News, Thought leadership

Becoming a “science superpower”; more than words on a page

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life sciences sector

In late July, The Economist declared that there is “no better example” of Britain’s strengths than the life sciences sector. To what extent have the government’s ambitions translated into action?


Earlier this month, former Conservative minister, William Hague, described ensuring that Britain becomes a science superpower as “the single most important activity” for the incoming Prime Minister.

As the final two candidates for Conservative Party leadership were announced, former Science Minister, George Freeman MP, stated he would back “whoever as Prime Minister will best put science technology & innovation at the heart of our economic plan”. Lastly, in their most recent report, the House of Lords Science and Technology Committee hailed the “exceptional science and technology base in the UK” but highlighted that without continued commitment, “science and technology superpower” would simply be an empty slogan.

The desire for the United Kingdom to cement itself as a flourishing and competitive life sciences, research and development, and innovation nation is evident. This was recognised in the 2019 Conservative Party Manifesto, which detailed commitments to the life sciences sector, vaccine development and medicines. It was here that the ambition to make the UK “the leading global hub for life sciences” was cemented.

Key stakeholders in the sector have launched the campaign to keep the delivery of the Life Sciences Vision at the top of the agenda. But in the face of the cost-of-living crisis, questions regarding the integrity and character of Boris Johnson, and a seemingly ever more divided Conservative Party, it’s position of importance seems to be slipping.


A strong foundation

It is not news that science and technology in the UK has a long and established history, greatly contributing to the field globally. From Newton, to Darwin, Franklin, Crick, Berners-Lee, Hawking, Lovelace and Fleming, many greats in the history of UK science need no introduction.

This legacy of excellence, combined with world-leading Universities and political will has translated into the UK continuing to play a leading role in further the advancement of science. Through the 100,000 Genomes Project and the development and deployment of the Oxford-AstraZeneca vaccine to help tame the Covid-19 pandemic, to name but two examples.

In announcing the 100,000 Genomes Project, former Prime Minister David Cameron said that “it is crucial that [the UK] continues to push boundaries [of science]”. Since then, through continued support along with scientific and political will and investment, the UK has truly established itself as a global genomic superpower.

Additionally, in building upon the strength of the UK’s universities, the formation of a life sciences cluster has become ever more prevalent, the three most prominent of this cluster being the three corners of the “golden triangle”: Oxford, Cambridge and London. With the announcement of £900 million being invested to expand the Stevenage UK Bioscience Hub, creating up to 5,000 jobs, the potential to expand the sector further is clear.

Considering few industries have greater growth potential than life sciences, even in the midst of current political and social challenges, the will to deliver the UK’s mission to become a science superpower must not waver.


An empty slogan?

The UK presents a ripe environment within which the life sciences sector can continue to thrive and yield great benefits to society and the economy. However, if development of the sector is not resourced, the UK will only run the risk of falling further down the global leader board.

The impact of the Covid-19 pandemic has been felt across the healthcare sector, greatly impacting the NHS; however, decline in the delivery of research, for example, has been noted since 2017. While the pharmaceutical industry invests more in R&D than other sectors, since 2012, the share of global pharmaceutical R&D expenditure – according to data from the ABPI – has fallen from 7.7 per cent to 4.1 per cent. Prior to that, since 2010, the UK has fallen from 4th to 98th place in overall trade balance in pharmaceuticals.

As stated in The Economist, “real change requires political will”, rightfully setting out the mission for the next Prime Minister. While recent debates and hustings have focused upon economic growth through tax cuts, playing to the UK’s strengths will be mission critical. The life sciences sector lies at the heart of achieving that vision.

Supported by the Life Sciences Vision, Genome UK, The Future of Clinical Research Delivery and the Government Office for Science, to name but a few, the stage is set for the UK to propel itself to the top of the global science and tech leader board. If it fails to harness the potential of the life sciences sector, the “science superpower” mission statement will be nothing more than letters on a page. It’s down to the next Prime Minister to not let this opportunity slip the nation’s grasp.

News, Thought leadership

What should integrated care partnerships be prioritising?

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integrated care partnerships

As the wheels of integrated care begin to turn, Eliot Gillings explores exactly what integrated care partnerships should be prioritising, and why.


An integrated care partnership (ICP) is ultimately responsible for the creation of an integration strategy that can inform the work of integrated care boards (ICBs) and partner organisations. Looking at short-, medium-, and long-term challenges to the delivery of health and care (which may impact certain regions disproportionately), the ICP has the opportunity to assess and address health inequalities through system-wide action.

Key to enacting system-wide action will be the development of collaborative networks between ICPs and partner organisations, including social care providers, charity and volunteer groups, primary care networks and others. Beyond enabling a more holistic and personalised provision of care, an institutional emphasis on collaboration will enable an ICP better understand the challenges faced by their systems and their populations.

In building that network, however, it will be key for ICPs to deliver short-term solutions to health inequalities within their systems, which will, in turn, necessitate the rapid establishment of institutional priorities. Accordingly, the following list highlights some key areas of consideration for ICPs as they continue to grow as statutory bodies.


     1. Closing the gap on data inequality

One of the central purposes of ICSs is reducing health inequality through population health strategies. However, while ICSs and health organisations already engage and utilise several sources of information, the development of new information-sharing networks should be a key priority to expand the assessment of outcomes and improve the provision of care.

Accordingly, ICPs should seek to explore the variety of local partners and stakeholders engaged with communities whose health data does not currently feed into the system level. This is of particular consideration for systems where deprivation is unevenly distributed amongst certain demographics – but also those that experience high levels of digital exclusion.


     2. Finding new solutions to inclusion health challenges

ICSs generally face challenges meeting the health and care needs of socially or economically excluded people. This is especially true of systems that already experience high rates of economic or social deprivation. Meeting the needs of people who are socially excluded and may experience multiple overlapping risk factors as a result, is particularly challenging from a population health perspective as they may be inconsistently accounted for in health databases.

To address these groups, ICSs must work to build information-sharing relationships with third-sector organisations and local groups who may offer services to socially excluded individuals and build relationships with the communities and individuals themselves. This work should also involve regular assessments of the impact of information sharing on health outcomes among these populations. Constant collaboration with partners and stakeholders to adjust the collection of information and the provision of care and outcomes should also be prioritised.


     3. Developing novel approaches to information

Building out a network that includes partners and stakeholders engaged with underrepresented and/or excluded groups and individuals is one means to improve access to data. However, the utilisation of new forms and sources of data will also be a key consideration for ICPs. For instance, ICPs may consider exploring a ‘whole-family’ approach to care, where the knock-on impacts of health within family units are considered within a strategy.

Strategies for the use and integration of new information should also be developed in conjunction with partner organisations and designed to address the particular needs of a system. However, it is key that frameworks for information sharing remain consistent to improve collaboration between ICSs.


     4. Utilising all levels of ICS functions

Often, individuals or organisations will be better served by engaging with an ICS at the neighbourhood or place level. This is particularly important when health inequalities are considered, as outcomes may drastically differ within a health system and a lack of engagement with health authorities may serve as a blocker to the delivery of improved outcomes to a vulnerable group. Accordingly, ICPs should ensure that well-developed strategies are in place to engage at these levels, and form insights that can inform work at the neighbourhood, place, and system level.


     5. Provisioning for social care

The adult social care landscape contains a diverse range of providers. Many are small enterprises which may have competing priorities, but these organisations nonetheless have close ties to the communities and individuals they serve. They may also provide care to individuals whose needs are misunderstood or not met in traditional health care settings. As such, they are an incredibly valuable resource to ICPs, particularly those keenly engaged with finding solutions to the health inequalities faced by the socially excluded.

It will be crucial that ICPs do not come to speak for these providers, but rather serve to connect them to a broad network of information-sharing that can simultaneously improve their provision of care and deliver insights to improve health outcomes elsewhere. ICPs should, therefore, prioritise outreach to adult social care providers for the delivery of short-term solutions to health inequalities.

Thought leadership

If integrated care is to be delivered locally, then it must be discussed locally

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The ICS Roadshow

Public Policy Project’s ICS Roadshow offers the only opportunity for the wider health and care community to identify challenges and opportunities of integrated care at a truly local level.


Now that integrated care systems (ICSs) are officially here, it’s time to maximise their value by tapping into their strengths. That is, delivering localised, personalised high-quality care for local citizens and reducing health inequality.  

For these systems to bear fruit and make meaningful impacts on the nation’s increasingly complex health challenges, then discourse surrounding integrated care must become more granular. If this is indeed to be ‘national policy delivered locally’, then visiting specific regions and assessing their progress and challenges at a local level will surely be the most effective means to scale success. 

Building to a localised approach

The arrival of integrated care systems (ICS) as statutory bodies earlier this month marked the beginning of the UK’s journey towards reframing health and care. Bringing together the NHS, local authorities and the third sector to allocate resources and deliver care to patients, the strength of the ICS is its ability to adapt to a region’s needs.  

Central to both the NHS Long Term Plan and Health and Care Act, the 42 ICSs that span across England are all comprised of integrated care boards (ICBs) and integrated care partnerships (ICPs). While the ICB’s essential function is to deliver NHS services in the ICS area, an ICP works to develop and deliver the ICS strategy with a broad range of local stakeholders.  

The ICS itself works over three levels – the first being the system level, across which the ICP and ICB work, and where the broad strategy for an ICS area is planned and delivered. The second level is the ‘place’ level, at which localised services and community care are planned in close conjunction with local Health and Wellbeing Boards. The third is neighbourhoods, or localities, which focus on specific areas within places – such neighbourhood organisations include primary care networks. This allows ICSs to respond to needs of specific communities or demographics that may find themselves underrepresented even at the ‘place’ level.  

The delivery of health and care within an ICS, as such, will require the ICP to work across all three levels of the ICS area to accurately assess need and develop individualised plans of action. The ICB, too, will need to work closely with stakeholders at every level to ensure their provision of care is maximally responsive. Accordingly, even though the ICS model allows for a more personalised delivery of care than its predecessors, there is a pressing need for stakeholders at every level to establish collaborative working relationships – both within and without their own ICS area.  

The PPP ICS Roadshow will take place across five cities across the UK, and will serve as an opportunity for members and stakeholders in local ICSs to discuss their roles in delivering fairer, more adaptive and responsive health and care systems.  

The ICS Roadshow will be a valuable opportunity for the members and stakeholders of nearby ICSs to connect, share expertise and best practice, and collaborate with organisations from further afield. It will also, however, serve to showcase the diversity of health and care challenges across the UK – and the need for ICSs to equip themselves to deal with these challenges accordingly.  

Below is a brief profile of each of the stops on the ICS Roadshow, outlining the diversity of health and care challenges different ICSs must approach and showcasing their potential to respond to acute needs within their areas.  

Birmingham 

  • 40 per cent of Birmingham and 12 per cent of Solihull residents live in the most deprived communities in Britain. 

Birmingham is demographically one of the most diverse regions in the UK. It is also one of the most socially and economically deprived. This poses a unique set of health and care challenges, particularly as communities may find themselves isolated or underrepresented for myriad social, cultural and economic factors.  

Birmingham will be the first stop of the ICS Roadshow and will host systems leaders from the Birmingham and Solihull ICS and Black Country and West Birmingham ICS. The session will not only be an opportunity to discuss how people can be empowered by integrated care, but how these systems can best modify and develop themselves to respond to the needs of their evolving demographics. 

Bristol  

  • Bristol reports a higher rate of common mental health conditions than the rest of England, at20.7 per cent, versus 15.5 per cent across the rest of England. 

Bristol boasts a high healthy life expectancy, low levels of cancer, and an infant mortality rate that is one of the lowest in the country. However, Bristol still faces unique challenges from an ICS perspective. With the second highest suicide rate in the country, the Healthier Together Partnership (an ICS which accounts for Bristol, North Somerset and South Gloucestershire) has made developing mental health services of all varieties a key priority.  

Bristol also has the second highest rate of diabetes in the country, and an ageing population. As such, preventative, early intervention and holistic care system are a particular priority in the region, and are likely to be especially well served by work at the neighbourhood level which focuses on outreach to the elderly.  

The Healthier Together Partnership also presides over an area with an acute shortage in its care capacity, having the lowest number of G&A and CC beds per capita in the country. Utilising the ICS effectively to relieve pressures on staff and deliver care more effectively and efficiently will, as such, be crucial to the ICS. Accordingly, this session will be of keen interest to ICS stakeholders seeking to find solutions to capacity problems.  

Manchester  

  • As one of the early adopters of the ICS model, and operating under a devolution settlement, the Greater Manchester Health and Social Care Partnership already has more than 5 years’ experience serving 2.8 million people living across ten boroughs. 

As one of the first ICS systems in the country, the Greater Manchester Health and Social Care Partnership already boasts a robust governance structure that serves as an example of the potential of the ICS framework.

More than two thirds of early deaths in the Greater Manchester region are the result of preventable causes, such as smoking, alcohol dependency, poor diet or air pollution. As a result, the Greater Manchester Health and Social Care Partnership has embarked on a series of targeted campaigns designed to promote healthier lifestyle choices, improve access to support, and directly engage with the communities most affected.  

The delivery of these programmes has relied on Greater Manchester’s strong system of governance, which has established protocols for governance and accountability that deliver the consistency of delivery that other ICSs will strive towards in the coming years. This session will be a valuable opportunity to see how the ICS model can be leveraged to address community-specific issues, and how the frameworks to deliver that support should look.   

Leeds  

  • There has unfortunately been a rise in the infant mortality rate in Leeds since 2013/15, and a persistent gap in outcomes between more deprived areas of Leeds and Leeds overall. 

The West Yorkshire ICS, who PPP will host at the fourth instalment of the ICS Roadshow, is a prime example of the importance of ICPs within an ICS. There are significant inequalities between the more deprived areas of Leeds and Leeds overall – the third highest in the country – and there is a significant geographical element to this inequality. As such, the role of ‘place’ level leaders will be instrumental to closing the gap and delivering better health and care outcomes within the ICS.  

The West Yorkshire ICS is currently prioritising the delivery of improvements to infant mortality and reducing mortality amongst those living with learning disabilities and autism. This instalment of the roadshow will accordingly develop insight into how ICSs can rise to the challenge of delivering highly personalised care based on a social model for health.   

London  

  • In 2019-20, those in the 90th net income percentile in London took home 10.8 times more than those in the 10th net income percentile. 

The final date of the ICS Roadshow will see PPP play host to the 5 ICSs that serve London. While London faces several unique health and care challenges due to its size and diversity, lessons from the development of London’s ICSs will be valuable to system leaders across the country.  

London’s extreme wealth inequality, and the geographical proximity of some of its most affluent and most deprived areas mean that its ICS systems will arguably have the largest gaps in care to close – and how they adapt their governance and outreach across the three ICS levels will be key. Each of its ICS systems are actively working to develop systems of care that reach diverse and often fragmented local communities, and the final instalment of the roadshow will be an opportunity to share their best practice.  

The ICS Roadshow kicks off on September 13th and runs through to November 1st 2022. To find out how to get invovled, please visit our Roadshow homepage.

Thought leadership

Sickle Cell Disorder: Recognising health inequalities in genomics research

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genomics health inequalities

Can the UK regard itself as a Life Sciences Superpower without addressing the inequalities present in the healthcare system? Public Policy Project’s (PPP) Grace Girling continued discussions held at the Global Genomics Conference with Kye Gbangbola, reflecting on the problems faced by those living with Sickle Cell Disorder and the crucial reasons why diversity must be engrained in genomics research.


Global Genomics Conference in May 2022 hosted a variety of discussions encompassing the policy and ethical considerations of furthering genomics’ widespread benefits to ensure they reach all pockets of global society.

Kye Gbangbola, former Chair of the Sickle Cell Society and central member of the Sickle Cell and Thalassaemia All Party Parliamentary Group, articulated the barriers to greater diversity in genomics in the first session of the in-person conference.

Kye works tirelessly to transform the current healthcare system into one which is equitable and accounts for everyone’s needs. His upcoming book “The Sickle Cell Guide” is a comprehensive source of extensive information on sickle cell disorder (SCD), to help organisations and individuals on their journey of understanding and better healthcare.

The treatment and care of Sickle Cell Disorder (SCD), an inherited blood condition which affects mainly people of African and Caribbean heritage, is a microcosm of existing health inequalities.

Currently, although it is the world’s most common genetic blood condition, there are just five approved treatments in the UK for a patient community of 15,000, compared to the 511 treatments for Cystic Fibrosis which has a patient community of 10,500. Kye immediately addresses that, “this is never about pulling anyone down, it’s about saying, what about us?”

Genomics offers the opportunity to ‘level up’; the primary concept of generating a fairer society. Hence, if the genomics ecosystem aligns correctly, this will have a profound positive impact on the Sickle Cell community through the development of effective treatments.

Following the conference and engaging in further dialogue with Kye, it is evident that advancing genomics carries the risk of continuing the trajectory of a healthcare system which sustains systemic inequalities. However, recognising and addressing such problems is achievable with the efforts of stakeholders from across the health and genomics ecosystem.

The meaning of genomics beyond science

The UK’s Life Sciences sector is at the forefront of the genomics revolution. Although it is clear that leading the advancement of genomics will solidify the UK’s position as a ‘Life Sciences Superpower’, understanding what this means for society, particularly marginalised communities, should not be lost through a myopic vision of this title.

For those living with SCD, genomics represents the opportunity of a life free from the unmet medical needs and daily burdens, such as ongoing physical and mental suffering, which result as the consequence of living with this inherited genetic condition. In addition to this, SCD patients face increasing multi-dimensional poverty, with over 66 per cent of people living with SCD in the UK living in the most deprived communities. Undeniably, genomics being applied to gene therapies will engender a much-improved quality of life for patients and their families.

If the human aspect is not convincing enough, genomics also has a huge economic case. As SCD results in regular hospitalisation of patients requiring resources from a myriad of disciplines, an effective, or even preventative, treatment would diminish the financial cost this necessitates – both on the patient and the wider health service. As such, the case has been made by Jonathan Salcedo, Jennifer Bulovic and Colin Young to show that a hypothetical cell or gene therapy for SCD is likely to be cost effective, with the large upfront costs being offset by significant downstream economic and human health gains.

However, diversity in genomics across the datasets and the wider ecosystem is crucial to the roll out of new treatments. Parallels can be drawn with Covid-19 with respect to health inequalities, felt both by certain ethnic groups and marginalised communities in and between nations as a result of underrepresentation in vaccine trials.

As reiterated by Kye, “Diversity should be a key trait of being a life science superpower.” To achieve this, systemic health inequalities and poor healthcare for marginalised groups must be addressed.

Health inequalities and equity in genomics

Currently, 40 per cent of people living with SCD fear going to hospital due to widespread poor care standards for the condition which carries a high risk of death. Following an inquiry into the preventable deaths of those living with SCD by the All Party Parliamentary Group on sickle cell and thalassemia, it was highlighted that race and inequality are at the root of these issues of poor care.

Raising awareness of this neglect is crucial in provoking systematic change in the healthcare system. The Sickle Cell Society’s report ‘No one’s Listening’ published recommendations based on this inquiry, which included high-level policy shifts to provide sickle cell patients with the standard of care and respect deserved.

As Kye emphasises, “Cell and gene therapies are here, delivering remarkable outcomes, people with sickle cell are being cured. These cures offer the opportunity to prevent and mitigate the harm that health inequalities cause. Genomics can act on communities as a key element of building and editing back better”.

If the purpose of the NHS Race and Health Observatory to remove health disparity could be embedded in health policy, we could avoid perpetuating the injustices of the past and move towards equitable healthcare for all in the future.

Design for equity and equality: Health is not just medical

Not only should equity be a key goal of the advancement of genomics, but the mitigation and elimination of existing health inequalities should be at the heart of the decisions taken by both the public and private sector stakeholders. Institutions should be continuously reflecting on how they can incorporate factors which will generate trust and alleviate public concern over accountability.

SCD is the world’s fastest growing, and most common genetic blood condition. People living with sickle cell are highly correlated with a lower socioeconomic status, this impacts health literacy, which limits the ability of this community of people to demand quality healthcare. This is a vicious cycle which can be tackled with initiatives to increase health literacy amongst disadvantaged groups, in turn this will also increase participation in clinical trials which will manifest into treatments with higher efficacy.

Presently, participation in clinical trials and research for treatments, including gene therapies, is hindered by the forms of employment marginalised populations are often engaged in which can be restrictive in terms of paid absence for participation. Specifically, individuals earning below 50,000 USD are 27 per cent less likely to participate in clinical trials.

These issues must not be side-lined, they must be at the centre of research design to provide adequate representation of marginalised groups. For example, positive action has been taken in the EU and in the USA to provide compensation as a component where work conflicts may act as a barrier to participation. This is particularly important for conditions such as SCD where diversity is imperative to the success of the research, resulting in an effective treatment.

Outlook for a fairer future

Genomics is the future of healthcare; however the present system is still not functional for all groups in society. The Sickle Cell community is just one example of a group which has faced decades of substandard care and lack of attention. As detailed, treatment for SCD would be beneficial in a multitude of ways.

In order to secure the UK’s position as a Life Sciences superpower, it is essential that health inequalities are recognised and not perpetuated by the cell and gene therapies that result from genomics research.

As stated by Kye “if we are serious about ‘‘levelling up,’’ we must acknowledge the misdeeds of the past and change policies and practices to create a fairer health service and ensure no one gets left behind.”

Thought leadership

Stagflation ahead: World Bank projects growth to slow while inflation rises

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World Bank stagflation

As the cost of living continues to rise and supply chain disruptions hamper industrial efforts, the spectre of a recession looms ever larger in the public’s imagination. Fortunately, according to the World Bank, the global economy is on track to avoid negative growth. Unfortunately, that’s the end of the good news.


Roughly six months ago the World Bank projected that global growth would slump in 2022, from 5.7 to 4.1 per cent. While 2021 had seen the global economy rally back from the 2020 dip precipitated by Covid-19, a growth rate of 5.7 per cent was seen as unsustainable – in large part due to the particularly slow recovery of EMDEs (emerging markets and developing economies) and LICs (lower income countries).  

However, last week the World Bank released the latest instalment of their Global Economic Prospects series and announced that their projection for global growth in 2022 had fallen from 4.1 to 2.9 per cent. 

Even more concerningly, the World Bank says that the tripartite of supply chain congestion, rising commodity process and Covid-19’s lingering presence could suppress those projections even further – though not enough to trigger a global recession. Instead, the world economy is likely to settle into a prolonged period of stagflation (meaning that commodity prices are likely to continue rising, while growth rates lag behind).  

Food poverty and insecurity 

The main reason for this downturn has been the war in Ukraine. Soaring prices and increased volatility have had a significant impact on the energy market. This has buoyed the fortunes of some exporters, however in the context of the global market these gains have been offset by headwinds in most other economies.  

Conflict in Ukraine has also seen a jump in agricultural commodity prices – which has in turn exacerbated food poverty and insecurity. These jumps in prices have not been accompanied by an upswing in the fortunes of exporters, however, as high energy prices have suppressed fertiliser production and accordingly affected yields.  

While the rise in agricultural commodity prices is set to impact the global community broadly, EMDEs and LICs will be hit particularly hard. Already, it is projected that per capita income in developing countries will drop almost 5 per cent below the pre-pandemic trend.  

However, as commodity prices skyrocket and economic growth remains tepid, the likelihood is advanced economies will begin tightening their monetary policies to rein in inflation – as they did in the 1970s. The raising of interest rates will, in turn, see the capital cost of economic growth rise in developing countries – which could precipitate a series of economic crises, as it did in the 1970s.  

The precarity of the position EMDEs and LICs find themselves in has very little to do with the exposure of individual countries to the Russian or Ukrainian markets. Rather, the reason 2022 growth forecasts have been downgraded for more than 80 per cent of LICs (and 70 per cent of EMDEs) is that food expenditure makes up a massive portion of household budgets.  

In fact, in LICs food consumptions accounts for nearly 45 per cent of household expenditure – and all LICs are food-deficit countries reliant on imports, leaving the governments of LICs minimal options to offset rising cost of living. 

Growing inequality  

The long-term impact of the economic suppression of EMDEs and LICs will be a slower global recovery. The most recent Global Economic Prospects report shows, as the edition released six months ago did, that EMDEs have started to see inequality gaps grow – despite those gaps steadily closing over the previous 20 years. Within developed countries these same trends are also visible, as they are in LICs.  

In EMDEs and LICs, however, the prospects for recovery are decidedly grimmer. Educations across many EMDEs and LICs have be affected by Covid-19, and the vast majority have mandated some form of school closure in response. As a result, almost 77 million children missed “almost all in-person time,” which has seen learning poverty dramatically increase. While the share of children under 10 who were unable to read was already 50 per cent before the pandemic, that number has now reached 70 and is likely to continue rising.  

In monetary terms, the impact of learning inequality will be disastrous for EMDEs and LICs, unless governments are able to find a way to recover losses. Otherwise, it has been estimated that the cumulative loss of lifetime earnings (in present value terms) for students affected by school closures could reach nearly £14 trillion.  

The international community must act decisively 

While the global economic outlook is rather bleak, and even more so for developing countries, there are a few saving graces. For one, the dollar is a lot stronger than it was in the 1970s, meaning international trade should be somewhat buoyed.  

Secondly, the increases in commodity prices have occurred more steadily, allowing central banks more time to plan their approaches. Thirdly, central banks are in stronger position than they were in the 1970s. But fourthly, and most importantly, central banks also have a better idea of how to ensure price stability and have accrued a strong track record for meeting inflation targets.  

That means that if the international community can act decisively and quickly enough, there is every reason to believe that the backsliding of the international community can be halted. That will, however, demand that countries make a greater effort to alleviate debt and rollout vaccines where they are currently not readily available. It will also require domestic supply-side responses from advanced economies.  

However, the World Bank warns that these efforts will need to steer clear of price controls, subsidies and export bans – lest their knock-on effects deepen the ongoing crisis. Instead, governments will need to “reprioritise spending toward targeted relief for vulnerable populations,” and take a hands-on approach to supporting developing economies.  

Thought leadership

The digital future of social care

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digital social care

On the 18th May 2022, PPP’s social care network came together for an evidence session entitled A Care System for the Future: Digital Opportunities and the Arrival of Caretech. In this session, participants discussed the benefits of digitisation for integration, digital tools for managing care, and technology to enhance quality of life. 


The opportunity for digital and data driven approaches to creating better patient pathways for social care has never been greater. Population engagement in digital technologies is at an all-time high, making this a unique opportunity, to integrate service design and improve the experience of those in the social care system.  

The impact of Covid-19 

Over the course of the Covid-19 pandemic, many aspects of life have moved online, and we have become increasingly dependent on digital systems. One network member described how “everyone was slightly too comfortable with operating on paper-based systems with forms for absolutely everything, when there was no national picture for what was happening in social care.”

The pandemic has driven forward the digitisation of social care, which has the potential to be benefit  staff and users alike. 

“Right now, I think we are seeing enough alignment between local authorities and the NHS and providers, to have some hope that we will see a significant mass adoption of basic infrastructure across health and social care for individuals to at least be known to the system.” 

“Integrated care systems will have a significant role in shaping the landscape of digital going forward.”

Digitisation and integration 

Network members explored how fully integrated organisations will benefit most from the use of technology. It was emphasised that “telecare paid for by social services that summons assistance to someone who has fallen often benefits the NHS by avoiding or shortening a hospital stay”.  

Other digital technologies can contribute to better health, “sensing outputs can be linked to appropriate messages, or to encourage  people into healthier lifestyles, or at least remind them to take their medications and exercise appropriately”. 

Proper digital communication between hospitals, local surgeries and care homes will aid integration, which is essential to proper care. One participant emphasised that “there is a lot of information in social care that could help healthcare provide a better, more efficient service to individuals that float between the two systems”.  

It was recommended that “there should be a standard that means people who are moving from a hospital into a care home don’t need to explain to everyone they come into contact with who they are, what type of care they need, and what their frailties are – there is a system for that now called ‘about me’”. The value of technology is that it is able to bridge gaps and smoothen transitions when there are transfers of care. 

Integrated care systems (ICS) “will have a significant role in shaping the landscape of digital going forward,” said one network member. The main platform for coordinating health and care plans across the UK is an infrastructure called the shared care record.

The shared care records are being implemented in patches that are broadly aligned with ICSs; providers may have to deal with a plethora of ICSs which all behave differently in the way they manage their information, introducing unnecessary complexity. 

 It was suggested in the session that “the social care systems used by care providers are a better environment for data to flow with the individual than what the NHS has created for it, for information and care coordination.” 

Digital and health 

Secondly, increased use of digital communication for users of social care has and will continue to improve health and wellbeing more generally. One participant expressed that they “recently surveyed a sample of 11,000 service users, who confirmed that their overriding concern is loneliness, one of the main causes of depression and anxiety, as well as being a major driver of acceleration of the ageing process.”

Digital communication can be a vital tool to reduce loneliness and increase support, by virtually connecting those living in care to their loved ones. 

A member of the lived experience panel shared their positive experience of digital communication, saying that “during covid, technology was an absolute lifeline for clients who had autism and other disabilities, who didn’t understand why they couldn’t see families, or for those that were deaf. When zoom came in, they had that face-to-face contact.”

However, there is a lower level of digital inclusion in care homes, with “many being unable or scared to use digital tech. This lack of online skills prevents people in care from being able to access services, as well as reinforcing loneliness”.  

For users of social care services to benefit from digital communication, they must not only be provided devices if required, but empowered and supported to use these devices to communicate with friends and family.  

“Getting used to technology in care has been  really difficult, but at the same time it has freed up so much time to do other things.”

How digital supports the workforce

Network members emphasised that digital technology has the potential to better support the social care workforce, and improve the quality of care provided. One network member described that “technology can enrich working lives by cutting out the tedious monitoring, checking, and recording, enabling staff and volunteers to focus on caring”.   

Another network member added “I think we all recognise its potency and ability to assist – although I don’t think it brings huge efficiencies in terms of staff time because most of it is assistive. I think what it does do is enhances the quality of the interaction of staff with residents.” 

Concern was expressed that there is an unwillingness to embrace digital technologies by social care and NHS staff. One network member shared that in their experience “some carers are not confident using IT, and do not want to receive training.” However, another network member challenged this, and said that current online systems are badly designed and poorly implemented which make them difficult for staff to use.  

They described that “care workers walk in to work, and are logging on to systems that are a lot harder to use than Facebook. It’s not that technology works or doesn’t work; the reality is that technology can be well designed and can be implemented in context in a way that works for people.”. 

A network member added that “the reality is that it is not a widespread case that care workers don’t like technology, we have care workers in their seventies who want to adopt technology, and want to have it explained to them. Once they understand the technology works to help them; they feel empowered” 

Alongside this, it must be made sure that social care staff are adequately supported to learn to use relevant devices and systems, and raise public awareness of its benefits. One network member shared that in their experience “when [they] showed carers what the technology can do in focus groups, enthusiasm rose from 5 per cent to 69 per cent”.  

A member of the lived experience panel shared that “getting used to technology in care has been  really difficult, but at the same time it has freed up so much time to do other things.”

“Technology will increasingly offer more scope for people to care for themselves in their own homes.”

Digital improvements and  quality of life 

Digital technology, if implemented correctly and thoughtfully, has the potential to greatly improve the quality of life for people in social care.

One network member shared with the group, “For me, digital technology is a life enhancer. It helps me to get in and out of bed, and with other aspects of daily living where it reduces the amount of physical effort required of me and those who support me. It keeps check on various parts of my body which are prone to go wrong, and enables me to get around during the day.”

Assistive technology has the potential to provide dignity and independence where it is required for those in social care, given that “technology will increasingly offer more scope for people to care for themselves in their own homes.”

One network member shared that “[they were] in a care home yesterday where there were three people who were all younger. They were in electric move-around wheelchairs, and all felt they were capable of living independently, but there was nowhere appropriate for them to go,” in terms of a living space equipped with the proper technologies to support them to live. 

 Another network member added that “for younger people who need to live with support, technology can give them control without relying on a member of staff – for some young people it can be embarrassing to need constant support from carers.” 

The same network member added that this kind of care can be cheaper than from social care staff. One participant found that in her experience, “paying for technology in supported living was cheaper than paying for residential.” 

However, several members of the network expressed that in most cases, the digitisation of social care and the introduction of caretech should not take away from the personal and relationship-based care which can be so important to people in receipt of social care.  

Digital improvements are there to support, not to replace, relationship-based care from trained carers. One member said “I do not want to see people being replaced by technology, sometimes the only person a client sees in a day is their carer”. 

The importance of co-production 

It was emphasised several times that technology designed for social care users should be co-produced with those it is designed for. Firstly, it means that the technology being designed  is of value to those it is for, and will be used to improve quality of life. Secondly, if we involve the consumer voice from the start, this will this reduce the risk of over engineering and more expensive solutions in social care.  

One network member shared that “technology introduction needs to be collaborative – the relationship between technology providers and care providers needs to be very close knit.” This can help ensure  that the right technologies can be implemented for the benefit of care providers and users. 

It may be that through this process of co-production, we find that the technologies most beneficial for system users already exist. Several network members suggested that voice activated speakers may be of benefit to many in receipt of social care. 

A social care app 

The possibility of a social care app was also discussed by the network. Given the success of the NHS app since the start of the pandemic, some network members proposed that a centralised social care app may be used to access social care services.

However, it was highlighted that a social care app may not be as easy to design, as much of social care is delivered by councils, and social care looks different between different providers. Therefore, it would not be quite as easy to organise as it would be via the NHS. 

Dignity and a better quality of life

Digital tools and systems in social care have the potential to improve the quality of care provided to users, as well as the working conditions for those employed in the sector.  

Despite concerns, one network member insisted that “it is not true that technology in social care will face higher barriers than in other sectors,” provided that the technologies offered are designed and implemented correctly.

Good technologies will be simple to learn to use. They should save on time, money and energy and must be co-designed with those they are created for in order to fulfil current needs. Overall, they must provide dignity, and a better quality of life for those who use them. 

This discussion is to be continued in the next roundtable on the topic, on the 22nd June 2020. For more information, or to be involved, please contact Mary Brown.

Mary.brown@publicpolicyprojects.com 

Thought leadership

Right time for reform: An outdated Mental Health Act

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mental health act reform

Almost 40 years old, the Mental Health Act (MHA) is in great need of modernisation. On 10 May, the Queen’s Speech outlined government plans to change the Mental Health Act and shift the focus on to the individual patient.


The MHA was due to be replaced in 2007 but the proposal faced opposition in parliament. Instead, a series of amendments were made, including the removal of mental impairment as an example of a mental disorder. While these changes made small improvements to the Act, a critical review of its entirety is long overdue.

The current proposed amendments to the Mental Health Act include shifting the focus of mental health care onto the individual patient requirements. According to a press release for the white paper, the amendments aim to ‘deliver parity between mental and physical health services and put patients’ views at the centre of their care’.

Specialist service provision

It is hoped that these amendments will prevent those with learning disabilities and autism facing excessive sectioning and instead cater for these individuals through more specialist service provision. Between 2020 to 2021, 53,239 were sectioned under the MHA, a 4.5 per cent increase from the previous year.

Sectioning refers to the process of detaining an individual in hospital for the safety of themselves and others. Currently, under Section Two of the MHA, an individual can be sectioned for up to 28 days to receive a mental health assessment and appropriate treatments.

While this can act as emergency refuge to prevent harm to an individual, and offer a lifeline to those most in need, a reduction in detention use is always desirable.

As many patients reflect on the trauma endured during sectioning, it is hoped services will be adequately improved and individualised to make sectioning a last resort.

Tackling the imbalance

There is a disproportionate detention of ethnic minority communities under the MHA which must be addressed. According to annual figures from NHS Digital, individuals within the broad ‘Black or Black British’ ethnic group (including Caribbean, African and other) are four times more likely as ‘White’ people to be detained under the MHA.

A Community Treatment Order (CTO) is issued to ensure that a patient receives supervised treatment in the community for their mental health and lasts six months with specific conditions.

The CTO rate within the ‘Black or Black British’ group was over 10 times more frequent than ‘White’ people. This may be due to a number of reasons, including a disproportioned likelihood of being sectioned and lower levels of community health service uptake. Whatever the reason may be, this disparity cannot be ignored.

At least one in four people are affected by mental illness, with new and existing conditions worsened for many by the isolating settings during the Covid-19 pandemic.

The new MHA should prepare healthcare professionals for the long-term impacts of the pandemic on the population’s mental health, and offer a critical opportunity to ensure community services, digital advancements and interprofessional care are optimised for a new era of mental health policy.

Last month also saw a 12-week call for evidence in preparation for a proposed ten-year plan to improve mental health services. There is no doubt this call for evidence will highlight the disparities among ethnic minorities and individuals with learning disabilities.

The obvious misalignment in sectioning rates should promote a shift of focus to those most in need and build an inclusive foundation of care across the next ten years.

Support services

If you are struggling with your mental health, NHS services and charities listed below can offer support.

Find your local mental health charity: https://hubofhope.co.uk/
Find your local GP surgery: https://www.nhs.uk/service-search/find-a-gp
24/7 NHS urgent helpline: https://www.nhs.uk/service-search/mental-health/find-an-urgent-mental-health-helpline

Thought leadership

Queen’s speech highlights opportune moment to encourage scientific innovation

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Anna Dickinson headshot

One part of the Queen’s Speech which has received little public attention was that of comprehensive research, development and the innovation agenda. There was, in fact, promising signals for genetic engineering, gene editing and technologies being introduced for agriculture. Properly supported, these innovations could have profound implications for our economy and public health.


The ‘Science Superpower’ and ‘Innovation Nation’ agendas have further entrenched the need to invest in research and development (R&D) as core government commitments.

Globally, gene editing developments are rapidly transitioning from the lab to market. With the pool of countries adopting and adapting legislation to promote such technologies remaining small, the UK is presented with the opportunity to cement itself as a leader in this ever-evolving space.

While the topic of gene editing was only briefly mentioned in Tuesday’s Queen’s Speech, the innovation holds the potential to impact agriculture for years to come.

Two sentences summarised the overall aim of the new Genetic Technology (Precision Breeding) Bill, to “encourage agricultural and scientific innovation at home. Legislation will unlock the potential of new technologies to promote sustainable and efficient farming and food production.”

Until Brexit, the UK was bound by the EU’s policies banning the conduct and exploration of research on genetic engineering and editing, and its potential uses in agriculture. However, a commitment to divorce such legacy policies was clearly established.

The Bill holds the potential to provide a more clear-cut route to market for produce developed with gene editing and breeding technologies. With countries such as Canada, Japan, Australia and Argentina already exploring the uses of such practices, the scope through which inward investment and research collaboration may be harnessed has widened.

If this present opportunity is seized, the integration of gene editing and breeding technologies into agricultural practices will allow the UK to expand it’s already booming genomic ecosystem. Propelling the UK ever closer towards the 2.4 per cent target for R&D.

An opportunity that must not be squandered

The potential this Bill holds is vast, but the effective integration and adoption of gene editing and breeding technologies in agriculture practices will not happen overnight.

The UK boasts an established and highly respected legacy in genomics and genomic science, but through an almost exclusively health care lens. For integration and adoption to be as fruitful as possible, the ethical considerations and need for public consultation must not be cast aside.

Legislation clarifying the status of genome-edited products must be accompanied by an ethical framework, allowing its adoption to generate a flourishing ecosystem.

The Genetic Technology (Precision Breeding) Bill marks an important step in integrating genomics and gene editing into the public psyche. The government and industry must be prepared for potential backlash. Ensuring public trust, engagement and support are harnessed will therefore play a crucial role in truly establishing the UK as a global leader in scientific innovation.

Thought leadership

Understanding the UK approach to carbon removal

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UK carbon removal

According to International Energy Agency (IEA), more than six million tonnes of carbon dioxide (CO2) must be captured each year to reach the UN’s climate change targets. If we are to reach net zero by mid-century, it’s no longer enough to simply mitigate emissions.


In its 2018 report, the intergovernmental panel on climate change (IPCC) made clear how “all pathways that limit global warming to 1.5C with limited or no overshoot project the use of carbon dioxide removal (CDR) on the order of 100–1000 GtCO2 over the 21st century”.

Most recently, in its 2022 report, IPCC reaffirmed the importance of carbon capture use and storage (CCUS) and carbon removal in meeting the Paris Agreements goals, while also stressing that these technologies cannot work as substitute for ending our dependence on fossil fuels.

Committing to carbon capture

Although carbon removal technologies have been labelled as part of the solution to the climate crisis for more than two decades, it is currently only used in small scale projects.

The UK considers CCUS as a key technology in achieving net zero emissions and as an opportunity for economic growth. The country’s long-term strategy hopes to capture 47 million tons of CO2 by 2050.

In 2018, the UK government published the “CCUS Cost Challenges Taskforce” report, outlining its objective to drive down costs so that the technology can be deployed at a large scale in the 2030s.

“The CCUS infrastructure is key to unlocking huge clean growth potential in the UK and can contribute to a cost-effective pathway for reducing UK CO2 emissions,” the report says.

As part of its wider Net Zero Strategy, the government selected two CCUS clusters in the north of England in October 2021. The objective for the clusters is to develop multibillion pound carbon capture projects and have the technology fully operational by 2050.

The first fast-tracked cluster by the government is the East Coast Cluster, which hopes to cut up to 27 million tonnes of CO2 a year by 2030. The other project, HyNet, plans to reduce ten million tonnes of CO2 emissions a year by the end of the decade.

Further evidence of the government commitment to carbon capture was given by Energy Minister Greg Hands who, back in October 2021, told parliament that carbon capture is “essential to meeting our net zero emissions”.

Raising awareness

If the UK is to succeed in its ambition to deploy CCUS at a large scale in 2030s, it’s important to involve the public and listen to their concerns. Awareness should be raised on CCUS to educate on the importance of this technology to achieve the climate goals.

A study carried out by the University of Manchester on public awareness of the CCUS found that 61 per cent of the respondents had “never heard” of CCUS, 27 per cent “have heard of it” but “don’t really know what it is” and only nine per cent “have heard of it and know what it is”.

Participants in ‘Public Dialogue’ research on CCUS, commissioned by the Department for Business, Energy & Industrial Strategy, highlighted how safety, costs, feasibility and environmental impacts are the greatest areas of concerns for them.

Driving down the cost of the technology, which will allow large-scale deployment, is certainly an important factor that will determine the future use of this technology. However, public participation and understanding must not be underestimated and should be considered a key priority.

News, Thought leadership

The long road to the first complete human genome

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A computer generated image of a human chromosome

With the Telomere2Telomere Consortium’s publishing the first complete human genome, research into telomeres and genomic sequencing could have profound impacts on healthcare around the globe.


On 31st of March 2022, the first fully completed human genome was published by the Telomere2Telomere (T2T) Consortium, coming almost 20 years after the publication of the first human reference genome. Launched in 1990, the Human Genome Project (HGP) was an international endeavour to uncover the genetics that makes us human, predicated on the knowledge that DNA and RNA are the basic components of living things.

Public Policy Projects (PPP) has recently published works on UK Genomics and Global Genomics which explore the developments since the HGP, the economic benefits of genomics, equitable access to genomics and many more highly valuable topics. Now, following the publication of the T2T Consortium’s human genome, is seems pertinent to ask: what difference do these developments make?

The Human Genome Project (HGP)

It was believed the HGP initiative would completely uncover the genetic information of humans and their sequence of DNA and RNA, thus revolutionising healthcare and research by fundamentally altering disease diagnosis and treatment. The scale of the HGP was immense, and the global collaboration required had never been seen at such scale in biomedical research, as laboratories across the world contributed their findings to this project over the course of 13 years. However, the published HGP genome was incomplete, containing only 92 per cent of the total genomic sequence and missing out certain highly repetitive sequences.

Telomere2Telomere (T2T) Consortium

Following 32 years of research in generating a human genome, the first complete gap-free human genome was published in March 2022 following the work of the T2T Consortium. T2T is the namesake of the telomere, areas of genomic sequence that reside at the beginning and the end of a chromosome. Telomeres appear as a series of repeat sequences and were a key part of the mystery 8 per cent of the human genome uncovered by the T2T Consortium. In addition to uncovering this 8 per cent, T2T corrected structural errors in previous human genomes and discovered up to 99 new genes. While this progress in genomics is certainly an exciting development in research, what does this advance in genomics mean for human health?

What do telomeres do?

Ageing

As we age, our telomeres shorten. Many chronic diseases are associated with ageing, including cardiovascular disease, osteoporosis and Alzheimer’s. To date, there has been an observed correlation between onset of these diseases and telomere shortening in associated cells. For example, according to the work of Jih-Kai Yeh and Chao-Yung Wang in 2016, cardiovascular cells in individuals with cardiovascular disease contained chromosomes with shortened telomeres.

Cancer

The enzyme that extends telomeres, known as telomerase, is commonly found in cancer cells, and leads cells to divide without shortening chromosomes, ultimately triggering cell death. This allows cancer cells to survive and multiply, resulting in tumours and other cancerous masses.

Why are telomeres important?

Ageing

According to The King’s Fund, 58 per cent of people over 60 live with a long-term health condition. As populations continue to live longer now than ever before, the number of people suffering with age-related chronic illnesses will increase and the financial and staffing costs of managing these conditions will continue to grow. Further research into the processes associated with telomere shortening and the impact of this on our bodies could, in time, allow some of the negative consequences of ageing to be mitigated. In turn, this could result in global populations living healthier lives as they age and a reduction of the burden on healthcare systems.

Cancer

According to Cancer Research UK (CRUK) approximately 1,000 cases of cancer are diagnosed daily, equivalent to the diagnosis of 375,000 new cancer cases per year. As a result of the availability of this new genome sequence, variation in telomere sequences that is linked to telomere maintenance in cancer cells, can be explored. This may eventually provide potential treatment or screening targets in oncology. As cancer has a 50 per cent survival rate, stratifying screening and treatment based on these new developments could increase the survivability of this disease, saving thousands of lives every year.

Human genomes: nature or nurture?

While our individual genetics are often viewed as determinants of our future, telomeres are a powerful example of how our genetics can absorb information from our environment. Elizabeth Blackburn, winner of the Nobel Prize for Medicine for her research on telomeres, has said that “to an extent that has surprised us, and the rest of the scientific community, telomeres do not simply carry out the commands issued by your genetic code. Your telomeres, it turns out, are listening to you. They absorb the instructions you give them. The way you live can, in effect, tell your telomeres to speed up the process of cellular aging. But it can also do the opposite.”

“Telomeres do not simply carry out the commands issued by your genetic code. Your telomeres, it turns out, are listening to you.”

Telomere shortening can be exacerbated by obesity, smoking, alcohol consumption and exposure to pollution. By living healthier lives, we can take action to reduce telomere shortening every day, decreasing our risk of disease. Putting this into practice, however, requires the adoption of a population health approach.

While future research on telomeres (facilitated by the work of the T2T Consortium) has the potential to change approaches towards disease prevention, treatment and even cures, chronic disease and cancer predominantly impact individuals in lower income households, who live in areas of higher deprivation and who are educated to a lower level. Therefore, without addressing underlying social inequalities that exacerbate these health issues, potential benefits unlocked by research into telomeres will be stymied. It is essential to approach telomere-associated research endeavours while remaining mindful of the social determinants of health, so we can effectively reduce pressures on our healthcare systems and equitably increase health span for the entire population.