The healthmatters blog; commentary, observation and review
There has been a large rise in the volume of social work research undertaken in the UK over the past 20 years but one topic remains stubbornly under researched: student funding in social work education. This is all the more surprising when we remember the attention given to tuition fees in the last three general elections. In June 2017, the Department of Health and Social Care Policy Research Programme commissioned the Social Care Workforce Research Unit to undertake a short review of the social work bursary.
We had already done a similar piece of work so we had not expected to uncover a large research evidence base. However, it still seems surprising that there is so little research on social work students finances given that many social work students are drawn to social work after being in care or experiencing discrimination or poverty.
Research findings are just one influence on the policy making process. This may be even more nebulous when the evidence base is thin. Nevertheless, we thought there were eight possible policy options based on the material we identified:
- Prior to the introduction of the bursary, there was a steep rise in international recruitment in the late 1990s because of declines in the numbers of social work students. The social work bursary should be maintained for at least the period leading up to Brexit to maintain a stable supply of student numbers and avoid the risk of over reliance on international recruitment to fill vacant social work posts.
- The Centre for Workforce Intelligence (2016) predicted that demand for social workers would have increased by a third between 2015-2035. Cross departmental discussions between the Department of Health and Social Care and the Department for Education could be held to update estimates about the number of social workers needed in adult and children’s services, while recognising that unforeseen events can always affect the best laid plans. (A good example of this is the Cheshire West judgment which increased the number of Deprivation of Liberty Safeguards.)
- The key to cost-effective social work education is retention because it means that organisations are not playing ‘catch up’ to match the number of newly qualified social workers with those who are leaving before the age of retirement. There is a role for discussions with the new regulator Social Work England about its possible role in collecting data on retention rates among registrants that can be used in research and workforce planning.
- There is some evidence that the social work bursary has helped attract a more diverse range of social work students. An impact assessment would help answer questions about the contribution the bursary makes to maintaining diversity within the profession.
- Future announcements about the bursary need to be made in time to allow potential applicants sufficient time to make alternative arrangements – for instance to apply to study part time.
- Currently there is considerable diversity in qualifying routes to become a social worker. What would be the consequences if monopoly suppliers developed in social work education? A risk assessment could be undertaken to consider what might happen if this occurred.
- It is estimated that two-thirds of graduates will never pay off their student loans. There is potential to examine the extent of non-repayment of student loan debt among moderate earners such as social workers, nurses and teachers and consider whether there are other options for student finance.
- We know very little about the extent to which social work students access student services and other sources of financial information, such as the Money Advice Service, for financial advice. Are steps needed to help students make the most of these services?
Jo Moriarty is Senior Research Fellow and Deputy Director at the Social Care Workforce Research Unit. The report, which she co-authored with Jill Manthorpe, is available for download.
In January 2018, the cybersecurity world was hit by two Intel vulnerabilities, Meltdown and Spectre, affecting a substantial number of the world’s computer processors designed by Intel, AMD and ARM. From smartphones to PCs, supplied by any vendor and running almost any operating system, the vulnerabilities affected practically any modern computer.
Despite some patches being issued for the devices affected by these vulnerabilities, there has not been a complete solution and the vulnerabilities still represent a significant security risk to the health industry, especially with regards to the medical devices that it relies on so heavily. These medical devices are controlled by an application, meaning they can be directly compromised by Meltdown and Spectre. Unfortunately, because these vulnerabilities are part of the processor, the security protections that are usually in place are irrelevant. The vulnerabilities exist in the underlying system architecture of the medical devices, so can be exceptionally long-lived, providing attackers with sufficient time to develop direct attacks.
What are the effects?
The health industry relies on the use of so many medical devices every day, including things like MRI machines and pacemakers. It is likely for these devices to be compromised, putting patient data and safety at risk.
The vulnerabilities create the possibility for hackers to steal very sensitive patient information and personal data. This is to do with the memory of the application. For example, a hacker would be able to figure out how and when sensitive data is accessed or transmitted, then steal that specific information related to that patient from memory before it is sent over the network encrypted by SSL of the Operating System.
Equally, through vulnerabilities like Meltdown and Spectre, unauthorised people may gain access to more personal information from the backend systems. Credentials and keys required to access connected or backend systems, if exposed, would allow an attacker to further compromise systems containing more information and that of many patients.
It’s no quick fix
When it comes to mitigating the vulnerabilities on devices, it is going to take time to patch and update the large number of systems affected and, it could be that not all medical devices will ever get updated. Although some patches have been issued, many have been recalled as they haven’t helped, in some cases they have actually made things worse. The most poignant example is that Intel recently pulled back the patches they issued for Spectre. The process is already fairly slow, and patch recalls are certainly not going to help.
Despite these patching difficulties, it is still possible to increase the security around Spectre, and application protection can provide this.
Protecting applications against Spectre involves hiding key materials, hiding data, and making the application and its control flow more difficult to instrument. There are several techniques which facilitate this, including white box cryptography, data encryption and control flow obfuscation. With white box cryptography, the key to the data is never resident. This means for attackers to gain access to any data, they would have to pull back and reverse most of the application before figuring out how to replay the authentication, making it very difficult to make any progress towards accessing patient data.
Meanwhile, changing the control flow makes it more difficult to instrument the application and identify areas of interest, meaning identifying the registers or the memory locations in order to extract information becomes a lot harder. Encrypting the data within these registers or memory locations then adds another layer of protection as it hides the important values when not immediately needed. If an attacker does manage to exfiltrate the register or memory location, if the data is encrypted, they would have to figure out how to decrypt that piece of data which, unless they have the key, is significantly difficult to do.
What does the medical industry need to do?
With cybersecurity beginning to frequent the national news, more and more people are worrying about the security of their devices, applications, and internet. When it comes to medical devices, patients may start to feel less comfortable with those used for their treatment. Companies need to start promoting the efforts they are making to secure their medical devices, and the applications are used to control them. Whilst they do not need to flaunt their security strategy in front of attackers, patients need to be able to feel confident the medical devices being used for their treatment have been properly secured. Much of the time it is unlikely doctors or hospital staff will be able to explain the security behind the devices they are using. It comes down to the argument of clinical functionality and treatment being a higher priority than cybersecurity. Really, it is the manufacturers of the devices who are responsible for ensuring and demonstrating the security of the medical devices
Rusty Carter, VP of Product at Arxan Technologies
Healthcare presents a major opportunity for start-ups aiming to transform industries using technological innovation. The NHS is a healthcare delivery system on a massive scale. Our system needs to adapt to meet coming challenges – an ageing population and increasingly complex health and care needs. As demand increases, finances and workforce capacity are not keeping up. Incremental change will not supply the necessary solutions. Instead “step change” innovation is needed.
Technological innovation can enable disruptive change, but the NHS needs to look both within, for ideas generated by front-line staff in response to unmet needs and to industry to find innovative solutions to service redesign challenges.
A variety of emerging and established technologies are likely to play a huge part in leading innovation in healthcare in the next decade, from artificial intelligence to 3D bio scanning and printing, and precision medicine such as biomarker based diagnostics and therapeutics, robotics, blockchain and the Internet of Things (IOT).
A current example of a service improved through technological innovation can be found in the EarFold® implant invented by Mr Norbert Kang, a consultant plastic surgeon from Hertfordshire. EarFold® is an alternative procedure to correct prominent ears, which is thought to affect 1-2% of the UK population. The procedure inserts a material called a Shape Memory Alloy under the skin of the ear. In time cartilage re-forms around the implant, and the ear bends permanently into its new shape. This rapid and effective process, under local anaesthetic, has fewer side effects than normal otoplasty surgery and is far less intrusive.
Mr Kang had his idea after a patient died under general anaesthetic, during conventional otoplasty surgery to pin back her ears. With the help of medical technology consultancy Health Enterprise East, Mr Kang formed a spin-out company with West Hertfordshire Hospitals NHS Trust called Northwood Medical Innovation in 2010. Five years later, the company was bought by global pharmaceutical company Allergan and the product is now selling widely across Europe.
Hurdles to be jumped
As opportunities beckon there are unavoidable challenges in the UK healthcare system. The NHS needs to focus on improving value for every pound that it spends, but technology developers need commercial returns on investments to re-invest in further generations of products.
If these possibly competing interests are to balance, developers need access to clinical experts within the health service, to help them develop products that offer improved health outcomes at lower costs. User needs drive innovation, so insight in to those needs from the perspective of both service and patient is critical in the early stages of product development.
Examining the future of healthcare over the years to come, there are many drivers for change. There is an increasing need for new Models of Care including more patient-centred, personalised medicine, and better service integration. This can be achieved through better use of ICT and communication tools, and could see the beginning of the seven-day NHS. New treatments for chronic disease such as diabetes, cardiac disease, stroke, lung disease, and cancer will be needed, including increasingly targeted drugs, earlier and more accurate diagnoses, new technologies and health delivery systems. There will also be a drive toward less invasive, more out-of-hospital care.
These innovations can be holistically encouraged by drawing together respective service and patient needs, clinical insight and entrepreneurial technology developers from the UK’s thriving start-up community. These developers will save both time and cost during the product development phase. Meanwhile, the benefit to the NHS will come in affordable and appropriate products, with patients profiting through access to new treatments, more personalised services and increased empowerment.
Markets: we have been warned
The privatisation of adult social care is a 30-year process that has grown unchecked, made worse by austerity politics. Should the private sector lose interest and leave the market, the consequences will be grave. Bob Hudson writes that, whilst it is not feasible to eliminate a model that has become so deeply embedded, improvement is possible. He explains how this would include a combination of better funding and smarter commissioning. To read the full argument, go to http://blogs.lse.ac.uk/politicsandpolicy/adult-social-care-is-privatisation-irreversible/
From contracting out to spining off
The Health Services Journal reports that 3,000 NHS estates and facilities staff – cleaners, porters and maintenance teams – are employees of eight NHS Trust owned subsidiaries. Most of these workers have been transferred from the parent Trust. The Journal’s research suggests that a further 8,000 NHS employees may be transferred to similar subsidiary companies in the near future. The number of staff moving depends on the extent of outsourcing to private suppliers. These spin-off companies may pay less VAT (a loop hole that will close quickly, NfN moles say) as well as saving on pay by recruiting new staff on less expensive non-NHS contracts. NHS Trust staff that are currently transferring will retain NHS terms and conditions. (Lawrence Dunhill HSJ 14/2/18)
Health and homelessness
A new study that maps primary health care services for people who are homeless in England finds significant variation in the type of service available, with some areas poorly covered.
Of the 900 homelessness projects (hostels and day centres) that were surveyed by the researchers, only 43% were linked to a specialist primary health care service. Homelessness projects in smaller towns and rural areas, and those working with young people who are homeless, were much less likely to be served by a specialist primary health care service.
In this study information was collected from 243 homelessness projects not linked to a specialist primary health care service about their views and experiences of primary health care arrangements for their clients:
- One in 10 managers of such projects (11%) said that their clients experienced ‘a lot’ of difficulties accessing primary health care services;
- Nearly half (47%) said that their clients experienced ‘some’ difficulties;
- Fewer (43%) said that there were no problems;
- Difficulties were most commonly reported by managers of projects in parts of NHS Midlands and East Region, and the South West and South East Regions.
The researchers identified 123 specialist primary health care services, spread across the five NHS England regions. Some were a specialist health centre primarily for people who were homeless, some were mainstream GP practices that provided additional services to people who were homeless, some were a mobile homeless health team that ran clinics in hostels and day centres used by homeless people, and a few were provided by volunteer health staff.
In 29 of the 35 largest cities in England outside London at least one specialist health service was identified. Of the 32 London boroughs and the City of London, only 14 were known to have a specialist primary health care service.
Dr Maureen Crane, the study’s lead researcher, said: ‘At present there are evidence gaps to guide health service commissioners and providers about the most appropriate types of primary health care services for people who are homeless. Better understanding of the effectiveness of different models in different settings is crucial if their primary health care needs are to be successfully addressed.’
Homelessness is a growing problem in many areas across England, and can have a devastating impact on health and well-being. People who are homeless and sleeping rough or staying in hostels and shelters have significantly higher levels of physical and mental ill-health, and problematic drug and alcohol use, than the general population. There are many difficulties in addressing their health care needs.
Copies of the report are available on request. For more information, please contact firstname.lastname@example.org / 0207 848 7443.
Innovation, innovation, innovation!
The NHS is famous for inventing new treatments and tools, and then not using them. A way round this is being pursued by joint ventures between commercial, academic, local government and clinical organisations. A good example of this is Medtech Accelerator, a joint venture with NHS innovation hub Health Enterprise East (HEE) bolstered by investment worth £500,000 from Essex County Council.
Medtech Accelerator is a joint venture between the NHS and regional business partners, including Health Enterprise East (HEE), New Anglia and Greater Cambridge Greater Peterborough (GCGP) Local Enterprise Partnerships (LEPs), the Eastern Academic Health Science Network (AHSN) and Essex County Council.
The organisation supports innovators within the NHS at the earliest stages in the product development pathway, by offering funding as well as practical advice on commercialisation and regulatory issues to help ensure that innovations that are inspired from the frontline of the NHS get to market as quickly as possible. The awards are aimed at supporting proof of concept work with the view to creating future spin-out companies that will be established across the region.
Medtech Accelerator has so far funded seven individual projects, with awards amounting to £670,000. One project within the portfolio has also allowed Medtech Accelerator to take its first equity holding in a spin-out company. Projects that have received financial backing range from enhanced tissue ablation technology, used in the treatment of tumours, to a safer technique for administering anaesthesia. This funding has brought innovators closer to selling and marketing their innovations, and given them access to guidance at crucial junctures on issues such as building and designing prototypes and conducting human study trials. Read more at www.medtechaccelerator.co.uk
To screen or not to screen?
Prostate cancer has hit the headlines recently for being more common than breast cancer, and, inevitably, there are calls for screening. Should the NHS set up a screening programme? The much-esteemed Academic Health Economists weekly commentary on health services (aheblog.com/2018/02/05/chris-sampsons-journal-round-up-for-5th-february-2018/) says “not yet”. This is because over-detection and over-treatment are common and harmful. A recent systematic review of cost-effectiveness models evaluating prostate-specific antigen (PSA) blood tests as a basis for screening found 10 studies with results that are not consistent. None of the UK-based cost-per-QALY estimates favoured screening. A lack of good data seems to be part of the explanation for the inconsistency in the findings. “It could be some time before we have a clearer understanding of how to implement a cost-effective screening programme for prostate cancer”, conclude the economists.
Responding to the Home Affairs Committee’s immigration report, Cavendish Coalition co-convenor, Nadra Ahmed, said:
“This report highlights the huge challenges faced by UK employers in securing their current and future workforce during a period of great uncertainty.
“The health and social care system remains under intolerable pressure and so we simply cannot afford to lose the talented EU staff we currently employ. Faced with shortages of key staff and skills which cannot be met domestically, it’s imperative we do not continue to see fewer colleagues choosing the UK.
“We welcomed the December confirmation that the rights of EU citizens will be protected– but now is the time for more detail.
“Employers and staff urgently require clarity on the next steps – not just for those who are currently in the UK, but for those who arrive during the transition period and beyond
“The Cavendish Coalition remains ready and willing to support the Government during this critical phase of negotiations.”
New research among more than 2,000 UK adults commissioned by HealthTech start-up WeMa Life has revealed the struggles informal carers face. The independent, nationally representative survey found:
- 15% of UK adults currently consider themselves to be informal carers – equating to 7.85 million people
- On average, an informal carer spends 13 hours a week taking on duties such as cooking, cleaning and caring for someone close to them
- 53% of informal carers say the role has had a significant impact on their emotional state
- 30% of carers have fallen out with friends and family because of tensions around their responsibilities
- Two fifths (39%) say the financial burden of being an informal carer has prevented them from leading the lifestyle they want
- 35% would pay for professionals to take on the carer duties but cannot afford to do so
- 77% of informal carers across the UK – 14.08 million people – think they ought to get more support from the Government
Acting as an informal carer is causing significant stress and financial strain to almost 8 million people across the UK, new research commissioned by HealthTech start-up WeMa Life has revealed.
An informal carer is any individual giving regular, on-going assistance to another person – typically a family member, friend or neighbour – free of charge. According to WeMa Life, 15% of UK adults currently consider themselves an informal carer, equating to 7.85 million people across the country, while a further 10.5 million (10% of UK adults) have previous acted as an informal carer for someone.
On average, these informal carers – both presently and from years gone by – spend 13 hours a week performing these duties. Moreover, the study uncovered that being an informal carer has had a huge impact on their day-to-day lives.
More than half (53%) of informal carers say the role has put them under notable emotional stress, with 30% stating that they have fallen out with friends or family members because of tensions around the responsibilities they have taken on.
Almost two fifths (39%) of informal carers have been prevented from leading the lifestyle they want or previously had because of the financial strain of the role. Meanwhile, 35% say they would pay for professionals to take on the carer duties but cannot afford to do so.
As a result of the significant disruption it causes to their lives, the overwhelming majority (77%) of informal carers believe the Government must do more to offer financial, emotional or educational support to informal carers across the UK.
Rohit Patni, CEO and co-founder of WeMa Life, commented on the findings: “Today’s research sheds light on a hugely important issue. Whether for a close friend, elderly relative or long-time neighbour, many people at some stage in their life take on the responsibility of being an informal carer for someone close to them. However, in doing so they are clearly putting a massive financial and emotional strain on their day-to-day lives.
“More support is clearly needed for the country’s informal carers. Technology stands to make things far easier, with digital solutions making it simpler for people to manage and monitor their health. But the survey has also uncovered a clear desire among informal carers for the Government to offer greater support to those sacrificing time and money to care for their loved ones.”
9:30 am Arrival & Registration
Plenary Session 1
10:10 The people’s stake: Can citizen’s wealth funds solve the inequality crisis?
Stewart Lansley, University of Bristol & City, University of London
10:35 Socioeconomic inequalities in stillbirth rates in Europe: Measuring the gap using routine data from the Euro-Peristat Project
Prof Alison Macfarlane
11:00 Data in Society: Challenging Statistics in an age of globalisation. A progress report on the Radstats collection
Jeff Evans, Humphrey Southall and Sally Ruane, Radical Statistics
11:20 Coffee/Tea break
11:40 Workshops I (choice of)
Citizen’s wealth funds: pros, cons and alternatives
Socioeconomic inequalities and reproductive health
12:40 pm Lunch
Plenary Session 2
1:40 Inequality and Intimate Partner Violence against Women
Dr Jude Towers, University of Lancaster
2:05 Greentown by numbers: exploring the feasibility of a new low- or zero-carbon town in the UK
Dr Mike Page, University of Hertfordshire
2:30 Coffee/Tea break
2:50 Workshops II (choice of)
Housing and inequality: Has Grenfell lifted the lid?
Measuring violence: opportunites and treats
Full details and booking
Today is the launch of The Origins of Happiness by Andrew Clark, Sarah Flèche, Richard Layard, Nick Powdthavee and George Ward. Prof. Layard outlines the key findings and recommendations from the research.
Over the course of our lives, what factors stand out as having the biggest impact on our wellbeing? All else being equal, what single element, or group of elements, make a difference to how anxious or dissatisfied we are with our lives?
I and my colleagues looked at the evidence from survey data on over 100,000 individuals in Australia, Germany, the UK and the US to discover what the origins of happiness might be.
WHAT DID WE FIND?
- Schools and teachers matter: Schools and individual teachers have a huge effect on the happiness of their children. Indeed, the school that children attend affects their happiness nearly as much as it affects their academic performance.
What’s more, if we wish to predict which children will lead satisfying adult lives, the best indicator is their emotional health at age 16. This is more important than their academic qualifications right up to the age of 25 – and more important than their behaviour in childhood.
- Children’s emotional health is vital: The best predictor of an adult’s life satisfaction is their emotional health as a child.
- Relationships count: Most human misery is due not to economic factors but to failed relationships and physical and mental illness. Even in poor countries, mental illness accounts for more misery than physical illness does.
- Tackle mental illness: Eliminating depression and anxiety would reduce misery by 20% while eliminating poverty would reduce it by 5%. Mental illness deserves a much greater share of resources in every country.
- Rethink inequality: The fundamental inequality between people is the inequality of wellbeing, not the inequality of income. Those who most need help are the miserable, whatever the reasons for their misery.
- Life satisfaction predicts elections: In European elections since 1970, the life satisfaction of the people is the best predictor of whether the government gets re-elected – much more important than economic growth, unemployment or inflation.
WHAT DOES THIS MEAN FOR POLICY IN THE UK?
Public policy needs a new focus: not ‘wealth creation’ but ‘wellbeing creation’. Public expenditure, taxation and regulation should increasingly be based on evidence about how they affect the subjective wellbeing of the people.
Andrew Clark of the Paris School of Economics is a professorial research fellow of the Centre for Economic Performance. Sarah Flèche is a research officer in CEP’s wellbeing programme. Richard Layard is founder director of CEP and its wellbeing programme. Nick Powdthavee and George Ward are research associates in CEP’s wellbeing programme.
- Research from the 2017 Britain’s Healthiest Workplace survey (BHW) has revealed that employees lose, on average, the equivalent of 30.4* days of productive time each year as they take time off sick and underperform in the office as a result of ill-health (otherwise known as presenteeism)
- This is equivalent to each worker losing six working weeks of productive time annually
- Productivity loss due to physical and mental health issues is costing the UK economy an estimated £77.5** billion a year
- Worryingly, employee work impairment and the associated productivity loss appears to be on a worsening trend, up from 27.5 days and £73 billion respectively in 2016
Shaun Subel, Director of Corporate Wellbeing Strategy at VitalityHealth, said: “The Britain’s Healthiest Workplace results illustrate the significance of the productivity challenge facing the UK, but importantly also point to an exciting alternative in how employers can approach this problem.
“For too long, the link between employee lifestyle choices, their physical and mental health, and their work performance has been ignored. Our data demonstrates a clear relationship – employees who make healthier lifestyle choices benefit from an additional 25 days of productive time each year compared to the least healthy employees, and also exhibit higher levels of work engagement and lower levels of stress. As a result, effective workplace health and wellbeing solutions can deliver tangible improvements in employee engagement and productivity, and make a significant impact on an organisation’s bottom line.”
*Figure calculated using an average work impairment of 11.7% and an average working year of 260 days. Work impairment is calculated using the Work Productivity and Activity Impairment (WPAI) Scale across the 31,950 employee participants in Britain’s Healthiest Workplace 2017.
**Figure calculated using ONS statistics for the period July-September 2017, and making adjustment for part-time workers. £26,468 average wage; 32.324 million people in work (of which 8.439 part-time); 10.8% cost of lost productivity as a proportion of total wage bill (calculated from Britain’s Healthiest Workplace 2017).
***The Britain’s Healthiest Workplace research process took place between February and August 2017. It looked at a number of lifestyle, mental wellbeing, clinical risk and productivity factors amongst 31,950 employees, together with a broad view of leadership and cultural dimensions and organisational policies, practices and facilities that could directly impact on employee health, across 167 companies. Results based on UK workforce as reported by each company surveyed.
Millions of Brits are ‘too busy’ to be healthy, a study has found.
A poll of 2,000 adults found more than half want to eat healthily and get plenty of exercise – but are hindered by their hectic lifestyles.
Two thirds admit they often eat ‘badly’ because they don’t have the time to prepare nutritious food.
And 75 per cent revealed they skip meals entirely for the same reason.
It also emerged, three quarters have avoided going to the gym because they have been too rushed off their feet.
In fact, more than one fifth have cancelled memberships altogether because they have been too busy to attend sessions.
Commissioned by healthy recipe box company, Mindful Chef, the research found two thirds are worried about the impact their hectic lifestyle could be having on their health.
Giles Humphries, co-founder of Mindful Chef,www.mindfulchef.com, said: “Whilst the importance of a healthy diet is becoming increasingly recognised, it’s clear a huge proportion of us need more help to achieve a healthy lifestyle.”
The research also found one third don’t have the time to plan ahead to ensure they eat healthy dinners throughout the week.
Amid this, six in 10 said they find it difficult to find recipes which inspire them to eat more nutritious meals.
When those polled do find the time to buy food from supermarkets, 68 per cent said they choose unhealthy meals because they believe it is quicker to prepare.
And half have skipped breakfast, lunch or dinner when they haven’t had enough time to do a food shop.
Incredibly, those surveyed said they typically skip mealtimes a whopping 136 times a year in total as a result of their chock-a-block lifestyles.
Giles Humphries added: “Our research found of those who have tried a recipe box, eight in 10 said it made eating healthily easier.
“We think this shows a healthy lifestyle is possible – even for the large chunk of us who lead incredibly busy lives.”