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Social determinants, rather than health issues, cause 1% of the population to need up to a third of ambulance call-outs.

Michael Kitts

IMPOWER’s Michael Kitts reflects on how the The National Health Executive (NHE) has highlighted the need for a greater focus on social determinants to secure health and wellbeing.

The NHE recently reported that as few as 1% of the UK population account for a third of ambulance call-outs and nearly 1 in 6 A&E attendances.

As flagged in much of the media, the health and care sector is facing massive challenges impacting on many UK citizens and, of course, health and care providers.

ADASS recently reported that:

  • almost 400,000 people are awaiting an assessment of their needs or service
  • over 1.5 million hours of commissioned home care could not be provided between August and October 2021 because of a lack of staff, despite record growth in provision
  • half of councils have had to respond to a care home closure or bankruptcy over the past six months.

The picture is no less concerning for health.

  • A 236-fold increase in the number of patients waiting more than a year for treatment compared to August 2019.
  • The total waiting list is at a record high, 5.72 million and growing.
  • Patients waiting over 12 hours in corridor trolley beds for admission to hospital has increased to a record high of 5,025 compared to 458 in August 2019.

Why is this? It’s easy to say we don’t have enough hospital beds or funding… and of course Covid has had a massive impact but as Mike Adamson, chief executive of the British Red Cross, recently said:

“High intensity use of A&E is closely associated with deprivation and inequalities – if you overlay a map of frequent A&E use and then deprivation, they’re essentially the same… repeat visits to an A&E flag the need to tackle other issues like barriers to accessing services, or societal inequalities that affect people’s health (or wellbeing)… housing insecurity is a common challenge… all having a knock-on effect on people’s finances, mental health, social networks and access to services.”

Some of these points have been picked up in the Social Care White Paper published on 1 December, in particular the focus on housing – being one of the greatest social determinants of wellbeing. When working in Australia, I found that

75% of the required interventions to support people not going into hospital were non-health related… social determinants were far more important

We also found that less that 1% of one State’s 8m population consumed 30% of the health and care budgets – so, very similar to UK findings flagged above.

Numbers around care deficits, long waiting lists and unsupported vulnerable people are therefore, in our view, far more about doing different things, rather than applying more resources to do more of the same. Our passion is starting with the end in mind and working backwards, rather than further fuelling the beginning, its inputs and activities.

All this points to migrating from traditional and siloed universal services, often delivered after the event, to more joined-up & tailored strengths-based interventions (that would really have an impact) that are delivered on a preventative basis. How can social determinants be addressed in a way that supports people’s well-being and living at home independently?

This is exactly what IMPOWER’s Valuing Home approach is all about. It would be great to discuss how we could really help you shift the dial by pulling different levers in very different ways.

Written by

Michael Kitts



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