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Regional inequalities inhealth and social care
The power of digital technology toclose the gap
A white paper by Microsoft

Contents

Chapter 1:

Executive summary
Chapter 2:

The Challenge of Regional
Inequalities
Chapter 3:

Can Advances in Health Tech Help
Close the Gap?
Chapter 4:

Case Studies: Improving Health
Outcomes with Digital Technology
A.	Case study 1

Optimising care team performance in Dorset

B.	Case study 2

Enabling personalised care in Greater Glasgow and Clyde

C.	Case study 3

The future of healthcare

Chapter 5:

Implications for policymakers:
Integration and Partnership

Regional inequalities in health and social care | 2

Regional inequalities in health and social care | 3

01
Executive summary
Governments of all political leanings have, in recent years, sought
to reduce health inequalities between regions. This short reportsuggests that digital technology can begin to address theseinequalities — and that it may also be one of the best ways totackle long-term economic imbalances between regions.
•

The Covid-19 pandemic has demonstrated that despite people being able toaccess the same NHS services, there remain variations in health outcomes acrossthe country. We already know that there would have been 40,000 fewer deaths in
the UK if the national Covid mortality rate had been as low as the least deprived
places.

•There are also large regional differences in cancer mortality outcomes andlife expectancy. This undue variation in health outcomes has a direct link tovariation in economic outcomes – for example in workforce productivity or work
incapacity. In general, life expectancy is highest in those areas of the UK with thehighest productivity – London, the South East, and the East of England – andlowest in those areas with the lowest productivity – Wales, the North East, andthe North West.

•

Policymakers are now seeking to rectify these disparities. This is a project
occurring simultaneously across every nation and region of the UK, in both the
NHS and social care.

•

Despite exciting and dynamic advances, health technology is often framed
as something that can reinforce health inequalities rather than help tackle
them. Covid has accelerated the use of digital technology and demonstrated
the benefits it can bring. In the Health Foundation’s survey of NHS staff
conducted between October and November 2020, 82% of respondents said
their organisation had increased its use of technology to some extent during
the pandemic and 51% had been personally involved in that increased use oftechnology.

Regional inequalities in health and social care | 4•

However, whilst the pandemic has shown the positive benefits of the role ofdigital technologies in health and social care, it has also shown the difficulty of
being able to reach particular groups and communities, particularly those oftenwith poorer health relative to their local populations.

•

Policymakers are increasingly interested in how far maximizing population
health can be achieved by collecting better and more regular data on those
populations. By ensuring data is collected on the most at-risk groups, or thosewith the most complex needs, the health and social care system should bebetter able to respond in times of individual need, in turn reducing variation in
ill-health and mortality outcomes across the UK. This applies as much to social
care as to health care.

•

Outgoing NHS England Chief Executive Simon Stevens, as part of moves
towards Integrated Care Systems (ICSs), has echoed this, setting out the need for
the NHS to play a more proactive and prevention-focused role in public healthin the years ahead.

•

However, poor health outcomes do not have a single cause and just as
important as integrating services within the NHS is forging partnerships
with organisations working outside the health and social care system, suchas employment support or housing associations. As such, technology has
genuinely transformative power to help – by being the infrastructure aroundwhich disparate services and organisations can support each other’s long-term
objectives.

•

In short, by collating better data on patients, in turn enabling early detection
and prevention, it is hoped that the stubborn link between longer term
conditions and increased hospital admissions (disproportionately affecting
people living in more economically disadvantaged areas) can be significantly
disrupted.

Regional inequalities in health and social care | 5

03

Recommendations
There are several areas where government could make more or betteruse of technology specifically to reduce undue variation in health. We
would identify five broad areas for priority attention, which together
provide a strategic framework for improvement:

System intelligence – improved system intelligenceand information would enable health and social caremanagers, and local government leaders, to better monitor
population health in their communities and design better
health interventions.

Organisational working – supporting staff in individualorganisations involved in the provision of health and social
care would improve the delivery of services for patients:
supporting and connecting staff, and improving digitalskills and confidence, should be a big priority.

System and organisational partnerships – health andsocial care organisations both within and outside the NHS
should be working together in partnership at a systemlevel. This would help deliver much better preventative
care.

Supporting outreach – technology should be playing
a more central role in outreach and engagement withharder-to-reach groups who are more likely to have poorer
health outcomes. This should be allied to a digital inclusion
agenda.

Data sharing – we need more data sharing, more fluidly,
across integrated NHS services and also with external
partner organisations, including local government, schools
etc, in order to better manage overall population health.

Regional inequalities in health and social care | 6

We see these five areas as priorities for a technology-led strategy
to reduce undue variation and raise outcomes. They provide aframework with which to design a strategy for driving specificinterventions that could help close health inequalities.

Regional inequalities in health and social care | 7

02
The Challengeof Regional
Inequalities

Regional inequalities in health and social care | 8

Regional inequalities in health and social care | 9

02Regional health variation—
The pandemic has demonstrated that despite
people being able to access the same NHS
services, there remain variations in healthoutcomes across the country.
A report from a cross-party group of MPs earlier
this year found that:

Over recent years, governments of allpolitical leanings have sought to reduce
health inequalities between regions.
Whereas policymakers have previously
focused almost solely on economic
outcomes – which forced a critical lookat regional investment in areas likeinfrastructure and skills – now the sameattention has turned to health. A primary
aim of health policy is now to tackle
undue regional variation in life expectancy
or disease among different regional
populations. This short report suggests that
digital technology can begin to address thisvariation — while noting that doing so may
be one of the best ways to tackle long-term
economic imbalances between regions.

Regional inequalities in health and social care | 10•

90% of those who died with Covid hadsignificant prior poor health.

•The most deprived places had much higher
Covid mortality rates; Blackburn and Darwen
had 345 per 100,000 die, five times more thanSouth Cambridgeshire with 68 per 100,000.

•

There would have been 40,000 fewer deaths in
the UK if the national Covid mortality rate had
been as low as the least deprived places.1

There are also variations in outcomes for major
healthcare conditions. For example in cancer
the latest data shows that North East has thehighest rate of cancer incidence at 646.1 patientsdiagnosed per 100,000 people, whilst London
has the lowest rate at 567.6 patients diagnosed
per 100,000 people. Other specific cancers whose
regional incidence rates varied across Englandinclude: oesophageal, stomach, melanoma of theskin and cervical cancer.2
These can be mapped fairly well onto other healthindicators such as the number of GPs per 1,000
patients, a general measure of health coverage inan area. While the East Midlands, Yorkshire, andthe North East all have worse than the Englandaverage cancer mortality rates (with London
having the best), they all have fewer GPs per 1,000
patients than the England average (with London
having the highest).

Tackling these health inequalities has been a goalof policymakers of all political parties, and features
as an explicit goal of the present Government’s‘levelling up’ agenda. A strategy to deliver this,however, as part of the response to the 2019
Prevention Green Paper, has been delayed due tothe pandemic.
At a speech at Policy Exchange, in August 2020,
the Secretary of State for Health and Social Carechampioned the importance of tackling healthinequalities in relation to ‘levelling up’: “Levellingup health inequalities and preventing ill-health isa vital and a broad agenda… It must be embedded
right across government, across the NHS, in
primary care, pharmacies, and in the work of every
local authority.”This applies as much to social care as tohealthcare, indeed across every part of the system:“pharmacies, primary care, community care,mental health, hospitals, and social care too.”3This is reflected in the approaches taken by thegovernments of Scotland and Wales. Digitalisation
is not just a project for NHS England. The SNP
manifesto included new commitments to
reduce health inequalities and shift the focus ofhealthcare to prevention.4 In Wales the Labour
majority administration is in the process ofcontinuing to enhance the implementation of
the wellbeing framework, which seeks to ensure
public bodies are acting in a way that improves
and enhances public health.5

Regional inequalities in health and social care | 11

02

Productivity (Nominal GVA per unit of labour input) (Index UK=100)

160
140

In many ways, the devolved nations and regions
are actually leading the charge towards integrated
health and social care. Digital Health and Care
Wales has recently launched, for example,
providing national technology and data services
across the country and the Welsh Government
has identified the development of digital services
as key to delivering transformed health and social
care (in many disadvantaged communities).

Among the combined authorities, Greater
Manchester’s Digital Platform – which joins up
data from the NHS, local authorities, and otherpublic bodies – is maximising the use of digitaltechnology within the health and social careecosystem. These efforts, often in areas of poor
health outcomes, have been undertaken in orderto improve indicators, reducing undue variation
across the country.

120
100
80
60
40
20
0

The health-economy link
This undue variation in health outcomes has adirect link to variation in economic outcomes –for example in workforce productivity or work
incapacity. Below is a chart showing the healthy
state life expectancy in different regions of the UK.

In general, life expectancy is highest in those areasof the UK with the highest productivity – London,
the South East, and the East of England – andlowest in those areas with the lowest productivity– Wales, the North East, and the North West.6

Variation in ‘healthy state life expectancy’ across the UK

86

84

East
Midlands

London

North
East

North
West

South
East

These statistics are mirrored in other healthoutcomes such as overall life expectancy andproportion of life spent in ‘good health’. They
are also reflected in the rate of children eligible
for free school meals, where 26.3%, or over 1 in
4 pupils, are eligible in the North East and 23.3%
in the West Midlands, compared to only 15.1% in
the South East where both productivity and life
expectancy are among the highest in the country.7
In Scotland, where productivity is relatively high,poor health outcomes map onto other economic
measures such as low wages.8
These correlations between health and economic
outcomes are increasingly considered to becausal. Ill-health has a direct negative impact on
economic outcome. Last year the Northern Health
Science Alliance found that 30% of the £4 perperson per hour gap in productivity between the
North and the rest of England is due to ill-health.
In fact, data even suggests that decreasing rates of
ill-health by 1.2% and decreasing mortality rates
by 0.7% would reduce productivity gap between
the North and the rest of England by 10%.9

82

80

78

76

74

72

East

East

East
Midlands

London

North
East

North
West

South
East

Health State Life Expectancy (from birth) - Female

Regional inequalities in health and social care | 12

South
West

West Yorkshire and Wales
Midlands the Humber

Scotland

Health State Life Expectancy (from birth) - Male

Northern
Ireland

A report from the All-Party Parliamentary Groupfor Longevity earlier this year found that:

South
West

West Yorkshire and Wales
Midlands the Humber

ScotlandNorthern
Ireland•

30% of the productivity gap between the
North and the rest of England is due to illhealth.

•

Health inequalities between the North and theSouth cost £13billion a year in lost productivity.

•

1.2m people aged 50-64 are not working
for health reasons and health is the principal
reason people in that age bracket aren’t
working.10

As more data arrives showing a very clear link
between poor health outcomes and weakerproductivity, policymakers are increasingly looking
to tackle regional economic inequalities throughthe prism of health. The benefits to the national
economy are potentially huge: if productivity in
the North increased to match the UK average, itwould equate to a potential £44 billion real terms
gain to UK GDP.11
The time has come to reframe healthcare
spending as an enabler of both transformed
health and improved economic outcomes in all
regions of the UK. The challenge is identifying thestrategies and tools that will deliver this.

Regional inequalities in health and social care | 13

03
Can Advances in
Health Tech Help
Close the Gap?

Regional inequalities in health and social care | 14

Regional inequalities in health and social care | 15

03
Despite exciting and dynamic advances,
health technology is often framed as
something that can reinforce healthinequalities rather than help tackle
them. This is particularly the case withsmartphone technology which enables
those with them to access greater
healthcare information and advice
through their devices.

This is broadly because wider access to health technology is unequal.
National Voices, the coalition of 170 patient charities has highlighted
this issue consistently:“

System leaders (must) confront digital
exclusion head-on. A significant
proportion of the population is digitally
excluded. Income, language, literacy,
confidence – all play a role. But digital
exclusion isn’t equally distributed those on low incomes, older people,
people with disabilities, and specificcommunities, many of whom arealready at particular risk of poor health,
are all much more likely to face digital
exclusion. They also face the double
digital health inequality of not being able
to access other essentials online - food,
employment, education, social support12.

”

These patient and public representative groups are not anti-technology
in health and social care (both have praised the way technology has
enabled people to continue to access care in different ways throughCovid); but they want to know that the system caters fairly for all users.
There is thus a strong sector view that the NHS and local authorities
should be doing more to ensure that digital exclusion does not affecthealth and social care access and outcomes.
Regional inequalities in health and social care | 16

Regional inequalities in health and social care | 17

“Covid-19 and the use of technology in healthcare
Covid has accelerated the use of digitaltechnology and demonstrated the benefits it
can bring. In the Health Foundation’s surveyof NHS staff conducted between October andNovember 2020, 82% of respondents said theirorganisation had increased its use of technology
to some extent during the pandemic and 51% had
been personally involved in that increased useof technology. Examples in recent months haveincluded the use of telemedicine to support virtual
patient consultations, integrating data to monitor
population-level responses to disease, including
hotspots of infection, and the use of online
platforms such as Microsoft Teams to support andconnect health and social care staff.

However, whilst the pandemic has shown thepositive benefits of the role of digital technologies
in health and social care, it has also shown the
difficulty of being able to reach particular groups
and communities, particularly those often withpoorer health relative to their local populations.
The vaccine rollout, while a major success, isdemonstrative of this. Public Health England Covid
surveillance data demonstrates the difficulties,
for example, of Black / African / Caribbean / Black
British citizens in taking up the vaccine (see chart
below).13

A recent article in the British Medical Journal
by Osama et al also noted the difficulties ofproperly tackling health inequalities throughtraditional health policy development and that
Covid 19 had demonstrated this:

93.3

51.0
87.5

47.5

Indian (Asian or Asian British)
Black/African/Caribbean/Black British

26.5

Pakistani (Asian or Asian British)

28.0

65.4
75.3

Other Asian/Asian British

81.7

34.9

Mixed/Multiple Ethinic Groups

33.0

76.4

Other Ethnic Group

32.6

74.1

Not Stated/Unknown

31.8

Total

76.5
89.5

46.9
0

One of the core aims of health policy
is maximising overall population
health while achieving equitable
health distributions. Tensions between
efficiency and equity often lead topositive and negative impacts ofhealth policies and interventions
being distributed unequally within
populations, as observed during
the Covid-19 response. For publichealth interventions to be consideredeffective, and not only efficient, thoseat highest risk must be targeted,protected, and supported, thereby
ensuring that health outcomes are
improved.14”

Cumulative weekly COVID-19 vaccine uptake by ethnicity in England in those aged 50 and over
White

03

20

40

60

80

100

% Vaccine Uptake
Dose 1 %Dose 2 %Regional inequalities in health and social care | 18

Regional inequalities in health and social care | 19

The better use of healthcare data
Policymakers are increasingly interested in how far maximizing population
health can be achieved by collecting better and more regular data on those
populations. By ensuring data is collected on the most at-risk groups, or
those with the most complex needs, the health and social care system should
be better able to respond in times of individual need, in turn reducing
variation in ill-health and mortality outcomes across the UK.
This applies as much to social care as to health care. A new report publishedby Digital Social Care and Skills for Care in June 2021 “shows that there
has been a steady increase in the use of all types of digital tools over an 18
month period with a seismic shift in the use of video conferencing software(+65%).” That has raised the confidence and ability of organisations to leadwith a digital approach, “20% care organisations now consider themselves tobe digitally ‘expert’ as opposed to only 12% in 2019.”15
Indeed, many of the lessons of wider digital technology use in Covid-19 are
now being taken into other areas of health and social care to integrate andimprove services. One major area in particular is how to use hyperscale cloudproviders, such as Microsoft Azure, to better link together healthcare data todeliver improved population health.
This comes alongside reforms set out in the NHS White Paper Integration
and Innovation: working together to improve health and social care for all
for delivering more integrated care across different regions of England.
Outgoing NHS England Chief Executive Simon Stevens, as part of moves
towards Integrated Care Systems (ICSs), has set out the need for the NHS
to play a more proactive and prevention-focused role in public health in
the years ahead.16 The NHS Long Term Plan, published in January 2019
included commitments to improve the measurement and focus of the healthsystem onto health inequalities17. In May 2020 the NHS Confederation and
NHS England launched a new NHS Race and Health Observatory which is
identifying and tackling the specific health challenges facing people fromBAME backgrounds.18“

03This pandemic has highlighted the value ofrooting our approach in the National Planning
Framework, the importance of preventative
practices and public cooperation. We will
increase our work on prevention, improving
life expectancy and promoting physical andmental health. Focus on putting in place
services, environments and wider approaches
that support people to live healthy lives.19”

The Welsh Covid recovery plans include similar messages andcommitments.20 The focus for health services in Northern Ireland is moresecondary care and acute focused given the pressures on the hospitalsystem in the country.

The challenge as the NHS emerges from Covid therefore is how to ensuretechnology is seen as part of tackling health inequality and variationand making the actions of healthcare systems more inclusive rather than
exclusive.

Similarly NHS Scotland’s Covid recovery plan included commitments toensure that a future policy framework was rooted in improving prevention
and public health:

Regional inequalities in health and social care | 20

Regional inequalities in health and social care | 21

04
Case Studies—

Improving Health
Outcomes with
Digital Technology

Recent work from across the digital technology sector is ensuringthat the emerging health data ecosystem is primed to tackle someof the most persistent health inequalities across the UK. In order tobetter understand the necessity of this work, in this next section we
look at three case studies based on work Microsoft has undertaken inhealthcare.
There are three ways to reduce health inequalities with digitaltechnology: optimising care team performance, enabling
personalised care, and using future technologies.

Regional inequalities in health and social care | 22

Regional inequalities in health and social care | 23

04
Case study 1—
Optimising care team performance in Dorset
A major way to reduce health inequalities is to
optimise the performance of care teams. Digitaltechnology can be a driver of this, using data tobuild cross-system collaboration across ICSs.
Health service collaboration across regions has
historically been difficult, with different healthand social care organisations working alongsideeach other in a relatively complex set up. Thatcomplexity has created silos in which integrationof working between public bodies has not
happened.
Fortunately, many areas have begun to shift
towards a more integrated model and ICSs havebeen developing better and more convenientservices, invested in keeping people healthy andout of hospital, as well as setting shared priorities
for the future.
This integrated approach has a significant digital
aspect, which hugely benefitted some areas
during the Covid-19 pandemic.

Regional inequalities in health and social care | 24

The ‘Our Dorset’ ICS had been building a matureapproach to data into its digital strategy since2016. By early 2020 it had built a data warehouseon Azure, Microsoft’s cloud computing service, tosurface insights using Power BI, Microsoft’s datavisualisation platform — and this was being widelyused by care teams.
The benefits were obvious. Multiple datasets fromacross the county were brought together onto
one platform, allowing them to be analysed by inhouse teams. Not only did the process save money
previously spent on external consultancies but it
also allowed Our Dorset ICS to respond quickly
during the Covid-19 crisis.
“We got the call a couple of weeks before COVID
really started hitting asking whether we could
use our linked-in datasets and our linked-in
people to build a COVID system report,” reports
Heather Case, the Intelligent Working ProgrammeManager at Dorset Intelligence & Insight Service(DiiS). Within two weeks its team had built drillable
dashboards that offered insights into risk andresponse planning, as well as operating as a casefinding tool for partner clinical organisations.
But the data was far more than just a Covid-19
database: “As we collectively started to know
more about Coronavirus, we could be a bit morepractical about what we were likely to want toknow, the groups that would be most impacted,
and which of our services and our workforce
would be most impacted. We started building
something that was far wider than just trying to
track the disease.” That meant real time updates
from across the patient population with no in-built
latency while staff compiled spreadsheets andamalgamated disparate datasets.

Over time, this data could help to close the healthoutcome gap between the most vulnerable,
complex patients and the rest. The integration
aspect continues as well, with data being sharedwith the police and fire service, all supplemented
by local authority information and detail on
mental health. All of this is helping to optimise
care team performance across Dorset.

The crucial fact is that this system is now being
turned to post-pandemic population healthmanagement. Dorset ISC can now analyse
comprehensive patient care records dating backto when they are first created in the county. This
represents a huge wealth of data about people’s
histories, how they’ve been treated and how
they’ve responded.

Regional inequalities in health and social care | 25

04
Case study 2—
Enabling personalised care in Greater
Glasgow and Clyde
Using the example above, it is easy to see how changes in the use of data can benefit
care teams. More data, more accessibly collated, with the benefit of real time updates
has the potential to make the health service far more responsive and efficient.
But the purpose of benefitting care teams is, ultimately, to benefit patients. Reducing
health inequalities is about making real changes to treatments on the basis of more
information.
NHS Greater Glasgow and Clyde is now using cutting-edge technology to remotely
monitor and treat people with a life-threatening lung condition in their own home.
Of all UK deaths from lung diseases, Chronic Obstructive Pulmonary Disease (COPD)
makes up over a quarter. It can be a debilitating condition, usually worsening overtime without treatment, and is the second most common cause of emergency hospital
admissions.
In 2019, two NHS consultants in Glasgow tried to improve these figures. Glasgow has
some of the worst health outcomes in all of the UK — initiatives which benefit patientsin the city have the potential to reduce health inequalities all over the country.
By using wearable devices and Microsoft’s Azure cloud platform to remotely
monitor COPD patients’ breathing machines in their homes and vary their treatment
accordingly, NHS Greater Glasgow and Clyde hoped to avoid hospital admissions
by catching warning signs early. That not only saves on the £6,000 cost of a hospital
admission but it improves the wellbeing of patients more generally, managing thecondition before it progresses so far that an emergency admission is required.

Regional
inequalities
in health|andReconcilingthe irreconcilable
02 social care | 26

The medical team partnered with Storm ID, a Microsoft partner that specialises indeveloping new digitally enabled care models. Alongside them, the care team wasable to see real time physiology data produced by a patient’s wearable device and tocommunicate with them through a cloud-based platform.
There is an empowerment aspect to this too, which ties in with poor health outcomes
across the country. By giving patients the tools to start to self-manage their own care,
the NHS hoped to give back a sense of agency to patients for whom an urgent hospital
admission was a constant and unpredictable possibility.
The trial, originally conducted with 400 patients, was a success. Hospital admissions
were reduced significantly over the course of the year. That success means similar
programmes will now be rolled out for other illnesses and conditions, including frailty
and diabetes. By tracking patients using wearable tech and feeding this data back into
the healthcare system in real time, some of the areas with the worst health outcomesare now beginning to close the gaps; empowering the most at-risk groups to manage
their care effectively before hospital admission is even required.

Regional inequalities in health and social care | 27

04
Case study 3—
The future of healthcare
Technology can be used during times of increased strain, such as the recent pandemic,
to ensure vital and routine health procedures are still provided to the public. Advanced
technology, such as Microsoft’s HoloLens can help in facilitating remote evaluations andtreatment while health care professionals keep a safe distance.
Protecting staff and patients from transmissible diseases, whilst also continuing normal
healthcare procedures has been a difficult balance, especially when there has been avariation in which areas are most high-risk, in turn impacting their ability to treat patientsas quickly and effectively as possible.
At the height of the pandemic, Dr. James Kinross, a surgeon at Imperial College, noticed
29 people were working close together during a trauma call. He realised that the hospitalneeded to change its way of working to manage the increased pressure on hospitals andhigh transmission rates in wards.
Imperial College Healthcare began using Microsoft’s HoloLens to protect healthcare
professionals providing critical care to patients. The HoloLens with Dynamics 365 remoteassist, a mixed-reality remote support tool, uses Microsoft Teams to send a live video-feed
to a nearby computer screen, allowing healthcare teams to interact with patients virtually.
Unlike virtual reality, which is completely computer generated, HoloLens allows users
to place 3D digital models in the room alongside them and interact with them using
gestures, gaze and voice. Using Dynamics 365, doctors wearing HoloLens are able to:•Hold Teams video calls with colleagues and experts anywhere in the world, enabling
virtual consultations•

Receive advice whilst also interacting with the patient at the same time•

Superimpose 3D views of MRI images and CT scans•

View medical notes and X-rays through the HoloLens glasses during patient
consultations

Regional inequalities in health and social care | 28“

Imperial College Healthcarebegan using Microsoft’s
HoloLens to protect healthcare
professionals providing criticalcare to patients.

”

The recent pandemic has shown high-tech innovation is notjust optional, but essential during health crises. Imperial College
Healthcare NHS Trust, which includes Charing Cross Hospital,
Hammersmith Hospital and St Mary’s Hospital, advocated for thetool, stating that it led to an 83% cut in the amount of time staff
spent in high-risk areas. It is also significantly reduced the amountof personal protective equipment (PPE) being used, as only thedoctor wearing the headset must dress in PPE. Early figures show
using HoloLens is saving up to 700 items of PPE per ward, perweek.
Covid-19 has changed how we approach healthcare forever,meaning tools such as HoloLens will be useful and necessary for
decades to come. Dr. Kinross remarked, “We’re now looking into
other areas where we can use HoloLens because it is improving
healthcare without removing the human; you still have a doctor
next to your bed, treating you. Patients like it, too. They areinterested in this new piece of technology that’s helping them.”
Due to the technology’s multiuse capabilities, healthcare
professionals can utilise its functions for various health services
and procedures. HoloLens can be used in departments suchas intensive care, trauma and in surgery to overlay CT scans
onto patients during operations, improving surgical accuracy
and reducing radiation exposure. HoloLens can also be used
for educational purposes, teaching medical student’s surgicalprocedures virtually, and creating immersive patient experiences
for students to use. It’s clear that Microsoft’s technology can beused in areas where hospitals are the most understaffed, andwith patients who are incredibly vulnerable or elderly. Lessons
learnt from the recent pandemic alongside the versatility of thetechnology used, is helping medical professionals reimagine thefuture of healthcare.

Regional inequalities in health and social care | 29

05
Implications forpolicymakers—

Integration andPartnership

Regional inequalities in health and social care | 30

Regional inequalities in health and social care | 31

05
Poor health outcomes do not have a single cause and just as
important as integrating services within the NHS is forging
partnerships with organisations working outside the health andsocial care system, such as employment support or housing
associations. By working in partnership with these bodies, healthand social care systems are increasingly building up pictures of
how to help patients with complex needs.
As such, technology has genuinely transformative power to help
– by being the infrastructure around which disparate services
and organisations can support each other’s long-term objectives.
Indeed, this potential is already being recognised. The NHS Long
Term Plan, for example, lists a number of benefits to introducing
digital health technology and investing further in digital
inclusion, including “improved self-management of long-term
conditions” and “costs saved through accessing services digitally.”
What it also allows for, however, is the “more appropriate use ofservices, including primary and urgent care.”21 By collating betterdata on patients, in turn enabling early detection and prevention,
it is hoped that the stubborn link between longer term conditions
and increased hospital admissions (disproportionately affecting
people living in more economically disadvantaged areas) can besignificantly disrupted.

Regional inequalities in health and social care | 32

Recommendations
There are several areas where government could make more or better use of technology specificallyto reduce undue variation in health. We would identify five broad areas for priority attention, which
together provide a strategic framework for improvement:

System intelligence – improved system
intelligence and information would enable healthand social care managers, and local government
leaders, to better monitor population healthin their communities and design better healthinterventions.

Organisational working – supporting staff inindividual organisations involved in the provisionof health and social care would improve thedelivery of services for patients: supporting andconnecting staff, and improving digital skills andconfidence, should be a big priority.

System and organisational partnerships –health and social care organisations both within
and outside the NHS should be working together
in partnership at a system level. This would help
deliver much better preventative care.

Supporting outreach – technology shouldbe playing a more central role in outreach andengagement with harder-to-reach groups who are
more likely to have poorer health outcomes. Thisshould be allied to a digital inclusion agenda.

Data sharing – we need more data sharing, more
fluidly, across integrated NHS services and alsowith external partner organisations, including
local government, schools etc, in order to better
manage overall population health.

We see these five areas as priorities for a technology-led strategy to reduce undue variation and raiseoutcomes. They provide a framework with which to design a strategy for driving specific interventions
that could help close health inequalities.

Regional inequalities in health and social care | 33

Conclusion
and areas forfurther study
References
1

Patterns of poor health and life expectancy across the regions map very
closely to indices of regional economic deprivation. We know the two
fields both cause and exacerbate one another, but there is always aneed for more research on specific causes – and crucially, which specificareas are most amenable to technological interventions.
There is also a need to quantify the impacts in order to better justify
additional resource being put to specific forms of health technology. For
example, in the outreach priority above, we need to understand how
far language can be a barrier to accessing NHS services; and how healthand medical-related language apps or devices could help more patientscome forward, while helping staff understand the issues. There is a huge
range of potential examples.
The other key aspect is to assess costs and benefits associated withthis. Making even modest improvements in undue variation in healthoutcomes would not only improve millions of lives, the additional
economic prize is likely to be worth billions each year added to the UK’s
economy.
The key in all of this is to identify specifically how far technology canbe used as a vehicle for closing variation. This should be the focus of
substantial new work by government, in partnership with industry andpatient groups.

Regional inequalities in health and social care | 34

https://appg-longevity.org/events-publications

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/cancerregistrationstatisticsengland/2017
3 https://policyexchange.org.uk/pxevents/keynote-speech-by-the-rt-hon-matt-hancock-mp/
4 https://www.snp.org/manifesto/
5 https://www.futuregenerations.wales/wp-content/uploads/2018/11/FGCW-Framework.pdf
6 Figures from the ONS, 2017-2019
7 https://explore-education-statistics.service.gov.uk/find-statistics/free-school-meals-autumnterm/2020-21-autumn-term
8 https://www.gov.scot/binaries/content/documents/govscot/publications/statistics/2018/11/
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9 https://www.thenhsa.co.uk/app/uploads/2018/11/NHSA-REPORT-FINAL.pdf
10 https://appg-longevity.org/events-publications
2

https://www.thenhsa.co.uk/app/uploads/2018/11/NHSA-REPORT-FINAL.pdf
12 https://www.nationalvoices.org.uk/blogs/what-digital-asks-should-now-be-nhs-wish-list
13 https://twitter.com/Dr_D_Robertson/status/1390304027473109003?s=20
11

14 https://blogs.bmj.com/bmj/2021/04/08/what-is-behind-the-low-covid-19-vaccine-take-up-in-

some-ethnic-minorities/
15 https://www.digitalsocialcare.co.uk/new-report-on-the-digital-maturity-of-the-social-caresector-published/
16 https://www.thetimes.co.uk/article/simon-stevens-nhs-coronavirus-vaccine-success-shows-ourblueprint-for-the-future-3kf6l20c0
17 https://www.longtermplan.nhs.uk/online-version/chapter-2-more-nhs-action-on-preventionand-health-inequalities/stronger-nhs-action-on-health-inequalities/
18 https://www.england.nhs.uk/2020/05/nhs-england-and-nhs-confederation-launch-expertresearch-centre-onhealth-inequalities/
19 https://www.gov.scot/publications/re-mobilise-recover-re-design-framework-nhs-scotland/
20 https://gov.wales/health-and-care-services-pandemic-recovery-plan-published
21 NHS Long Term Plan