution when agreeing to external terms and conditions to avoid inadvertently transferring ownership."

Management. People managers are accountable for the performance and conduct of their team members, and this remains. For example:

"Our managers are critical to the responsible use of AI tools in the organisation. We expect managers to encourage and discuss with their teams on how to improve their productivity and performance through use. Managers should continue to give coaching and guidance as appropriate."

Improper use. Be clear on how improper use will be dealt with. For example:

"Where an employee's action contravenes this policy, this will be managed through our existing performance and conduct policies".

Ongoing iteration. Acknowledge that AI will continue to evolve. Encourage employees to stay up to date, but be clear on responsibility. Your organisation may want to create a space such as an intranet page or social channel where the organisation and employees can share information, good practice, updates and so on. For example:

"The use of AI is evolving rapidly, and this policy will be reviewed and refreshed regularly. All employees are encouraged to maintain their skills and capabilities in relation to the use of AI by staying up to date on advancements, sharing good practice, experimenting responsibly, and participating in learning exercises."

Security, monitoring and audit. Explain the organisational responsibility to maintain its reputation and retain customer confidence, as well as how this will be done. For example:

"The organisation is committed to operating safely and securely. We will measure use, sample activity and audit use of AI, in line with existing data security practices."

Raising concerns. Be clear on how employees can raise concerns with AI use. This is likely to link to existing policies. For example:

"Where employees become concerned that AI is being used improperly, is driving inequity or bad judgement, or is being used with ill-intent, they should speak up. Employees can raise concerns in the same way as for other issues - directly with the relevant line manager, through grievance or whistleblowing procedures."

Conclusion. Reinforce your overall approach and philosophy. For example:

"This policy sets out the expectations for our employees in the use of AI. These guidelines and principles will ensure that we use AI to work more effectively and productively. They also ensure that we maintain high quality judgement, creating a culture where we use AI tools to support high quality professional expertise."

Consider methods for communicating the policy. Introducing an AI use policy is likely to be sensitive. Employees who are already using AI tools may feel restrained. Others who are suspicious of the tools may feel alarmed. Managers and senior leaders may feel a loss of control.

As such, the policy should go through wide consultation before introduction - share your intention, seek to reassure, and ideally conduct focus groups or surveys to gather input. This will bring in insight as well as an exercise of employee voice, but also prepare the organisation for introduction.

Consider a method that fits with your culture, for example, if it is a reasonably straightforward culture, then you may simply release the policy with a news announcement. If your culture invites experimentation, then you may want to create challenges (eg encouraging all employees to experiment and share their feedback). Videos, newsletters, messages from senior leaders (possibly generated using AI) can all help to encourage use.

Look at opportunities for training, trialling and guiding good use.

The broad access to generative AI tools means this can be a free-for-all. Employees will not necessarily understand the ethical risks associated with the adoption of tools. Training should made available to cover:

1. Basic guidance relating to the use of generative AI - getting started, how to ask good prompt questions, things to look out for

2. Ethical guidance (likely to be mandatory) that helps employees understand ethical requirements, the need for compliance with policies, responsible usage

3. How to contribute feedback for development of practice

4. How to speak up when they see things aren't going well (see 'Raising concerns' above).

Monitoring and measurement. The risks of AI use must be managed, but should be balanced with employee privacy. This is likely to require working with wider teams in the business (eg risk and audit functions) to build considerations of ethics and bias safeguards into their review processes. This is to ensure that policies and practices remain fair and don't discriminate against any set of stakeholders.

As AI use is potentially more difficult to review or audit, organisations may decide that employees report on AI use as part of their performance management or other practices, or be available for interview/sampling to support auditing.

In some cases it may be useful to create controls and permissions for AI tools. However, for end-user tools, this may have limited impact as employees could access tools via personal devices.

Maintenance of policy. Set out a framework for review. In many cases, employment policies are reviewed on a three-year cycle or similar. AI will continue to evolve rapidly, with the need to review policy and philosophy more frequently. An annual review cycle may be more suitable initially.

Using AI to support HR functions

AI tools can be used to support almost every aspect of HR practice. In some cases (eg reward, case management) data may be too sensitive for the use of open-source tools. In other HR functions, there is ample opportunity for use.

There's also a major philosophical consideration for HR - how do we ensure we access the productivity benefits of AI? For many workers, AI can deliver hours of work in seconds. It can eliminate the need for certain activities, amplify other work, and create new roles.

HR functions should consider the use of AI in three broad areas:

how it can reshape HR or people strategy

how it creates a new paradigm for HR teams

how it can impact every stage of the employee lifecycle.

AI presents the greatest opportunity to raise productivity for employees who use technology. This creates a raft of considerations for people strategy outcomes.

AI use becomes a new factor to consider alongside other fast-emerging people trends such as positive psychology and psychological safety, risk of burnout, EDI, future skills, good work, four-day week, hybrid working, and others.

HR strategy needs to consider the impact of AI on all of these elements. It also needs to consider who benefits from productivity gains - does it mean organisations do even more work, or could it create the opportunity for much more flexibility in work, for example, a four-day week.

HR teams often identify developments by benchmarking against other organisations or competitors. AI challenges this model - there are no benchmarks for the use of personal AI. There are no templates for how to adopt use into an HR function. HR teams need to find new ways to develop strategy and working practice.

Create space to try it out. Depending on their workloads and level of comfort with technology, some HR professionals may intentionally avoid using AI. But there's no substitute for trying it.

Find opportunities for your team to have time and space to experiment. For instance, conduct an offsite and give them a set of challenges to use personal AI tools to, say shape policies, coach individuals, design training programmes, plan an organisational change. Getting teams to try it in a safe environment creates valuable experience in a short period of time.

Make it part of your HR plan. Ask every part of the HR function to shape a plan on how they would use generative AI in their teams. If they are stuck, encourage them to use an AI tool as a start. Set the tone that teams can uncover more productivity by using the tools.

Get systematic. At present, much AI use is opportunistic. It's driven by curious individuals applying tools themselves. That might mean it isn't being used to the greatest effect. One option would be to create a team in HR to shape the plan for testing out AI in HR. That plan should have:

a framework (eg HR structure or employee lifecycle)

an approach (eg what experiments to use)

a means of overcoming barriers (eg upskilling)

a means of prioritising areas (eg which team first), and

the opportunity to work with teams.

Understand the gains. Across each part of HR, assess the work that can be accelerated.

Agree the next steps. As you identify productivity gains, think through the consequences and the opportunities.

You may take a view that in the short term, people can experiment, learn and secure productivity benefits within teams.

For the medium term there are some material decisions that you'll need to consider as HR leaders, for example:

Productivity creates capacity. What do we do with that capacity? More of the same, or something different? Does it create opportunity for more development, different work-life arrangements?

Are productivity benefits felt evenly across the team? Is there a need for organisational redesign in HR?

What is the impact on management and decision-makers - is there a risk of creating decision-making bottlenecks?

Impact on stakeholders - what is the capacity of the business to absorb more from HR?

The CIPD guide to responsible investment in technology can help explore some of these people impact considerations.

Use the approach outlined above to explore opportunities for applying AI against the employee lifecycle and to prioritise actions.
Attraction
Each element of attraction could be enhanced with generative AI, including:

Finding routes to candidates, such as identifying the most effective job boards for specific roles, or the events and approaches that can broaden attraction.

Where social media is used to promote employer brand, generative AI can help shape a content strategy and individual post content.

Transforming detailed role profiles into candidate-centric job adverts. They can improve inclusive language, brand consistency and clarity.

Selection
Generative AI tools can help candidates be much better prepared for job search - it can help research companies, prepare presentations and prepare answers to questions.

This means that old selection practices may need re-examining and updating, including:

Consider the questions you ask, and how you score them. There may be a need to weight specificity in answers over generalisations. AI can help people to answer thematic questions, but less so about specific experiences.

Consider the use of psychometrics. These provide an additional lens on candidates, giving an opportunity to assess candidates' attitudes and mentality, and there're no right or wrong answers.

Make ability to use AI a selection criteria - this is effectively a demonstration of curiosity and initiative. To test for this, ask candidates to prepare a case study, and specifically ask them to use AI to help them. This gives the opportunity to ask questions about the subject, but also to ask how the candidate used AI, where they added to it, and how they applied judgement.

AI tools can provide a useful service in sifting and ranking candidates based on their written applications. However, there are some material risks that you should consider:

If you are using an open-source tool, how do you protect candidate data?

How do you minimise risk of discrimination (eg make sure you are clear on the selection criteria being applied, and how the AI has been trained)?

How are you tracking and correcting any potential discrimination from the AI tools?

These risks are mitigated by HR professionals investing the time to properly set up AI tools - being clear on criteria, providing quality context, testing with sample data and refining. Treat AI outputs as draft recommendations - always bring human expertise and judgement to bear in making decisions. AI use prepared in this way can guard against human bias, and maintain consistency in assessing applications (AI does not get bored or tired). It is critical that the professionals own the outcomes, and actively test to mitigate bias.
Induction
Induction processes can be difficult to shape and maintain. AI can support with planning induction programmes, stakeholder meetings, sharing relevant information, phasing training and reading for new starters.

AI-powered search engines and chatbots could change this process, creating a much more interactive way of getting to know the company, or scouring organisational resources to accelerate learning.
Onboarding
Generative AI tools could be used to create more personalised onboarding plans based on the role, the new hire's experience, and interview outputs.

Proprietary AI tools such as Microsoft Copilot can be used to provide 24/7 support to new hires to answer common questions (removing reliance on the old HR FAQ documents). They could help shape personalised learning plans for the new hire based on assessment of interview notes, experience, and the nature of the role. They can provide support for hiring managers in clarifying important tasks, and significantly reduce the time spent searching HR materials or speaking to HR teams.
Compliance training
Compliance learning can be difficult to design and to maintain, as organisational policy or external regulation develops. For policy owners, AI tools could accelerate this activity through review of current copy and identifying legislation changes.

AI can test to ensure that learning modules prioritise the key learning points for users, and can be used to write tests that reflect the most critical learning points.

Existing approaches risk becoming less effective as employees click-through videos and slides then use AI or simply search engines to answer tests.

There is an opportunity to rethink the approach to compliance learning overall. For instance, AI tools could be used for open-text questions, replacing the usual multiple-choice tests. There is a greater degree of rigour in assessment and more self-driven learning.

A further step would be to shift from the current learning modules to employees sourcing information for themselves, using AI tools. This could be developed into coaching style conversations with chatbots to explore the area of learning.
Organisational policies
It is possible to use an AI tool to draft a policy on a specific subject incorporating previous policy, updated expectations, applying a house style or similar. This can accelerate the development of policies, and create consistency in style of policy. However, it remains important for the professionals to review and own the content.

Where internal tools are available, an AI-powered chatbot can point employees to relevant sections of policy as and when required. An alternative approach is to use AI to produce user guides, or process walkthroughs. This is particularly helpful if policies are reflecting complex legislation. In areas of high risk or ambiguity, it would be advisable to have employees check with the HR team.
Reward
Reward practice can benefit from AI tools, but is an area where data security must be considered. It is worth teams exploring where data can be secured (eg by ensuring employees cannot be identified) or identifying tools that can be used in-house to manage company data.

One simple action to manage security is to use extracts of data, with unique identifiers in place to replace identifiers such as name or employment number.

With measures in place, there are opportunities to use AI for activity such as:

Analysing data including performance metrics, productivity, skills and activity, to provide more thorough benchmarking for reward decisions.

Analysing internal and external reward information to ensure fairness and alignment. This has the potential to identify discrepancies and trends over time which in turn can help address pay inequity.

There is potential for employees to use generative AI to really personalise their use of rewards and benefits, for example 'discussing' their personal position and the outline of company benefits with AI. This could be done with personal tools, but could become more targeted if enterprise tools were adopted.

Reward teams can potentially identify how benefit packages are used, what is the relative value of different elements, and produce targeted communications to help colleagues make informed choices.

There's also the potential to use AI to improve the speed and quality of pay benchmarking submissions.

Ultimately, there may be enterprise-level, data-compliant AI tools that are better suited to help in this area, but personal tools can also be of good use.
Wellbeing
As wellbeing offerings are extended by the organisation, generative AI can help navigate the offering. For example, AI can help wellbeing professionals to access information, accelerate learning, and build strategy.

For employees, AI tools could help navigate resources to find what is most suitable. There is also great potential for coaching - employees and managers can use generative AI to help frame conversations, gather information, identify good practice and get to more personalised solutions faster.
Learning and development
AI can accelerate the development and design of learning programmes, creating outlines, detailed content, exercises and notes for facilitators. Company behaviours or priorities can be updated, allowing developers to ensure programmes remain current.

There's an opportunity to encourage learners to use AI as part of their pre-reading, or as follow-up exercises. This gives the opportunity to build confidence in AI use as well as the subject of the course.

Finally, it is common for organisations to have catalogues of learning resources. AI could be used to:

Help employees find and summarise content from the library (less time searching, more time learning)

Remove the need for some of these catalogues altogether. AI tools can be used to find and identify openly available material, summarise it and give core information. There is a risk regarding the accuracy and variety of source content, and qualifying parameters should be established. Shaping guidance on using AI for learning prompt good questions of how to connect it to role needs and what are important roles for development teams.

Management
One way AI can support managers is to help them identify and manage the demands on their time. But as generative AI is embedded into software packages (eg Microsoft Copilot), it may be more about using enterprise-level rather than personal AI to schedule 1-1s, team meetings, capturing action points and so on.

Another use is to help managers understand what policies apply in specific situations, and how to apply them. AI tools can help managers to boil policies down into a short list of tasks they need to complete, give them guidance on how to approach conversations with colleagues. This significantly simplifies HR advice, allowing HR professionals to provide more in-depth support for complex situations.

More importantly, management skills change with AI. As employees use AI more, managers need to have quality coaching skills, the ability to assess and understand the use of AI. As team members shape pieces of work, managers will need to prepare questions such as:

"How did you use AI to help with this piece of work?"

"How did you validate the inputs?"

"What other sources did you use?"

"How did you bring organisational context to your work?"

"Where did you add your judgement?"

"How did you ensure data security?"

There is also a wider consideration. In recent years demands on managers have increased, as issues like worker wellbeing, inclusive culture and managing hybrid teams or flexible working all compete for attention. AI use adds another layer as it requires managers to be able to coach others around AI use. HR teams should consider managers' capabilities and the impact on their capacity. This may require some role and/or organisational design changes.
Performance management
AI tools can support each step of the performance management journey, reducing the administrative burden to create more focus on quality management.

Tools can help craft objectives (using historic ones), organisational priorities or strategies, assess existing workload and external data. Cascading objectives can similarly be accelerated. All this activity can increase organisational alignment and improve collective performance.

Development plans can be developed in a similar way - individuals can receive guidance from AI tools on how to identify development priorities, how to work towards them, along with specific suggestions. Increasing the quality of development plans and the speed of generation allows more time for thought.

Enterprise-level AI tools magnify the potential to assess what people have done. AI and workplace analytics embedded into applications like Microsoft VIVA can identify where people have spent their time, who they've spent time with, what they've prioritised and what they've neglected. It can allow for much more evidence-based performance discussions.

A key element of performance management is ongoing feedback. Many people will spend hours crafting feedback to ensure their meaning is clear, or to avoid offence. AI can help in crafting and editing messages and adopting the right tone of voice.
Career progression
AI tools can help employees identify their own career paths and opportunities based on their experience and preferences. If an employee has a known goal (eg chief people officer), information on their starting point (eg reward analyst job description and their CV), and potential steps to get there (eg competency frameworks, HR team structure, CIPD Profession Map), then AI can trawl all these sources to recommend a route.

Frequently all these information points will exist within organisations, but bringing them together manually would be time-consuming.
Talent assessment and profiles
Talent processes can be sensitive, and there are risks relating to bias in the dataset due to historic data (eg senior leaders are potentially more likely to be male, white, straight, university educated).

Nevertheless, AI can be used to help collate, analyse and plan talent outcomes. It can be used to generate standard talent profiles based on data such as CVs and LinkedIn profiles and use that data to identify cross-functional succession candidates, suitable people for key projects and longlists for internal vacancies.

As already mentioned, the requirement for human judgement and validation is critical here to avoid bias in the system.
Guidance
AI tools can make this significantly simpler. Applying a generative AI tool to internal policies would allow managers and employees to ask for information, for guidance on how to handle a situation, for the right forms to complete, to check for deadlines and so on. It can shift to a true self-service model, based on questions that managers and employees really do ask, rather that HR teams having to develop sets of FAQs. This is likely to be significantly easier and more tailored as enterprise-level tools incorporating generative AI become more widely available.

This then lifts HR teams into a more value-adding role, with more focus on advice, quality assurance and intervention in complex situations.

An important opportunity for HR

There is a huge shift for HR professionals in terms of skills and mindset. There will be concern from employees that they will lose their role if AI can do it in a fraction of the time. Similarly, there will be concern about changes in ways of working or skillsets for some members of the HR team themselves.

There may be the need for a skills audit, assessment of career goals, or cultural piece of work to encourage HR colleagues to seize the opportunity.

There is a tension for HR teams. A great deal of HR practice is confidential and sensitive. Some HR activity is likely to need internal (enterprise-level) AI tools to be deployed to ensure data security. However, even in areas that deal with sensitive data, there may be ways to anonymise data to allow use of open access, personal AI tools.

At the same time, there is a lot of HR work that is not proprietary or sensitive. In these spaces, using open access AI becomes entirely reasonable, meaning there are no real barriers to use today.

HR teams should consider the case for adopting generative AI technology 'officially' through enterprise-level tools, whether that is replacement of existing applications, saving managerial time, or improving access to information for managers and employees.

People in your organisation, those working with you, and those applying to your organisation will be using AI tools. It is changing the way we work, so HR teams need to get and stay ahead of it. Equally, it is critical to remember that AI is a tool and only part of any solution. AI may get you two-thirds of the way there, but the final and crucial third is human judgement, expertise and application.

Sometimes HR can be cast in the role of the police or controller. For instance, writing and enforcing social media policies might have been a relatable experience for many a practitioner. Or maybe more recently this would have been for use of Teams or Zoom. The sheer variety of AI use makes a hard, rules-bound approach almost impossible. Instead, we should lean into the possibility, use high-quality management and human judgement, guided by core values, to lead the way on application in this brave new world.

This guide was written on behalf of the CIPD by Francis Lake, founder of Green Juniper, a people advisory consultancy.

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CIPD | Preparing your organisation for AI use

# data[].attributes.attachment_link.description
Guidance on how to prepare a user policy on generative AI for your workplace and how this technology can be used to support HR functions This guide focuses on the use of generative artificial intelligence tools - the personal, publicly available AI technology like ChatGPT, Google Bard and similar which have become increasingly popular and widely used.

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Broken trust: making patient safety more than just a promise

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Broken trust: making patient safety more than just a promise

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There have been significant developments in patient safety over the last decade. But there is a concerning disconnect between increasing activity and progress made to embed a just and learning culture across the NHS.

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The ONS' Health Index provides a systematic, independent view of health in England. It enables users to compare health over time and across geographies.

It provides a picture of health in its broadest sense recognising the importance of health outcomes, risk factors and the social, economic and environmental drivers to support health to improve now and for the longer term.

The Health Index provides a framework to understand health pre-pandemic, including whether health issues were persistent, improving or deteriorating and to explore how the pandemic impacted on health in 2020 and 2021.

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Health Index for England: 2015 to 2021 - Office for National Statistics

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The ONS' Health Index provides a systematic, independent view of health in England. It enables users to compare health over time and across geographies. It provides a picture of health in its broadest sense recognising the importance of health outcomes, risk factors and the social, economic and environmental drivers to support health to improve now and for the longer term.

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Health in England: 2015 to 2021 - Insights into England’s health during the coronavirus (COVID-19) pandemic at national, regional and local authority level, using the Health Index.

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Health in England: 2015 to 2021 - Insights into England’s health during the coronavirus (COVID-19) pandemic at national, regional and local authority level, using the Health Index.

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A score of 100 in the Health Index and its components represents health in England in 2015. A higher number always means better health and a lower number means worse health.

The Health Index for England was improved in 2021 compared with 2020, though it remained below 2019 levels.

The Health Index has three domains, covering different areas of health: Healthy People improved considerably in 2021 (by 2.1 points), but remained well below scores seen before the coronavirus (COVID-19) pandemic.

The change in the Healthy People score in 2021 came from improvements to personal well-being, mortality and physical health conditions (up 7.7, 1.6 and 1.2 points respectively), which were partly offset by worsening difficulties in daily life and mental health (down 2.5 and 0.8 respectively).

Healthy Lives declined in 2021 (down 1.2 points), having also declined a similar amount in 2020; it had improved between 2015 and 2019, but these latest declines almost return scores to 2015 levels.

The decline in Healthy Lives in 2021 was mostly because of a decline in protective measures, coming from a reduction in cancer screening attendance, which saw the largest decline in score of any indicator (down 7.7 points).

Within the Healthy Places domain, the living conditions subdomain increased (up 1.3 points); the main contribution to this was improved household overcrowding and air pollution.

Statistician's comment

"Today's release provides more insight on how the pandemic affected so many aspects of our health. In 2021, the Healthy People score improved on 2020, caused by improvements in personal well-being, mortality rates and physical health. This could partly reflect the easing of lockdown restrictions and the vaccine rollout.

"The Healthy Lives score, representing the behaviours and circumstances which affect our health, declined further in 2021. Meanwhile, the Healthy Places category saw continued improvement, largely due to a reduction in air pollution and household overcrowding.

"We will continue to gather and analyse the data to better understand health trends in 2021 and beyond. In the meantime, we encourage everyone to try our Health Index online tool to explore how health has changed in their area."

Greg Ceely, Principal Statistician, Health Index and Projections, Office for National Statistics

Estimates are experimental and still under development. For 21 of 56 indicators, change may have been expected in 2021 but could not be measured because of unavailable or inconsistent underlying data. This most affects the Healthy Places domain and the overall Health Index value. Scores represent our best current assessment; data that become available will be added to future releases.

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2. Health in England in 2021

Figure 1: Health in England in 2021

Figure 1 shows health in England in 2021, measured by Health Index scores. It shows results during the coronavirus (COVID-19) pandemic, which had substantial impacts on many aspects of health. Increased cost of living and other events may have also influenced scores.

All scores are relative to the 2015 baseline of 100. To allow comparison across all parts of the Health Index, scores have been calculated so that a higher score on any aspect is better for health. Figure 1 shows the overall Health Index scores, as well as scores for three areas of health (or domains) within it:

It also shows the subdomains within those, and the indicators in each subdomain.

Health in England overall improved slightly in 2021 (0.7 point improvement on 2020). This represents changes in only the indicators that could be updated.

The impact on different aspects of health within the Index was varied. We cover this in more detail in Sections 3 to 6. Please see Section 9 for information on understanding the Health Index.

View our  Health Index contents and definitions methodology  for more detail on the areas of health included in the index.

Our  Health Index methods and development article  provides information on how the Health Index is made.

An interactive map in Section 7 shows local authority area Health Index results. Our separate How health has changed in your local area article highlights some of the main findings in each area. Results for integrated care systems are provided in our  Health Index datasets.
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3. Different aspects of health in England

Figure 2: The Health Index has three domains, covering different areas of health; Healthy People improved, Healthy Lives declined, and Healthy Places improved

Notes:

1. The Health Index has 56 indicators, summarised into 14 subdomains, 3 domains and the overall Health Index score. Results presented here are for the overall score and the three domains.

2. A score of 100 means health is equal to England's health in 2015. A score higher than 100 means health is better; a score lower than 100 means health is worse.

3. There may be small inconsistencies when comparing changes in scores on this chart with changes presented elsewhere in the bulletin because of rounding.

4. The change in the Healthy Places score is based on updates to only 6 of 17 indicators within the domain.

Healthy People improved considerably in 2021, up 2.1 points. There was a large decline in 2020 (4.1 points), meaning 2021 remained well below levels from before the coronavirus (COVID-19) pandemic.

Healthy Lives declined by 1.2 points in 2021, following a similar decline in 2020. It had improved between 2015 and 2019 to a peak of 102.5. The recent declines mean the 2021 score is back to around 2015 levels (100.2).

Healthy Places contains a lot of indicators that could not be updated in 2021, which means the change in score is based on 6 indicators of 17. This shows an improvement in 2021 (up 0.8 points). We do not know if this would be the case if all indicators could be updated.
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4. Healthy People domain: health outcomes

In the Healthy People domain, personal well-being was the largest contributor to the increase in 2021. This followed a large decline in 2020, meaning that personal well-being was still below levels observed in all years before the pandemic.

Mortality improved in 2021, compared with 2020 (up 1.6 points). This followed a decline of 4.8 points in 2020, so at 99.8 it is still below previous levels. Between 2015 and 2019 this subdomain had been steadily improving to a high of 102.9.

Physical health conditions similarly increased in 2021, meaning fewer people reported living with the conditions. It was up 1.2 points to 101.2, though not all conditions saw improvement and mental health conditions were reported more than in 2020.

There are a few reasons we might see a reduction in reporting of physical health conditions during years affected by the coronavirus (COVID-19) pandemic. Diagnostic services were reduced while healthcare services were reorganised to tackle the pandemic. People may have been less likely to seek help with symptoms because of concerns about overwhelming health services, or risk of COVID-19 infection if attending in-person appointments. Many of the health conditions measured in the Health Index put people at greater risk of COVID-19 mortality, so fewer people living with these conditions could unfortunately be a result of deaths involving COVID-19.

Conversely to the overall Healthy People trend, the difficulties in daily life subdomain saw a 2.5 point decrease because of increased disability. The mental health score also declined by smaller amounts in both 2020 and 2021.

Figure 3: Improvements in 2021 partly offset the declines in 2020 in personal well-being and mortality

Changes in Healthy People subdomain scores, England, 2019 to 2020 and 2020 to 2021

Source: Health Index for England from the Office for National Statistics

Notes:

A positive change in score means health is better than the previous year; a negative score means health is worse.

Download this chart

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5. Healthy Lives domain: protective measures

Healthy Lives covers health-related behaviours and personal circumstances.

The decline in the Healthy Lives domain in 2021 was mostly because of a fall in the protective measures subdomain. This reduced from 100.8 in 2020 to 97.5 in 2021 (down 3.3 points).

The change comes from declined cancer screening attendance, with the score worsening by 7.7 points, taking it to 95.3. This is the largest decline in any indicator score across the whole Health Index in 2021. It is based on screening attendance for bowel, breast and cervical cancer. While others worsened, the underlying data show that attendance for bowel screening improved. This is potentially because interventions have targeted previously low rates for bowel screening. Additionally, home testing means there is no need to visit a medical setting, which is not the case for other screening types.
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6. Healthy Places domain: living conditions

The Healthy Places domain covers the wider influences on health that relate to the places where people live.

The living conditions subdomain was the main contributor to the change in the Healthy Places score in 2021.

Figure 4: Living conditions continued to improve in 2021

Living conditions subdomain scores, England, 2019 to 2021

Source: Health Index for England from the Office for National Statistics

Notes:

1. A score of 100 means health is equal to England's health in 2015. A score higher than 100 means health is better; a score lower than 100 means health is worse.

2. There may be small inconsistencies when comparing changes in scores on this chart with changes presented elsewhere in the bulletin because of rounding.

Download this chart

The living conditions subdomain increased considerably between 2019 and 2021, up a total of 5.3 points. The change from 2020 to 2021 came from improved household overcrowding (up 3.8 points). The only indicator in this subdomain to worsen considerably in 2020 or 2021 was noise complaints (by 6.1 points in 2020).

The household overcrowding indicator uses data from the 2011 Census and Census 2021. Improvements over the ten years are treated as though they happened equally each year, but this may not be the case.
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7. Local health differences

Select a local authority area in the interactive map in Figure 5 to view results for the Health Index overall, as well as the different domains, subdomains and indicators within it. Our separate How health has changed in your local area article highlights some of the main findings in each area. Results for integrated care systems are provided in our  Health Index datasets.

Figure 5: Select an area to view its Health Index results
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9. Understanding the Health Index

The Health Index provides a single value for health in England and local authorities each year that can be broken down into different areas of health. This allows users to understand any changes over time or differences between areas.

The index uses a broad definition that aligns with the  World Health Organization's (WHO's) definition of health: "health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity".
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Experimental Statistics

Experimental statistics are official statistics that are in the testing phase and not yet fully developed. They potentially have a wider degree of uncertainty than official statistics without this label. The Health Index for England has this label because new methods are still being tested and are subject to modification.

Healthy People

The  Healthy People  domain covers health outcomes that include mortality, and the impact of physical and mental health conditions.

Healthy Lives

The  Healthy Lives  domain covers risk factors for health that relate directly to individuals. This includes risk factors that can be modified or changed by individuals, and social factors that cannot always be controlled by individuals but affect the population at the individual level.

Healthy Places

The  Healthy Places  domain includes social and environmental risk factors that affect the population at a collective level. These relate to circumstances that can influence health outcomes and risk factors. However, they often cannot be addressed solely at the individual level.

View our  Health Index contents and definitions article for more detail on the domains, subdomains and the indicators within the Index.
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Data sources

Data for each of the Health Index's 56 indicators come from publicly available sources. Most are produced by the Office for National Statistics (ONS) or other government departments, so certain quality standards have already been met.

To meet the needs of the Health Index, we checked:

enough years of data were available to make comparisons over time

there was reasonable certainty that data would continue to be available into the future, to ensure that comparisons over time are based on consistent data as far as possible

data were available for lower-tier local authority areas (LTLAs)

For further information on data sources, see our  Health Index contents and definitions article and our  Health Index datasets.

Method

For use within the Health Index, data required imputation to fill missing values, and transformation so that statistical analysis could meaningfully group indicators into domains and subdomains. All techniques used follow standard statistical procedures, which were reviewed for suitability by experts.

We used statistical tests (called factor analysis) to understand which indicators should be placed together in domains and subdomains. They were also used to decide what weights indicators should be given, that is, how important they are in measuring health.

We used the results to produce values for:

Values were calculated for local authorities, then combined with respect to population size to give values for regions and for England as a whole.

Read more about the methodology used to construct the Health Index in our  Health Index methods and development: 2015 to 2021 article.

Acknowledgements

The data identification, acquisition, processing, analysis and interpretation required to produce the Health Index was performed by the Health Index and Projections Team:
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12. Strengths and limitations

Strengths

The Health Index presents a collection of indicators representing how health changes over time. Data are selected to represent specific topics considered to be relevant to health.

We calculate index scores using time-indexed normalisation. This means every score can be compared with the same base of 100 representing England's health in 2015. At every level a score greater than 100 means health is better than England's health in 2015, and a score lower than 100 means health is worse than England's health in 2015.

The Health Index can be broken down to different geographic and topic levels, and every level uses this scale. All aspects of the Health Index are presented with this same base of 100 for England in 2015, meaning comparisons can be made between scores over time and between different geographies.

Limitations

Availability of data

Some aspects of health cannot currently be included in the Health Index because no suitable data are available. Other topics included could be represented more fully if more comprehensive data were available.

There are sometimes challenges with the underlying data which mean we cannot update certain indicators, more so during the coronavirus (COVID-19) pandemic. For details of the affected indicators, see our Health Index methods and development: 2015 to 2021 methodology.

Timeliness

We are working to improve the timeliness of the index. Data for 2019 were published in March 2022, and for 2020 in November 2022, while 2021 data are now being published in June 2023. The future availability of data may affect the extent to which we can improve the timeliness of the release, but we are exploring timeliness improvements, such as publishing provisional data more regularly than annually.
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Health in England - Office for National Statistics

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Insights into England’s health in the earlier stages of the coronavirus (COVID-19) pandemic at national, regional and local authority level, using the Health Index.

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Fear or future? Getting to grips with the AI skills gap

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Fear or future? Getting to grips with the AI skills gap

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Generative AI - tools such as ChatGPT - has bulldozered its way into our work and personal lives. How can HR and learning teams upskill employees to use it productively and overcome the concerns over its potential to transform, or even replace, jobs?
There's a lot of fear around the impact artificial intelligence will have on the labour market. One of the most dramatic recent predictions came from Goldman Sachs, which suggested that generative AI - meaning tools such as (but not limited to) ChatGPT - could replace 200 million jobs.

At the same time, HR teams are rapidly reviewing policies and processes, recognising that employees' use of AI in their everyday roles could require some "guardrails" to ensure they are using it fairly and ethically. In March, research from Gartner found that half of HR professionals were introducing policies to regulate the use of AI at work.

But in the rush to place boundaries around how employees use AI tools, could HR be fuelling the fear and miss out on the benefits?

Role transformation

According to learning software company Skillsoft, there is a "fast-growing AI skills gap" that companies need to address. Its research has found that 96% of L&D teams believe that AI will transform job roles, yet 63% of organisations in EMEA have not provided employees with any AI training in the last year.

Only 58% of respondents said their organisation's investment in AI skills building would be enough to close the gap.

The company has recently launched an 'Intro to ChatGPT' course that educates learners on how generative AI works, its risks and limitations, and how to create effective prompts when using the tool.

Mark Onisk, Skillsoft's chief content officer, says there is still a large proportion of organisations that are taking a wait-and-see approach with generative AI.

"There are many who have placed a moratorium on this until it gets mainstreamed," he says. "They're saying they don't want to put themselves at risk. But those who are looking at it are rapidly skilling up, starting with the basics of what the technology can do right up to the ethical considerations and the guardrails they need to put in for compliance."

Onisk argues that there are three key considerations when integrating generative AI into the workforce: the technical skills needed to use it in someone's role; the leadership and professional skills required to use it effectively; and how you manage the potential risks and compliance issues associated with it.

"This should begin with the foundations of what generative AI actually is," he adds. "It's important not to get too indexed on the tool itself, there is much more out there than ChatGPT. Once employees understand that you can move on to policies and responsible use."

Getting ahead

If organisations are taking an overly cautious approach, they may find that their employees and customers are already experimenting with generative AI, and some may bring it into the workplace before policies or training are in place.

Potential new employees are already using the technology before they even join, according to research from CV-Library. More than four in 10 are using ChatGPT to help write their CV, 37% to write their cover letter, and 35.2% to get a better understanding of the job they're applying for.

Lee Biggins, founder and CEO of CV-Library, says this is "both expected and understandable", and that the technology can help candidates create a more powerful CV so they stand out in the hiring process. For HR, it's a signal that they need to equip themselves and hiring managers to understand the benefits AI can bring as well as any red flags that might be raised.

In turn, learning and development teams need to consider adding or developing training content that builds those skills - from practical uses of ChatGPT such as generating lists, to the 'softer' skills greater use of AI necessitates. Skillsoft's programme includes modules on ethical issues around AI, for example, such as how far we should trust its outputs and the importance of casting a human, critical eye over AI-generated work.

Job design

As well as developing learning paths that support the transition to a more AI-friendly workplace, businesses need to think more broadly about how jobs are designed and what that means for individuals' career progression.

Furniture retailer Ikea has shown how this can be done, reskilling its call centre workers in interior design as AI 'bots' take over an increasing number of straightforward queries.

One of the key skills deficits noted by Skillsoft among employees was 'soft' skills such as leadership (54% of survey respondents) and communication and problem solving (52%).

Onisk adds: "It's about how we reimagine work, how business processes look in the age of generative AI, and how leaders support teams through that.

"In every organisation, there will be a threshold where you can't leave the AI to run the business - some things require human intervention. If you're a salesperson, for example, you can automate a list of common objections but if there's a pricing conflict, a human needs to step in.

It's about how we reimagine work, how business processes look in the age of generative AI, and how leaders support teams through that" - Mark Onisk, Skillsoft

"Once you understand that, what skills transformation is needed? How do you lead people with empathy through disruption? There are low-stakes roles that can legitimately be automated, but that creates a lot of anxiety."

Learning platform Degreed has been creating career pathways for its own employees. "The CEO has put us all on an upskilling journey," says Janice Burns, chief career experience officer at the company. Degreed gives employees a $1,200 education stipend every year and staff are encouraged to start learning about Chat GPT and generative AI.

In weekly team meetings, presenters can "show and tell" what they've learned about the tools that week, and what they found tricky. The company is in the process of introducing generative AI into some internal tasks and processes so they can be more efficient. "We're learning together - no one feels like they're the one that doesn't know what they're doing," she adds.

Creative support

Digital business Evo Agency has been using AI to perform tasks such as searching for imagery to go on a new site for a client.

"We can lose hours searching for the right images to go on a new site. With some cleverly crafted prompts, Midjourney [an AI image generation tool] can pump out high-quality options that are exactly what we're looking for - no big-budget photo shoot needed," explains marketing manager Helen Hawkins.

Another tool is Figma, an AI integration that will further enhance and assist the design process, she adds, while the agency uses Google Ads' AI tools daily to speed up account management and search engine optimisation for clients. "Machine learning creates predictive data insights which further enhance the results. And that's us just scratching the surface," she adds.

Evo is embracing, rather than fearing, the impact of AI. "As a digital agency, you'd expect us to be all over ChatGPT and other AI tools and we are - it goes with the territory. AI is something that excites us rather than freaks us out," Hawkins says.

"For us, supporting the team to use as many AI-related tools as they can to improve processes is a given. We're all tech-minded and curious so playing around with these tools is encouraged and naturally part of the job.

"More importantly, we're focusing on upskilling the web developers and designers of the future to it. For them, it will be the norm but education is lagging well behind in offering the kind of training they'll need to enter this world. A world that changes at lightning speed. That's where we think we can help the most."

The company is also supporting work experience students to get to grips with ChatGPT. They have been using the tools to help them create their own sports brand and website.

"We've had them follow the web design process from the product to the branding to the full web design. Part of that process for us now includes using ChatGPT to come up with metaphors which in turn form part of a Midjourney prompt to generate images," she adds.

"Whereas previously we would have been limited to using generic stock imagery for these tasks, Midjourney allowed them to create specific products and promotional imagery focused on exactly what they wanted. These tools are getting more powerful all the time, so it's important the next generation is aware of them and learn to use them in the right way."

Human element

While generative AI will take over much of the transactional work and save time, employees still need to be able to lead teams, manage projects or deal with humps in the road - the "human" aspect of jobs that AI can't replace.

We're teaching employees to use it as a foundation, but then there's a quality control process you need to go through." - Janice Burns, Degreed

Neil Finegan, leadership and management tutor at DLC Training, says it's vital that companies prioritise soft skills training as their use of AI increases.

"Adopting a learning mindset is essential to get the most of AI tools and to stay up to date with their limitations, capabilities and the broader impact they may have in the workplace," he says.

"Emotional intelligence is also not to be overlooked, particularly as AI makes its way into the professional environment. AI tools lack human understanding and empathy that are an essential component of HR. Skills such as active listening, understanding non-verbal cues, conflict resolution and maintaining positive relationships are crucial.

"Finally, critical thinking is arguably one of the most important non-technical skills that should be prioritised. Using AI is a great starting point for task automation but they should always be viewed through a critical lens, particularly with ethical considerations in mind."

Julia Morgan, director of permanent recruitment at IT resourcing company Experis, agrees that human oversight will remain essential.

"Human soft analytical skills, like critical thinking and contextual understanding, are vital in ensuring accurate and meaningful insights. With AI handling more mundane tasks, people will have more time and energy to dedicate to other areas, such as strategic thinking, collaboration, and exploring new opportunities," she says.

"This shift allows individuals to focus on their unique human strengths and drive progress. Furthermore, AI can fuel creativity by answering hypothetical questions, providing new perspectives and insights, and opening possibilities for innovation and problem-solving."

Ethical approach

Furthermore, it's important to take an ethical approach to their use. A survey by the website B2B Reviews recently found that one in 10 HR employees at technology companies are using ChatGPT to write employee termination letters, for example.

Another poll from Aimpoint Digital revealed that one in 10 UK employees had used AI at work without their manager's knowledge.

What we don't know is whether those letters were accompanied by human, wraparound support, potentially making their source less relevant (after all, many HR professionals use template documents for just such occasions).

"Like many other sectors, those in HR are feeling the pinch when it comes to time and cost-saving measures which means it can be tempting to fall back on AI to help us in our day-to-day," Finegan adds.

"While neither inherently good nor bad, it's important to remember that AI lacks the most important element of the HR profession - humans. It's vital that if you do decide to start incorporating AI into your role, you do so responsibly, ethically and within reason."

ChatGPT can be a good starting point for something like a dismissal letter, he advises, but HR teams must review the output carefully as "AI generated text can often lack depth as these tools have a limited understanding of the nuances of natural language", meaning they can end up being "cold and robotic". Furthermore, adding in individual details can help to personalise documents that are initially generated by AI.

Part of the learning phase at Degreed has been working out where human oversight comes in, says Burns. "AI can help you be productive, can analyse data more quickly than a human, but the results are not always accurate. So we're teaching employees to use it as a starter, a foundation, but then there's a quality control process you need to go through."

There are no formal policies as yet, but as a guideline, employees should avoid putting proprietary data into generative AI as this carries the risk of data protection breaches. "It's about asking ChatGPT for information rather than giving it," she adds. "What it has been useful for is helping developers come up with taxonomies, mapping skills to roles, and personalise learning journeys on its own platform."

Burns argues that the rate at which AI is becoming a mainstream part of the workplace means companies must act sooner rather than later. "It's taught us that the concept of lifelong learning is real," she says. "Before, people thought it was a nice- to-have but didn't really understand the necessity of it. But with the tech advancing so quickly, if you're not continuously learning, you will be left behind."

L&D job opportunities on Personnel Today

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Fear or future? Getting to grips with the AI skills gap

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AI skills gap: How can HR and learning teams upskill employees to use generative AI productively and overcome fears around jobs?

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Measures to improve the interface between primary and secondary care - June 29, 2023

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Measures to improve the interface between primary and secondary care - June 29, 2023

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Download Publication Online Reader The interface between primary and secondary care is the space of a growing volume and variety of activities for the NHS, ranging from referrals to specialist care, diagnostic testing and medicines management. An effective and efficient interface has never been more…

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A selection of publications by DGT staff

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A selection of publications by DGT staff

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How we are delivering innovation in health and social care services

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How we are delivering innovation in health and social care services

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Innovation is crucial for enabling the NHS to increase the speed of diagnosis and deliver better outcomes for patients. We know patients benefit enormously from new technologies, with breakthroughs enabling prevention of ill-health, earlier diagnosis, more effective treatments, and faster recovery.

We have today announced £21 million funding boost to roll out the latest artificial intelligence (AI) across the NHS and help cut waiting lists. NHS Trusts will be able to apply to the AI Diagnostic Fund to accelerate the deployment of the most promising AI imaging and decision support tools to help diagnose patients more quickly for conditions such as cancers, strokes and heart conditions.

Here are a few examples of how the NHS is championing new technologies and innovation in healthcare.

Brainomix - AI brain scanning

Brainomix e-Stroke uses AI to analyse brain scans of people who have had strokes to assist doctors with diagnosis and treatment decisions. The platform also gives doctors a space to share information between hospitals in real-time, which can avoid delays to treatment.

Early studies have shown Brainomix can reduce the time between a patient arriving at hospital after they've had a stroke, to receiving treatment by more than one hour through providing instant interpretations of brain scans to help guide treatment and transfer decisions for stroke patients faster.

The studies also showed it can triple the number of people achieving functional independence after having a stroke, from 16% to 48%, through allow allowing more patients to get the right treatment, in the right place, at the right time.

CaRi-Heart - AI heart scanning

CaRi-Heart is a device using AI to analyse routine heart CT scans and gives clinicians a patient's personalised risk of heart attack over the next eight years.

It helps cardiologists identify people most at risk so they can work with these people at an earlier stage to help reduce their risk of heart disease and death.

It has been tested in The Harley Street Clinic, London Bridge Hospital, The Wellington Hospital and The Lister Hospital as part of the AI in Health and Care Award.

CaRi-Heart has also been used in NHS trusts including Oxford University Hospitals NHS Foundation Trust, Milton Keynes University Hospital NHS Foundation Trust, University Hospitals of Leicester NHS Trust, and The Royal Wolverhampton NHS Trust.

Project OSAIRIS - AI in radiotherapy treatment

Project OSAIRIS uses AI to assist clinicians with preparing patients' scans before radiotherapy and can reduce the time between referrals and starting treatment.

The technology clearly marks healthy organs before a patient begins radiotherapy to protect these organs from radiation.

It was developed by Cambridge University Hospitals NHS Trust and University Hospitals Birmingham NHS Trust.

It is currently being used by Cambridge University Hospitals NHS Trust for head and neck and prostate cancers.

Continuous glucose monitors

FreeStyle Libre 2 are wearable glucose monitoring devices which transform care for eligible diabetes patients by offering intermittent continuous glucose monitoring and eliminating the need for finger prick testing by allowing users to scan the sensor for a reading.

Following a successful uptake programme, FreeStyle Libre is now used by more than 50% of patients with Type 1 Diabetes in the NHS.

These technologies will help people with diabetes manage their condition better by reducing hospitalisations and related illnesses, improving their quality of life and ultimately easing pressure on the NHS.

Dexcom ONE and GlucoMen Day are wearable arm monitors which automatically send information to a mobile app, allowing people with diabetes to always keep track of glucose levels without any kind of testing. They use sensors no bigger than a bottle cap which attaches to the arm for up to 14 days and measures glucose levels from just under the skin.

People with Type 1 diabetes and people with Type 2 diabetes on multiple daily insulin injections can now access life-changing real time continuous glucose monitoring.

Dexcom ONE is now available to NHS patients to collect from pharmacies after being prescribed by their hospital or GP.

SHREWD - an online database for clinicians

Single Health Resilience Early Warning Database (SHREWD) is an online tool which helps track patient flow across hospitals, reducing pressure in pressure points and ensuring people are treated quicker.

It has been developed in Kent & Medway Integrated Care System and allows clinicians to follow every step of a patient's journey from admission to discharge.

Systems such as SHREWD show the demand on Integrated Care Systems (ICSs) and is currently being used in almost half of ICSs and is used by regional and national teams.

What are we doing to deliver innovation in healthcare?

Innovation is the key focus of the NHS Long Term Plan and NHS England has established the Innovation board to promote participation in research, develop technologies to benefit patients, and contribute to economic growth.

We're building the best health and care data in the world by introducing lifelong records to deliver better patient access through the NHS App.

The Our Future Health research programme collects information from up to 5 million adults across the UK to make new discoveries about health and disease.

We are delivering innovation through focussed, system-wide deployment, encouraging ambitious research and implementing processes to increase the speed of rollout.

So far £123 million has been invested in 86 AI technologies across three rounds of the AI in Health and Care Award, supporting over 300,000 patients and improving their care and treatment for health conditions such as cancer, heart disease, diabetes, mental health and neurological disorders.

We published the first government strategy for medtech in February, outlining how we will work with the industry to ensure the NHS has fast and safe access to the latest innovations. We're also creating a new pathway to enable innovators to bring their products to professionals and patients at the earliest, safe opportunity.

The role the NHS has in embracing a culture of innovation throughout the system is fundamentally important to developing the tools needed to drive innovation adoption forwards.

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How we are delivering innovation in health and social care services

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Innovation is crucial for enabling the NHS to increase the speed of diagnosis and deliver better outcomes for patients. We know patients benefit enormously from new technologies, with breakthroughs enabling prevention of ill-health, earlier diagnosis, more effective treatments, and faster ...

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The first ever NHS Long Term Workforce Plan was commissioned by the government to set out a series of interventions train, retain and reform the workforce, and put the NHS on a sustainable footing into the future. Backed by more ...

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NHS Long Term Workforce Plan - 30 June 2023

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NHS Long Term Workforce Plan - 30 June 2023

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The first comprehensive workforce plan for the NHS, putting staffing on a sustainable footing and improving patient care. It focuses on retaining existing talent and making the best use of new technology alongside the biggest recruitment drive in health service history.

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Nuffield Trust response to announcement on NHS Long Term Workforce Plan -                                    Dr Billy Palmer responds to the imminent publication of the NHS Long Term Workforce Plan.

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Nuffield Trust response to announcement on NHS Long Term Workforce Plan -                                    Dr Billy Palmer responds to the imminent publication of the NHS Long Term Workforce Plan.

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Responding to the government's announcement ahead of the publication of the NHS Long Term Workforce Plan, Nuffield Trust Senior Fellow Dr Billy Palmer said:

Notes to editors

2. A new Nuffield Trust analysis of NHS staff sickness rates, All is not well: Sickness absence in the NHS in England, has been published today and can be seen on our website here.

3. The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate www.nuffieldtrust.org.uk

4. For all queries or to arrange an interview, contact: Simon Keen: 07780 475571 / simon.keen@nuffieldtrust.org.uk; or Eleanor Martin: 07920 043676 / eleanor.martin@nuffieldtrust.org.uk

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Nuffield Trust response to announcement on NHS Long Term Workforce Plan

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Dr Billy Palmer responds to the imminent publication of the NHS Long Term Workforce Plan.

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The state of medical education and practice in the UK: workplace experiences 2023

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The state of medical education and practice in the UK: workplace experiences 2023

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Click HERE to subscribe

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This is a good point to reflect on what has worked well, what we have learned and what more can we do to improve the health and wellbeing of people across the country. When we speak to colleagues across the country, we see examples of good practice in every system, and in this bulletin, we look at some of the ways in which closer partnership working is making a real difference for populations.

Throughout the year, I've visited systems who are delivering impactful and innovative care services to their communities. During my visit to Gloucestershire, I spoke to primary care teams at Rosebank Health working with elderly residents and other vulnerable groups through a single 'front door' frailty service that personalises care around each patient. Excellent partnership working between health and housing providers is tackling health inequalities in deprived social groups and a social enterprise 'Treasure Seekers' hub that worked alongside health teams to support vulnerable groups with mental health and learning disabilities.

The next year will see systems continue to focus on their priorities - whether in helping people stay healthier for longer, tackling inequalities or supporting broader economic and social development. I am excited to see the where the next year takes us.

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This is a good point to reflect on what has worked well, what we have learned and what more can we do to improve the health and wellbeing of people across the country.

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All is not well: Sickness absence in the NHS in England

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All is not well: Sickness absence in the NHS in England

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Monthly sickness absence rates over the last calendar year never once fell below even the peak in the pre-pandemic year and, on average, the reported rate for NHS staff across 2022 was 29% higher than in 2019 (5.6% v 4.3%).

The reported level of sickness absence - some 27 million days across 2022 - equates, on average, to around 74,500 full-time equivalent staff, including 20,400 nurses and 2,900 doctors. This is likely to be a significant underestimate due to various causes of under-recording of the sickness absence rate.

Over the course of 2022, some 6 million days were recorded for staff being sick due to mental health and wellbeing related reasons. The number of reported days of absences related to anxiety, stress, depression and other psychiatric illnesses increased by 26% between 2019 and 2022.

High sickness absence is bad for NHS staff, bad for providers of health care in terms of costs and disruption to patient care, and expensive for the taxpayer. Sickness absence is also associated with a higher likelihood of staff leaving the NHS.

What are the levels of sickness absence in the NHS?

Over the course of the last calendar year, from January to December 2022, we saw an unprecedented and sustained high average level of sickness absence for the NHS in England. The reported sickness absence rate for NHS staff across 2022 (5.6%) was substantially higher than in the year before the pandemic (4.3% in 2019). In fact, the monthly sickness absence rate across 2022 never once fell below even the peak for 2019 (4.9% in December 2019).

The reported sickness absence rates in 2022 were equivalent to 74,500 additional full-time staff, including 2,900 doctors and 20,400 nurses. In reality, the scale of absences could be substantially greater as not all sickness absence days are thought to be recorded, particularly for some staff groups. The rise in reported sickness absence rates between 2019 and 2022 alone is equivalent to 16,900 full-time staff. Separate data suggest that there were 122,501 staff reported as absent from work through sickness or self-isolation at the peak across health care providers in 2022 (on 6 January during the Omicron wave).

Is this trend consistent across England?

While the directions of the trends are fairly consistent across the English regions, the absolute reported sickness absence levels are substantially higher in some areas (Figure 1). By the end of 2022, the reported sickness absence rate stood at 7.4% in the North West compared to 5.4% in London.

All types of NHS trust - from small to large and from acute to community - have, on average, seen a substantial increase. That said, reported levels across mental health and learning disabilities have been less affected overall. However, there is significant variation at a provider level. Sixteen trusts had their sickness absence rates increase by over half between 2019 and 2022, and three ambulance trusts saw their rates soar to 10% across 2022 (Figure 2).

The absolute level of absences is vast for some providers. For example, in the first week of 2022 - during the Omicron wave - 30 NHS trusts reported having, at some point, more than 1,000 staff absent on a given day from work through sickness or self-isolation (with six of these providers having more than 2,000 absent on at least one day over that week). Fast forward to the last week of 2022, and a sizeable number (11) of trusts were still reporting over 1,000 absences.

What are the reported reasons for sickness absences?

There has been a large rise in absences related to anxiety, stress, depression and other psychiatric illnesses which account for around a quarter (23%) of sick days (Figure 3). In fact, across 2022 there were around 6 million reported sick days for these mental health and wellbeing related reasons. The data available suggest that sickness absence days due to these reasons increased by around a quarter (26%) between 2019 and 2022, substantially outstripping the growth in staff numbers of that period (around 13%).

Across 2022, around one in six (18%) of sickness days were reported as specifically due to Covid-19. However, looking at the detailed reasons for sickness absence (which does not identify Covid-19 separately), it appears that Covid-19 and similar conditions (chest & respiratory; cold, cough or flu; infectious diseases) account for much of the increased levels compared to 2019 (27% in 2022 compared to 10% in 2019).

Have some staff groups been particularly affected?

Comparing sickness absence rates between staff groups can be problematic as, for example, some professions are less likely to actually record absences. In addition, the nature of the roles of different staff groups affects the degree to which staff can work with certain conditions - including the extent to which they are patient-facing or, for example, involve physical tasks - and the ability to work remotely or when self-isolating.

Compared to 2019, most staff groups saw a reported increase in sickness absence of broadly around 1 percentage point in 2022. However, some had no or low increase (managers, central functions, and for some categories of largely locally employed doctors) while other professions, including ambulance staff (2.3 percentage points), support to ambulance staff (3.2) and midwives (1.9), saw larger increases. The rates for foundation doctors (medics in their first two years after graduating) more than doubled, but this was from a comparatively low pre-pandemic level (Figure 4).

The reported reasons for absences vary by staff group. Prior to the pandemic in 2019, midwives for example were more likely to have reported sickness absence for mental health reasons (28% of all absences) than doctors (24%). Moreover, around twice the proportion of reported sickness days for ambulance staff and clinical support staff related to musculoskeletal conditions than for doctors (17% compared to 9%). And in the last three years, some groups have been disproportionately affected by certain reasons for sickness absence. For example, reasons for absence relating to influenza, chest and respiratory problems, and infectious disease (i.e. those that could relate to Covid-19) for ambulance staff alone rose from equivalent to a 0.3% sickness absence rate to 1.9% (for all staff the sickness absence rate for those reasons alone increased from 0.4% to 1.5%).

Is this increase unique to the NHS in England?

Differences between sectors and settings in the way sickness absence rates are defined and recorded makes such comparisons difficult. However, the increase in overall public sector sickness absence between 2019 and 2022 was similar to the NHS in England. That said, the sickness absence rates remain well above the public sector average (3.6% in 2022, albeit measured in a different way to that of the NHS) despite a target from the NHS Long Term Plan to get them down to those levels.

Increased levels of sickness absence in 2022 not only affected the health service in England, with surges too in the NHS in Wales and Scotland (the latter despite the data excluding Covid-19 absences, which in part explains the different apparent trend in that nation). While this analysis focuses on the NHS, the recent spike in sickness absence for teachers is also notable (Figure 5). Prior to the pandemic - between 2015 and 2019 - sickness absence rates had been fairly stable in the NHS in England and for teachers too, while reported rates had fallen on average across the public sector.

These increases coincide with more people leaving the labour market due to long-term sickness. Staff employed in "human health and social work" have - compared to some other sectors - relatively high retention issues due to long-term sickness (7.8 former workers economically inactive because of long-term sickness per 1,000 current staff, 2021/22) which, for example, was above the education sector (4.7 per 1,000) but below wholesale and retail services staff (10.4 per 1,000). Again, such comparisons need to be treated with some caution due to the nature of the roles in different sectors and, for example, the ability to work remotely including when self-isolating.

Discussion

Sickness absence levels tell us about the physical and psychological health and wellbeing of a workforce. And this analysis is not the first, by any means, to highlight health and wellbeing issues for the NHS workforce. The annual staff survey for NHS staff in England showed, for instance, a higher proportion of staff feeling unwell as a result of work-related stress in 2022 (45%) relative to three years prior (41%). Not only this, but over half (57%) of staff reported going into work despite not feeling well enough. While the proportion dipped in 2020 due to Covid-19 self-isolation requirements, this has gone back to levels seen in 2018.

Where staff sickness cannot be adequately covered by temporary staffing, then this could have a direct impact on those receiving care and - as the ability to clear the backlog would be hindered - those yet to receive care. It can also have indirect effects on other staff working in stretched services. Around a sixth (16%) of the total temporary (bank and agency) nurse and midwife use is to cover long-term sickness. While we do not know the exact cost of this, a sixth of the spend on agency nurses in 2020/21 equates to around £130 million.

Health reasons are also increasingly a cause for staff to leave the NHS. The number of NHS staff pointing to health as the reasons for leaving their role has more than tripled in the decade to 2022, including increasing by 52% since 2019. Of nurses, midwives and nursing associates leaving the professional register in 2022, physical and mental health is the second most commonly cited main reason and burnout or exhaustion the third, both behind retirement. Across these professionals leaving, of those that were educated in the UK, nearly one in three (31%) reported physical or mental health as a reason for leaving, with one in seven (14%) suggesting it as the main reason.

Sophisticated recent analysis highlighted a strong association between probability of leaving the NHS acute sector and sickness absences for both physical and (particularly) mental health reasons. For instance, compared to those that have not had absences, an NHS consultant missing three days of work for mental health reasons is 58% more likely to leave three months later. Given high sickness absence levels and poor retention are both causes of and caused by increased pressure of services, the NHS risks being stuck in a vicious cycle.

Sickness absence rates are known to relate to a huge array of factors. In particular, previous work has highlighted its relationship with season, infectious disease outbreaks, job satisfaction and employee engagement, workload over previous years, effort-reward imbalance, socioeconomic status, and gender. The solutions needed to solve the current high levels of sickness absence are, therefore, likely to be manyfold. However, there is an array of UK and international experience on interventions to address, for example, long-term sickness absence and reduce risks of recurrence.

In any case, the concern is that, despite emerging from the peaks of Covid-19, the levels of NHS sickness absence are still stubbornly higher than what was observed before the pandemic. But the NHS has a moral duty to protect the physical and mental health of its staff and, in doing so, can benefit the entire workforce and current and future patients. And, for this reason, understanding and ameliorating sickness absence levels are something that we hope will feature centrally in the highly anticipated NHS long-term workforce plan.

*We have calculated the NHS's sickness absence rate by dividing the total sickness absence days (including non-working days) reported by the sum total days available per month for each member of staff (also including non-working days), while the BBC (for whom we carried out this analysis) have calculated annual sickness absence rates taken as an average of the monthly sickness absence rates in a given year.

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All is not well: Sickness absence in the NHS in England

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Billy Palmer and Lucina Rolewicz draw on published data to explore the trends in, reasons for, and impact of sickness absence in the NHS. The briefing primarily focuses on hospital and community services in England, since this is where most is known, although we do compare to trends in other sectors and health services in the other UK nations, where data permits.

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Access to unplanned or urgent care  Date: 21 Jun 2023 - National Audit Office    

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Access to unplanned or urgent care  Date: 21 Jun 2023 - National Audit Office    

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Background to the report

NHS services have been under increasing pressure in recent years, particularly since the start of the COVID-19 pandemic. We have previously reported on the NHS's efforts to tackle the backlogs in elective care and its progress with improving mental health services in England.

Jump to downloads

Scope of the report

This report gives a factual overview of NHS services that may be used when people need rapid access to urgent, emergency, or other non-routine health services, and whether such services are meeting the performance standards the NHS has told patients they have a right to expect.

It covers:

general practice

community pharmacy

111 calls

ambulance services (including 999 calls)

urgent treatment centres

accident and emergency (A&E) departments

Specialist services such as optometry, dentistry, paediatrics, and tertiary care are outside the scope of this report. NHS England (NHSE) considers that the combination of StrepA, influenza and COVID-19 in winter 2022-23 significantly exacerbated the challenges it already faced. We have not sought to isolate or quantify the impact of these factors.

Concluding remarks

More people than ever before are receiving unplanned and urgent NHS care every day. To support these services, the NHS is spending increasing amounts of public money and employing record numbers of people. Nevertheless, patients' satisfaction and access to services have been worsening, suggesting there is no single, straightforward solution to improving what is a complex and interdependent system.

NHSE's recovery plan for urgent and emergency care aims to improve services by March 2024. The long-term trends in workforce, activity, spending and performance indicate this will be a significant challenge.

Downloads

Publication details

Press release

View press release (21 Jun 2023)

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Access to unplanned or urgent care - National Audit Office (NAO) report

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A National Audit Office (NAO) report assessing the government's approach to improving urgent and emergency care services in England.

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Reflecting on 75 years since the arrival of HMT Empire Windrush

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Reflecting on 75 years since the arrival of HMT Empire Windrush

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HMT Empire Windrush arrived at Tilbury Docks on 22 June 1948, bringing with it several hundred passengers from across the British colonies in the Caribbean.

The arrival of the ship and its passengers is often seen as the start of a wave of migration from the West Indies to the UK. The Windrush generation helped Britain recover from the impact of the Second World War, filling jobs in the postal and transport systems, as well as the newly founded NHS.

The Windrush generation and their descendants have played a vital role in the running and development of the health and social care system. Despite this contribution, NHS staff surveys repeatedly show that real progress isn't being made in diversity and inclusion.

As part of our work for the Windrush anniversary, we've heard from Caribbean NHS staff experiencing barriers to career progression, access to training and development and discrimination. Explore more of this history through the articles, online resources and publications featured on this page.

You called and we came: Windrush and the NHS

Hear stories from the Windrush generation and their descendants on their experiences of working in the NHS in our online exhibition.

Acting with intent: Chief Nurse, Karen Bonner, on diversity and belonging in the NHS

How can we ensure that health and care staff from all backgrounds feel respected, valued and listened to at work? Siva Anandaciva sits down with Karen Bonner, Chief Nurse.

Blog: How it started... how it's going

Shilpa Ross considers the experiences of staff from ethnic minority groups in the newly formed NHS and the NHS of today and asks why, in the intervening years, so little has changed.

Windrush 75: reflecting on the contributions of generations to the NHS

Additionally, to mark 75th anniversary of the arrival of HMT Empire Windrush, Sally Warren and other panelists celebrated the significant contribution Caribbean and Ethnic Minority staff make to the health and care system.

Watch the online event below to explore:

the persistent trends in the lived experience of working in the NHS of the Windrush generations and their descendants

the disproportionate disparities in employment and working conditions faced by BME staff

the UK's continued heavy reliance on international recruitment to plug health and care workforce gaps.

Related episodes from our podcast

Celebrating 75 years: social care, the NHS and Windrush

75 years of social care

The National Assistance Act came into force in 1943, marking the start of the social care system as we know it. Through a blog series and podcast episode, we examine the history of social care and the challenges it's facing today.

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Reflecting on 75 years since the arrival of HMT Empire Windrush

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We're marking 75 years since the arrival of the HMT Empire Windrush to the UK by celebrating the contribution made by the Windrush generation and their descendants to the NHS, as well as highlighting the challenges they've faced.

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How does the NHS compare to the health care systems of other countries?

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How does the NHS compare to the health care systems of other countries?

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Why we did the research

The current pressures on NHS services and 75th anniversary of the NHS's founding mean this is a particularly important moment to assess how the UK's health care system is faring compared to its peers. Every health care system has 'something to teach and something to learn'. So, comparing the health care systems of different countries can help UK politicians and policy-makers assess the performance of the UK health care system and identify where it can improve.

We compared the health care systems in different countries by doing three things. First, we reviewed the research literature and assessed previous attempts to rank and compare health care systems. Second, we interviewed academic experts in international health care policy and experts who had extensive knowledge of the UK, German and Singaporean health care systems. Third, we analysed the latest quantitative performance data for the UK health care system and the health systems of 18 higher-income peer countries.

We analysed data in three main domains:

the context the health system operates in (eg, the health status and behaviours of the population)

the resources a health system has (eg, levels of staffing, equipment and health care spending)

how well the health care systems uses its resources and what it achieves as a result (eg, measures of efficiency in delivering services, quality of care, financial protection from the costs of ill health, and health care outcomes).

What we found

A system with fewer resources

The UK has below-average health spending per person compared to peer countries. Health spending as a share of GDP (gross domestic product) was just below average in 2019 but rose to just above average in 2020 (the first year of the Covid-19 pandemic, which of course had a significant impact on the UK's economic performance and spending on health services). The UK lags behind other countries in its capital investment, and has substantially fewer key physical resources than many of its peers, including CT and MRI scanners and hospital beds. The UK has strikingly low levels of key clinical staff, including doctors and nurses, and is heavily reliant on foreign-trained staff. Remuneration for some clinical staff groups also appears to be less competitive in the UK than in peer countries.

A mixed record on efficiency and quality

The UK health system performs relatively well on some measures of efficiency, such as the rate at which cheaper generic medicines are prescribed. The UK also spends a relatively low share of its health budget on administration.

But waiting times in the UK for common procedures like knee, hip and cataract operations were broadly 'middle of the pack' compared to peer countries in 2019 (before the Covid-19 pandemic). And the fall in activity for these procedures in the first year of the pandemic was dramatically sharper in the UK than in peer countries.

Good financial protection but poor health care outcomes

People in the UK receive relatively good protection from some of the catastrophic costs of falling ill. Relatively few core NHS services are charged for and certain population groups are exempt from charges. But financial protection is weaker for some services, such as dental care, and there is growing concern that people in the UK may be forced to choose between funding their own care or enduring longer waits for treatment.

But the UK performs noticeably less well than its peers - and is more of a laggard than a leader - on many important measures of health status and health care outcomes. These include health outcomes that can be heavily affected by the actions of a health system (such as surviving cancer and treatable mortality), and outcomes such as life expectancy, which are significantly affected by factors beyond the direct control of any health system.

Wider reflections

There is little evidence that one individual country performs consistently better than another across a range of performance indicators. Even countries such as Germany and Singapore, that score highly on several health system performance measures, are facing the challenge of rising demand from a growing and ageing population and the need to improve health care outcomes.

There is also little evidence that one 'type' of health care system or health care financing model achieves consistently better results than another. And the costs of transitioning from one system to another can be significant. As a result, countries predominantly try to achieve better health outcomes by improving their existing model of health care, rather than by adopting a radically different model.

Comparing the NHS to the health care systems of other countries

A quick look at five charts from the report

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How does the NHS compare to the health care systems of other countries?

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Comparing the health care systems of different countries can help us assess how the UK health care system is performing and where it could improve. Our new report found that the NHS is neither a leader nor a laggard when compared to 18 similar countries.

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The NHS productivity puzzle: Why has hospital activity not increased in line with funding and staffing?      The NHS crisis will only be solved with capital investment, increasing management capacity and staff retention – not just more doctors and nurses.

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The NHS productivity puzzle: Why has hospital activity not increased in line with funding and staffing?      The NHS crisis will only be solved with capital investment, increasing management capacity and staff retention – not just more doctors and nurses.

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The full report can be downloaded HERE

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Politicians need to seriously engage with the real problems facing the NHS - or the decline in hospital performance levels will become extremely difficult to reverse.

This report - written jointly by the Institute for Government and Public First, and funded by the Health Foundation - assesses why NHS hospitals are failing to deliver higher activity despite higher spending on the service and higher levels of staffing over the last couple of years.

It argues that politicians need to urgently focus on capital investment, staff retention and boosting management capacity, and sets out key questions for policy makers to address if they want to solve the NHS crisis. The NHS has been on a longer-term negative trajectory: most of the challenges identified in the report existed before the pandemic and have been exacerbated since.

The report particularly identifies the following as causes:

Hospitals are chronically undermanaged, and where existing managers are operating they have too many constraints and poor incentives.

Underinvestment in capital - including a lack of hospital beds and many beds filled by people who should not be in them.

An exodus of senior staff - with inexperienced replacements recruited.

The report also draws on interviews and roundtables with dozens of experts and clinicians. It is published after a terrible period for the NHS: the elective waiting list stands at over 7.4 million and continues to rise, ambulances took 90 minutes to respond to strokes in December, and 10% of people attending A&Es waited more than 12 hours in February.

With NHS satisfaction levels at record lows and with an election next year, the report says politicians need to engage with key questions about how the crisis in hospitals can be addressed.

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The NHS productivity puzzle | Institute for Government

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The NHS crisis will only be solved with capital investment, increasing management capacity and staff retention - not just more doctors and nurses.

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Login using OpenAthens to access the full text. If you are unable to access send an email to library.dvh@nhs.net

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NHS performance summaryThe latest NHS performance data, updated monthly.

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NHS performance summaryThe latest NHS performance data, updated monthly.

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Headlines

Ambulance response times saw unprecedented increases in December 2022, with Category 2 incidents (such as stroke or heart attack) seeing their average response time exceed one-and-a-half hours.

In the last two weeks of December, 41% of patients arriving by ambulance at A&E had a handover delay of over 30 minutes.

More people than ever, over a third, waited more than four hours in A&E to be admitted, transferred or discharged in December.

Over 170,000 people waited more than four hours in A&E between a decision to admit and admission, while almost 55,000 waited more than 12 hours.

Almost 95% of general and acute beds in Type 1 trusts were occupied at the start of January.

The analysis below includes the latest data on key activity and performance measures from November and December 2022 (as well as some daily performance data from early January 2023), as published by NHS England on 12 January 2023. This includes data on the NHS's performance against some key targets, including some of those set out in the latest planning guidance as well as other indicators of patient safety and care.

Emergency care

Ambulances

In December 2022, ambulance response times saw unprecedented increases on the previous month, leading to record high average response times.

Average Category 2 (emergency conditions such as stroke or heart attack) response times saw the starkest jump, increasing by almost 45 minutes, to a record high of 1 hour 33 minutes. This is over half an hour longer than the previous record (1 hour 1 minute), and over five times the 18-minute target.

Category 1 incidents (life-threatening conditions, such as cardiac or respiratory arrest) saw their average response time almost reach 11 minutes for the first time.

In the last two weeks of 2022, there were over 57,000 ambulance handover delays to A&E departments of over 30 minutes. This represents 41% of patients arriving by ambulance.

Note: For October and November 2022, response times are not available for London, so England times are calculated using incident counts also excluding London.

For more information, see our ambulance response times indicator.

A&E waiting times

In December 2022, 35% of people attending A&E spent more than four hours from arrival to admission, transfer or discharge. This is the fourth month in a row the record for such waiters has been broken, and the biggest month-on-month increase so far. This comes in the wake of the announcement of a target of bringing this down to 24% by March next year.

December 2022 saw the highest total number of A&E attendances on record, with 2.28 million people going to A&E over the course of the month. However, the number of emergency admissions remain below pre-pandemic levels, with 8% fewer in December 2022 than in December 2019.

Trolley waits, the time taken between the decision to admit a patient and them being admitted, also rose to new heights. The number of people who waited over four hours in December rose by over 26,000 compared to the previous month. Meanwhile, the number of people waiting more than 12 hours rose by almost 17,000, exceeding 50,000 for the first time.

For more information, see our A&E waiting time indicator.

Planned hospital care and diagnostic test waiting times

The waiting list to start elective (planned) care exceeded saw a slight decrease, from 7.21 to 7.19 million, from October to November 2022.

The number of people waiting over 52 weeks to start elective care also dropped slightly in November, for the second month in a row, to 379,000. In almost eight years preceding the pandemic, there were never more than 4,000 of such waiters in a given month.

There also was another small decrease in the number of people waiting over 18 months to start treatment, of around 3 percentage points. All the remaining 44,994 waiters (except those who choose to wait longer) would need to be seen by April for the government to meet its previously stated target, which is very unlikely at this rate of decrease.

27% of people waited over six weeks for a diagnostic test in November. This is a smaller proportion than in the previous few months but still far beyond the current 1% target. The aim is to bring this proportion down to 5% by March 2025.

Note: Statistics for over 52 weeks and over 18 months waiters do not currently include estimates for missing data.

For more information, see our treatment waiting times and diagnostic test waiting times indicator.

Cancer waiting times

In November 2022, 39% of patients who had their first treatment for cancer following an urgent GP referral waited longer than two months. This is an improvement on the previous two months, but still the fourth-worst performance on record. The target of 15% was last met almost seven years ago, in December 2015.

The total number of patients waiting longer than two months from an urgent GP referral to first treatment of cancer was 6,356. When the 15% target was last hit, only 1,704 patients waited more than two months for their first cancer treatment.

For more information, see our cancer waiting time targets indicator.

Bed occupancy

The week beginning 2 January saw the highest bed occupancy (Type 1 acute trusts) this winter, with 94.8% of beds occupied.

This follows a smaller-than-usual dip in the proportion of occupied beds in the last two weeks of 2022 (down 1.2 percentage points compared to the previous week).

The aim is to bring general and acute bed occupancy to 92% or below.

Patient discharge

The average daily proportion of patients who no longer met the criteria to stay in hospital but were not discharged has been slightly higher for this winter so far, than for the same period last winter (61% vs. 57%).

For those patients who had been in hospital for over 21 days, the average daily proportion not discharged is almost identical to the same period last winter (89% vs. 89%).

This winter so far, the average total number of patients who no longer met the criteria to stay in hospital was over 3,000 higher per day (22,200 vs. 19,000).

About this data

During this unprecedented time for the health service, QualityWatch continues to provide independent scrutiny of the health and social care system. The most recent data published today reflects changes in access and service compared to pre-pandemic health care delivery. It is also worth noting that NHS England have suspended data collection for some of their performance statistics, including delayed transfers of care.

In March 2019, the Clinically-Led Review of NHS Access Standards Interim Report was released, proposing some significant changes to many of the targets reported on here. A six-month Progress Report from the NHS Medical Director was also published in October 2019. Field testing of the proposed new standards began in 2019 and NHS England consulted on the recommendations for urgent and emergency care.

For urgent and emergency care, the field test sites have not been submitting four-hour performance data since May 2019. The time series presented here excludes the field testing sites and so is comparable across months and years. For elective care, performance of the field test sites will continue to be included in the national time series, so the data is fully comparable over time.

For interactive charts showing the quality of health and social care over time, please refer to our 200+ indicators.

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Ambulance response times saw unprecedented increases in December 2022, with Category 2 incidents (such as stroke or heart attack) seeing their average response time exceed one-and-a-half hours. In the last two weeks of December, 41% of patients arriving by ambulance at A&E had a handover delay of over 30 minutes.

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High-performing teams: An evidence review                          Explore the latest research on how to create a positive environment to build and nurture effective teams

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High-performing teams: An evidence review                          Explore the latest research on how to create a positive environment to build and nurture effective teams

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Focusing on team dynamics is especially important for people that work virtually, have little history of working together or have high interdependency. The aspects of working life that can affect employee performance are nuanced, but our research shows that well-planned interventions can help to increase team effectiveness.

This evidence review explores how to build an effective team and the factors that employers and people managers need to draw on to create an environment in which their employees can work together successfully.

See the practice summary for the main insights and practical recommendations for action.

See the scientific summary for our methodology and technical information on the research and study references.

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CIPD | High-performing teams: An evidence review

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Focusing on team dynamics is especially important for people that work virtually, have little history of working together or have high interdependency. The aspects of working life that can affect employee performance are nuanced, but our research shows that well-planned interventions can help to increase team effectiveness.

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NHS England - Statistics - including Hospital Activity

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NHS England - Statistics - including Hospital Activity

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NHS England published the National Wheelchair Data Collection for July - September 2023. The collection includes information on: the number of registered users of NHS funded wheelchair services; time from referral to equipment delivery; and expenditure on wheelchair services. Further information and the publication.

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Health and high quality care for all, now and for future generations

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The current status of digital technology and skills in health and care education                                   This review looks at the current status of digital technology and skills in undergraduate and preregistration health and care education.

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The current status of digital technology and skills in health and care education                                   This review looks at the current status of digital technology and skills in undergraduate and preregistration health and care education.

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Health Education England | Digital Transformation

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The current status of digital technology and skills in health and care education | Health Education England

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This review looks at the current status of digital technology and skills in undergraduate and preregistration health and care education.

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Requirements for implementing a ‘just culture’ within healthcare organisations: an integrative review

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Requirements for implementing a ‘just culture’ within healthcare organisations: an integrative review