Episode #13: Narrowing the gap: A fairer and more sustainable future for public health

Life Sciences Connect

In our thirteenth episode of the Life Science Connect podcast series, we discuss the findings from The Future of Public Health Series, covered in the overview report: Narrowing the gap: A fairer and more sustainable future for public health. This first instalment of the series summarises the key takeaways from our research of the challenges pre-pandemic, the impact of COVID-19 and the implications for the future for public health systems in the UK.

Joining our host Karen Taylor, Research Director of the Deloitte UK Centre for Health Solutions, is Karen Kirkham, Chief Medical Officer and Lead Partner for Integration in Deloitte’s Health and Social Care team and Cosima Pettinicchio, Director in Consulting in the Health and Social Care team.

This month, our host, Karen Taylor, Research Director of the Centre for Health Solutions talks to Karen Kirkham, Chief Medical Officer and Lead Partner for Integration in Deloitte’s Health and Social Care team and Cosima Pettinicchio, Director in Consulting in the Health and Social Care team about how to achieve a fairer and more sustainable public health system in the UK. But how far can the gaps in funding, health inequalities and workforce capacity be narrowed?


Karen Taylor
Research Director, UK Centre for Health Solutions

Karen is the Research Director of the Centre for Health Solutions. She supports the Healthcare and Life Sciences practice by driving independent and objective business research and analysis into key industry challenges and associated solutions; generating evidence based insights and points of view on issues from pharmaceuticals and technology innovation to healthcare management and reform.

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Dr Karen Kirkham
Chief Medical Officer & Partner, Health and Social Care

Thomas is responsible for the Strategy activity for Deloitte Consulting in France, and specialises in Life Sciences. He supports pharmaceutical and biotechnology companies on their issues: strategic and digital, product launches, and price / market access.

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Cosima Pettinicchio
Consulting Director, Health and Social Care
Deloitte UK

Cosima is a director in Deloitte UK’s strategy practice. She has over 15 years’ experience architecting major government and private sector transformation programmes in healthcare.

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Karen Taylor [00:00:03:02]: Welcome to Life Sciences Connect Deloitte’s podcast on the life sciences and healthcare industry. This series features conversations with leaders from across the healthcare ecosystem, sharing their insights on the critical issues facing the industry today.

My name is Karen Taylor, and I'm the research director of Deloitte Centre for Health Solutions, the independent research hub that supports Deloitte's health care and life sciences industry teams. One of the most enjoyable aspects of my work is being able to meet industry leaders, discuss their views on the critical challenges that are affecting our clients, and also to explore potential solutions to these challenges.

Over the past seven months, the centre's been conducting extensive research into the future of public health, culminating in a series of six reports examining the current challenges and future requirements for resilient public health system. Our executive overview report ‘Narrowing the gap a fairer and more sustainable future for Public Health’ summarizes these insights from the Deeper Dive reports.

I'm delighted to be joined today by two of my colleagues, my public health team, Dr. Karen Kirkham, Deloitte's new chief medical officer and a partner in the public health team, and Cosima Pettinicchio , a director working in public health and service integration. If I could ask my guests to introduce themselves, Karen, could you go first?

Karen Kirkham [00:01:28:09]: Thank you Karen, yes as you say I’m Karen Kirkham I’m a doctor with a General Practice background and I am a partner and chief medical officer in the Deloitte U.K. health care practice. Until recently, I was the integrated care system lead in Dorset, one of the integrated care systems in Dorset, leading on the delivery of the COVID vaccination program and a local response to COVID. I've also been a clinical advisor with the national team in NHS England, in both primary care and system development and population health management, again spending a considerable amount of time on the COVID response within the last year.

Karen Taylor [00:02:06:00]: Thanks, Karen. Cosima, would you like to go?

Cosima Pettinicchio [00:02:08:01]: My name is Cosima Pettinicchio and I'm a director in our health care strategy practice at Deloitte. I lead our strategy support to major health care programs with national, regional, and local health care organizations. Over the past year, I've been supporting Deloitte support to the COVID 19 response program, and I'm particularly passionate about delivering measurable impact through the faster diagnosis of infectious diseases, better preventative services and ultimately helping improve life expectancy for citizens equally.

Karen Taylor [00:02:41:16]: Thanks, Cosima, and as you both know, the research for our report comprised a survey of health care practitioners working across health care. It involved interviews with leaders across the public health sector, and it also drew insights from my colleagues, yourselves, working in public health and in the integration of health and social care systems.

So you're quite familiar with that, and I thank you for all your input. But clearly, there are certain things that will resonate most with you. So we did this research as you will, as you know, against the backdrop of the pandemic and public health ourselves in the eye of the storm or also really getting its moment in the sun for you. What were the standout challenges that were facing them during the pandemic?

Karen Kirkham [00:03:31:10]: So I don't think we could start with anything else than talk about the challenges of being prepared at the beginning of this pandemic situation that we found ourselves in, that rapid mobilization against an unknown, deadly threat, the consequences of which were far reaching. Many of our colleagues, who responded in your research, reflected on just how difficult it was to to deal with the death and the numbers of people dying and how difficult it was for the health care frontline teams to be able to deal with that, you know.

But I would also recognize how difficult it was for public health doctors around the around the country, also trying to grapple with what essentially was a very unknown threat to us, and our preparedness for that threat was something that wasn't where it should have been, and there is lots and lots to learn from that and we'll talk in a minute.

I'm sure about some of that, some of the things that we saw that came out of it. Some of the opportunities that we have going forward and through some of the real positives that came through that that awful period. But it was really, really hard on the local teams and particularly hard on the public health teams.

The second is the operational challenges that we all had to deal with. So, you know, getting to grips with really good, high quality rapid testing, tracing, infection prevention and control and getting back to the basics. Understanding maybe what was happening in other countries and applying the same sort of principles in our own country, where others had learnt from epidemics such as SARS and ????. Thinking through the operational challenges of the data collection, rapid dissemination into local services to be able to act on that, to support local patients, and then just the sheer capacity needed of that these public health teams needed to rapidly mobilize and support local health care systems.

Then thirdly, that really important sharing of intelligence and information both in local delivery systems and indeed around the UK and around the world as the pandemic spread. Some of the challenges really were in terms of the resourcing of those teams, resourcing of that expertise, which was extremely challenging and we would need to learn those lessons as we go forward. So we welcome your research Karen and your report to help us learn those lessons for the future and some positive calls for some further reflection.

Cosima Pettinicchio [00:06:09:14]: Thanks, Karen. Yeah, I think it's important to highlight when thinking about the challenges of some of the long term trends as well, I mean, Karen, your the research in your report highlights some really worrying trends around cuts and public health funding.

I think government does need to do more to try and reverse this backwards trend. You know, health inequalities have increased, and the recent ministerial report really highlights those gaps, particularly among young people, people from a black or minority ethnic backgrounds and people with a learning disability.

I mean, ultimately, that's led to reversals in some of the recent positive trends made around life expectancy and healthy life expectancy. So, you know some really big long term trends that have unfortunately worsened in the past 18 months, but as Karen said lots of opportunities to do better as well.

Karen Taylor [00:07:02:06]: So maybe we should turn to those opportunities because we definitely have seen some real positives, not least the public awareness of public health and the importance of public health teams, not just with the public, but actually with the wider health and social care system.

And housing and education, they've been invaluable in helping inform and work with these different stakeholders to try and ensure that, yes, after a shaky start, we could start to really respond effectively. So you, maybe start with Cosima, what would you say are the real positives that you've seen from the last ten, twelve months?

Cosima Pettinicchio [00:07:42:21]: Absolutely, Karen, you know, gosh, there are so many, as you say, you probably want to highlight just a couple. I think now there's much more of an emphasis on citizens feeling empowered to manage their own public health and being treated much more as consumers rather than patients.

You know, for example, you know, more and more diagnostic testing is being done at home when that's appropriate instead of going into a health care facility, video consultations are now the norm. I think this shift towards consumers and that shift towards taking a greater ownership of their health and wellbeing is a really positive step for public health.

The second thing that I would call out is as a result of the pandemic we've developed in the UK world leading diagnostics and genomics capabilities that have been born out of the COVID 19 response and potentially a massive future implications for pathogens much broader than COVID 19. So you know repurposing some of those assets towards broader pathogen genomics or human genomics and really harnessing the science and technology and pushing it to alternative use could be a really positive legacy that comes out of the pandemic.

Karen Kirkham [00:08:54:08]: I think on more local reflections, thinking about how local systems mobilized. I think I was struck firstly by the enormous energy and commitment that was felt bringing together communities, particularly around maybe our shielded patients in the first wave of the pandemic, when we literally asked people to just stay in their homes for twelve weeks and local communities mobilized around them, joined together with the GP surgeries, the local government services, people volunteered to bring shopping and prescriptions. You know, some amazing stories that developed, and I think that development of the local community self-supporting and helping each other mobilized and coordinated by local government and by public health was just an incredible thing to see. We must hold on to that and that kind of ethos and way of working.

I think the second was around that incredible leadership journey that many people went on in terms of working together, that sharing the data and learning from what the local systems needed to put in place and then finding solutions in real quick time.

I think the third, the real highlight for me, was around the use of data as a single source of the truth and the local systems to start thinking about how they deliver care differently, this is how we started to understand our pressures and how to respond to them. I think it highlighted how much more we need to do in terms of just that, data collection, developing the insights and then having actions as a result of them.

Then just finally and really important, just linking into the health and equality agenda, it shone a light and a lens on health inequalities in a way that has never been shown before. To highlight that story about the vaccination program was how we really tried to reach into local communities, whether that was faith groups or went out and delivered vaccination in mosques and temples, places of worship, working with faith leaders to understand vaccine hesitancy and how we could overcome that and how we helped people who are homeless to get a vaccine.

All of those same principles can be used going forward in the delivery of any single path, any bit of care that we deliver, and I think just holding on to those positives about those new working relationships that we that we rapidly developed in local communities is something that we just need to harness going forward.

Karen Taylor [00:11:31:21]: Thank you. And we do echo that in the report, as you know.

Just thinking about some of those mitigation strategies that you've talked about, you know, the lockdowns, home working, the loss of employment opportunities, the loss of opportunities just to network and be with people. All of that has exacerbated one of the problems that was here before the pandemic, and that is the mental health of our population. It's also exacerbated physical health for those people that were unable to get treatment or afraid of seeking treatment for various reasons.

So going forward, these social economic consequences and the health consequences of that sort of waiting list that we still see now they're going to need concerted action, and as you've said, it's not just about the public health, NHS or social care, it's about bringing that whole ecosystem together. One of the people that we one of the reports we highlight is the role of employers, and I just wondered if you've got some observations about that, what that means for really trying to address some of these of these problems that have been there for a long time.

Karen Kirkham [00:12:44:10]: Well, if we just think about the focus on the well-being of staff then and I'd also just reflect on the high cost that was paid by staff in the low paid sectors such as home settings, transport settings, taxi drivers, bus drivers. They were, you know, as we know in the first wave, people who suffered the worst as a result of the pandemic.

It makes me really reflect on how that inequality that is in society also affects our local workforces, our workforce as well, and therefore reflecting on well-being of all of our staff generally. But also again, thinking about the health inequalities and the effect of multigenerational living in high density accommodation, means that we have to better remunerate and give really good career pathways for our population. But focus also on their mental and physical well-being, both from an individual and a carer perspective.

So there is something about understanding what we've been through and ensuring that health inequalities are on widened in that sector. There's something for me, too, about being really open and understanding of the mental distress and anguish that has come as a result of the pandemic, either because of the way that we were all directly caring for people and then thinking through how we reduce those health inequalities and how we actually help employers to focus on the health of all of their employees. Almost because now health is everybody's business, everyone collectively has a common theme around how to be healthy, how to look after ourselves and each other. And how we make sure that our workforce are as fit as they could possibly be both mentally and physically is I think something that employers large and small need to be addressing now going forward, again as a really positive outcome of the pandemic.

Cosima Pettinicchio [00:14:52:09]: Completely agree with you, Karen. You know, when we looked at the FTSE 350 and its analysis of the big board agenda items, health and well-being is up there at the top, and boards are really concerned, rightly, about the health and well-being of their employees.

And I think it's a real positive legacy that actually employers and big businesses are sort of starting to pay attention to this, and hopefully relieve some of the burden on publicly funded services by actually privately funding health and wellbeing services as well.

And many organizations, including Deloitte, are starting to create a Common Wellbeing Index scores, so that they can measure and track employees health and well-being over the pandemic and into the future, and I think through using data and measuring and tracking, that is a really important way to help improve outcomes for employees.

Karen Taylor [00:15:50:00]: One of the things I observed myself as a non-executive on a hospital board was the real change in attitude towards supporting the health and well-being of NHS staff and some of the initiatives that were put in place to try and improve and help them deal with this unprecedented and pretty devastating illness that they had to deal with.

I'm just wondering if you had any observations, views on how local authorities were able to support the health and wellbeing of public health employees, and if you if you saw any examples of good practice there. Well, maybe that's for you, Karen.

Karen Kirkham [00:16:27:03]: So I think all employers had to focus on their staff very rapidly. Now interventions can be as small as just creating opportunities for groups to talk together about the distress that they felt and to try to create some resilience in those local teams, to digital platforms so that staff can be supported.

So I think actually it's an opening market in terms of development and opportunity to try and give people the source of information and help that they need, whether that is face to face or whether that is digital and for each of us there are different options available.

But I think more than that, it's just about ensuring that whoever you are, whatever you do, in whatever job, you would have been affected in some way by this pandemic. Whether you've been on the frontline in intensive care, whether you're a health care worker in a care home, whether you've been a transport driver, whether you've not been able to see people for 18 months because of the way you've had to work.

I think all employers and all local systems will have to try and understand what they can do to help those local populations as much as anything, because otherwise we are going to lose great swathes of a very valuable resource in our workforce, if we don't support them and if we don't address those needs. Certainly the rise and the rising tide, and I see this all the time as a GP, in depression, but also anxiety and in kind of phobias that are emerging and also the rise in mental health of children who've been affected by loss of schooling, by loss of relatives and friends within their environment and by that that complete lack of the usual development process that they've been through.

We're seeing, you know, higher high rates now of children and young people's distress coming forward. So all of that links together to say, really, what we need to do is have a huge awareness and be a very open society to understanding the effect of mental distress and the importance of really good mental and physical well-being as we go forward.

Karen Taylor [00:18:48:00]: Thanks. Obviously, COVID 19 stress tested the government's ability to deal with unforeseen events, as we talked about a little bit at the beginning, and as you've said, Karen, it exposed the impact of the social gradient on the ever widening health inequalities.

There's been a lot of discussion about these health inequalities, and you've mentioned some of these issues. But what sort of ingredients do you think public health teams need, to be able to deal with these, because they remit is so wide from protection, to prevention, to prolonging life? You know, those are really easy things to say, but really hard to do, and in this environment, you know, what do you think are the ingredients that they might need to improve how they do business?

Karen Kirkham [00:19:35:21]: So I think we've got a really good opportunity as we develop the new integrated care systems, first of all to put public health leadership really front and central with the leadership in the integral integrated care systems, but also at the place, the place level where much of the delivery takes place and indeed at very local primary care network level.

That's not to say that all senior leaders need to be in every group of GP practices, but there is a distributed form of public health leadership that can permeate all levels of our integrated care systems, and now is the opportunity to start making sure that the priorities are there for each system that public health has a very clear voice and remit within that and are enabled then to undertake that business in each of those systems. So there's never been a better time than now to put that leadership front and centre.

I think the second thing is to, on this kind of theme of distributed leadership, take the work that we can all do as individuals, in terms of every contact counting, to try and make sure that we talk about prevention in every situation. However, whether you're in a hospital, whether you're in a GP surgery, whether you are in a care setting, or in any other form of social care, to make sure that we are constantly asking and encouraging our citizens to develop that skill around prevention.

So I think we have an opportunity to do things differently, and I think we have an opportunity to create new care models as a result of that, and I think the results of that public health leadership within those integrated care systems should mean that we have a strong and long focus on health inequalities within each individual system. And we should be ambitious in our desire to reduce those health inequalities in a way that we haven't really been able to tackle in recent years.

Cosima Pettinicchio [00:21:35:10]: I completely agree with Karen around the point around leadership and workforce. I think the key to delivering better public health is through investment in the workforce, and, as Karen said, pushing the director of public health in that leadership role in the integrated care system. And I think what the pandemic has taught us is that investing in resilience, the agility and the skills and capability of that public health workforce is going to be really critical, and that's not just at the local level, but also the regional and the national level and having that leadership work together in a coordinated way is going to be really important. Obviously, with the recent announcements around the NHS leadership review, you know, hopefully that will be a really good catalyst to support leaders and invest in the future workforce for public health.

That would be my first point, and I think the second point really is just reiterating the point you mentioned at the beginning around public health funding. You know, that trend really does need to be reversed if we're going to tackle some of these health inequalities. But I think really investing in interventions and initiatives that have a proven cost benefit case, you know, with really rigorous health economics that underpin that so that people can feel confident in the investment case for prevention and early diagnosis.

Karen Taylor [00:22:57:08]: Thanks. We’re coming to the end of our discussion, which has been fascinating across public health, is so wide ranging and reaches into so many different little nooks and crannies, and we could talk about this for a lot longer. But I'm just going to ask you if there's one takeaway you'd like to leave listeners with, what would it be?

And I'm going to go first. Just so to give you an opportunity to think of that answer, because I know you could probably give a lot of takeaways, so just the one that would really resonate most with you.

For me, the issue is, as we know, inequalities are deep seated. They are complex and we've and we've seen lots of attempts at trying to tackle them and reverse inequalities. There's even a target to reverse to reduce inequalities, but they take years and we know that. So for me, we do need to have a much longer term funding settlement that gives public health security and certainty and allows them to invest in some of those voluntary and charitable organizations that depend on that investment to be able to provide the additional services that we've seen have been so valuable.

So for me, it's longer funding cycles, encouraging longer commissioning cycles and leading to service stability and improvements. So I've stolen that one. I don't know Karen whether you've got what your one would be?

Karen Kirkham [00:24:18:13]: OK, I think my one would be a relentless focus on using the data that we have to drive the insights into actionable change and particularly around health inequalities as part of everything that we do. And I'm just going to sneak in a second one because whilst a lot of these changes around prevention do take a long time, so poverty takes a long time to change.

I think there are some high impact changes as well. So not forgetting about doing the basics, stopping smoking, weight reduction, increase exercise and really importantly, attention to hypertension as part of a relatively short cycle of change that can happen.

There are things that we can do now, and we should be passionate in our adoption of taking this on straightaway.

Cosima Pettinicchio [00:25:09:23]: For me, I think the one takeaway would be, you know, we focus so much on the onset of COVID 19 the past 18 months, but government and industry need to think much more broadly about the potential threats to public health in the future. So, for example, longer term threats such as antimicrobial resistance and really importantly at the moment, climate change or planetary health, is going to have huge implications on the health of the UK and global population. So, you know, I'd like to see much more science and research being directed towards those areas that are going to have a profound impact on our society.

Karen Taylor [00:25:47:14]: Thank you Cosima, because yes, we haven't mentioned till now climate change, but we know that this, the next public health emergency, is with us now and we really have to talk. We have an opportunity to tackle it now. I've got a lot to thank you. I'd like to thank both my guests, Dr. Karen Kirkham and Cosima Pettinicchio , for sharing their views and their insights on what is a really far ranging and complex issue.

And I'd like to thank our listeners for giving us the time to talk to you, and also, I hope you'll join us again for our next podcast of the series, but thank you very much.

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