The value of partnerships in enabling holistic diabetes care

By Navodi Kuruppu

PPP’s Director of Market Access and Policy, Ameneh Saatchi, spoke with Naj Rotheram, Medical Lead for Partnerships at Boehringer Ingelheim, to discuss their view on primary care, partnerships and how they can best support the NHS in delivering a new holistic approach to diabetes care.

The Diabetes Care programme has been sponsored by Boehringer Ingelheim. Boehringer Ingelheim has had no influence over the agenda, programme development, content or selection of faculty. This Editorial was written by PPP but features content from an interview with Boehringer Ingelheim. Boehringer Ingelheim has therefore reviewed the content for factual accuracy only.

Since their establishment in 1885, Boehringer Ingelheim has evolved into a leading manufacturer of pharmaceutical drugs for both human and animal healthcare. As a research-driven company operating in the UK among many other countries, Boehringer Ingelheim aims to support the NHS in improving clinical outcomes, access to evidence-based care and the quality of life.^[1] To make this happen in diabetes care, Boehringer Ingelheim researches and develops innovative medications to support patients throughout their care journey.^[2]

Naj Rotheram is Medical Lead for Partnerships at Boehringer Ingelheim. Having worked in the NHS for fifteen years before joining industry thirteen years ago, her experience makes her well-placed to understand how the NHS can deliver successful holistic care to people with diabetes. In her current capacity, Naj collaborates closely with the NHS across all disease areas, including diabetes, to address challenges and improve patient outcomes.

Developing preventative, holistic care

Naj describes a now familiar picture of the NHS: a system burdened by resource constraints, backlogs, workforce pressure, low morale – issues that have been further exacerbated following the COVID-19 pandemic. These challenges have dominated health discourse in recent years, and were recently highlighted in Lord Darzi’s independent investigation, with political figures warning that the system will collapse without reform. In view of this fact, Naj has long advocated for a structural transformation within integrated care systems (ICSs) to enable entire care pathways to deliver care collaboratively and holistically, treating patients as a whole rather than focusing on a single diagnosis.

“The long-term goal of structural transformation is to support better integrated care and therefore a better patient experience, hopefully across the entire pathway and better working together. But it does take time for that integrated way of working to embed itself.”

ICSs were set up with the aim of improving health and care services, prioritising a focus on prevention, better outcomes and reducing health inequalities. The power of prevention in diabetes care has already been demonstrated by the NHS-funded Diabetes Prevention Programme, which has been shown to reduce the risk of type 2 developing by 40 per cent. Yet, a study by The King’s Fund has found that local systems are at risk of going ‘off-track’ due to pressures on services, intense political scrutiny, and extremely difficult economic circumstances – and the impact these conditions are having on the ability of local, regional and national leaders to act.^[3]

The challenge for ICSs is reflected in diabetes prevalence and linked co-morbidity figures, which are continuing to rise. Since 1996, the number of people with diabetes in the UK has risen from 1.4 million to more than 4.8 million and is estimated to reach 5.3 million by 2025.^[4] The challenge of a growing at-risk cohort is compounded by an ageing population, and the complexities linked with long-term diabetes management, including complications and multimorbidity cases. Recent data from the 2023 National Diabetes Audit shows that more than 3.5 million people registered with a GP were identified with non-diabetic hyperglycaemia, also known as pre-diabetes. ^[5][6]

Diabetes often “starts with one diagnosis,” explains Naj, “and then accumulates a host of other health risks and problems”. In fact, diabetes is the leading cause of blindness in working-age adults, and around 10 per cent of diabetes patients will develop leg ulcers at some point in their lives.^[7][8] Naj’s ideal vision is a model of localised care, centred on early diagnosis, better prevention and early intervention, thereby reducing the risk of these complications developing. Central to this approach is including patient perspectives to better understand their experiences. Naj also emphasises the importance of involving primary care professionals, ICS leaders, commissioners, and national policymakers in the development of multidisciplinary, holistic care pathways.

“Patients want to be treated by someone who considers the impact that disease might have on their heart, on the kidneys, on their brain, on their eyes. They say, ‘please look after me as a whole person,’ but the NHS isn’t necessarily well set up for that.”
-Naj Rotheram

Diabetes outcomes are significantly impacted by health inequality, with rates of undiagnosed diabetes being twice as high in areas in the lowest Index of Multiple Deprivation quintile compared to the top.^[9] Naj stressed the importance of harnessing and embedding data-driven insights from population health management (PHM) into diabetes care pathways to allow systems to identify, and target interventions towards, underserved communities. An example of this is the Joint Working Project between Boehringer Ingelheim Limited and Salford Care Organisation.^[10] The project aims to implement an integrated, neighbourhood-based, holistic diabetes service to address the complex needs of patients with cardio-renal-metabolic (CRM) diseases in Salford. By employing a workforce with diverse skillsets, and using data to identify individuals with the greatest needs, the project has successfully engaged communities within Salford’s population that have traditionally been reluctant to participate in healthcare.

“Utilising the insights at a very local level can help us understand the challenges affecting specific areas and allow us to develop programmes and care pathways.”
-Naj Rotheram

ICSs have a range of assets available to build more holistic, preventative diabetes care. Utilising all of general practice, community pharmacy, dental services, and optometry, primary care is in a strong position to deliver comprehensive, holistic diabetes care. However, Naj points out that current support for primary care is inadequate due to limited resources and high patient volumes – leading to a more reactive rather than a preventative approach. This means that primary care is often an underutilised preventative asset.

To remedy this, Naj advocates for greater support in terms of resources, training and action on workforce sustainability. “Primary care should feel valued; they are working on issues that matter to patients,” says Naj. “These primary care healthcare professionals are making a difference at a community level, and this long-term holistic focus is the reason why they entered the profession in the first place.” Naj also discusses the importance of supporting and valuing the workforce’s skills, by addressing discrepancies in workforce development, job reimbursement, and fair pay. An international survey has found that primary care doctors in 10 high income nations say that they are overworked, demoralised, and undervalued. ^[11]

The value of partnership

Another often underutilised asset in improving diabetes care is industry partnership. The NHS and pharmaceutical industry have an opportunity through partnership to redesign local and national pathways, enabling better collaboration for the patient’s benefit. Alongside clinical and care pathway knowledge, industry partners offer a range of practical resources and expertise relevant to NHS system ambitions, including project management, stakeholder involvement and multidisciplinary team mobilisation.^[12] Naj has been intimately involved in this work, and posits partnerships as one way of promoting ethical practices and to provide highly regulated and standardised settings in which the NHS and industry can operate. Naj believes that partnerships can help to improve trust between the NHS and industry through greater transparency regarding all parties’ actions, long-term motivations and impacts. For this reason, the NHS could rely more on the “tremendous” skills and resources that industry brings, which extend beyond just the financial resources it provides.

We need to embrace working together and pooling those skills and those resources to overcome some of the NHS challenges that we are collectively facing.
-Naj Rotheram

PPP’s Diabetes Care Programme 2024 has uncovered fascinating insights and developed vitally important recommendations to improve the delivery of diabetes care. Stakeholders and experts present across the roundtables have consistently highlighted the need to move away from treating diabetes as a single diagnosis and condition to treating the whole patient in holistic terms.

The theme of holistic care has shaped the basis of 2025 Diabetes Care Programme, Holistic approaches to diabetes care: treating the whole patient, to discuss the challenges and opportunities for a holistic approach to care that treats the ‘whole’ patient and not just their diabetes. The series will feature a set of roundtables to create insights and strategies for holistic approaches to diabetes management and long-term conditions. We will address key questions including:
• How can systems balance personalisation and population health management to ensure we get population health rights, while meeting the individual needs of people?
• What role can technology, data and digital play in reducing inequalities for those with the highest needs?
• What innovations are game changers and are they sustainable?
• How do we develop our prevention and risk strategy, to break down siloed disease working so that cardio, renal, and metabolic condition are joined-up effectively within the health and care system?
• Where are the overlaps within the multi-morbid patient population and how can we create a one-stop shop in the community?
• How significant is genetic predisposition in causing diabetes compared to dietary and environmental factors?

If your organisation would like to learn more about getting involved in this innovative programme, then please contact Ameneh.saatchi@publicpolicyprojects.com to find out more.

References

[1] https://medical.boehringer-ingelheim.com/uk/nhs-partnering
[2] https://www.boehringer-ingelheim.com/uk/human-health
[3] https://www.kingsfund.org.uk/insight-and-analysis/reports/integrated-care-systems-workforce
[4] https://www.diabetes.org.uk/about-us/about-the-charity/our-strategy/statistics
[5] https://www.england.nhs.uk/2024/06/nhs-identifies-over-half-a-million-more-people-at-risk-of-type-2-diabetes-in-a-year/
[6] https://www.endocrine.org/patient-engagement/endocrine-library/diabetes-and-older-adults
[7] https://www.cdc.gov/diabetes/diabetes-complications/diabetes-and-vision-loss.html
[8] https://www.england.nhs.uk/north/wp-content/uploads/sites/5/2018/05/NWCSN_Diabetes_Footcare_Final_Report_2017-1.pdf
[9] https://assets.publishing.service.gov.uk/media/66e1b49e3b0c9e88544a0049/Lord-Darzi-Independent-Investigation-of-the-National-Health-Service-in-England.pdf
[10] https://www.boehringer-ingelheim.com/uk/salford-crm-joint-working-summary
[11] https://www.bmj.com/content/382/bmj.p1925
[12] https://www.nhsconfed.org/publications/partnering-purpose-ICS-industry

Data-driven, proactive prevention. Are we finally ready for population health management?

By Simon Swift

As we navigate the complexity of modern healthcare, it is clear that preventative, data-led, approaches can help solve some of the NHS’ major challenges. But ‘are we finally ready for population health management?’ asks Health Navigator CEO, Simon Swift.

I am sure every generation of health and care leaders think they face unprecedented challenges. I don’t think it is an error to say the current NHS leadership feels this, and with some justification. Urgent and emergency care services are under immense pressure, planned care waiting lists remain very close to the 2023 high of 7.7 million, while persistent health inequalities threaten the foundations of the UK’s universal healthcare model.

We must ask ourselves a crucial question: what, if any, proven approaches are there to deliver better outcomes for patients while ensuring the long-term sustainability of our health systems?

I firmly believe that the answer lies in harnessing the power of data. This data-driven approach takes different shapes at different points across the system. For example, optimising system design and service scale and location at the macro level, while at the micro level, there are cumulative marginal gains to be made through ‘command centre’ type solutions to operational management, optimising efficiency and safety for people in A&E or waiting for planned care. These are impactful uses, but not sufficient.

Another use of data is to enable a shift from reactive to proactive care models. Logically it is attractive; we stop people becoming acutely unwell, which is good for them. If they don’t become acutely unwell, they don’t need urgent and emergency care, reducing demand at the front door. This (in the UK system) means we can allocate resources to focus on other things, and there is plenty to do. If we are going to be responsible custodians of health services, this transition is not just desirable; it’s imperative.

The case for change: A closer look at the crisis

Waiting times for emergency care have reached historic highs, which is a miserable experience for patients, an awful work environment for staff facing intolerable moral hazard and probably dangerous.¹ Bed occupancy rates in many hospitals mean managers are in constant firefighting mode, with waits backing up into A&E and elective cancellations routine, without a bed to admit a cold patient into.

Though this pressure on hospitals is universal, emergency department attendance rates are more than twice as high for those living in the most deprived areas compared to the least deprived, demonstrating the deep-rooted inequalities in our health system and society. The inverse care law is alive and well.

The COVID-19 pandemic has exacerbated these issues, creating a backlog of need that will take years to address. Moreover, an ageing population and the rising prevalence of chronic conditions are adding to the complexity of healthcare delivery. These challenges are not just statistics; they represent real people experiencing pain, anxiety, and diminished quality of life for many.

A data-driven approach to prevention

I believe we must use preventative, data-led, approaches to address these challenges, finally taking a step away from sole focus on the traditional reactive model. The evidence base is growing that the logically attractive proactive, preventative approach, leveraging the data at our disposal, actually works.

By harnessing this data (how this works is a sexy thing to some – advanced analytics and machine learning algorithms), we can identify patients at high-risk of unplanned care needs months in advance. This foresight allows us to intervene early, providing personalised support that empowers patients: precision population health management (PHM). The potential of this approach is enormous, offering a way to improve people’s health and so reduce pressure on acute services in the short-term and planned care in the longer term.

At HN, we’ve seen first-hand the transformative impact of this precision PHM approach. Our Proactive solution has demonstrated significant reductions in emergency admissions and A&E attendances.

Empowering patients and supporting healthcare systems

With advice from the Nuffield Trust and with the support of several NHS trusts, HN conducted a randomised controlled trial.² It meticulously tracked up to 2,000 patient outcomes across multiple trial sites. We demonstrated a 36 per cent reduction in A&E attendances for patients supported by health coaching, which is in line with other studies. This isn’t just about numbers; it’s about people avoiding traumatic emergency visits and receiving care in more appropriate, less stressful settings.

The benefits of proactive, data-driven care extend far beyond reducing hospital admissions. We saw improvements in mortality rates, Patient Reported Outcome Measures (PROM’s), patient activation, and quality of life.

These outcomes are transformative on multiple levels. For patients, it means taking control of their health, understanding their conditions better, and enjoying an improved quality of life. For healthcare systems, it translates into reduced pressure on acute services, better resource allocation, and improved overall efficiency.

This approach helps to address health inequalities. By identifying at-risk individuals early, regardless of their socioeconomic background, we can provide targeted interventions that prevent health issues from escalating. This is particularly crucial in areas of high deprivation, where health outcomes have traditionally lagged. For those close to this type of risk modelling it will be no surprise that deprivation (income and health) is a significant risk factor.

The role of technology

As we navigate the complexity of modern healthcare, it’s clear that innovation and technology will play a crucial role. However, it’s essential to understand that technology is not a panacea. The true power lies in how we apply these tools to reimagine healthcare delivery. Those who have worked in this arena for any length of time know that implementing a technology rarely delivers benefit alone, and is often problematic and unhelpful. Carefully designing the change in process, behaviour, decision making etc. that the technology enables is the key to delivering value.

While the potential of data-driven, proactive healthcare is material, we must acknowledge the challenges in implementing the approaches. Data privacy and security are serious concerns that need to be addressed rigorously. We must ensure that as we leverage patient data for better care, we do so in a way that respects individual privacy and complies with all relevant regulations. However, the current red tape-bound and bluntly obstructive approach to information governance in the NHS needs improving if we are to derive value at a meaningful scale and pace.

Looking to the future

The opportunities are tantalising. By embracing data-driven insights and personalised interventions, we can create a more proactive, efficient, and equitable healthcare system that actively helps people live healthier for longer. This approach not only addresses immediate pressures but also lays the foundation for a more sustainable future.

The change from sickness to health care will require collaboration across all sectors of health and care – from policymakers and healthcare providers to technology companies and, most importantly, patients themselves. We need to encourage innovation, where new ideas can be tested and scaled rapidly.

At HN, we’re committed to being at the forefront of this transformation. Our work in AI-guided clinical coaching is just the beginning. We envision a future where patients receive personalised, proactive care that keeps them healthy and out of the hospital.

References

¹ Jones S, Moulton C, Swift S, et al. Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emergency Medicine Journal 2022;39:168-173.

² Bull LM, Arendarczyk B, Reis S, et al. Impact on all-cause mortality of a case prediction and prevention intervention designed to reduce secondary care utilisation: findings from a randomised controlled trial
Emergency Medicine Journal 2024;41:51-59.

Community Care, Featured, Social Care November 1, 2024

Reforming diabetes care in care homes: training, collaboration, and compassion

By Navodi Kuruppu

Navodi Kuruppu, spoke with Lynne Reedman, Founder and Service Lead for DUET Diabetes, and Martin Scivier, diabetes advocate part of #dedoc° and T1D patient, to discuss the impact of Covid-19 on care home residents with diabetes, the importance of peer support, and the urgent need to prioritise care for vulnerable and older populations.

In 2020, the first wave of the Covid-19 pandemic had a devastating impact on care homes in England; with over 40 000 residents dying by the end of 2021, 97.8 per cent of whom were aged 65 and over. Numerous investigations and the ongoing Covid inquiry have already highlighted major shortfalls in care homes, including lack of testing and personal protective equipment (PPE) for residents and staff. ^[1]^[2]

Delivering quality care during the pandemic was an even bigger challenge for residents with long-term conditions like diabetes. A skill gap in diabetes care among staff and deficiencies in technologies resulted in a lack of clarity and coordination regarding who to contact for immediate help, which led to preventable hospital admissions and increased mortality.^[3] However, these deficiencies were not the result of the pandemic, but rather pre-existing gaps in the system that the Covid-19 crisis exposed and exacerbated.

Training of staff in social care is fundamentally important says Lynne Reedman

At least one in four care home residents currently has diabetes, however, an estimated 13,500 care home residents live with undiagnosed diabetes.^[4] By 2050 the number of people aged over 85 is estimated to exceed eight million in the UK, which is likely to place additional strain on the social and residential care sectors.^[5]

Lynne Reedman founded DUET Diabetes in 2015 from a desire to improve the understanding and knowledge of those looking after adults with diabetes. Designed to improve the skills and confidence of carers, nurses and healthcare support workers and the standards of diabetes care they provide, DUET Diabetes seeks to address knowledge gaps that were brutally exposed during the pandemic. Lynne argues that to solve these challenges, social care must be guided by three key principles that DUET Diabetes champions: communication, collaboration and education.

The 2022 National Advisory Panel on Care Home Diabetes (NAPCHD) was established to address the root causes of inadequate diabetes treatment in care homes. Their report identified several issues, including a lack of knowledge of key principals of ethical diabetes care on the part of care home staff, diabetes care teams and social services; ethnicity-related challenges in clinical care; and the importance of residents’ emotional wellbeing – all of which led to poor management of diabetes complications.^[6]

Lynne observes that many team members including nurses in care homes lack a basic knowledge of diabetes best practice, reiterating the fact that diabetes training is currently not mandatory for care home staff. She says, when you talk to [the staff], a lot of them don’t have much confidence or knowledge [of diabetes care].

Residents shouldn’t have to wait for a district nurse to come in and manage their diabetes. We need a care sector that knows and fully understands diabetes and knows how to support these people.

Lynne Reedman, Founder and Service Lead at DUET Diabetes

Lynne strongly advocates for the implementation of a basic diabetes awareness programme across the social care sector, coupled with extra training to enable staff to disseminate knowledge within their own organisations. The NHS Diabetes Prevention Programme (DPP), along with campaigns organised by Diabetes UK and other organisations around the country, has played a central role in raising awareness at both national and local levels. Lynne’s proposal is innovative, in that it considers the combined needs of diabetes and social care, with the aim of supporting an all-around prioritisation the condition that is necessary to bridge the gaps specifically found within social care. You have to treat a person as a whole in care homes, she insists, and the care has to be tailored to each resident.

The NAPCHD proposes a multi-disciplinary model, focusing on collaboration between care homes, community and specialist services, primary care, and other key stakeholders. Within this model, the resident with diabetes is placed at the centre, supported by a nurse-led facilitator from the GP-Primary Care Unit and adult social services. Local Primary Care Networks (PCNs) would play a key role in supporting this service, by deploying existing primary care nurses with diabetes experience into facilitator roles, following additional training. While funding for this model may require agreements across multiple agencies, health economic studies are anticipated to demonstrate its cost-effectiveness, showing reductions to hospital admissions, ambulance callouts, GP visits, and medication expenses.

Using insulin pens, checking expiry dates, monitoring technology devices, maintaining a good diet and level of physical activity – there is a lengthy list of a daily actions that diabetes patients must juggle. These challenges are compounded for older patients with diabetes, who may encounter more difficulty caring for themselves daily. Studies have shown that diabetes may decrease mobility and restrict activities of daily living (ADL) by approximately 50-80 per cent, with this decline becoming more pronounced with age.^[7]

One important aspect that the review does not touch upon is the role of peer support in diabetes care for older patients. Whether in a care or nursing home, emotional support is just as important as physical care.

Martin Scivier, a diabetes advocate, fully recognises the power and value of peer support. Now 75, Martin was diagnosed with type 1 diabetes (T1D) in 1954. Seventy years later, he feels healthy and lucky, having experienced only a few diabetes-related complications. To give something back to the diabetes community, Martin started running his own blog, Martin Scivier’s Mellitus – Type 1 Diabetes, in 2022, documenting his journey and experiences with T1D.

When I go to the hospital for appointments, I just sit there in the corner and don’t talk to anybody, I keep myself to myself. And then I see the nurse, see the doctor, and then I go out and go home. But thanks to social media I have found this wonderful diabetes community and started to get involved. Thanks to peer support, I am not on my own

Martin Scivier, Diabetes Advocate and T1D Patient

In 2018, Martin joined social media, finding many self-help groups on Facebook, Twitter and WhatsApp, such as the #GBdoc hub. I never went to diabetes camps when I was younger, so I used to be very much on my own, recalled Martin, but now I have all these new friends. This peer support acted as a hugely important space for Martin to feel supported and comforted after his regular check-ups at the hospital.

Martin’s story is testament to the power of peer support and its capacity to provide a safe space where patients like him can find comfort in sharing their experiences, feel supported and be reassured they are not alone. Martin has an optimistic outlook on the future, which he aims to realise through his advocacy and engagement with organisations like PPP. However, he was quick to acknowledge that many others are not as fortunate as him.

Older people need and deserve more says Martin Scivier

The NAPCHD strategic document acknowledges that many care home residents are highly vulnerable, and their diabetes condition is often worsened by complications, including uncontrolled hyperglycaemia, hypoglycaemia, which can lead to eminently preventable hospital admissions. It is estimated that 75 per cent of people with diabetes die because of cardiovascular complications, many of which could be prevented.^[8] We have lost too many people along the way because of complications [of diabetes], adds Martin.

However, the condition and complications are often compounded by another factor – loneliness. Age UK has reported that around 1.4 million older people often experience loneliness each year in the UK.^[9] Another study has found that loneliness is a bigger risk factor for heart disease in patients with diabetes than diet, exercise, smoking and depression.^[10] Loneliness can also lead to decreased daily activity, contributing to increased inflammation and blood pressure, cognitive and motor decline, anxiety and depression.^[11] Healthcare systems and providers must recognise that loneliness is a significant risk factor, affecting both psychological and physiological health outcomes, as well as health-related behaviours of older adults with diabetes.^[12]

Martin shares Lynne’s belief that better training leads to better care. He recalled the 2016 education model run by Benikent within Swale CCG to improve diabetes management in care homes.^[13]

Through this model, unregistered practitioners in care homes were trained diabetes management to improve diabetes care and delegation of insulin, ultimately seeking to provide individualised care plans and appropriate diabetes-specific training for all staff in the care. ^[14] Martin argues that this proves to me 100 per cent that any training is better than no training. But compulsory training would be brilliant.

PPP’s Diabetes Care Programme seeks to bring different stakeholders to the table. Hearing the stories of patients with lived experience of diabetes, together with the perspectives of experienced professionals, makes clear the importance of person-centred diabetes care. This approach supports both the medical aspects of the condition, such as managing complications, reducing hospitalisations, and lowering mortality rates among the elderly, as well as the human elements of treating patients fairly. As described by Martin, patients deserve to be treated with dignity and respect.

An individual should be cared for with dignity and respect. Their rights should be paramount.

Martin Scivier, Diabetes Advocate and T1D Patient

To learn more about how to get involved in the 2025 Diabetes Care Programme, visit the website here.

Martin Scivier, Author and Diabetes Patient Advocate

Lynne Reedman, Founder and Service Lead, DUET Diabetes

References

[1] https://www.alzheimers.org.uk/get-support/coronavirus/dementia-care-homes-impact

[2] https://www.amnesty.org/en/documents/eur45/3152/2020/en/

[3] https://onlinelibrary.wiley.com/doi/full/10.1111/dme.15088

[4] https://www.carehome.co.uk/advice/managing-diabetes-in-older-people

[5] https://www.diabetes.org.uk/for-professionals/improving-care/good-practice/diabetes-care-in-care-homes

[6] http://fdrop.net/wp-content/uploads/2022/05/FINAL-NAPCHD-Main-document-for-FDROP-website-08-05-22.pdf

[7] https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2023/03/Healthbox-Diabetes-Care-Home-Guidelines.pdf

[8] https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2023/03/Healthbox-Diabetes-Care-Home-Guidelines.pdf

[9] https://www.ageuk.org.uk/our-impact/policy-research/loneliness-research-and-resources/

[10] https://sph.tulane.edu/study-loneliness-heartbreaker-diabetics , https://academic.oup.com/eurheartj/article/44/28/2583/7190012?login=false

[11] https://pubmed.ncbi.nlm.nih.gov/26799166/

[12] https://doi.org/10.1080/13548506.2023.2299665

[13] https://diabetes-resources-production.s3-eu-west-1.amazonaws.com/diabetes-storage/migration/pdf

[14] https://diabetes-resources-production.s3-eu-west-1.amaz…2520in%2520care%2520homes%2520in%2520Swale%2520%28June%25202016%29.pd

All news

A People Powered NHS – A call to all health leaders

By Dr Allison Smith

Dr Allison E Smith, Director of Research & Insight at the Royal Voluntary Service discusses the key role that volunteers can play in delivering on core NHS goals.

The Prime Minister’s speech on 11th September 2024 pledged that this would be the ‘biggest reimagining of the NHS since its birth’. Hence, as we reflect on the plan for the future, we should challenge ourselves to think differently and work in ways which prioritise patient care and staff wellbeing. We should be bold and ambitious as the founders of NHS were in 1948.

In the original blueprint of the NHS, it was always intended to be a partnership between the state, the citizen and their communities. Public participation in the NHS e.g. via volunteering, informal carers and patient groups, has always played a vital role in the delivery of better health care. But in many ways, public involvement is a postcode lottery – a few areas do it really well, some do it (not well), and others have nothing. From the perspective of a volunteer-involving charity like Royal Voluntary Service – who have been supporting the NHS since before it was even founded – it is hard to get volunteering truly embedded in healthcare delivery. It still feels as if we are on the outside looking in or ‘pushing water uphill’. The purview of ‘integration’ appears largely limited to that of the NHS with social care.

With the public consultation on the 10-Year Health Plan, now is the time to rethink how the NHS – and wider healthcare system – works collaboratively with the public for the common good. System leaders need to stop putting up barriers to public participation and think ‘how can I build inclusive blended teams of staff and volunteers?’. Leaders should be embracing and nurturing the public interest and love for the NHS; 66 per cent of those signing up for the NHS and Care Volunteer Responders programme do so because they ‘want to support the NHS’.¹

The business case – in terms of the impact of volunteers on the NHS and wider healthcare system – we feel has been made.² The NHS and Care Volunteer Responders (NHSCVR) programme – first launched during the pandemic – has continuously proved its effectiveness, from driving system efficiencies to better patient care, workforce recruitment, and staff morale. For system leaders and frontline staff that embed NHSCVR within their local delivery there are big gains to be had.

For those unfamiliar with NHSCVR, this programme is a unique partnership between a charity (Royal Voluntary Service), a public service (NHSE) and a tech company (GoodSAM). It can match, via an App in real-time, requests for support from staff or patients with members of the public that can lend a hand. The programme is a key auxiliary service supporting the NHS and patients to expedite patient discharge, provide practical support to patients at home, deliver equipment for virtual wards, and provide support to ambulance crews waiting outside A&E. It is a free resource for local areas, is NHS approved, and can provide a critical safety net to mobilise volunteers at scale at times of high demand on the system.

In the past four years the programme has achieved significant scale; more than 2.6 million activities have been delivered in support of patients and the NHS, 221,000 individuals have been supported, and over 1 million members of the public responded. And while these numbers are indeed impressive, on the ground in local areas the programme delivers significant benefits for the system, staff, and patients – see table below.

The data also finds that those who volunteer report higher wellbeing. In a 2021 study by the London School of Economics, those that volunteered experienced statistically significant higher wellbeing compared to those who did not volunteer, and this wellbeing impact lasted for at least 3 months.⁶

This article is a call to all NHS system leaders; the breadth of impact – from this programme – plus others (see Helpforce) surely warrant the immediate integration of volunteers in NHS ‘BAU’, and centre stage in our reimagining of the NHS over the next 10 years.

Royal Voluntary Service will be attending the Integrated Care Delivery Forum in London on the 5th November.

For more information or to connect with a member of our team, please reach out to your Regional Relationship Manager. Contact details are available at nhscarevolunteerresponders.org.

References

¹ NHSCVR baseline survey, n=8481)

² See King’s Fund 2018 Views from the Frontline, Helpforce, 2020, Volunteer Innovators Programme

³ Programme data & Volunteer Annual Survey March, n=6302

⁴ Staff Annual Survey October 2024, n=345

⁵ Client/Patient Survey June/July 2024, n=687

⁶ https://blogs.lse.ac.uk/covid19/2021/06/02/happy-to-help-how-a-uk-micro-volunteering-programme-increased-peoples-wellbeing/

10-Year Health Plan must address cancer care failings identified by Darzi

By Gabriel Blaazer

From improving access to care and speeding up diagnosis to addressing treatment delays, Lord Darzi’s recent independent investigation of the NHS in England highlights the complex web of challenges facing the NHS. In doing so, it also offers a series of starting points for the upcoming 10-Year Health Plan to address.

Cancer remains one of the leading causes of avoidable death in the UK, and despite improvements in survival rates over the past decades, the country still lags behind others in cancer care. Lord Darzi’s recent independent investigation into the NHS in England offers a comprehensive review of the current state of cancer treatment within the NHS and points to several factors that have contributed to its struggles. These include funding constraints, the aftermath of the Covid-19 pandemic, and systemic issues within healthcare management.

Using the failings identified by Lord Darzi as a basis, the upcoming 10-Year Health Plan for the NHS has the chance to radically transform cancer care provision in the NHS.

Rising cancer waits and slowing survival rate improvements

Cancer cases in England have steadily risen, increasing by approximately 1.7 per cent per year from 2001 to 2021. When adjusted for age, the rise is still significant at 0.6 per cent annually. This translates to around 96,000 more cases in 2019 than in 2001. Although survival rates for one-year, five-year, and ten-year intervals have improved, the rate of improvement slowed considerably in the 2010s.

The UK also continues to record substantially higher cancer mortality rates than its peers. International comparisons show the country falling behind not only European neighbours but also the Nordic countries and other English-speaking nations. While survival rates have inched upwards, “no progress whatsoever” was made in early-stage (stage I and II) cancer detection from 2013 to 2021. However, this has recently changed, with detection rates improving from 54 per cent in 2021 to 58 per cent by 2023, partly driven by the success of the targeted lung health check programme. This initiative has helped identify more than 4,000 cases of lung cancer, with over 76 per cent caught at stage I or II, significantly boosting early intervention efforts.

Nonetheless, challenges remain in treatment selection, particularly for brain cancer patients. While genomic testing, critical for tailoring treatments, is now more widespread, only five per cent of eligible brain cancer patients can access whole-genome sequencing. A recent Public Policy Projects (PPP) report has highlighted the inequalities in access to genomic sequencing. Moreover, turnaround times for genomic tests – only 60 per cent of which are processed on time – further hinder timely treatment for many patients.

Access delays and missed treatment targets

One of the key areas within the Darzi investigation is the NHS’ ongoing struggle to meet its cancer treatment targets. The 62-day target from referral to the first treatment has not been met since 2015, and as of May 2024, only 65.8 per cent of patients received treatment within this window. Similarly, over 30 per cent of patients now wait more than 31 days for radical radiotherapy, reflecting growing delays in critical care pathways. Given the importance of timely cancer treatment, the upcoming Plan must consider how to reduce delays in access to treatment.

While the number of cancers diagnosed through emergency presentations has decreased, with the percentage falling from nearly 25 per cent in 2006 to under 20 per cent in 2019, access to primary care services continues to be “uneven”. This affects the timeliness of cancer referrals, especially as the proportion of patients waiting more than a week for a GP appointment rose from 16 per cent in 2021 to 33 per cent per cent by 2024. Darzi notes that declining access to general healthcare services directly reduces the likelihood of timely cancer detection and treatment.

The drivers behind performance issues

Several factors have compounded the challenges facing the NHS’s cancer care system, as identified by Lord Darzi, which the 10-Year Health Plan must seek to address:

Austerity and capital starvation: Funding restrictions and limited capital investments over the past decade have led to under-resourced healthcare infrastructure, making it difficult to accommodate growing patient demand. The underinvestment in estates and facilities is also preventing the NHS from making full use of diagnostic advancements; in many cases, hospitals may be able to purchase new state-of-the-art diagnostic and imaging equipment, but not have a suitable site in which to use it. PPP has explored this topic in detail in a previous report.
Covid-19 pandemic: The pandemic severely disrupted healthcare services, creating a backlog of cases and delaying non-Covid-related care, including cancer treatments. Although efforts have been made to prioritise long-waiting patients, the effects of the pandemic still ripple through the healthcare system, contributing to worsened performance.
Lack of patient voice and staff engagement: The investigation highlights that the perspectives of both patients and healthcare staff have often been overlooked in decision-making processes, resulting in management structures that are out of touch with the realities on the ground. A more engaged and responsive system would likely yield better outcomes. The need for coproduction was reiterated at PPP’s recent Cancer Care Conference, and is increasingly being recognised in Cancer Alliances’ health inequalities strategies.
Management structures and systems: The report also points to inefficiencies within the NHS’ management structures. These systems are often seen as bureaucratic, which slows down decision-making and the rollout of new treatments. Disparities in the adoption of new systemic anti-cancer therapies highlight these inefficiencies, as some regions wait over a year for access to drugs approved by NICE, while others see the same drugs introduced within a month. This inequality in access to drugs is a key driver of the postcode lottery that is seen in cancer care.

The importance of early diagnosis and screening

A clear priority identified by Lord Darzi is the need for more effective early diagnosis strategies. Cancers detected at stages I and II are much more treatable, and early intervention is strongly associated with better survival outcomes, as well as substantially lower treatment costs. Darzi notes, however, that progress in this area had been stagnant until recent years, with no gains between 2013 and 2021. The improvements seen in early-stage detection from 2021 to 2023 offer hope, but Darzi cautions that further efforts are needed.

The 10-Year Health Plan must also seek to address the UK’s lack of CT and MRI scanners relative to other comparative companies – a major inhibitor of greater diagnostic capacity in the NHS.

Screening participation rates have also declined, with breast and cervical cancer screening coverage falling since 2010. Yet there are signs of promise. For example, the bowel cancer screening programme has been highly successful and provides a model that could be replicated for other types of cancer.

However, hopes for improved early diagnosis cannot rely solely on the establishment of national screening programmes. Poor levels of health literacy, particularly among underserved communities, must also be addressed to ensure that people know which signs and symptoms to be aware of, and to seek treatment if necessary.

More sophisticated treatments but growing delays

The development of more sophisticated treatments is a key area of progress, but the availability of these treatments is often constrained by capacity issues. While the NHS is a world leader in incorporating genomic testing as part of routine cancer care, delays in processing these tests and long waiting times for treatments like radiotherapy undermine their potential impact and can lead to poorer outcomes.

As Darzi points out, “turnaround times are poor… [which] can delay the start of treatment,” especially when coupled with the system’s failure to meet its 62-day target for referral to treatment. In a healthcare system already stretched by rising demand and workforce shortages, delays in treatment can make the difference between life and death for many cancer patients.

Addressing the challenges ahead

Lord Darzi’s investigation underscores the critical need for systemic reforms within the NHS to address the growing cancer burden. From improving access to care and speeding up diagnosis to addressing treatment delays, the report highlights the complex web of challenges facing the NHS. In doing so, it also offers a series of starting points for the upcoming 10-Year Health Plan to address.

While recent advancements in genomic testing and early detection programmes offer hope, the NHS must tackle its systemic inefficiencies, funding shortfalls, and management issues if it is to close the gap with its international counterparts and improve outcomes for cancer patients.

For more information about PPP’s Cancer Care Programme, or to request further discussions, please contact: Rachel Millar, Programme Lead for Cancer Care: rachel.millar@publicpolicyprojects.com

Dr Chris Rice, Director of Partnerships for Cancer Care and Life Sciences: chris.rice@publicpolicyprojects.com

Bridging language gaps could be crucial for safer maternity care

By Dr Rachael Grimaldi

Dr Rachael Grimaldi, a practicing anaesthetist and co-founder & CEO of the healthcare translation app CardMedic, has witnessed first-hand the critical need for language support within the NHS. Following the CQC’s review of maternity services, she delves into the alarming normalisation of harm in maternity services and how communication barriers contribute significantly to this concerning issue.

The CQC’s review of maternity services published recently has highlighted how quality and safety across England are suffering. Patients don’t feel listened to, people with poor English report much worse experiences of care and accessing interpreting support can be a challenge. What’s more, harm in maternity services seems to be being normalised and communication barriers play a significant part in this.

Technology as a bridge for the language gap

Many people are doing excellent work to break down communication barriers, but we need action and accountability to prevent harm in maternity services. Staff need access to interpretation and translation support 24/7 to provide good quality patient care. Technology can help, it’s here and it’s working.

Communication issues are rife across the NHS, yet access to interpreting services can be challenging, even when this is directly linked to devastating outcomes. As midwife and inclusivity champion Maria Rowntree has found, pregnant people who don’t speak English are 25 times more likely to die in NHS maternity care.

The statistics cited by Maria Rowntree are alarming. This statistic alone should be a wake-up call for the entire healthcare system. It highlights the urgent need for accessible, reliable and culturally competent language support services.

Effective communication is essential for providing safe maternity care

One of the most concerning aspects of the CQC review is the normalisation of harm within maternity services. When adverse events and poor patient experiences become accepted as an inevitable part of the system, it is a clear indication that fundamental changes are needed. This normalisation is particularly dangerous in a setting where clear communication is literally a matter of life and death.

Effective communication is essential for providing safe and high-quality maternity care. It is the foundation upon which trust, understanding and informed decision-making are built. When language barriers exist, this foundation is compromised and the risk of misunderstandings, missed critical information and ultimately, harm, increases significantly.

Even though the NHS has tried to offer interpretation services, getting access to them is still a major struggle for a lot of people. Interpreters may not be available when needed, or the quality of interpretation may be inadequate, leading to crucial information being lost in translation.

Technology can play a crucial role in addressing these communication barriers. Digital translation and interpreting solutions like CardMedic can provide immediate access to professional interpreters and accurate translations, bridging the language gap and ensuring that every patient receives the care they deserve, regardless of their language proficiency.

However, technology alone is not a panacea. It must be accompanied by a broader cultural shift within the healthcare system, one that prioritises effective communication and recognises it as a fundamental aspect of patient safety and quality care.

The call for a maternity commissioner and accountability

We support the call for a maternity commissioner to bring much needed accountability and to address the issues raised in the report. And while NICE guidance says that reliable interpreting services should be available when needed, we support Maria’s call to make communication a protected characteristic within healthcare. Organisations have to take communication challenges seriously. These shameful events have to stop.

The findings of the CQC review are deeply troubling, but unfortunately not surprising to those working on the frontlines of maternity care. For too long, communication barriers have been an unaddressed issue, leading to preventable harm and tragic outcomes. It is a systemic problem that requires urgent attention and comprehensive solutions.

A maternity commissioner is a step in the right direction, as it can bring much-needed accountability and oversight to address the issues raised in the CQC review. However, this must be coupled with a commitment to investing in language support services, training healthcare professionals in cultural competency, and fostering an environment where communication barriers are not only acknowledged but actively addressed.

Seizing the opportunity for systemic change

Ultimately, the normalisation of harm in maternity services is a symptom of a larger systemic issue – the failure to prioritise effective communication as a cornerstone of patient care. By recognising communication as a protected characteristic within healthcare, as Maria Rowntree suggests, we can begin to shift the paradigm and ensure that every patient, regardless of their language proficiency, receives the high-quality, compassionate care they deserve.

CardMedic works with maternity teams nationally to provide a highly effective digital translation and interpreting solutions to hospitals across the country. Like them, we are deeply concerned to see the results of this review.

The events highlighted in the CQC review are indeed shameful, but they also present an opportunity for meaningful change. By addressing communication barriers head-on, investing in language support services, and fostering a culture of accountability and patient-centred care, we can work towards a future where harm is no longer normalised, and every patient’s voice is heard, understood, and respected.

Study demonstrates effective treatment of localised prostate cancer using higher doses of radiotherapy

By Integrated Care Journal

Research confirms efficacy of higher and fewer doses of radiotherapy for treatment of localised prostate cancer, conferring benefits to both patients and the NHS.

Treatment times for patients with localised prostate cancer could be reduced by as much as 75 per cent using higher-than-normal doses of radiotherapy, according to a study published in the New England Journal of Medicine.

The study, led by researchers from The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, found that people with intermediate risk, localised prostate cancer can be treated as effectively using fewer and higher doses of radiation therapy delivered over five treatment sessions as they can with lower doses delivered over several weeks.

Results from the PACE-B (Prostate Advances in Comparative Evidence) trial were published this week in the New England Journal of Medicine (NEJM).

The research builds on previously reported data and shows that stereotactic body radiotherapy (SBRT) performed as well as standard radiotherapy treatment for people whose prostate cancer had not spread, demonstrating a five-year 95.8 per cent disease control rate, compared to 94.6 per cent for conventional radiation.

PACE-B investigated whether SBRT was non-inferior to conventional radiation for treating people with intermediate risk, localised prostate cancer. Non-inferiority was measured by whether patients remained free of biochemical clinical failure (BCF), defined as an increase in prostate specific antigen (PSA) levels, distant metastases or other evidence the cancer was returning, or death from prostate cancer.

SBRT, which can be delivered on a CyberKnife or standard radiotherapy machines, allows clinicians to target tumours to sub-millimetre precision. This approach uses advanced imaging and treatment planning techniques to deliver radiation with pinpoint accuracy, minimising damage to surrounding healthy tissue. It delivers five high doses of radiation to patients over one to two weeks, compared to standard radiotherapy (Intensity-Modulated Radiation Therapy, or IMRT), which delivers more moderate doses over a much longer period of time – usually around 20 sessions for patients in the UK, which can take up to one month.

Five years after treatment, people treated with SBRT had a BCF-event free rate of 95.8 per cent compared to 94.6 per cent for those treated with conventional radiotherapy, demonstrating that SBRT was non-inferior to conventional radiation.

The study showed that side effects were relatively low in both groups. At five years post-treatment, 26.9 per cent of patients who received SBRT experienced grade two or higher side effects affecting the genital or urinary organs, such as urinary frequency and urgency, compared to 18.3 per cent in the conventional group.

The cumulative incidence of late grade two or higher gastrointestinal effects was 10.7 per cent in patients who received SBRT and 10.2 per cent in the conventional group. At five years, 29.1 per cent of men treated with conventional radiotherapy and 26.4 per cent of men receiving SBRT reported erectile dysfunction.

Chief Investigator Professor Nicholas van As, Medical Director and Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust, and Professor in Precision Prostate Radiotherapy at The Institute of Cancer Research, London, said: “At The Royal Marsden and the ICR, we are focused on developing smarter, better and kinder treatments for patients across the UK and internationally. Standard radiation treatment is already highly effective and is very well tolerated in people with localised prostate cancer but for a healthcare system and for patients, to have this treatment delivered just as effectively in five days as opposed to four weeks is hugely significant.

“To be able to sit with a patient and say, ‘We can treat you with a low toxicity treatment in five days, and your chance of keeping the cancer at bay for five years is 96 per cent,’ is a very positive conversation to have. We expect our trial to be practice changing and people with intermediate risk prostate cancer should be given the option of SBRT as an alternative to conventional radiation or prostate surgery.”