Community Care, Featured, News

Working in partnership to improve wound care services through a shared care pathway

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Lead Medical Specialist at Coloplast, Paddy Markey, relates how a collaborative partnership has helped an NHS organisation introduce a shared wound care pathway, releasing capacity and delivering improved wound healing outcomes.


Coloplast’s purpose is to make life easier for people with intimate healthcare needs. Requiring both an understanding of patient’s medical challenges and other concerns impacting their lives, Coloplast listens to both patients and the clinicians who care for them. Coloplast’s business includes Wound and Skin Care, and understands that although wound healing can be complex, choosing the right solutions doesn’t have to be. By combining effective products and services designed to release clinical capacity, reduce harm, and optimise services, Coloplast works with clinicians to reduce health inequalities and deliver optimal wound care for patients.

An NHS organisation decided that to succeed in reaching The Commissioning for Quality and Innovation targets set for 2020-21, it would combine the elements of accurate wound assessment and self-care to redesign a wound care service. The pilot’s designated wound assessment clinic was implemented to enhance capacity of community staff, provide early wound assessment, and reduce unwarranted variation in treatment. It also provided an opportunity to introduce a supported shared-care pathway, further releasing capacity.

At initial appointments, patients were assessed for their suitability for supported shared-care. The project is an example of collaboration and partnership with Coloplast who helped develop and produce the shared care resources required.

Coloplast supported the development of the patient shared-care information pack, shared care inclusion criteria, and wound self-care pathway. The self-care pathway was based on a patient’s ability to use one wound bed conforming silicone foam dressing (Biatain Silicone with 3DFit Technology by Coloplast) on wounds up to 2cm in depth*.

Wound audit data suggests that nearly 80 per cent of wounds are less than 2cm in depth, and in an international consensus among wound care specialists, 83 per cent agreed that the best dressing choice for wounds up to 2cm deep is a dressing that conforms to the wound bed. Through previous case studies, Coloplast has demonstrated an avoidance in filler dressings when using Biatain® Silicone on wounds up to 2cm in depth*. The studies also demonstrated 49 and 51 per cent savings on dressing procurement costs respectively.


*Tested in vitro, Conformability may vary across product design.

Featured, News, Population Health

Prioritise nutrition and hydration to boost broader health outcomes, says new report

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New report from PPP finds that efforts to implement a multidisciplinary approach to nutrition and hydration are needed to help address the dysphagia burden across the NHS.


A new report from Public Policy Projects (PPP) finds that with the UK becoming a ‘super-aged’ society, declining nutritional and hydrational status among elderly and frail populations will place increasing strain on health and care services.

The report, Prioritising nutrition, hydration and dysphagia in an integrated care context, states that while considerable work and investment has been allocated to reduce the incidence of obesity and the diet-related diabetes, malnutrition and hydration are not given the same focus, despite their significant impact on health outcomes and its role in the management of other conditions.

The report is the culmination of two roundtables held by PPP in 2023, which convened stakeholders to discuss how ICSs embed nutritional and hydrational health into integrated care strategies. The discussions focused on specific elements of the debate, including improving the management of dysphagia and care provided for frail populations in different care settings. Attendees included NHS England clinical leadership, allied health professionals (AHPs), including speech and language therapists (SLTs), social care providers, primary care representation nurses and other key health and care stakeholders.

Graphic showing levels of elderly population at ICS level in 2021. Source: Census 2021

According to the report, recent reforms to the health and care sector (most notably, the introduction of ICSs) present new opportunities to develop comprehensive approaches to nutrition and hydration, in a way that improves holistic patient care and saves valuable resource for the NHS.

However, among its recommendations, the report calls on the Department of Health and Social Care to launch a national review into food and drink provided across the care sector, to help improve the nutritional and hydrational status of frail citizens in social care. This review should follow the structure and ethos of the NHS Hospital Food programme, the report argues.

It adds that addressing dysphagia should be central to broader NHS goals of enhancing the quality of life for the elderly population, and that by prioritising the management and screening of dysphagia, the NHS could prevent avoidable hospital admissions and promote more efficient use of resources across the health and care sector.

Download the report here

To address the complex and multifaceted challenge of dysphagia, with various medical, neurological, and anatomical elements potentially contributing, will require systems to adopt a multidisciplinary approach, says the report. This will necessitate close collaboration between diverse teams of healthcare professionals, each with specialised expertise.

It finds that a multidisciplinary approach that includes speech and language therapists, dietitians, and physicians, is essential for managing dysphagia and addressing the complex healthcare needs of the elderly in a holistic fashion. To help enable this multidisciplinary approach, the report argues that the model of speech and language therapy sitting in community settings should be scaled nationwide, and adopted across ICSs within integrated care strategies. These strategies should also closely involve the voluntary sector.

The report also recommends an expansion of the speech and language therapy workforce, with ring-fenced funding for broader allied health professionals – in line with ambitions set out in the NHS Workforce Plan.

“The nutritional and hydrational needs of our elderly and frail citizens has been neglected for far too long. As the UK moves towards a ‘super-aged’ society, NHS organisations, care providers and integrated care systems must increasingly focus efforts on improving nutritional and hydrational health,” said report author and Group Editor at PPP, David Duffy. “It is vital that resources are orientated to support allied health professionals, particularly speech and language therapists, who play a vital role in maintaining nutritional health for elderly and frail citizens.

“Nobody in the UK should suffer from malnutrition or dehydration in this day and age, especially not our frailest and most vulnerable citizens. We hope that this report will help shine a light, not just on the scale of the problem, but also on achieveable solutions that we believe will help address the terrible burden of dysphagia.”

Recommendations:

  1. NHS England must prioritise nutrition, hydration and dysphagia as part of its drive to improve system performance and broader health outcomes. Nutrition and hydration management are underdeveloped areas which can help enable success in key national strategies, such as the elective care backlog plan, workforce strategy, the urgent and emergency care plan and the delivery plan for recovering access to primary care.
  2. Integrated care systems should consider dysphagia and wider nutritional and hydrational health as key parts of preventative health policies that can help future proof local health systems.
  3. The Department of Health and Social Care (DHSC) should commission a national review into food and drink provided across the care sector. This review should follow the structure and ethos of the NHS Hospital Food programme. The review should be led by a range of stakeholders from within the NHS and social care, as well as representatives from industry and the private sector.
  4. As the population becomes a ‘super-aged’ society, an integrated strategy is required to manage the health of the elderly and frail population. This should draw upon global and international frameworks provided by the WHO’s ICOPE framework.
  5. ICSs should ensure that maximising the ‘intrinsic capacity’ of citizens is a key priority within integrated care strategies, to prevent deterioration of health and supplement preventative health policies.
  6. ICSs should work to prioritise evidence-based nutritional and hydrational approaches within the social care sector, harnessing tools such as nutritional supplements where necessary, to assist those who have difficulty eating, drinking and swallowing.
  7. The model of speech and language therapy sitting in community settings should be scaled nationwide, and adopted across ICSs within integrated care strategies. These strategies should also closely involve the voluntary sector.
  8. NHS England should undertake a national dysphagia screening drive to identify individuals as early as possible. Social care staff and AHPs should be trained to conduct dysphagia screenings for all elderly and frail patients in their care, and much like falls, dysphagia should be considered among the primary risks in any risk assessment of elderly and frail patients.
  9. The speech and language therapy workforce should be expanded with long-term ring-fenced funding for broader allied health professionals.

Download the report here.

 

Featured, News

Optimising DOAC Therapy: A collaborative approach to improved patient care and cost efficiency

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By Selma Abed, Head of Medicines Optimisation, Spirit Health, and Duncan Richardson, Head of Service Delivery, Spirit Health.


Spirit Health

As an independent service provider to the NHS for over 15 years, Spirit Health do things differently. We specialise in partnering with NHS Medicines Optimisation teams to provide products and clinical services that help deliver cost efficiencies and quality improvements in patient outcomes.


The situation

Direct-acting oral anticoagulants (DOACs) are widely recognised as alternative anticoagulants to prevent strokes in patients with Atrial Fibrillation (AF). There are four DOACs available; the aim was to optimise care for all patients prescribed a DOAC for NV-AF and to review patients prescribed apixaban to see if a lower-cost alternative could be used. When the work was undertaken, apixaban was the highest-costing drug to the NHS in England in the 2022/23 period.

The issue is that stroke and bleeding risks change over time, so medication needs to be reviewed annually. This requires high levels of collaboration between primary and secondary care to review all eligible patient medication for drug interactions, over-the-counter medications and herbal/alternative therapies.

The opportunity was to optimise the quality of care for patients on a DOAC across a locality and review if an alternative lower-priced DOAC was suitable. Carried out between October 2022 to May 2023, the work would ensure patients were on the appropriate DOAC and dose regime for their renal function, liver function, weight, co-morbidities, and medication to ensure optimal oral anticoagulant (OAC) therapy.


Objective

The main objectives were to optimise care for all patients prescribed a DOAC for NV-AF and to review patients’ prescribed apixaban to see if a lower-cost alternative could be used.

The Spirit Active Implementation™ team identified all patients on existing DOAC therapy, checking patient eligibility to change through up-to-date patient blood records, calculating Creatinine Clearance, CHA2DS2-VASc7 and HAS-BLED/ORBIT scores. They also discussed any patients with incorrect doses/significant interactions/safety concerns or identified issues with the appropriate clinician.

To fulfil the objectives, the project required continual collaboration between the Spirit Active Implementation™ team with multiple GP practice staff, secondary care HCPs, and multiple stakeholders across the locality.

The review service not only highlighted those who were eligible to be switched to a lower-cost DOAC alternative but also identified:

  • Patients requiring alternative medication
  • Dosage adjustments needed
  • Enhanced monitoring required
  • Drug interaction identified

Ultimately, the work improved patients’ care beyond the project’s original scope and highlighted additional patients who required further attention to optimise their DOAC therapy.


Scalability of work

From a patient quality perspective, the project’s learnings hold promise for broader impact, potentially on a national scale. From a cost-savings lens, the works highlight potential roadblocks to scaling. However, these can be overcome using the learnings from the project.

Positive signs for scalability include:

  • Successful collaboration: The project effectively partnered with secondary care, indicating this approach could be replicated across national localities when specialist advice is required.
  • Spirit’s resource potential: Utilising our nurses, pharmacists and technicians for patient communication and assessment demonstrates the potential to scale within busy primary care environments.
  • Identified needs: The project revealed a significant portion of patients requiring updated bloodwork or an intervention, suggesting a broader population likely benefits from similar assessments.
  • Potential for broader savings: The project identified opportunities for cost savings beyond the initial medication switches. When clinically appropriate, the availability of generic DOAC alternatives presents further avenues for cost reduction, assuming sufficient supply and adherence to clinical guidelines for DOAC selection.

Challenges to consider include:

  • Return on investment: Existing primary care capacity constraints led to outdated patient bloodwork, impacting potential cost-saving medication switches for 56% of patients, thus affecting the savings benefit of the work.

Evidence of success

The work demonstrates an innovative quality review project to optimise patient care for those prescribed a DOAC for AF. It offers evidence of important changes with the potential to impact multiple stakeholders.

Delivered change:

  • Improved Patient Care: Identified 1224 patients requiring intervention across 25 practices, including medication adjustments, discontinuation, or additional monitoring, impacting their individual health outcomes.
  • Cost-Effectiveness: Identified 32 per cent patients potentially eligible for a more cost-effective medication, offering substantial savings for the locality.
  • Enhanced Collaboration: Actively supported collaboration between nine key stakeholders across primary and secondary care, with an average of three meetings per stakeholder (including two face-to-face and one virtual), across a total of 3489 patients.
  • Proactive Approach: The project identified 1,938 patients with outdated blood work and weight measurements, these findings were communicated to the locality for further assessment. Additionally, direct intervention was taken by Spirit for 1,551 patients whose records were up to date. This two-pronged approach demonstrates a proactive strategy to address both immediate needs and potential future concerns before symptoms arise.

Number of interventions identified in locality DOAC review service

Potential impact:

  • Patients: Improved health outcomes, reduced medication errors, and potentially lower medication costs.
  • Healthcare System: Cost savings through prescription switches and potentially reduced hospital stays due to improved preventative care.
  • Healthcare Providers: Up-to-date patient records and enhanced AF training, potentially leading to better patient outcomes.
  • Future Initiatives: Provides valuable insights and a potential model for broader implementation of similar quality review programs.

This quality review service is a compelling example of how such initiatives can improve patient outcomes, optimise healthcare systems, and empower providers.


Next steps

To see how Spirit Health delivers results and to learn more about their success in optimising therapy areas, please click here.

To explore how to improve patient care and reduce costs, contact Spirit Health today to discuss a partnership for your current and future medicines optimisation reviews.

Featured, News, Social Care

Accelerating remote monitoring innovation in social care

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With the number of people who will require at-home care set to increase, innovation to boost capacity and drive efficiencies in social care is desperately needed, writes Fiona Brown, Chief Care Officer at Lilli.


In the ever-evolving landscape of social care, the need for transformational system-wide change has become increasingly apparent. Capacity and demand are reaching a critical level, with 73 per cent of healthcare leaders saying a lack of social care capacity is having a significant impact on their ability to tackle the elective care backlog. This is where new proactive care technology emerges as a vital ally in addressing challenges like workforce shortages and access to services.

However, navigating this path to technology adoption amid a stretched workforce, bureaucratic hurdles and a lack of long-term solutions to social care capacity, presents its own set of challenges. Procurement processes, often burdened by strict and outdated internal controls, can create barriers to meaningful change. Instead of embracing a holistic approach to technology integration, these internal barriers can lead to the development of tenders with narrow specifications, overlooking the wider system impact.

Pilots, while valuable for testing and refining solutions, often fall short of achieving lasting impact due to insufficient time for advocacy or momentum building, unclear outcomes and an organisational requirement for quick financial returns. In addition, lack of early engagement with the market further complicates efforts to drive systemic change. As a result, pilot fatigue can set in across teams. To counteract this trend, there needs to be a shift towards long-term commitment to proven solutions to see real transformation.

Across the sector, central government has launched several types of competitive and highly sought-after technology funds for organisations to apply for, including the Adult Social Care Technology Fund and the Digitising Social Care Fund. Yet more recently a new type of fund has been launched directly from the technology sector. The Proactive Care Fund (PCF) aims to expedite the adoption of home monitoring technology by offering local authorities and integrated care boards (ICBs) up to £1 million of matched funds, ushering in a new era of efficiency and efficacy in care delivery.

Home monitoring technology that discreetly monitors patterns of behaviour and indicators of wellbeing has been proven to help to address many of the key challenges in the system – from staff shortages to shrinking budgets – by supporting carers to right-size care packages, keeping people living independently for longer.

The technology can empower carers to be on the front foot and proactively respond to signs of health decline before conditions become acute. Data from remote monitoring company, Lilli, for instance, shows that it can generate thousands of additional carer hours, and accelerate hospital discharge by up to 16 days. Moreover, for every £1 spent on the technology, £9 can be reallocated into the care budget.

The PCF provides the necessary support and resources for organisations to break free from the reactive delivery of care and adopt a proactive care model to explore and implement innovative technologies with confidence while realising the benefits of saving money, time and resources.

Central to this paradigm shift is the creation of a conducive procuring environment within the sector. The PCF addresses this need head-on by streamlining procurement processes and providing matched funding to alleviate financial pressures. By facilitating quick and easy access to transformative technologies, the PCF empowers organisations to embrace innovation quickly without undue burden. G Cloud contracts, committed to a minimum of 12 months, offer organisations the time and flexibility needed to realise the tangible benefits and assess the broader impact on the care ecosystem.

Last year, several organisations – including borough councils, county councils and ICBs – across the UK saw successful applications through the first PCF. These included Hillingdon Council, Medway Council, Oxfordshire County Council and North Central London ICB, who embraced the initiative to support a variety of adult social care services and enable their residents to live safely and independently.

According to the latest research, the number of people who will require publicly funded care at home in the UK is expected to grow by 36 per cent between 2024 and 2035, so it is crucial that transformation happens now to prevent further crisis in the future. The PCF represents a significant step towards accelerating the adoption of proactive models of care, while having a positive knock-on effect across the rest of the health ecosystem, reducing pressure on emergency services, reducing hospital admissions and speeding up hospital discharge. In current times, where central and local government are struggling to fund basic services, private sector initiatives, with a track record of savings and efficiencies, could prove to be part of the puzzle to help a sector in crisis.


To find out more about Lilli’s remote monitoring technology, please visit www.intelligentlilli.com.

Featured, News, Upcoming Events

Q&A with Dame Elizabeth Anionwu

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Professor Dame Elizabeth Nneka Anionwu is Emeritus Professor of Nursing at the University of West London and Life Patron of the Mary Seacole Trust.


As the first sickle cell nurse in the UK, Dame Elizabeth Anionwu is credited with blazing a trail in the treatment of the disease.

Ahead of her keynote address at the Skills for Health’s Our Health Heroes Awards on 16 April, Dame Elizabeth spoke about her contributions to the world of healthcare and why it’s important to recognise and celebrate those of the wider healthcare workforce.


Dame Elizabeth, you’ve had a long and successful career in healthcare, as a clinician, academic and advocate for the treatment of sickle cell disease and thalassaemia. What attracted you to a career in healthcare in the first place?

I was in a children’s home for the first nine years of my life, and I’d always suffered with eczema as a child.

I received excellent care from a nun, a nursing nun, who was the only person that could change my dressings without hurting me. She also had a huge sense of humour and she used to use words like ‘bottom’ in a very religious environment, which as a child made me burst out laughing.

I sensed that this was a kind, caring woman who wanted to avoid hurting me. And then I discovered she was something called a nurse and I thought, nurse, I like the idea of that.

That’s when I decided I wanted to be a nurse and I never changed my mind at all.

I started as a school nurse assistant when I was 16, working in what was then called a residential school for delicate children. It was run in collaboration between the NHS and the local authority for children with conditions like cerebral palsy, asthma and heart conditions.

I went into higher education from working as a sickle cell nurse in the community to the Department of Nursing in a university for the last 10 years of my career.

During that time, I retained links with community nursing, but also with acute nursing by having a clinical link in an NHS Trust on a ward involved with the care of patients with sickle cell disease.

I felt it was very important not to lose touch with the clinical side, so I continued to practice.

You can’t educate students if you are not up to date and involved with care yourself personally.


Looking back on your career, what would you say is your proudest achievement?

My proudest achievement was becoming the very first sickle cell nurse.

Because it was an innovative position, seen as pioneering at the time, I could actually develop quite a lot of it in the way that fitted my ideals of multidisciplinary activity.

I’ve always enjoyed working in a multidisciplinary context and very much in alignment with patients and their families.

I worked in that post for 10 years and it really was the most enjoyable period of my career.


And what’s the legacy of that work in the NHS today, do you think?

There are many, many more sickle cell nurse practitioners, so that’s very good to see.

The value of the nursing contribution, both in the community and in the acute sector, has grown, and that that really wasn’t the case when I first started.

Up until a couple of decades ago probably, sickle cell was very marginalised and quite neglected in terms of its status, if you like, within the hierarchy of illnesses.

That has changed. There’s still work to be done, of course, but I’m delighted that nurses have played their role along with other professionals and families to ensure that the disease is fully understood, and treatment is available across the country.

I’m one of the patrons of The Sickle Cell Society, the national charity, so I am constantly aware that there are still areas that need to be improved, where there’s been, sadly, for example, a couple of deaths that shouldn’t have happened.

I mean, that’s the worst that can happen. They’ve all been taken seriously. They’ve all been investigated. When that happens, thankfully, it’s rare, but it jolts you to realise there’s still work to be done.

For example, nurses need much more education and that is now happening as a result of one of the tragedies. So, you’re never complacent, but you do recognise where improvements have definitely been made. I mean, the prognosis, the life expectancy for individuals with the condition has improved tremendously.

That in itself is a massive step forward.


The Our Health Heroes Awards celebrates the healthcare roles that are often hidden from view. Why do you think it’s important to celebrate this part of the workforce in particular?

Oh, I think it’s vital.

Without them, quality care for patients simply couldn’t happen.

If porters could not take a patient from the accident and emergency department to the ward or if the cleaners are not able to do their work properly the whole system fails.

Following the pandemic, it is even more vital that we say thank you and take time to appreciate the workforce.

They’re not looking for appreciation, but when they’ve had to struggle it not only affects them personally, but their families and their colleagues.

That’s why a celebration is needed – there are some amazing people working in the NHS and we need to let them know that they are appreciated.


Finally, what’s your message to the Our Health Heroes finalists?

First of all, good luck to everybody!

You have all done amazingly in being nominated for the awards, and I cannot wait to see you on 16 April to thank you personally for your contribution to our NHS.


Dame Elizabeth’s memoirs ‘Dreams From My Mother’ were published in 2021 and are available in paperback, Kindle and audiobook editions.

Featured, News

Harnessing local assets – the NHS and Care Volunteer Responders programme: people powered healthcare

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By Dr Allison Smith, Head of Research and Insight at Royal Voluntary Service.


The NHS and Care Volunteer Responders (NHSCVR) programme was first launched in March 2020 by NHS England to support and protect those individuals who were ‘shielding’ because of clinical vulnerabilities to Covid-19. The programme proved to be a critical auxiliary service adding vital capacity for staff and patients. Today the programme aims to support integrated care systems (ICSs) alongside other voluntary sector provision to improve efficiency, patient care and add capacity. It is free of charge, making it an accessible resource for healthcare teams and patients seeking additional support.

In today’s healthcare landscape, collaboration across sector partnerships is essential to delivering high quality care. NHSCVR exemplifies partnership working between a public service, a charity with a social enterprise (GoodSAM digital app) and citizens. To date over 40,000+ vetted volunteers across England have made themselves available to be deployed in real-time – via the GoodSAM app – to support the needs of local healthcare systems.

Volunteers provide emotional (e.g. welfare calls) and practical support (e.g. grocery/prescription deliveries) to help people stay well and independent. In addition, volunteers play a crucial role in supporting healthcare teams with, for example, quicker discharges and virtual ward assistance through the Pick Up and Deliver service.

Since the programme was relaunched last year, Royal Voluntary Service, with GoodSAM, has been working in partnership with several Trusts, ICSs, and local volunteers to embed and pilot various volunteer activities.

We showcase two below.


Barnsley Hospital – Pick Up and Deliver

The service supports Barnsley Hospital’s Discharge Unit, Virtual Wards, and Haematology Departments. This supports individuals being discharged from the hospital by transporting medication to their homes and enables patients to return home earlier, rather than them waiting for their prescriptions to be ready.

Delivering medication to a patient through Pick Up and Deliver

Barnsley Hospital staff load Pick Up and Deliver shifts into the referrer online portal. With real-time support the system ensures fast volunteer deployment. Volunteer Responders across the North-East sign up for shifts via the GoodSAM app, enjoying the flexibility to choose when they volunteer. Discharge staff feel that it both improves patient flow by getting patients off the wards and home quicker but also saves bed days by reducing the number of patients still waiting on-ward past 5pm.

Kerry Evans, the Regional Relationship Manager for North East, North Cumbria and Yorkshire has been working in partnership with Barnsley Hospital and their Discharge Unit and Virtual Ward teams:

“Members of their Discharge/Virtual Ward Teams approached me to see how Volunteer Responders could assist with the delivery of medications. It was a real collaborative effort from the start, involving hospital departments and the Royal Voluntary Service.

“Initially, we implemented an alert-based notification system for volunteers to respond to individual requests. After one month, we gathered feedback and assessed the process. It became clear that the volume of deliveries warranted a shift-based model. This provided hospital staff with greater certainty about volunteer attendance and allowed for contingency plans if shifts were unfilled.

“Volunteers have appreciated knowing their scheduled times, resulting in consistent participation. This has fostered trust and rapport between hospital staff and volunteers. The immediate impact of their actions within their communities has further motivated volunteers.

“The hospital staff have embraced the service and have been happy to explain to other Trusts about the benefits they have experienced and the collaborative nature of working with the voluntary sector. So much so, other Trusts are coming on board.

“It really is a case of listening to what the hospital needs, engaging with the volunteers to fully explain the service and then supporting all parties to make sure the process runs smoothly.”

Jacqueline Howarth, Operational Manager of RightCare Barnsley said:

“We are exploring the possibility of expanding the service to other patient groups and are in the early stages of developing these new pathways. Additionally, we are looking into other services provided by NHS and Care Volunteer Responders that would be useful to our Virtual Wards.

“We have found the Pick Up and Deliver service to be incredibly helpful and necessary. We have already recommended it to other colleagues and department heads in the hospital. The service is available seven days a week and is highly responsive, which is fantastic”.


Yorkshire Ambulance Service – Welfare Vans

The programme also worked in partnership with Yorkshire Ambulance Service NHS Trust and local volunteers to pilot ‘welfare vans’ in October and November 2023 (at York Hospital) to improve the wellbeing and working environment of ambulance crews as they waited outside A&E.

The volunteers were asked to make themselves available to support crews who were waiting to hand over patients at Accident & Emergency departments. They were required to provide ambulance staff with refreshments and the opportunity for a friendly chat. Volunteers undertook shifts of two to four hours – either solo or in pairs; the welfare vans were available from 12:00 to 20:00 and had a range of hot/cold drinks and snacks.

Overwhelmingly, both ambulance crews and volunteers benefited from this role. Crews reported high satisfaction with the welfare vans (n=89): 88 per cent reported that they were ‘very satisfied’ and 9 per cent ‘satisfied’.

“Always a friendly face at the welfare van. Happy to help and chat … A very welcome sight during a busy shift. Very much appreciated.”

“It’s an excellent service, with all the queuing we do to have a friendly face to give you a warm cuppa is great. All the volunteers at York are friendly and helpful so please keep it going. A big thank you to them.”

Volunteers also reported high levels of appreciation and value in doing this activity:

“I just got a really nice feeling about it, and they did appreciate it. They were keen to say thank you very much for being here … ‘We didn’t know you were going to be here.’

“I thought it was a really good idea to do. And so I was quite keen to sign up to it. So I did! They (crews) appreciated it, and it was nice to have an opportunity to chat to them.”

These examples demonstrate what can be achieved with true partnership working. Being able to welcome in local citizens, via volunteering, not only has benefits for the healthcare system, staff, and patients but we also know from an existing breadth of medical evidence it improves health and wellbeing of the volunteers, and can drive future workforce recruitment. In a recent survey (March 2024, n=2817) 21 per cent of Volunteer Responders stated that the programme has inspired them to ‘think’ or ‘actively look’ for a job/career in the NHS/care; 4 per cent stated because of NHSCVR they are now working in the NHS/care.


Royal Voluntary Service will be attending the Integrated Care Delivery Forum event in Birmingham on the 9th May.

If you would like further information or a conversation with one of our team – please contact your Regional Relationship Manager; details can be found at nhscarevolunteerresponders.org.

Rehab for all: fixing the NHS rehab access gap

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ICU nurse and creator of the Right to Rehab Campaign, Kate Tantam, shares her perspective on the importance of universal access to rehabilitation in the NHS.


I am an ICU nurse who has been collecting stories of recovery and rehabilitation since 2018.  The reason is simple – the wider public and even many health care teams absolutely do not see the impact of rehabilitation services. For many years rehabilitation services have been seen as the “nice to have, the icing on top of the cake”. I fiercely believe that rehabilitation is the icing in the middle of the cake, it cements everything together.

Rehabilitation is transformative. It is vital. It ensures that our patients make a full recovery and gets them back to the people and things that they love.  And while myself and my multi-disciplinary colleagues are aware of this fact every single day, the NHS system is not prioritising rehab. This fails dedicated and skilled healthcare workers and our patients across the UK.

My patients’ goals may not seem big – to hold their grandson, to make a cup of tea, to go to the loo on their own, to say ‘I love you’ – but for those who can’t move their arms or legs or have lost the power of speech, this is a mountain to climb.

Universal access to quality, person-centred rehab doesn’t exist across the NHS. It means that millions of people don’t have access to NHS rehab services in their area. Many of these people can’t afford to pay for private rehab services, creating huge economic inequality when it comes to recovery. Tragically, this means people’s lives must be put on hold, their conditions deteriorate, and they don’t stand a chance to reach those important personal goals or make a full recovery. This clearly impacts long term return to work, caring responsibilities for loved ones, ability to keep hold of housing and income with reliance on external financial support.

Christian is one of these stories – a young man working full time in his own business. He came into ICU over Christmas in 2022, was in multi-organ failure, and was an alcoholic. He spent months in ICU, and nearly a year in hospital. He was so unwell he had to have multiple abdominal operations, is now diabetic and has a colostomy. He had a rocky time, but I am incredibly proud to say that he is back at work. He is fitter than he has ever been and is debating becoming a model for Colostomy UK, sharing his recovery to support others and clinical teams.

Rehabilitation is work that needs all of us to partner with patients, loved ones and each other.  When healthcare professionals get it right, it makes every single person involved remember why they joined Team NHS. It doesn’t matter where they are in this team – the paramedic who brought the patient in, the GP who supported them after admission, the manager who sorted the funding for the service or the domestic assistant who cleans the ward – everyone impacts that story and shares its success.

Credit: Right to Rehab Campaign

I started this campaign for all the patients who aren’t as lucky as Christian. I see it every day across the UK and hear from clinical teams who feel lost fighting against the tide.

So, I joined forces with independent creative agency, Pablo, to create a campaign that celebrates patients’ ‘firsts’ since hospitalisation – the first tentative footsteps or first halting words – those monumental milestones for patients lucky enough to receive specialist rehabilitation care. The aim of the campaign is to raise awareness of the impact of rehabilitation and to ask for a rehabilitation strategy in every trust and a named lead.

This is a campaign that has had no budget – everything has been donated and we have all been working clinically full-time. For me, this demonstrates perfectly that the people who value rehabilitation will do anything they can to support and improve it. I work with a team of nurses, physiotherapists, speech therapists, doctors, occupational therapists, psychologists, dietitians and when we have the resources to support our patients to reach their goals and return home to their lives following traumatic accidents or life-threatening conditions, there is nothing more rewarding.

Some of my own patients’ first steps are now on billboards across the UK, including one patient who suffered a bilateral stroke on either side of her brain stem. She couldn’t sit, use her right arm or legs, she could no longer talk or even swallow and had to be fed via a tube. Her re-learned voice is now on a national radio advert promoting the campaign. The overarching message is for NHS leaders to provide much needed rehab services in all areas of the UK.

The campaign directs people to PetitionForRehab.com, where they can sign a petition calling for rehab to be made available everywhere and for a named rehab lead to be appointed on every hospital trust and board in the UK.  And much like it takes a multi-disciplinary team to support a person’s recovery through rehab, the call for universal access to quality rehab comes from a multitude of individuals, teams and organisations.

The campaign is supported by more than 30 healthcare charities, royal colleges and professional bodies such as the Chartered Society of Physiotherapy (CSP), the British Geriatric Society, Asthma+Lung UK, the Royal College of Occupational Therapists, and the Stroke Association who are all members of the Community Rehabilitation Alliance.

My ask of you is that you talk about rehabilitation, share your local stories of rehabilitation success, listen to your patients, their loved ones and each other.  The NHS is the sixth largest employer in the world – together we surely can achieve anything.


To sign the petition and call for universal access to access rehab services, please visit PetitionForRehab.com.

Featured, News, Population Health

Unpacking cancer disparities in England

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Despite major gains in diagnosis and treatment, England continues to experience high disparities in cancer outcomes, with social and financial deprivation major drivers.


In December 2023, The Lancet Oncology published a landmark paper highlighting the “astounding inequality” in the risk of dying from cancer in England. Researchers from Imperial College London looked at the 10 most deadly cancer types in England and analysed the risk of dying from these across England’s 314 districts from 2002 to 2019.

Although the overall risk of dying from cancer before the age of 80 had declined over that time period, their analysis shows huge inequalities in risk depending on where in the country someone lives. For women, the risk of dying from cancer was one in 10 in Westminster, while for women in Manchester the risk was one in six. Meanwhile, the picture for men ranged from one in eight in London’s Harrow to one in five in Manchester. The study found that lung cancer had one of the highest inequalities in risk across areas with those at greatest risk areas having triple the risk of dying from lung cancer compared with those in lowest risk regions.

The concept of health inequalities is now well established in the UK and beyond. The publication of the DHSC Black Report in 1980 demonstrated that, although there had been a general improvement in public health since the introduction of the welfare state, there were widespread health inequalities across the country. It found that the primary cause for these inequalities was deprivation. Over four decades later, there is now a vast body of evidence examining health inequalities and the evidence suggests that despite new treatments and technologies, overall health is deteriorating, and the inequalities are widening.


Social determinants still a major influence

Research has shown that for cancer, the social determinants of health impact both prevalence and prognosis. The Health Foundation describes the social determinants of health as the “social, cultural, political, economic, commercial and environmental factors that shape the conditions in which people are born, grow, live, work and age”.

A 2020 report demonstrated that more than 30,000 extra cases of cancer in the UK each year can be attributed to social and financial deprivation, while survival was found to be worse among the most deprived groups. Many of the risk factors for cancer are influenced by the social determinants of health. For example, individuals residing in areas with higher levels of deprivation are 2.5 times as likely to smoke compared to those in the least deprived areas, and they find it harder to quit.

Diet inequality is also an issue that affects the most deprived in society. Research has shown that people in deprivation have poorer diets, and consumer higher levels of poor quality, ultra processed, high calorie food than those in the least deprived areas. This population also suffers from much higher rates of obesity. As a result of such social determinants of health, those that grow up and live in deprivation are more likely to get cancer, but the story doesn’t stop there.


Variations in diagnosis

There is huge variation across the UK in cancer diagnosis. There are currently three UK screening programmes: for bowel, breast and cervical cancers. In theory these screenings are open to everyone eligible, however, in reality there are various barriers to screening that disproportionately affect certain populations, and this leads to inequalities in diagnosis.

Barriers to screening are an active area of research but there are several factors that have been identified to contribute. Stigma is one factor, with research showing that cancer stigma is linked to lower screening uptake, and this tends to be more prevalent among people from ethnic minority backgrounds.

Another barrier recognised is the practicality of attending a screening. For example, other responsibilities such as work or caring may make it difficult to get to an appointment. There are ways to overcome these barriers and increasingly NHS services are implementing changes to make screening more accessible to everyone. For instance, research suggests language barriers hamper screening uptake and therefore translation services can help overcome this. Also, offering greater flexibility on appointment times and re-invitations for those that haven’t responded have been found to positively impact uptake in underserved populations.

Overall, there are clearly gross inequalities across both the risk of developing cancer and the prognosis once it has developed. However, as researchers gain deeper insights into these inequalities and the mechanisms that contribute to them, NHS and public health services can implement best practices in order to try and level the playing field for cancer care. In April, Public Policy Projects will be hosting a round table event looking at regional inequalities in prostate cancer, so look out for the report later this year.

Featured, News

Improving the lives of people in our places through place-based procurement

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Place-based procurement is a strategic approach that provides benefits for healthcare systems, value for the taxpayer and serves as a catalyst for economic development. Stuart Watkins, Health Business Manager at Crown Commercial Service explains the importance of place-based procurement and offers key considerations for developing successful policies.


Providing a good quality and healthy life for people that live in the communities that make up our places is at the centre of public service provision.

Place-based procurement is about understanding the issues, interconnections and relationships in a place and coordinating commercial action and investment to improve the quality of life for people.

Beyond health outcomes, place-based procurement has the power to shape the broader landscape by encompassing social value, carbon neutrality, interoperability and sustainable economic benefits.

All the places that make up our diverse communities across the United Kingdom will have different health and social care models to meet their specific local needs. This gives rise to both Integrated Care System (ICS) place-based procurement challenges and opportunities.


The benefits of place-based procurement

There are several benefits that can be achieved through strategic place-based procurement, including:

  • Efficiency and cost savings: standardisation and place-based Cost Improvement Programmes (CIPs) of clinical pathways ensure the best possible outcomes for patients, place-based partnerships and the taxpayer.
  • Patient and community centred care: investing in place-based digital health services ensures the provision of accessible, patient-centred care at home or in other community settings.
  • Tackling health inequalities head-on: place-based procurement strategies directly address disparities by aggregating social value and sustainability requirements and helping ICSs improve access, outcomes and experiences.
  • Economic development through pricurement: the intentional support of local businesses and the aggregation of sustainability requirements not only support economic growth but also contribute to the overall well-being of the community.

Five considerations for your integrated care boards’s place-based procurement policy

While each region will have different strategies based on its unique goals and circumstances, the following place-based procurement strategies are helpful approaches for all ICSs to consider.

Choosing national procurement aggregation initiatives: A simple way for ICSs to save costs and improve procurement efficiency is through collective buying. When ICSs combine their own buying needs with those of other organisations across the public sector, they can tap into savings not possible when buying individually. CCS runs ongoing aggregation programmes for goods and services including IT hardware, mobile services, software licences and utilities. Joining an aggregation enables ICSs and place committees to combine local requirements with other ICSs nationally, ensuring economic value and favourable terms.

Regional collaboration through purchasing and innovation: Working together with regional NHS trusts, schools, science networks and universities helps develop and procure innovation. These contracts allow a lead group, or authority, to source goods and services for everyone within the ICS. This means that economies of scale can be achieved.  

Engaging communities / co-designing strategic projects: Place committees and integrated care boards regularly connect with local communities and interest groups. This makes it straightforward to turn these localised stakeholder engagements into strategic procurement projects that have a positive influence on places, like establishing a new acute hospital. 

Harnessing data-led procurement: ICSs are investing in data analytics to inform procurement decisions and enable them to secure sustainable procurement value.  

We understand that this is a critical area for the NHS. It is the foundation of developing an efficient, effective and economic commercial strategy, both nationally and locally. In this context, CCS has provided £12.8 million of funding over three financial years to support the rollout of the Atamis e-commerce system. 69 per cent of NHS organisations are already signed up, with a target of 90 per cent by 2025.  

Empowering local small and medium enterprises: Prioritising local SMEs aligns with ICS goals, supporting community growth. This creates business opportunities and  supports local development, as well as reducing environmental effects from distant supply chains. 


How CCS can help

At CCS, we’re committed to collaborating with our colleagues across the public sector to revolutionise health and social care, and improve the lives of UK citizens.

As the largest public procurement organisation in the UK, our scale allows us to access multiple savings and provide real benefits for customers.

Think of CCS as a collaborative partner. Our experts can help you successfully navigate the complexities of place-based procurement and achieve transformative healthcare outcomes.

Download our full white paper

Our latest white paper, ‘Place-based procurement strategies for Integrated Care Systems’, aims to enable ICSs to optimise every pound spent, address their communities’ unique needs and maximise the health and wealth of the regions they serve. You can download the guide from the CCS website.