Right care, Right time:
Driving value, outcomes
and experiences that matter

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For those of you who haven't heard one of my presentations, my job here at AXA

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Health is to look after the pricing and financial side of our large corporate

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portfolio. I wanted to take this opportunity to share with you

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how our claims trends have been developing recently.

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It's been a bit of a rollercoaster ride since the period of COVID.

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But I'm going to share with you some stats that are mainly from our large

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corporate portfolio. But for those of you dialing in who are involved

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in the SME market as well, rest assured the SME trends are

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extremely similar.

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So first of all, if we could go to the next slide.

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I wanted to talk to you, when I talk about claims cost inflation, what I

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mean. Some of you may have seen this slide before, but just to be clear what I'm

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talking about. So three component parts really of what

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adds up to our entire claims cost trend.

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Firstly is inflation, and I'll talk a little bit about that in a minute.

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We all know what inflation is, but there's things going on there at the moment.

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Incidence is perhaps the factor that's influenced us the most over the last

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three or four years. And I'll give you some stats of where we are with

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that. Some good news, though, you'll be pleased to hear.

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Complexity and innovation is the third aspect of what we all

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call medical inflation. I'm not going to talk about that much today, and my

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colleagues will do that much better than I will later.

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But let's focus on the first two. If we go to inflation first on the next

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slide, please.

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Okay, so inflation. We all know what it is.

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We all hear about it on the 10:00 news.

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Why is it important to our claims trends?

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Well, primarily,

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a lot of our hospital contracts are linked in some way, shape, or form

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to underlying inflation at some point. Clearly, there's a lot more to it than that.

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It's a lot more complicated, but in principle, we're going to have to pass on some

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sort of inflationary cost each year.

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So I've got a graph here on the right-hand side you'll see that tracks CPI,

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Consumer Price Index, Retail Price Index, and average weekly earnings.

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Now, for those of you who don't remember the 10:00 news from a couple of weeks ago,

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currently

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Consumer Price Index is going up at 3.3%.

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Average weekly earnings still higher, 3.8%.

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But you'll see from the far right-hand side of that chart that

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things have been picking up lately,

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and things are expected to pick up a lot more.

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You can't have missed the fact that there's a bit of a conflict kicking off in the

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Middle East. And because of that,

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the latest inflation figures are higher, mainly because of the

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spike in energy and oil prices and everything else.

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Bank of England have changed their normal way of predicting

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claims. For those of you who don't know, Bank of England normally forecast or have

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a target of inflation of 2%.

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Obviously, it's going the wrong way at the moment.

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They've actually issued three projections for the rest of the year,

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ranging between 3.5% and more than 6%,

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depending on how long and how significant the conflict in the Middle

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East becomes. So that's all a bit doom and gloom at the moment.

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Of course, it affects all of us in our personal lives, as well as what happens on

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medical inflation for our clients and our members.

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But yeah, sorry, a bit doom and gloom. Let's move on to some more positive stuff.

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If we can move on to the next slide, let's talk about incidents a bit more.

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So before I show you the incidents figures for AXA,

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I just wanted to set a little bit of context as to where the

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NHS is, because of course, all of our members have the NHS sitting

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behind their PMI membership as well.

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Incidents has always increased a little bit year on year on year.

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And this graph I've got in the middle is actually a BMA graph, which I always use

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to show how the NHS is doing in terms of waiting lists.

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So at the moment, there's about 6.1 million people

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waiting for about 7.2 million procedures.

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And you'll see how that's changed since COVID.

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The reason I use this graph, it bears a distinct correlation to our own

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incidents on our PMI schemes.

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So, dotted around the outside of the graph, we've got some key factors.

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Clearly,

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our corporate policies cover the working population,

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whereas the NHS stats look at the

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UK population as a whole. So there are some

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additional issues for us where we're covering the working

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population. So you'll see there that

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UK workforce sickness peaked in 2023, about the same

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time as the waiting lists were peaking and about the same time as the incidents on

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our PMI schemes peaked.

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Lots of the adult population, 18%, living with a long-term MSK condition.

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Over a third of the UK workforce now being over 50 years old.

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Being over 50, the likelihood of you making a claim on your PMI increases

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significantly, and I don't take that matter lightly given that I fall into that age

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category myself.

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And some mixed results on our NHS cancer

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turnaround stats. The time to start treatment hasn't been met for many, many

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years. So I think we all know the pressures the NHS is under and how that

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is linked to the general challenges in the

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demographics of the country, of older age, increased sickness, and

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unhealthy lifestyles and all that other stuff.

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So I just wanted to put some information in here about Doctor On Hand as well,

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because this is a really important part of AXA's PMI

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policies.

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There's a sort of game of two halves in this one.

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So the left-hand graph is the situation with the

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NHS at the moment. You'll see that about 44% of people manage to

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get an appointment on the same day, but the rest of the people are waiting quite a

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long time for theirs. And that, I have to say, is my experience of

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the NHS GP service as well. Equally, demands

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of the population, the same demographics that we talked about putting pressure on

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the NHS are also obviously going to put pressure on the NHS GP

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service as well.

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And the Nuffield

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Trust and the Health Foundation estimating that we'll need another 38,000

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GPs by 2031.I'm not sure where they're all going to come

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from. So it's

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struggling, I think it's fair to say, the NHS GP service.

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Looking at our AXA Dr at Hand service, which of course

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is our virtual GP,

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we've got 1.2 million lives activated on that now.

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As you see there, 642,000 appointments last year.

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Of those members that are using it, and not everyone does, but of those that are,

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you're generally having the average number of appointments in a year is 1.46.

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Really good feedback on the service, which we're really proud of.

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About half of the appointments you'll see there in the pink section

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on the pie chart are for advice only,

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and you'll see the top 10 reasons for where a

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referral was necessary. Well, I think the dermatology is always the top

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reason for that with any sort of GP, NHS or private.

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But this is some feedback that the volume of stuff, the

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consultations that we're providing through Dr at Hand is

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quite significant, but an excellent part of the service that they get from their

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AXA PMI.

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Right. So what happens if we add all this together? What does it all add up to?

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If we could go to the next slide, please.

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So I know these graphs are very small and you can't see the writing, but it's the

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shape of the graphs that are probably more important.

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So the top right-hand graph is the

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average amount that every life that I cover on my large corporate

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portfolio claims in a year.

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And you will see it starts off at around about COVID, when

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obviously things were less able to come, and you'll see

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this fast accelerating bit through the middle of the graph

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where the incidents were shooting up and the trends that we've been talking about.

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And then you'll see for the last year or so, year, just over a year

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perhaps, the claims trend has been actually quite flat.

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It is still going up, trust me, but it is relatively

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flat. And so what's been causing that?

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We've talked about inflation, we talked about incidents.

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Add all that lot together, you've probably got a small overall reduction

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in claimant incidents

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broadly offsetting inflation. Inflation is still there, there's

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no doubt about that.

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And increased utilization of our AXA pathways

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and other cost containment measures that we've put in place since the claims shot

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up to keep our products affordable.

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All of that coupled together has created this rather flat claims trend.

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Now, the million-dollar question, I guess, is what's likely to happen

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moving forward? I've put a graph at the bottom, which is our long-term

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incidents. I've only got the figures going back 10 years for employees.

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So the blue line on that middle graph, I want to put in perspective,

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although incidents is improving, it's only improving a

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little bit. It's not anywhere near going back to where it was before.

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You saw the figures before, it was up 20, 30% for most conditions

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over '23 and '24. It's going down a few percent on some,

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but overall, we're not going back to where we were before.

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So I don't envisage any return to pre-COVID claims

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trends.

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But they're improving, which is great.

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So what are we forecasting for the rest of the year?

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We are expecting to see by the end of 2026, an

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underlying overall, adding all these things together, claims cost inflation

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of around somewhere between 7 and 11%. Hopefully the lower end.

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Some of it will depend on what happens with inflation.

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Clearly, inflation impacts costs moving forwards because it impacts

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our hospital negotiations, which will then affect the period

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after those hospital negotiations have come into effect.

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So that's more of a long-term thing.

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But incidents and the state of the NHS, as we've seen, equally important.

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So we'll keep a close eye on all these trends for you because I think

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it's important that you're able to, A, be aware of what these trends that

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we're seeing from an insurer perspective, but also from an

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intermediary perspective, so that you can set your clients' expectations

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accordingly. Obviously, I can't make any promises for individual

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clients. Because of these trends,

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lots of clients are seeing their claims less than we expected, which means lots of

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clients are currently getting held rates and small decreases is

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not uncommon in the large corporate space at the moment.

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So that's all really positive, but obviously each client is priced on their

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claims trend in the large corporate space, so you never quite know what...

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This is average.

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But we'll keep a close eye and keep you up to date with what's going on.

Wonderful. Thanks, Clive. You did a great job there of setting me up, talking about the rollercoaster that we've been through post-pandemic, and if we

00:00
move to my first slide, you'll see that I've titled it not as a rollercoaster, but as a perfect storm.

00:08
So there might be some of you there who spotted when comparing some of Clive's tables and graphs that 2022,

00:14
when we saw huge increase in utilization well beyond what anyone had expected, also clashed with the highest inflation that we'd had for 40 years.

00:21
So 2022 really was setting the scene for a difficult period of time for us. Now, we didn't just let that happen

00:33
to us. We've got some things here that are outside our control, so I'm not going to go into these in too much detail. Clive certainly touched on a couple anyway.

00:40
But the incidents increasing was a driver, not just as a result of the NHS struggling, but you've got overall population health, which

00:50
itself is impacting the NHS capacity, so aging population, increasing obesity, poor access in general, both to primary care and to secondary, and then the

00:58
performance of the NHS directly, bed blocking, strikes, all sorts of staff shortages, really compounding that problem we've seen. As I mentioned, 2022 with the highest inflation in 40 years.

01:08
And underpinning all of this, a unique time as a positive, as a result of the pandemic, was the focus on medical

01:22
technology, medical developments, and tech. It really, really drove forward some initiatives that otherwise might have taken another decade to come through.

01:30
And I would love to talk to you about some of the science behind some of those innovations and how that's going to impact us.

01:40
I don't have time to do them in detail today, but what you need to know is a lot of these innovations will be life-saving.

01:46
They will offer opportunities for increasing life expectancy and life-saving treatments for people who otherwise didn't have any options or treatments available to them, but at

01:52
considerable cost. Think for those of you who might have encountered a case, we've only had a handful, but CAR-T,

02:03
so a type of treatment that takes the white blood cells, programs them to become killer cells to locate a particular cancer in the

02:11
bloodstream, and put that back in the patient, and we're seeing really, really fantastic responses. The same approach potentially can be used in all sorts of tumors,

02:18
including solid tumors, but we need to remember that the cost for that treatment in the past, before you had CAR-T, the treatment that was offered might have cost £40,000.

02:28
CAR-T is costing £400,000. So a collection of things driving some really worrying outlook, but we're not sitting still. So if we go to our next slide, please.

02:37
We preempted the volatility inflation and for many years, certainly for the decade I've been in the team, we have made sure our contracts with most of our

02:50
large providers and large independents have caps and collars within them. So it's not a surprise to you that we have annual

03:01
increases, that the hospitals are entitled to have an inflationary uplift each year, much like you will have on your mobile phone. The key difference is with your mobile phone, many of us will

03:08
have CPI, for example, plus an admin margin, so plus 3%, 4%, 5%. What we do is we take a

03:19
and from Clive's graph, we saw RPI all types up at 14%, RPI-X, which is one of the ones we use, was sitting around 10%, we

04:07
were comfortable that there was a degree of control that was saving 4%, 5%. And when you're spending hundreds of millions of pounds on hospitals, that 4% to 5% increase makes a

04:15
real difference. When we do our increases as well, we don't just do them flat. So the formula might come out at 4%.

04:26
We don't just say have 4% across the board. We will do targeted negotiations based on trend data. We will see what treatments are increasing.

04:34
We bring some horizon scanning and our medical tech data in to look at where we think the spend is going to go, and we will try to mitigate that

04:43
by freezing services, giving services either reductions or smaller increases, and offsetting that with higher increases in areas where we think less treatments are going to take place.

04:51
It's a game of cat and mouse because of course the hospitals have that data as well. But we've been fairly successful in the past.

05:03
The other thing we do is network optimization. So we don't just sit back once we've agreed a price and let it happen.

05:10
So recently, we have retendered our scanning network. The process involved clarifying some of the details around services. So actually, how quick can an appointment be

05:17
offered? When the appointment's taking place, how quick can you report on that scan and get it uploaded, if appropriate, back to us in one of our

05:29
pathways, if indeed that is the route the patient's gone. And on top of that, reducing the price. That activity alone has saved us around £20

05:36
colonoscopy. Now, an invasive procedure, which always carries risks and also not a very pleasant procedure because you have to go through bowel prep to prepare for it, and in many

08:21
of those cases of that population, they had no further treatment. They may have had a follow-up consultation, and that is it.

08:31
So our focus there was trying to reduce unnecessary interventions and investigations to help people access the care they require without going through that more costly and more invasive

08:38
process. This whole digestive health process has been successful on that basis, and the individual, during that conversation, can be

08:49
offered advice on dietary needs, low FODMAP diets, keeping a food diary, or perhaps if it's stress-related from when they completed their assessment, our clinicians who

08:57
offer this service will be able to direct back into our mental health assessment service to offer them some additional support on managing those stress or

09:08
anxiety drivers. Now, sticking on this slide, I'm just going to illustrate one other route. Let's say actually that this individual was either a positive

09:15
test, a fecal calprotectin test, they might have needed further investigations, or in a worst-case scenario, had a positive QFIT test, which means it might be bowel

09:25
cancer. We would go through the process. Again, they complete those tests. They'll have their follow-up consultation, and they will need to go and see a

09:32
clinician face-to-face for a colonoscopy. The clinicians we use, and I just want to dispel some myths here, are not

09:39
the cheapest clinicians. They're not the most junior clinicians that we recognize. 98% of our clinicians are signed up to our published

09:47
fees, so they're all charging the same price, and within that, they're all consultant grade. So all senior with a substantive post in the NHS or in the UK military.

09:55
Those clinicians are chosen and a preferred profile is created from comparing them and their peer-to-peer practice. So that will be their propensity to do investigations, how much

10:05
Those clinicians are chosen and a preferred profile is created from comparing them and their peer-to-peer practice. So that will be their propensity to do investigations, how much

10:05
pathology they do, how many scans they do, and associating that with the outcome. If they do lots and they get someone better quicker or better for longer, then

10:17
that's a great thing. But if they do lots compared to their peers and there's no difference in the outcome, they will be lower down our list.

10:26
Overpinning that are some clinical criteria. So specifically here for gastroenterologists, we might ask, what is your cecal intubation rate? Your ability, when you do a colonoscopy, to look around

10:33
the whole of the large bowel. Now, I know you'll all agree that if you're looking for bowel cancer, it absolutely makes sense you want to look at the whole of the

10:43
large bowel. Or we'll ask your adenoma detection rate, your ability to identify suspicious polyps, which is where the cancer might be.

10:50
There's a risk there that some people might go in and take out lots of polyps, which sounds like a great idea, but actually there's an increased risk of bowel

10:59
perforation, so a poor clinical outcome and an increased cost because histopathology of every polyp you take out might be £400 or £500.

11:05
So we eliminate specialists on that basis as well. Ultimately, the list that we come up with where we would direct the individual

11:14
who's had a positive QFIT test is a gastroenterologist that I would send my family, our AXA Health employees to. So I hope that reassures you on the approach we've been using there.

11:20
If they need cancer treatment, they will be referred to a surgeon from that investigation. A similar process might take place, or we take the

11:33
If they need cancer treatment, they will be referred to a surgeon from that investigation. A similar process might take place, or we take the

11:33
advice of the gastroenterologist, and beyond that, I want to illustrate where we do some cost control, again, from our contracts, but at the other end,

11:40
where we've seen a diagnosis and investigations coming to expensive chemotherapy drugs. Again, drugs are a driver of the innovation, and innovation is a driver of our overall claims

11:48
cost increases or medical inflation, as we might talk about it.We identify this as a risk, and we work within our contracts to try and pin hospital groups to the lowest

12:00
BNF. The BNF is the publicly available British National Formulary. It's got the price list, effectively, of every drug used in the UK.

12:11
Within that, you will have, and I'm going to use a very simple example you'll encounter in your everyday supermarket shop, Panadol as a

12:20
premium paracetamol at maybe £5, and supermarket paracetamol at 80p. They both do exactly the same job. The same thing applies to many cancer drugs, the branded and the generic.

12:26
We oblige people to bill us in line with the lowest BNF. Whether they procure that one or use the branded one is up to them.

12:37
We also then control markup on top. There does need to be a markup. There are expensive costs associated with the services to deliver

12:44
chemotherapy. You need aseptic rooms to mix the drugs up. You need to make sure it's available when those patients come in and need it, and

12:50
obviously a pharmacy running it in the background. So we have a markup to allow for that. But that markup is at a relatively low rate.

12:57
We've certainly made huge strides over the last five years to reduce from where it was. Historically, there were sliding scales in the market and all sorts of things.

13:04
We've managed to get it down to around 10%, in most cases, and applied a cap. So you will have lowest BNF, 10% markup,

13:12
capped at £300 to £500. That might still sound like a lot, but when you're talking about drugs that, in future, are going to be £20,000

13:21
a month for maintenance chemotherapy of three or four years, you can understand that having 10% capped at £300 or £500 will make a world of

13:28
difference to that overall claims cost. Next slide, please. So what does that actually mean, and what experience do our members get?

13:36
I'm going to pick out a few figures here. I'm not going to go through all of them. You'll be really delighted, or certainly I am delighted, to see just how many of

13:49
the numbers are 90s, and certainly high 90s, 98s, 99s. So some of the figures I'll pick out. Our most mature pathways are muscle, bones, and joints pathway, with

13:56
13,000 users per month. When I mentioned scanning negotiations earlier, and how we'd reduce the price and to find better and

14:06
stronger SLAs, that really comes into play here, where you will go through your investigations and may be referred for a scan before you see someone

14:14
face-to-face. Where we refer for those scans will be the most highly performing scanning centers based on those SLAs around appointment availability, reporting, and uploading of

14:21
results, on mileage, depending on the member's postcode of choice, home, work, family, et cetera, and on the cost multiplier.

14:33
So we come up with a figure to refer them to, and the more users we have for this pathway, the more we can refer down that route to our scanning

14:41
So we come up with a figure to refer them to, and the more users we have for this pathway, the more we can refer down that route to our scanning

14:41
centers, and the stronger negotiation approach we have next time we renegotiate them. 99% of people who require physiotherapy are getting seen within one

14:47
working day. That's pretty astounding. It's better than we expected. And with 4.6 out of 5 for satisfaction, I don't think we can argue with that.

14:57
The key point here, what does it mean? 33% saving when you use the muscle, bones, and joints pathway over an adjusted case mix, so the same sort

15:09
of claims that haven't gone via the pathway. That can be significant. Largely made up of avoiding unnecessary initial consultations and making sure that when a scan is

15:19
required, it's going to a cost-effective provider. The other one I'd like to pick up are the skin and breast pathways.

15:31
So the skin and breast pathways are cancer pathways. So you have people who inevitably have a symptom and are immediately

15:39
worried. 98% of people offered appointment within five working days for skin and 95% for breast. That means we've offered an appointment.

15:47
They might decline that and take one a little further away, which is why you can see that for skin, there is 6.4 days as the average,

15:55
versus 4.8 for breast. But again, the outcome, 4.89 out of 5 for the trust score on that, which I think

16:02
we'll all agree is really reassuring. Next slide. So this is just the recap. Many of you will be aware of this, but just in case

16:10
you're not, and very cognizant there are some of you who will have SME clients where some of these aren't necessarily applicable.

16:22
But the services currently available are muscle, bones, and joints, digestive health, dermatology, mental health assessment service, then cancer-specific breast, skin, and prostate.

16:30
So we come up with a figure to refer them to, and the more users we have for this pathway, the more we can refer down that route to our scanning

14:41
centers, and the stronger negotiation approach we have next time we renegotiate them. 99% of people who require physiotherapy are getting seen within one

14:47
working day. That's pretty astounding. It's better than we expected. And with 4.6 out of 5 for satisfaction, I don't think we can argue with that.

14:57
The key point here, what does it mean? 33% saving when you use the muscle, bones, and joints pathway over an adjusted case mix, so the same sort

15:09
of claims that haven't gone via the pathway. That can be significant. Largely made up of avoiding unnecessary initial consultations and making sure that when a scan is

15:19
required, it's going to a cost-effective provider. The other one I'd like to pick up are the skin and breast pathways.

15:31
So the skin and breast pathways are cancer pathways. So you have people who inevitably have a symptom and are immediately

15:39
worried. 98% of people offered appointment within five working days for skin and 95% for breast. That means we've offered an appointment.

15:47
They might decline that and take one a little further away, which is why you can see that for skin, there is 6.4 days as the average,

15:55
versus 4.8 for breast. But again, the outcome, 4.89 out of 5 for the trust score on that, which I think

16:02
we'll all agree is really reassuring. Next slide. So this is just the recap. Many of you will be aware of this, but just in case

16:10
you're not, and very cognizant there are some of you who will have SME clients where some of these aren't necessarily applicable.

16:22
But the services currently available are muscle, bones, and joints, digestive health, dermatology, mental health assessment service, then cancer-specific breast, skin, and prostate.

16:30
Just want to acknowledge there's a dermatology pathway and a skin cancer pathway. That might be confusing for people to go through, but our PAs,

16:41
whether you do that via live chat, member online, or phone us up, have the right questions to ask to make sure you follow the right pathway.

16:48
Essentially, it's suspicious lesion or it's rash and other, so it's quite easy to define. And some of our corporates have built-in pathways around gender dysphoria,

16:55
fertility, and neurodiversity. Coming up soon, excitingly to launch later this year, currently in pilot with some of our population, is neurology, cardiology, and urology

17:05
pathways. Those are the online outpatient services, so they follow the virtual assessment through to a consultant and on to diagnostics if

17:15
required. And just there in that box on the right-hand side, ultimately, our aim here to try and mitigate some of that increase in incidents and control some of the inflation

17:23
costs is designing and launching online outpatient services that offer safe, effective care and make sure our members get the right care at the right time.

Well, hello everyone. I'm really happy to be here. I'm Dr. Imran Stern, and I'm the head of mental health here at AXA Health, and I'm

00:00
delighted to be joined here by my colleague and friend, Shamira, from OneBright, for a conversation that's really close to our hearts.

00:07
That's around mental health. And I guess it's something that affects all of us in the room today and our loved

00:13
ones. So, let's dive in, Shamira. Thanks, Imran. Pleasure to be here as always. So let's start by setting the scene.

00:20
So what are your recent observations in terms of trends worldwide? Well, look, mental health is everywhere. You can't put the TV on or open a newspaper without seeing something about

00:29
mental health. I think what's been really interesting is seeing the trends that are happening globally. So we have the Mind Health report that

00:40
AXA produces every year. This is our sixth year of the report that involves 17 countries, and we have over 19,000 respondents of working

00:47
age that complete a self-report questionnaire looking at what's going on with their mental well-being. And year upon year, we're finding that there is an increase, unfortunately,

00:55
an increase in severity and an increase in need for support. There's lots of things that are impacting this. And what was particularly striking from the report this year is that financial

01:04
worries and the part that plays, as well as an increase in depressive symptoms, anxiety, and PTSD. Also, the younger population struggling more with our sort of 18 to

01:14
25-year-olds, particularly with loneliness and anxiety. Across the board in the workplace as well, Shamira, we're seeing that increase in stress, burnout, and the financial pressures, as I said

01:25
before, and we're looking at different solutions for this. And individuals are asking for more proactive support rather than reactive support and more targeted

01:36
strategies and interventions. And I guess, we're all seeing mental health sick absence growing, particularly in London, in the UK, and across the globe.

01:45
So as I said, there were 17 countries that took part, and in all of those countries, there's been an increase in mental health sick absence, where

01:56
individuals are off for longer with more complex presentations. And we've never seen this before. So it further highlights that there's a need to

02:02
find different solutions, and a need to really have this conversation even more. I guess from a clinical perspective, and what research tells us,

02:09
is there's a need for a different approach, a more layered approach to well-being and mental health, and I'm sure you see this, Shamira, in clinic,

02:17
where some individuals need that one-to-one support, some may need groups and webinars or training. So there's lots of different layers, and one size does not fit all with mental

02:24
health. And that's something that I know you and I talk about a lot as well. Yeah. Absolutely, Imran. It's what we're seeing on a daily

02:34
basis. So this- Mm-hmm ... sort of this idea of one size fits all I think is behind us now.

02:42
Corporate mental health is at quite an interesting point- Mm-hmm ... I would say. We know that obviously we've spoken today about the

02:48
reduction in state provision and the- Yes. Mm-hmm ... increase, although that's slowed in terms of incidents and claims rate.

02:56
And the other thing that we've noticed is that employees and employers have become a bit more discerning about the provision-

03:02
Mm-hmm ... that they're looking for. So they're looking for multi-channel, multiple ways of delivering. And also they're really thinking about the factors that are happening in their

03:09
workforce at the moment. So despite all these sort of best efforts and investment in this space, what's interesting is that actually-

03:18
Mm-hmm ... it is still the leading cause of absence today, and we know that it's obviously got the compounded impact in terms of productivity

03:26
as well. Which there's lots of department work and pensions initiatives- Yeah ... addressing productivity gaps at the moment. So the particular role of mental health driving that

03:34
productivity gap as well. So it's a very interesting time. Absolutely. And I think that's why having that global understanding and more local

03:44
understanding in the UK is really important. Because it affects all of us in different ways, particularly employees and employers, and there's so much emphasis on getting it right,

03:51
finding solutions, and that can be a real challenge. So from a provider perspective, what are you seeing as being helpful and

04:01
useful, Shamira, in this space? From a provider, we've had to really, in terms of we're thinking about EMPath, the provision, so we have over 20,000 AXA members come

04:07
through to us. Mm-hmm. And what they're looking for is a specialist service. So it's our job to help to guide them and navigate what services

04:18
are available. And rather than just seeking core support, so sort of more traditional modalities, actually they're looking for specialist services layered on as well.

04:27
Mm-hmm. So examples around that would be gender-based pathways- Yeah ... perinatal, postnatal support. We also have got pathways which

04:38
think about the comorbid impact of physical health conditions and psychological health conditions. And as you've mentioned, children and young people-

04:48
Mm-hmm ... so increased incident rates of children and young people coming forward and accessing our services. So, we're working with younger groups than ever, so pathways start from

04:55
age five, and that really, again, was another innovation to think about this really specialist provision. It is really interesting, isn't it?

05:07
I think, as a parent myself, and I've got teenagers, there's lots of pressures in society, and then this then translates as we

05:16
grow up into the workforce. So there's definitely lots of risks out there, and it's quite a complex picture. And we're seeing that a lot of

05:23
providers like yourselves are looking at different ways to address it. Absolutely. So I think, moving on, thinking about those key pressures that employers should be aware of.

05:31
I know, Shamira, you and I get asked this quite a lot about different things that we're seeing and what is impacting on mental health.

05:40
It's almost like the million-dollar question, isn't it? What is causing this increase in need? And I think something that we're definitely seeing at AXA is that

05:48
shift in age and that difference between different generations. So that younger workforce that are coming into employment now, who have

05:56
had the COVID generation, I guess you could say, who've had that experience. We're seeing a lot more anxiety, a lot more depressive symptoms, and also

06:04
loneliness playing a big factor. Another big part that's really important to think about and something that we're seeing in research

06:11
is the sandwich generation. So I am part of that. I am the young age of 46, as I'm sure you all agree,

06:19
who has got elderly parents as well as teenage children that I'm looking after. And the pressure that can be created from this is quite immense,

06:24
and I think it's something that we don't talk about enough. So again, there's all these different parts-To us, to our lives, that we bring to work.

06:32
And I guess also something that we're seeing is when we're mapping a life cycle, Shamira, and I'm sure you see this as well, there's different pressure points that

06:41
we'll go through in a life cycle. So for example, at the moment, it's GCSEs in my household for my 15-year-old. Shamira, your son is also going through them, I'm

06:48
sure. So, that's an added pressure for me when I'm thinking about home life. And then, coming to work, workload might be increasing.

06:55
There might be different pressures at the same time. So it's when these collisions happen that we really see this can impact on our mental well-being, and no one is immune

07:03
to this. So I think it's just really important to have this conversation. So Shamira- Please. Yeah, that's just exactly what we're seeing in our data points.

07:11
So there's sort of two marked points that we're seeing in terms of spikes of referrals- ... and populations coming across.

07:23
So Gen X, I know it's spoken about very, very regularly. So we know that actually, they over-index- Mm-hmm ... in terms of they come through in higher numbers than their population

07:29
would suggest. And then two things, we know that that is even more pronounced for females, so we're thinking in that sort of 16 to 25-year-old

07:40
range. Yes. But crucially, actually, their clinical severity- Mm-hmm ... is not higher than other generations. Okay. So they come forward in higher numbers, but clinical severity

07:49
is, yeah, is not higher than other parts of generational bandings. And then the other factor we see, as you've mentioned, is

08:00
sandwich generation. Mm-hmm. So again, over-indexing for females. So men tend to have a steadier- Mm-hmm ... sort of steadier referral rate across each of the

08:07
different generations. But we do know two things. When they do come forward, they've got higher clinical severity. Yes. So therefore, they're waiting longer to access care.

08:17
So employers just need to be thinking about all these factors, so mapping life stages- Mm-hmm ... life events, thinking about their population, because the risk factors are

08:27
quite well known and quite well-researched. Absolutely. I mean, I guess if I was to ask you, what can employers think

08:36
about on how to address these pressure points? So I guess, what can they look at in their data, and what things do you

08:47
think would be useful for them to address? So I think it's around who is coming forward, so in terms of their incidence rates,

08:54
their utilization, which groups are coming forward, which are not. Think about your generational bandings within your organizations. Who's claiming, who isn't? We do know that there are sort of predictive

09:01
risk factors on each of the different generational bandings and life stages as well. And then the other thing that people can do is really

09:13
focus on navigation. Mm-hmm. So people can have amazing provision, but actually- Yes ... if an employee doesn't know how to find the support that they need at

09:22
the point with which they need it, then that actually can be a challenge. So it's around signposting, navigation, and understanding

09:30
your population. Yeah, I couldn't agree more. And I think to add to that, also giving your employees time to join in and go to these events.

09:38
So, we speak to lots of different clients who put on fantastic webinars, workshops, training. But if somebody has got back-to-back meetings and they don't look up for air before

09:46
it's 4:00 PM, they probably miss a lot of that. So it's really thinking strategically and operationally how these things play out

09:57
that I think is really important. And I guess, we understand that many of our clients want to support their employees at every stage of that kind

10:03
of mental health journey because everybody experiences mental health in different ways. And as, Shamira, you said, sometimes men wait longer to get help, which

10:10
means they may come to services and present with much more complex needs. So as you can see on the screen there, we've got supporting

10:18
employees with their mind health and different things that we have available. So for example, the integrated mental health support that provides an easy

10:25
access and quick access with the appropriate level of care and ensuring that employees receive that right care at the right time to suit their needs.

10:32
I think it's really interesting when it comes to mental health because Shamira and I both get asked questions around, why was that treatment given, and why was it

10:39
quicker for someone to get better there? And there isn't an exact science. So one plus one does not equal two in mental health, unfortunately.

10:47
It doesn't equal 11 either, as my young child will say. But what is really important to capture here is that we follow NICE guidance.

10:53
We follow that clinical evidence, and all of our clinicians do as well. They're all accredited under the right governing boards.

11:01
In order to give the right dose of treatment, I think that's really important. So the key things here are rapid access,

11:08
thinking about getting the right dose of treatment in order to get that best outcome. And now, Shamira, I'd like to sort of come over to you because I

11:14
know that you're going to exemplify this even further by thinking about some case studies and really bring this to life.

11:21
So if we move on to those case studies, that would be great. Yeah, thanks. Thanks, Imran. So, it was quite difficult to

11:26
pick case studies for today. But what I hope that we've managed to do is actually pick two client stories,

11:33
but then think about actually they do have some quite typical hallmark and features that we're seeing and that we're assessing and treating every day.

11:40
So, a pleasure to introduce Cassie to you. So she is 11, and her mom makes contact with AXAAnd is booked in and referred over

11:47
to One Bright for our specialist children and young person's pathway. So that happens very quickly. We have same-day availability, and it's

11:59
really important that at that point that somebody reaches out and recognizes that they need support and help, particularly for families, that we're

12:07
able to respond to that very quickly. So at assessment, it becomes apparent that Cassie has been struggling. So she's recently transitioned from primary school

12:14
into secondary school. And again, when we're thinking about risk factors and life events, that is one that we see as a hallmark within children and young

12:25
people very regularly. And actually, over time, she's become more and more withdrawn at home. She's withdrawn in terms of her hobbies and activities.

12:33
During the assessment, Cassie discloses that actually she's been engaging in self-harm on her upper thighs and upper arms, which is obviously very difficult for

12:44
her mom to hear. So One Bright clinicians are really experienced, qualified, accredited, et cetera. And actually, on the children and young person's pathway, they're really skilled at

12:56
engaging the young person and anybody with parental responsibility as part of their therapy journey. So at the end of the assessment, she's matched with a clinician.

13:06
And as Imran said, it's really all around the evidence base. So based on the evidence that we know, what is the treatment

13:19
of choice that we should be recommending? So in this case, it was cognitive behavioral therapy. So Cassie attended just nine sessions.

13:26
And it's a flexible pathway, so some of those were with her mom, some were on her own, and actually some, two sessions, Cassie's mom actually

13:34
attended on her own. And that was really to understand more about self-harm, which obviously, as a parent, can be very alarming to hear that your child is

13:42
self-harming. So attended the full course of therapy, and really pleased to say that we had a fantastic outcome here. So an example of what

13:50
we did, we can see there the reduction in this belief of Cassie sadly believing that she was a bad person.

14:00
At the end of therapy, that had reduced to 5%. And the key thing there is that we know that if somebody has got that belief

14:06
about themselves, that will actually will be what is the triggering behavior, the triggering thought that leads to the behavior, which in this case

14:13
was self-harm. So teaching Cassie more adaptive ways of coping. So really positive case study to share today, Imran. Thank you. Perfect. And I guess lots of people on the call are probably

14:21
relating to this, and it might resonate with them. And, again, a question we get asked often is, and what are those ingredients that

14:34
make that best recipe for therapy to be successful? Because it is really hard, isn't it? Lots of stars need to align.

14:40
So what do you think are the key things? So I think one is around the skill of the clinician.

14:46
Mm-hmm. Definitely. So making sure that they, particularly for children and young people, really, really well trained- ... lots of CPD to support, maximize the engagement.

14:52
So we've used a metaphor here. Mm-hmm. So we're using metaphors, we're storytelling, we're bringing in elements of their life, their favorite characters, their favorite toys to engage the

15:00
children. The other thing is thinking flexibly. So it's around putting that child- Mm-hmm ... at the heart. So actually what interaction needs to be with

15:10
parents. Yes. So it's around a flexible deployment of an evidence-based pathway, yeah. Fantastic. Thank you so much. That's really useful.

15:18
And I guess flipping it now to the adult population. I know you've got a great case study as well of a male, typical kind

15:27
of presentation. Could you talk us through that as well, Shamira, please? Yeah. So I've chosen Carl. So he presents in the assessment with

15:34
generalized anxiety disorder. So that is the most common presenting problem that we see across both genders on the AXA

15:42
MPAS pathway. So he, again, a very typical story, which is that he has been experiencing work-related stress quite significantly, so over the last 18 months, and it's been

15:50
compounding. And when we're thinking back to that sandwich generation, actually, Carl has got all those features here. So he's got children undergoing exams, his

16:03
partner is working away, and he's got the responsibility of aging parents. So all of these life events, life factors,

16:13
partner is working away, and he's got the responsibility of aging parents. So all of these life events, life factors,

16:13
against a backdrop of work, of restructuring, the threat of AI looming, which I know is very familiar to most people on this call.

16:21
So compounding into a diagnosis known as generalized anxiety disorder. So he engages, again, and I think the key thing with

16:28
Carl is he was very clear about the type of clinician that he wanted to work with, the therapy that he needed, and also practically around the time of

16:39
day that he would like to do that. So all his preferences were reflected. And then he went on to attend a course of

16:47
therapy. So nine sessions in total. So those nine sessions spread over three months. So again, pleased to say that Carl

16:55
enjoyed a full recovery. So imagine that if you're thinking, "I cannot stop worrying," and that is you have that thought

17:04
continually every day. And actually, that goes to an absence of worrying. So a really significant impact for Carl. And we know that we were able to demonstrate that on all our clinically

17:12
validated measures and through our data as well. And Carl was quite an analytical individual, so sharing back those measures per session, being able to track his progress was something that

17:23
improved his outcomes as well. That's fantastic to hear. And it is really hard to listen to, and Shamira, you do this every day, but these are real people.

17:36
These negative thoughts, the way it impacts on everyday life. Mental health can be really debilitating, and I think getting the right help at the

17:47
right time is key. And something I wanted to ask you, Shamira, is around that clinician matching that you do really well at One Bright.

17:53
And just wanted you to sort of explain that a little bit further before we move on, if that's okay.

17:59
Yeah. So the evidence base tells us what the right modality is, so the intervention, the type of clinician, to increase the chances

18:04
of clinical recovery. But we also know that somebody's preferences really do need to be accommodated as well. So that happens right from the PA, so if somebody calls into AXA, the

18:12
PAs can make notes. They have live access into our system, so they're able to book the clinician, and then those notes come forward

18:23
into our system, and they will match. So Karl will only meet with a clinician that is actually completely in line with his preferences and needs, and that is

18:31
crucial. And I think the other thing that we know, that particularly men come forward later, is that we have to capitalize on that moment.

18:42
So they reach out, and all of this, if anybody comes into One Brit, they will be offered an assessment same day, next day, and then their first

18:49
treatment will be around two days if they choose to opt for remote therapy, and face-to-face over five days. So really rapid access, and I think that that is our role with AXA to do

18:56
that. Fantastic. So what I'm hearing, Shamira, is the importance of that early referral, early intervention, a key treatment plan that's targeted by qualified,

19:08
experienced staff, all adhering to NICE guidance that are flexible. So I think that's the key here. We know one size doesn't fit all.

19:17
We say that a lot, but we really do try to give individuals that flexibility so they can engage really well.

19:24
So thank you so much for those useful insights. That was great to hear. Thanks, Simran. So before we wrap up, do you want to just run through the top practical

19:30
tips, key takeaways from today? Yeah, absolutely. I think there's some key things that all of us can do a bit better, I guess, and reflect on

19:42
within the workforce and where we work. So some of the things that we've learned from AXA over the years is

19:53
leveraging that data and insight, so to have that targeted impact and it to be meaningful to your population. For example, there's lots of satisfaction questionnaires.

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I'm sure you are collecting your organization pulse data, different things that are building a picture of the actual population that you have.

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Because we need targeted interventions that are actually meaningful for those who are engaging in them. So gathering data is really important.

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Adopting that supportive, open culture and addressing psychological safety. Now, psychological safety's had a bit of a re-emergence, I think.

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It's been here for a long time. Amy Edmondson coined the term a good 25 years ago, but it is really important. We know that organizations that are more

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psychologically safe and employees feel psychologically safe have less mental health sick absence, and there's lots of data to show this, have

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higher rates of innovation, and the employees feel happy when they come to work, which is huge, because that's what we want.

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The other point here, and I think I said it before, is to make support accessible. That means offering different things for different people because they can address

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and engage with it at different times. So that could be offering something that's digital versus an EAP service where they get

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one-to-one help, or it might just be having a webinar or an open chat around what is mental health, and I think it's really important that we have

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that. I also think leadership play a role here and to lead by example. It isn't always easy to come to work and be open and honest about your struggles,

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but I think if you can have that tone with your team, it really does help. So we've said before about tailoring the needs to diversity.

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Again, that's really important in those life stages. And also to refine your approach. Things change. We had the massive boom of COVID and how that impacted on our

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working lives. Everyone now uses Teams so much more. I came from an NHS background and had to do therapy

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online for the first time. So it's all about refining what we do and making sure that we engage with our people in the best way that we can in order to support

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their mental well-being. So I guess wrapping up, Shamira, finishing off today, prioritizing our mental health is a strategic imperative, and implementing these strategies help us build

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healthier and more resilient workforces.