We provide a monthly international intelligence-scanning service on this page, and available via our monthly newsletter.
The Commonwealth Fund has interviewed Dr Garth Graham, Director of Healthcare and Public Health partnerships at YouTube, about the work the platform is undertaking with health systems in America to produce health-related content for the general public.
In his interview, Dr Graham covers the ways that health systems can work with influencers/creators to present complex and evolving health information in an accessible way, how platforms like YouTube and content creators can develop trust with their audiences, and how YouTube is implementing the recommendations of the National Academies of Medicine to elevate credible health content and limit the spread of misinformation.
New research from the Health Foundation, commissioned by the Financial Times, examines what the NHS can learn from the Dutch care system and how it supports people in the final stages of life.
As the population of the UK ages and individuals more routinely enter the final stages of their lives with more complex conditions, the current model of care that sees 45% of individuals die in hospital will become even more unsustainable. The Health Foundation estimates that this current model would require an increase in bed numbers of between 20 and 35% and cost between £17bn and £29bn.
The research points to countries like the Netherlands, Sweden and Denmark where similar numbers of beds per capita have been supported by far greater levels of investment in community provision. The research focused on the Dutch experience where a new approach to end-of-life care (following changes to laws governing euthanasia in 2002) has developed.
This new approach has included the integration of palliative care into wider packages of care, the public funding of hospice care and the treatment of palliative care patients for their social, psychological and existential needs, not simply their physical needs. It has been credited with reducing the proportion of people dying in hospital from 25% to 18% between 2010 and 2020.
Regardless of future approach, the research highlights that such is the demand on the English NHS that investment in beds will be required to give the system the breathing space required to implement similar approaches to end of life care, as in the Netherlands.
The European Observatory on Health Systems and Policies has produced two new reports exploring the contribution the health systems of France and Spain contribute to their wider economies, examining the impact through three lenses: innovation, workforce and socioeconomic inequalities.
In both France and Spain innovations in e-health constitute a growing proportion of GDP, with innovation start-ups expected to generate £40 billion annually by 2030 in France, up from £800 million in 2019.
Comparatively, the UK is far ahead of both countries in terms of investment in health innovation, with 21.5% of the government’s R&D budget dedicated to health and care, representing growth of 16% between 2011 and 2018, compared to a reduction of 28% in France over the same period. However, France has seen significant investment in telemedicine in response to a need to treat a rural population outside of the hospital setting, an equally important area for the NHS when considering inequalities in healthcare access.
Whilst both nations achieve good health outcomes when compared to nations spending similar amounts, inequalities in life expectancy and health outcomes are areas where the authors highlight greater investment is needed to reduce preventable conditions that have negative economic implications, due to their impact on well-being, productivity and care costs.
As the Covid-19 pandemic continues to disrupt healthcare services and our understanding of the currently waning effectiveness of vaccines over time improves, the reality that further booster vaccinations for a proportion of the population is becoming more apparent.
Despite this, it is currently unknown how receptive the public will be to the need for further vaccinations, and whether new methods will need to be developed to communicate the value of vaccination to an ever-wearier population.
To that end, research from Israel's University of Haifa has explored the effectiveness of different health policies for periodical vaccinations during an ongoing pandemic. The experiment presented participants with one of four policies. These were a vaccine mandate requiring all adults to receive a booster shot every six months; a negative monetary incentive that would result in a rise in health taxes to the tune of 50% for adults who do not receive vaccination every six months; a positive monetary incentive where all adults who receive vaccination every six months would have their health tax reduced by 50%; and greater information provision about the vaccination.
As the participant sample was designed to be reflective of the overall Israeli population, the researchers took steps to collect demographic and historical data from participants that would enable them to predict trends and variations in participants' responses across multiple subsets of the overall population.
The research appears to indicate that 60% of the Israeli population demonstrate hesitancy towards periodical vaccination, far higher than previously estimated. Factors including social norms, perceived self-efficacy, personal vaccination history, self-ascribed severity of the disease and trust in the government all had a bearing on vaccine hesitancy.
As the recent JCVI recommendations for autumn vaccinations recommends a second booster to a greater than expected section of the public, the recommendations of this report have the potential to be particularly timely.
Ambulance services are facing significant pressure not just in the UK. The familiar media headlines of long waits and queues of ambulances outside hospitals are also becoming common place in Australia, as repeated Covid-19 waves and the flu season add significant demand on the system.
Writing in "The Conversation", researchers from Monash University report how this increased demand is leading to significant investment by state governments in additional resources and the training of thousands more paramedics, as well as the Victoria State government adapting the model used by Leeds Teaching Hospitals NHS FT, where just 4.9% of handovers required more than 30 minutes, far below the UK average of 21%.
When discussing international comparisons, a commonly asked question is to what extent can public health interventions that are regarded as best practices be successfully implemented in other countries.
In an attempt to support the transferability of successful interventions, the OECD project on best practices was established in 2019 with the aim of helping countries select, implement and evaluate best practice health interventions to prevent, control and manage non-communicable diseases.
This paper presents a data-driven transferability assessment using cluster analysis, to identify groups of countries that have the greatest potential for the successful transfer of specific interventions. For each of the three best practice interventions discussed, key success factors are identified and country-level data on these factors collected from public sources. Countries are then clustered into groups with similar characteristics. Based on these characteristics, tailored recommendations are made for each cluster of countries regarding the potential transfer of the best practice intervention, allowing policy-makers to decide whether or not to transfer a public health intervention, and what factors to pay particular attention to when doing so.
In the words of the Ronald Lavater, CEO of the International Hospital Federation, “attacks against health care workers, hospitals and ambulances are not acceptable. Health systems can only function when both workforces and facilities are secure and protected.”
Released on 19 July, the results of the International Hospitals Federation’s joint survey with the International Committee of the Red Cross, International Council of Nurses, and World Medical Association addresses the increasing violence against health care workers during the COVID-19 pandemic. The survey shines a light on the scale of the problem and shares real-world solutions for prevention and mitigation of violence against health care professionals.
Despite limited attention paid to identifying the right composition and skill-mix of the health workforce in recent history, at the political level, there has been a positive increase in the understanding of its relevance to workforce planning. However, there remains a lack of common understanding of what skill-mix is, what professions are involved and what models exist in different care contexts.
So, what are skill-mix innovations and why are they relevant? This systemic analysis of health workforce skill-mix innovations provides an overview of the evidence and lessons for implementation across multiple countries. The authors focus on six core segments of health systems: health promotion and prevention, acute care, chronic care, long-term and palliative care, as well as access for vulnerable groups and people living in underserved areas. In addition, the book analyses the roles of educational systems, workforce planning and policy, and financing within individual countries' healthcare organisations from a cross-country perspective.
Although implementing skill-mix changes may be prone to stakeholder opposition or other barriers, this book helps identify ways to steer the process. The authors determine what skill-mix innovations exist, who may benefit from the changes and how to implement these changes within health systems.
In their recent publication of international comparisons, the U.S. based Commonwealth Fund examines the role that drug overdose deaths are playing in the decline in U.S. life expectancy and the differences in behavioural healthcare, drug policies and social services that cause the U.S. to perform far worse than other high-income countries.
Whilst in the UK only Scotland comes close to the U.S. rate of 277 deaths per million, at 267, the rate of death in England and Wales (76 deaths per million) places us at a higher rate than all other European comparator countries other than Sweden.
Whilst differences exist between the methodology used by courtiers to determine death by overdose (as the Commonwealth Fund acknowledges), drug-related deaths in England and Wales rose by 60.9% between 2010 and 2020 according to the ONS. Such an increase highlights the importance of learning from countries such as Portugal, France and The Netherlands where the rates are as low as 5, 7 and 15 deaths per million, respectively.
Avoiding unplanned re-admission is important. Unplanned hospital re-admissions indicate sub-optimal patient outcomes, care coordination and quality of care and contribute to significant avoidable healthcare costs. A significant proportion of hospital re-admissions are avoidable and vulnerable groups, such as older people, are disproportionally affected by unplanned re-admissions. The transition between hospital to the community requires good multi-disciplinary cooperation and timely, comprehensive, and accurate communication. However, these are not always achieved.
This paper discusses different models of care which have been used to prevent unplanned hospital re-admissions, including those models that improve transitional care, as well as virtual wards and telehealth. The paper also discusses the potential role of primary care, specifically general practice, in helping to reduce hospital re-admissions.
Compared to the general population, LGBTQI individuals are at a higher risk of cancer, but are less likely to participate in screening programmes or have a regular healthcare provider. LGBTQI individuals are also more likely to report high levels of dissatisfaction, barriers accessing services and difficulties communicating with oncology Health Care Professionals (HCPs). This is driven, in part, by incidence of heteronormative assumption and, hostility and discrimination.
Education and training for HCPs that is reflective of the diversity of age, sexual orientation, gender identity and cultural background, amongst the LGBTQI community is required to support effective communication between professionals and LGBTQI patients. There is however historically a lack of qualitative research in this area. This study examines the construction and experience of LGBTQI cancer care from the perspective of HCPs, LGBTQI patients and their caregivers, using qualitative methods.
Patients worldwide experience fragmented and uncoordinated care as they transition between primary and acute care. To improve system integration and outcomes for patients, in 2017/2018 Alberta Health Services (the largest health services delivery organisation in Canada) called for a coordinated approach to improve transitions in care. Healthcare leadership responded by initiating the development of a province-wide guideline outlining core components of effective transitions in care. This case study highlights the extensive design process used to develop this guideline, with a focus on the participatory design (PD) approach used throughout.
Sex, gender identity, and sexual orientation are key indicators of the demographic diversity in the United States. Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other. However, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualised. This in turn affects sexual orientation, because it is defined on the basis of the relationship between a person's own sex or gender and that of their actual or preferred partners. Sex, gender, and sexual orientation are core aspects of identity that shape opportunities, experiences with discrimination, and outcomes through the life course, therefore, it is crucial that measures of these concepts accurately capture their complexity.
Recognition of the diversity within the lesbian, gay, bisexual, transgender, queer, intersex, and other sexual and gender minorities - the LGBTQI+ population - has also led to a reexamination of how the concepts of sex, gender identity, and sexual orientation are measured. Better measurement will improve the ability to identify sexual and gender minority populations and understand the challenges they face. LGBTQI+ people continue to experience disparate and inequitable treatment, including harassment, discrimination, and violence, which in turn affects outcomes in many areas of everyday life, including health and access to health care services, economic and educational attainment, and family and social support. Though knowledge of these disparities has increased significantly over the past decade, glaring gaps remain, often driven by a lack of reliable data.
"Measuring Sex, Gender Identity, and Sexual Orientation" recommends that the National Institutes of Health (NIH) adopt new practices for collecting data on sex, gender, and sexual orientation - including collecting gender data by default, and not conflating gender with sex as a biological variable. The report recommends standardised language to be used in survey questions that ask about a respondent's sex, gender identity, and sexual orientation. Better measurements will improve data quality, as well as the NIH's ability to identify LGBTQI+ populations and understand the challenges they face.
Despite the diversity of the population, some 235,000 people experiencing homelessness (PEH) in Canada face a range of common challenges and stigma, such as access to healthcare services, including primary care. One method for overcoming this exclusion from health and care services is the provision of care in non-traditional settings, such as shelters.
Based on a review of academic and grey literature, as well as interviews with researchers and practitioners, the North American Observatory on Health Systems and Policies (NAO) has evaluated the delivery of services for PEH in these non-traditional settings and their report makes six recommendations:
- Foster positive interpersonal relationships between PEH and healthcare providers
- Include peer support workers and inter-professional team members to address the complex needs of PEH
- Establish a welcoming and inclusive environment to encourage primary care access and social connectedness
- Support system navigation and build connections to mainstream care to reduce barriers
- Enable collection and sharing of health information to improve care continuity and support evaluation of primary care programmes
- Adopt sustainable and adaptive funding models
The WHO has published the findings of a global horizon scan, conducted by a group of international experts in 2020-21, on emerging technologies and trends relevant to global public health. The group identified 15 new and emerging technologies and scientific advances that may have a significant impact on global health over the next two decades.
The priorities described fall broadly into three overlapping areas: changes in science and technology, changes in practices and broader societal and global trends and include vaccine distribution logistics, addressing disinformation and misinformation, and using emerging technologies such as AI, machine learning and wearables for purposes including app-based diagnostics, clinical support systems and antibiotic discovery.
Similarly to the UK, the Netherlands has recently implemented an opt-out consent system for the donation of organs. A public information campaign was implemented to inform citizens of the law change. However, as 29% of the Dutch population is considered to have limited health literacy (LHL), it is possible that the new legislation could have been implemented without meeting the information needs of a sizable proportion Dutch people.
To determine what these information needs might be, the Dutch Institute for Health Services Research conducted a series of workshops and individual interviews with citizens. The engagement found that current messaging materials were too hard and abstract. People with LHL require personal support to tailor general information to their personal situation, and practical help to register their choice. The research recommended that information on the opt-out scheme should address 5 key questions:
- choice options
- the role of partners/family
- impact on quality of care
- the process of organ donation
A new blog from the Institute for Healthcare Improvement (IHI), discusses two quality improvement programmes from Australia to improve birthing outcomes for women and babies. Both programmes, The Better Birth for Women Collaborative and Safer Baby Collaborative sought to combine the value of quantitative data with lived narrative to understand what was working well and what could be done to improve outcomes.
The blog describes how the sharing of personal stories relating to the impact of still births and perineal trauma (the focuses of the two collaboratives) with clinicians and improvement teams added a previously missing source of insight to the improvement process, that had the effect of motivating teams and adding focus to their improvement efforts.
Both collaboratives have also sought to embed this process of co-development into the quality improvement process by developing measurement strategies for the collaboratives with expert panels of individuals with lived experience of perineal tears or stillbirth, midwives, obstetricians, maternity service leaders, and improvement experts.
Dr Carlsten Engel, CEO of the International Society for Quality in Healthcare (ISQua), joined HealthManagement.org for a 20-minute interview on his experience of how healthcare organisations can improve patient safety.
Dr Engel discusses what he sees as the plateauing of improvements in patient safety of the last 10 years, with 10% of patients still affected by some form of medical error, 50% or which are preventable. He describes how this is the result of healthcare being a complex system which means changes in rules and regulations can only go so far in improving patient safety.
He goes onto explain how changes in culture can overcome the limitations of regulations. This could be the shift away from a culture of blame to a ‘just culture’ that acknowledges healthcare professionals are typically operating within the limitations of the systems; organisational leadership championing for a safety-first approach; or even regulators shifting their methodology from one of compliance to a narrative discussion with providers, which he notes the Dutch Healthcare Inspectorate have already implemented.
The Nuffield trust has recently completed research, commissioned by NHS England, to understand how other countries are approaching the challenge of growing waiting lists, resulting from COVID-19.
Nuffield’s work, recently summarized in the BMJ, has shown that across the 16 OECD and EU countries there has been some degree of disruption to elective care, no matter how well prepared the relevant health systems.
Despite this, the research points to a number of areas where the NHS is still able to learn from the approaches of other healthcare systems. For example, the research points to the the interconnection between elective procedures taking place in hospitals and primary, social and mental health care. A connection that has been recognised in the recovery plans of Austria and Portugal.
The research also places an emphasis on the role of workforce in recovering the elective backlog, and points to the renewed pay agreements that have taken place in France and Belgium as one of the many ways that this can be recognised.
Ultimately, the overall argument of the research is that elective recovery cannot be viewed as a standalone act to be undertaken in the acute setting, but recognised that it is influenced across all parts of the healthcare system.
Health Canada, the federal department responsible for improving the health of Canadians, has published a new report ‘Health of Canadians in a Changing Climate’.
The report assesses the latest research and knowledge to inform Canadians about the effects of climate change on health and health systems, populations most at risk from these effects, and the mitigating measures being taken in Canada. The report is designed to help decision-makers plan for the health effects of climate change and take action to reduce risks, as well as to empower individuals.
Patient-reported measures are a critical tool for improving policy and practice in mental health care. However, to date, the use of patient-reported measures in mental health care is limited to a small number of countries and settings—and there is a pressing need, both within and across countries, to consistently and effectively measure the effects and impact of care for patients who use mental health care services.
The PaRIS pilot data collection on mental health includes 15 data sources from 12 countries, collected over the course of 2021. While the scope of included data varied, the results demonstrate increased adoption of national and subnational efforts to capture patient-reported information in mental health care systems.
Analysis of data collected through the PaRIS mental health pilot, in general, shows positive patient-reported experiences of mental health care. The results also suggest improvement in patient-reported outcomes for those receiving mental health care services.
The Commonwealth Fund has added to its series of comparisons between the USA and other high-income countries, this time examining primary care. Whilst the comparison focusses on the US health system, the UK is included in the comparison and some of the data may be of interest to those in the NHS.
Of potentially most interest is the gap between the UK and other high-income countries when it comes to the scale of multi-disciplinary working. For example, whilst Sweden and the Netherlands report that 93% and 94% of primary care centres have in-house mental health practitioners, that figure is just 31% in the UK.
And there is a further comparison between the Israeli and Danish healthcare systems from the Israel Journal of Health Policy Research from the perspective of spending and health outcomes, with researchers asking why Israel has better health outcomes despite spending less on health than the Danes.
One of the oft-cited positives of the covid-19 pandemic was its initial freeing of the NHS from its usual incremental approach to change, allowing frontline workers to implement innovative changes to meet constantly evolving demands. As the pandemic evolved, focus was lent to collecting and evaluating these innovations, supporting and scaling them up where they were found to be of sufficient value.
This was not only true of the NHS, but almost all health systems. One such example came from the Allied Health Professionals Office of Queensland, where an Allied Health Professionals COVID-19 Innovation Register was established.
Recent evaluation, the summary of which has been published by the Australia Hospital and Healthcare Association, highlighted three key enablers which supported innovation. Firstly, an adaptive management style was employed that saw managers facilitating the implementation of innovation, followed by review and refinement. Secondly, a devolved structure of authority allowed key staff to make decisions at a level they had not previously experienced. And thirdly, the trust managers placed in their staff to make decisions, whereby felt confident making decisions and implementing innovative ways of working.
The WHO regional office for Europe, in collaboration with Exeter University, has launched a new knowledge hub dedicated to behavioral and cultural health.
Featuring videos, podcasts, reports, toolkits and other resources, on topics including mental health, cancer and vaccination, the hub will act as a one-stop shop for all best practice developed across the region.
The knowledge will be continually added to, and currently features a WHO research report on how to increase COVID-19 vaccination, case studies on the role of social media in promoting health access and healthcare, and how the Portuguese health system has maintained patient-centered diabetes care throughout the COVID-19 pandemic.