The NHS efficiency dilemma: Is AI really the answer?

By Peter Corpe

Despite the major digital transformation efforts ongoing across the NHS, money alone will not solve the challenges the health service faces. Neither will simply bolting AI solutions onto outdated processes, writes Peter Corpe, Industry Leader, UK Public Sector at Appian.

Despite the Government’s commitment to ‘bring the NHS into the digital age’ in its AI Opportunities Action Plan, healthcare organisations overwhelmingly still rely on legacy systems that aren’t fit for purpose. The recent State of Digital Government Review from the Department for Science, Innovation and Technology (DSIT) highlighted, the technology resource gaps that continue to derail work, waste time and delay essential services.

This is not just an inconvenience – it’s a growing crisis. A recent UK Public Sector Efficiency Survey revealed that NHS employees lose an average of five hours per week to clunky, inefficient systems. That adds up to a staggering 7.5 million hours of wasted work every single week. These valuable hours could be reinvested in treating patients, improving safety, and providing a better service. By addressing these systemic inefficiencies, we can improve healthcare services and enhance patient outcomes.

The UK Government announced the much needed £3.25bn Transformation Fund to boost public service efficiency in its latest Spring statement. It’s poised to drive productivity in public services, including the NHS, at a time when efficiency is under immense scrutiny. Backing a range of initiatives, the fund will include the introduction of AI tools to revolutionise front line service delivery.

But if we are serious about modernising the NHS, money alone will not solve the problem – we need targeted, measured reform. AI and automation are rightly gaining momentum in the sector. However, AI is not a magic solution on its own. Its effectiveness depends on the quality of the data it receives, and how well and quickly we act on insights. If we aren’t prepared to act on its findings quickly, we create bottlenecks instead of breakthroughs. Without the right groundwork, AI risks producing noise instead of value. AI must be embedded into well-designed processes to ensure it delivers real economic benefits.

I am often asked what are the biggest technology challenges in healthcare today, and what are the opportunities and barriers for the sector to use AI effectively. My response typically focuses on the following areas:

Manual services and outdated processes

Despite ongoing digital transformation efforts, most departments still rely on manual processes. The DSIT report reveals that 45 per cent of NHS services lack a fully digital pathway, with very few eliminating manual processing entirely.

The impact of outdated processes is felt directly by patients and healthcare workers alike. When services remain paper-based or rely on fragmented systems, productivity suffers, and resources are stretched thin. The functioning of these fragmented systems relies on ‘human glue’ – workers manually bridging siloes of data and process, which prevents recognition of the core deficiencies.

Streamlining these processes through digital transformation is not just a matter of convenience. It’s essential for improving efficiency, reducing administrative burdens, and ultimately enhancing service delivery for the public.

Process modernisation and automation is the most powerful lever available to drive service reform for such tasks. A process orchestration solution can automate time-consuming tasks such as data entry, appointment scheduling, progress tracking, compliance, and reporting. Automating these actions would enable a shift towards time spent on value-driven activities that can improve both internal efficiency and service delivery.

Fragmented and underused data

When data is scattered across multiple outdated legacy systems, information access and related processes slow down for everyone. This impacts productivity and the ability to resolve case work at speed. This lack of data integration also limits the potential of AI, machine learning, and advanced analytics. These data-driven technologies can only work with seamless access to high-quality data, to drive innovation and improve decision-making.

For the NHS to be truly AI-ready, the data must be in order. Solving this starts with adopting a platform that connects data and processes woven into a single framework. A data fabric, for example, creates a virtualised layer that links data across systems without needing to migrate it.

With advanced data management, organisations can train, refine, and deploy AI models more effectively, transforming vast amounts of information into valuable insights. High-quality data is the fuel AI needs to enhance decision-making and drive efficiency. Without it, the potential of a modern digital NHS will remain out of reach.

The future of AI-driven processes in the NHS

Optimism about AI is growing within the healthcare sector. 64 per cent of NHS workers have some or high confidence in AI’s potential to improve their organisation’s efficiency.

The key to unlocking AI’s full potential is embedding it within existing processes. Process is where actions happen. It’s where healthcare professionals make decisions, allocate budget and resources, serve patients, and move things forward. When AI operates within processes, it gains purpose, governance, and accountability – all vital to delivering value from AI.

While organisations are under pressure to integrate AI, its success depends on strong data infrastructures and human oversight. AI should be a partner, not a replacement, ensuring efficiency and innovation without compromising security or accountability.

To sustain long-term growth, healthcare organisations must invest in agile platforms that adapt to rapid AI advancements with process orchestration technologies. A platform approach can streamline operations, enhance decision-making, and improve service outcomes. Embracing these tools isn’t just about modernisation, it’s essential for efficiency, stability, and better healthcare service delivery.

Now is the time for the NHS to seize the opportunity. Every part of our health service runs on processes – from patient referrals to hospital workflows. When we improve these processes with automation technologies like AI and process orchestration, we create better working environments for our healthcare workers, improving service delivery for our NHS, for the betterment of patients.

Frailty: A silent crisis

By Dr Jon Tose

The time for a coordinated, pathway-driven response to frailty is now, writes Dr Jon Tose, GP at Northern Moor Medical Practice and Clinical Lead at HealthPathways UK.

We’re facing a crisis that’s growing silently, relentlessly – and dangerously: frailty. It’s not a dramatic headline-grabber. It doesn’t spark protests or fill news cycles. But frailty, particularly among older adults, is quietly becoming one of the most serious threats to the long-term survival of the NHS.

Unless we act now with a coordinated, system-wide response, frailty could push our healthcare system to the brink – and cost billions in avoidable care.

The numbers are alarming – and getting worse

Right now, around 1 in 10 people over 65 and more than half of those over 85 in the UK are living with frailty, according to the British Geriatrics Society. And with the UK’s ageing population growing fast, the Office for National Statistics predicts that over a quarter of the UK will be over 65 by 2043. These figures are just the beginning.

Without urgent action, the number of people with moderate to severe frailty could double in the next 20 years. That means more falls, more hospital admissions, longer hospital stays, more care needs – and massive strain on already stretched NHS services.

Frailty isn’t just a health problem. It’s an economic one

The cost of ignoring frailty is staggering. Older adults living with frailty are far more likely to end up in A&E, often after a fall, infection, or medication issue. But, critically, NHS England estimates that up to 40 per cent of these emergency admissions are preventable.

Those admissions come with a price tag. One study estimated that frailty-related hospitalisations cost the NHS around £5.8 billion a year, and that figure is climbing (Gale et al., 2020). If we don’t shift from reactive, crisis-driven care to a proactive, preventative model, we’ll be pouring money into a system that can’t keep up.

The system is buckling

Right now, the NHS treats frailty like it does many complex health issues – after the crisis hits. We wait until someone falls, gets acutely ill, or becomes too weak to cope at home. Then we send them to hospital, treat the immediate issue, and discharge them – often without enough support.

This model isn’t just inefficient – it’s harmful. Hospital stays can actually worsen frailty, especially for older adults. Even a few days in bed can lead to permanent declines in mobility and independence. And when discharged into poorly coordinated community or social care, many bounce right back into hospital.

This revolving door is exhausting staff, draining resources, and failing patients. We have to do better.

We have the tools. We just need to use them

There is a solution, and it’s not theoretical. It’s already working in parts of the country. It’s called a frailty care pathway – a structured, evidence-based approach that identifies and manages frailty before it becomes a crisis.

Frailty pathways typically include:

Early identification using tools like the electronic Frailty Index (eFI).
A Comprehensive Geriatric Assessment (CGA) that looks at medical, psychological, and social needs.
A personalised, multidisciplinary care plan.
Regular review and monitoring to prevent deterioration.
A ‘map’ of the services that can promote ageing well and those that can step in if the patient deteriorates.

When implemented effectively, these care pathways don’t just improve outcomes – they save money. A Cochrane review by Ellis et al. (2017) found that proactive, structured geriatric care reduced hospital admissions and improved quality of life. It’s simple – the earlier we intervene, the more we prevent.

Policy is starting to catch up – but it’s not fast enough

There’s been some good news. NHS England’s Long Term Plan includes a strong focus on ageing well, frailty, and anticipatory care. Initiatives like Urgent Community Response (UCR) and the Enhanced Health in Care Homes (EHCH) model are helping local teams manage frailty without sending patients to hospital.

Primary Care Networks (PCNs) are now expected to identify patients with moderate and severe frailty and provide proactive care. That’s a great step. But implementation is patchy, and many clinicians still lack training, tools, or time to deliver it well.

As the British Geriatrics Society puts it – we can’t afford for these care pathways to remain optional or unevenly applied. This needs to become the national standard.

What’s holding us back?

Despite the evidence and policy momentum, uptake of frailty pathways has been inconsistent. Why?

Workforce capacity is stretched thin.
Many GPs and community teams lack specialised training in frailty management.
The Voluntary, Community and Social Enterprise (VCSE) sector is not used to its maximum.
Managing frailty is multidisciplinary and navigating the system is challenging for patients and those who support them.
IT systems don’t talk to each other, making coordination across services difficult.

However, these are solvable problems. What’s really missing is urgency. We need to treat frailty like the system-wide emergency it is.

What needs to happen now

If we want to avoid a full-blown crisis in the next decade, we must:

Make frailty identification and pathway implementation mandatory across the NHS.
Invest in workforce training so GPs, nurses, paramedics, and allied health professionals can deliver proactive care.
Integrate digital systems to allow seamless sharing of care plans and patient status.
Fund community, VCSE, and social care services that are critical to keeping people out of hospital.
Track outcomes and iterate – because good care pathways evolve as needs change.

This is a ticking time bomb – there is no second chance

Frailty doesn’t come with sirens. It doesn’t flood wards overnight. It builds slowly and quietly until the weight becomes unmanageable. But make no mistake – the frailty crisis is already here, and the NHS is on the edge of being overwhelmed.

We already have the knowledge, evidence, and tools to address this. We just need to act.

Because when it comes to frailty, doing nothing is the most expensive option of all – for the system, for society, and for the people we serve.

Featured, Health Inequality, News May 27, 2025

NHS risking lives of millions with hearing loss – report

By Integrated Care Journal

A new report from SignHealth finds that the NHS is potentially flouting equality law, leading to serious failings that have left deaf people and people with hearing loss in the dark about their own health.

A new report from leading charities, the Royal National Institute for Deaf People (RNID) and SignHealth, has revealed serious and potentially widespread failings affecting the more than six million adults in England who are deaf or have hearing loss.

As part of the report, Still Ignored: The Fight For Accessible Healthcare, the charities surveyed 1,114 people who are deaf or have hearing loss and live in England, to better understand their experiences in accessing and receiving NHS healthcare. A survey of patient-facing professionals working in NHS healthcare settings in England was also conducted by Censuswide on behalf of RNID.

It reveals that 7 out of 10 (70 per cent) deaf people and people with hearing loss have never been asked about their information and communication needs when accessing NHS care – something that all healthcare providers should offer under the NHS Accessible Information Standard (AIS), a legal document setting out patients’ rights under the Equality Act.**

Health services like the NHS, as well as social care services across England, are required by law to offer extra support if people with hearing loss struggle when accessing services. For example, being provided with an accessible alternative to the telephone to be able to book appointments or receive test results, or communication support, such as a qualified British Sign Language (BSL) interpreter to ensure they can understand appointments and procedures.

According to RNID, more than 6 million adults in England have hearing loss severe enough that they would have difficulty in noisy environments, while an estimated 1 million would not be able to hear most conversational speech. More than half of the UK population aged 55 or over have hearing loss, while there are approximately 73,000 deaf users of BSL

Philippa Wynne, Director of Engagement at SignHealth, said: “This report has confirmed what our community has known for a long time: the NHS is not working for deaf people.

“Every day the health of deaf people is put at risk because their right to accessible information is being ignored. This is not good enough. It must stop. And it must stop now.”

Lack of communication support harming patients

The report makes clear the impact that a lack of communication support is having on deaf people and those with hearing loss across the NHS. Findings include:

Almost 1 in 10 have avoided calling an ambulance or attending A&E
1 in 4 have avoided seeking help for a new health concern
1 in 7 say a health problem they were experiencing was made worse
1 in 7 felt that their health was put at risk

Even when people are asked about their communication needs, too few receive the support they ask for. Of those who indicated they need a communication support professional to be present during an appointment (e.g. a BSL interpreter or lipspeaker), only 7 per cent said this is always provided for them.

More than half (54 per cent) of people who are deaf or have hearing loss have had to rely on either a partner, family member, or friend to relay information or interpret for them at a healthcare appointment, effectively removing their right to privacy and dignity in their own healthcare.

People who have been denied the basic information and communication support they need say it has resulted in situations such as:

Giving up trying to make an appointment (47 per cent) or missing an appointment (21 per cent)
A delayed or incorrect diagnosis (23 per cent)
Failure to understand their diagnosis (33 per cent), the outcome of their appointment (33 per cent) or how to take medication or treatment prescribed (25 per cent)
Almost half felt it has resulted in them not getting the follow-up care they need (44 per cent)

The consequences are particularly felt by those who use sign language and those who require a communication support professional – around half of sign language users (48 per cent) report not understanding their diagnosis or how to take medication/treatment given (47 per cent).

These failures are leading to dangerous and devastating consequences. One example cited in the report is of a woman who, owing to a lack of interpreter support, was left unaware that she had suffered a miscarriage.

The patient said: “I went into A&E for blood loss but no interpreters turned up after asking several times. I went through so many tests and wasn’t sure what it was all about. I was given medication, but I refused because I didn’t know why I needed them. The staff seemed gobsmacked, so I took it and was not sure how serious it was. The next thing a nurse took me into a bereavement room and sat me down with a leaflet that said ‘miscarriages’. I was in shock. They had not explained what the test was for. It was a massive misunderstanding and lack of communication.”

A further example includes a patient who did not receive any food or water during a hospital stay as they could not hear staff offering them.

The failure to provide adequate communication support is also feeding, and directly impacting, complaints procedures for deaf patients and those with hearing loss. Nearly 1 in 5 patients (19 per cent) reported that they have made a complaint to a healthcare provider about their information and communication needs not being met. A further 37 per cent said that they had a good reason to complain but have not pursued it, usually because they felt it would not change anything or lead to change.

NHS staff need more support

The report clearly shows that the NHS Accessible Information Standard (AIS) is not being met across England; awareness is low among NHS staff, with one third (32 per cent) saying they are unaware of the AIS. Only a quarter (24 per cent) of NHS staff say they can always meet the information and communication needs of patients who are deaf or have hearing loss.

NHS staff who do not feel confident that they can always meet patient needs face four main barriers: a lack of training (34 per cent), a lack of time or capacity in workload (32 per cent), a lack of standardised processes (31 per cent) and a lack of functionality of IT systems (30 per cent).

Crystal Rolfe, Director of Health at RNID, commented: “Imagine not being able to understand a cancer diagnosis, or having to rely on a family member to tell you that you’re seriously ill or even dying. The horrifying truth is that too many deaf people in England today don’t have to imagine it – it’s happening to them in real life.”

“The NHS is systematically discriminating against people who are deaf or have hearing loss: it’s a national scandal. It is not acceptable that deaf people and those with hearing loss are being routinely failed by an NHS that neglects their communication needs. Lives are being put at risk because of communication barriers, delays and out of date systems that are not fit for purpose.

“It is time to give deaf people more access and control over their physical and mental healthcare. We are calling on Ministers to bring NHS accessibility into the 21st century. The government needs to urgently address these issues, make staff training mandatory and overhaul current NHS systems, so that everyone can access their own health information in a way that makes sense – equal access to healthcare is a human right.”

Calls for urgent government action

RNID and SignHealth are calling for major changes to ensure the NHS meets the needs of deaf people and those with hearing loss. Key recommendations include:

DHSC (Department of Health and Social Care) to ensure that work to improve the NHS Accessible Information Standard (AIS) is properly resourced and prioritised, and lead on a transformation plan to ensure that people with communication needs can access the healthcare they need
Mandatory training for NHS staff in deaf awareness, as well as the AIS
The AIS to be made legally enforceable for the NHS, through the strengthening of legislation on NHS information standards

Finally, the report suggests that people with lived experience of communication needs should be at the heart of plans for change.

Philippa Wynne, Director of Engagement at SignHealth, added: “This report shows that serious diagnoses or instructions for taking medication are given without an interpreter present or provided only in English rather than BSL. This is not just dangerous; it is life-threatening. People have died because of inaccessible information and healthcare. These are not statistics – they are real people.

“In 2021, our survey showed that the AIS was not working properly for deaf people. Sadly, four years later nothing has changed. The evidence suggests that deaf people’s health is getting worse, with 88% saying lack of accessible communication affects their mental health and 82% saying it impacts their physical health.

“Deaf people’s health cannot be ignored any longer. Patients are being misdiagnosed. Lives are being put at risk. And, yes, people are dying. Enough is enough. The NHS must provide better access, and they must do this now.”

You can read the full report here.

Below is a selection of quotes from the report, detailing the lived experience of deaf people and those with hearing loss in accessing and receiving NHS care:

Kate Boddy is the child of a deaf adult (CODA) and was required to act as an interpreter for her own father, Richard Boddy, during a series of medical appointments, as communication support was either unavailable, haphazard, or actively denied. The impact for Kate, her father, and her wider family, was devastating. She said:

“Dad Face-Timed me in a panic and just said ‘I can’t see. Everything is black.’ I drove him to a hospital which has an A&E especially for eyes – but no interpreter. They did lots of tests and at the end of the day they said to me: ‘can you tell your dad he’s got cancer?’ So I told him. We went home in complete shock.”

Dr Natasha Wilcock is a deaf doctor who works in palliative care. She shared her experiences: “Legally, professionally and ethically, deaf insight training should be compulsory for all doctors. Right now, the experiences of deaf people and people with hearing loss are shocking. I have met patients who have been referred to palliative care services who have not understood that they will no longer be receiving cancer treatment – they haven’t understood that they are dying.”

Suffolk-based Pip Lee, a hearing aid user and lipreader, said: “It came to my appointment time and my pager hadn’t buzzed, so I sat tight. I vaguely heard someone shouting, and when I looked up everyone was looking at me. I waved at the shouting nurse, and it turned out she had been calling out my name. I explained that my pager hadn’t buzzed, and she apologised, repeating what the receptionist had told me; that nobody knew how to use the pagers, even though they’re really simple.

“But the situation got worse when I went in to see the consultant. He refused to take off his facemask, so I couldn’t hear anything he was saying. He picked up his iPad to use the speech-to-text function, but the text it produced was gobbledygook. I left only knowing that I would need an MRI of my brain, but when the post-appointment letter came, I was shocked to read it was to look for a possible tumour associated with my hearing loss and tinnitus. Because the medical staff did not meet my communication needs, I missed that important information. Thankfully I didn’t have a tumour, but the experience was up there as one of the most stressful, frustrating and patronising appointments I’d ever had.”

All news

2025 Our Health Heroes winners announced

By Integrated Care Journal

The winners of the ninth annual Our Health Heroes Awards were revealed last week (22 May) at a dazzling awards ceremony held at the Queen Elizabeth II Centre in London.

Supported by NHS England, NHS Employers, NHS Shared Business Services, NHS Race & Health Observatory, SFJ Awards and Integrated Care Journal, Our Health Heroes Awards honour the vital contributions of the broader healthcare workforce that supports our NHS doctors and nurses on the frontline.

From porters and cleaners to reception staff, gardeners, and security teams, these often-overlooked professionals represent around 40 per cent of the NHS’s workforce. This national awards programme shines a spotlight on their dedication and gives the recognition they so richly deserve for helping keep our health service running smoothly.

This year’s gold, silver and bronze winners (listed below in that order for each category) are as follows:

Individual categories

Outstanding Lifetime Contribution to Healthcare, sponsored by NHS Employers

Pauline Taylor, Children’s Complex Care Quality Assurance Nurse, Hampshire and Isle of Wight Healthcare NHS Foundation Trust
Caroline Dowsett, Clinical Nurse Specialist, East London Foundation Trust
Vedantee Shiebert, CAMHS Lead Nurse, Central and North West NHS Foundation Trust

Apprentice of the Year, sponsored by SFJ Awards

Olivia Parsons, Clinic Manager, Beacon House
Tim Muttock, Business Administration Apprentice, Bridgewater Community Healthcare NHS Foundation Trust
Nasser Mohammed, Service Desk Supervisor/Developer, Leeds and York Partnership NHS Foundation Trust

Operational Support Worker of the Year, sponsored by iCQ Awards

Hayley Pedwell, Information Assistant, Macmillan Cancer Care
Lois Ward, Communications and Engagement Officer, Chesterfield Royal Hospital
Brian Taylor, Ambulance Welfare Officer, North East Ambulance Service Unified Solutions

Clinical Support Worker of the Year:

Sarah Haynes, Healthcare Assistant, Modality Partnership
Sam Desborough, Assistant Practitioner Occupational Therapist, Southwark Council
Lynette Cook, Ward Coordinator, Northern Care Alliance NHS Foundation Trust

Healthcare Volunteer of the Year

David White, Patient Befriender Volunteer, Cardiff and Vale Health Board
Chris Wilson, Volunteer Community First Responder, Yorkshire Ambulance Service NHS Trust
Andy Emery, Transport Volunteer, Royal Voluntary Service

Team categories

Best Healthcare Workforce Collaboration, supported by Integrated Care Journal

Personalised Independence Programme, Age UK Herne Bay & Whitstable (Winner)
The What Matters Team, Royal Berkshire NHS Foundation Trust (Highly commended)

Dedication to Lifelong Learning Culture

Coventry and Warwickshire Training Hub (Winner)
Patford House Partnership (Highly commended)

Equity, Diversity and Inclusion Champion, supported by NHS Race and Health Observatory

West Midlands Ambulance Service (Winner)
Wakefield Hospice (Highly commended)

Digital Innovation, supported by NHS Shared Business Services

Recruitment RPA Project Team, Kent Community Health NHS Foundation Trust (Winner)
Paediatric Virtual Ward Team, Dudley Group of Hospitals NHS Foundation Trust (Highly commended)

The Our Health Heroes Awards 2025 is delivered by Skills for Health and supported by NHS England, NHS Employers, NHS Shared Business Services, NHS Race & Health Observatory, SFJ Awards, iCQ Awards and Integrated Care Journal. To find out more visit: www.skillsforhealth.org.uk/awards

NHS Surrey Heartlands partners with Community AI to deliver socially-driven investment in local priorities

By Integrated Care Journal

The partnership leverages a data-led model, harnessing local insights to support initiatives aligning with local priorities and needs.

NHS Surrey Heartlands Integrated Care Board (ICB) has entered into a strategic collaboration with technology platform Community AI, to harness voluntary supplier investment in support of community wellbeing initiatives across Surrey.

At the heart of the partnership is Community AI’s COMMUNITY VALUE™ framework, a data-led model that enables public bodies to align supplier contributions with the most pressing local needs. The framework draws on verified local data to identify where resources can have the greatest impact, directing support to initiatives that reflect the priorities of residents and service users.

The approach enables NHS Surrey Heartlands to secure additional, no-cost investment into its communities – supporting health and wellbeing outcomes without placing additional strain on public finances.

“This collaboration with Community AI is a significant step in how we think about procurement as a driver of better health and wellbeing for our communities,” said Jack Wagstaff, Executive Director of Strategic Commissioning at NHS Surrey Heartlands. “By using verified data to guide investment where it’s needed most, we’re ensuring that every pound of supplier engagement delivers measurable social value. This is about smart, inclusive innovation—and doing more for the people we serve.”

The COMMUNITY VALUE™ framework bridges public need and private sector capability through a transparent and equitable model of voluntary engagement. Community AI brings together smart technology, procurement expertise, and marketing insight to direct supplier contributions to projects that deliver tangible outcomes for communities.

Paul Polizzotto, Founder and CEO of Community AI, added: “We are honoured to work with NHS Surrey Heartlands to help bring new, voluntary investment into the community in a way that is transparent, equitable, and impactful. Our COMMUNITY VALUE™ framework helps bridge the gap between private sector capabilities and public sector needs—delivering verified outcomes at no cost to taxpayers.”

Beyond Surrey, Community AI is also working with Birmingham City Council and the Tees Valley region on similar programmes, signalling a growing appetite among local authorities for data-driven and socially responsible procurement models.

The partnership comes as part of Surrey Heartlands ICB’s drive to explore innovative, value-based approaches that enhance community wellbeing, strengthen local partnerships, and improve long-term outcomes without additional financial burden on the public purse.

NHS reform: Language has changed, objectives remain the same

By David Duffy

How strategic commissioning will transform services was central to discussions at Public Policy Projects’ (PPP) Integrated Care Delivery Forum, held last Wednesday in Birmingham. David Duffy shares some initial insights from the Forum’s System Transformation Theatre.

The cycle of health system reorganisation seen over recent decades has accelerated under Keir Starmer’s Labour government, marked by the scrapping of NHS England, major reductions in system levers, and a fundamental remodelling of integrated care board (ICB) purposes. But, as stakeholders at the Forum noted, the more things change, the more they stay the same. The key for health conferences such as this, is to analyse how the delivery of integrated care will change.

Naomi Eisenstadt argued that there remains a lack of a shared understanding of what integration is fundamentally. She largely welcomed the strategic direction outlined in the ICB Model Blueprint last week, with its focus on population health, health inequality and the important role of ICBs in managing contracts with providers and determining the flow of resources. However, further clarification as to the role of neighbourhood teams is needed and further emphasis on the 4th aim of ICSs (social and economic development) would be welcome.

Professor Patrick Vernon, Chair of Birmingham and Solihull ICB, acknowledged the “mixed” impact of ICBs so far, but stressed that significant work had been done to break down silos in the Birmingham and Solihull area. Vernon also pointed out that many of the actions outlined in the model framework are already being delivered through practical ICS working. But with providers facing persistent resource constraints and ICBs set to merge into even larger footprints, progress is likely to remain uneven.

Enhancing the role of strategic commissioning

Strategic commissioning, now at the heart of ICSs’ role as outlined in last week’s model ICB blueprint, will define how these systems operate going forward. But do we fully understand what’s being asked? And how is this different to previous approaches to commissioning? Eisenstadt, Chair of Northamptonshire ICB and Non-Executive Director at the Department of Health and Department for Education, spoke about the enduring challenges of collaboration and silo breaking.

There’s still a lingering mindset in parts of the system that “if only there were more of me, then everything would be alright,” she noted, perhaps a symptom of fragmented culture, not a lack of strategy. “I think we forget why the silos persist,” reflected Eisenstadt, “they remain because vertical accountability is far less complicated than an integrated approach.”

Danielle Oum, Chair of Coventry and Warwickshire ICB was keen to highlight the opportunities of ICBs having more streamlined priorities and a greater focus on strategic commissioning: “What this means now is that we can accelerate the pace of change,” Oum reflected.

She continued: “The blueprint helps set out how ICBs will the shift from transactional and operational oversight, with a focus on performance management, towards a far more strategic and informed approach to commissioning, using their purchasing powers and their role as contract holders to drive improvement across population health.”

Speaking on the same panel, Victoria Underhill, Director of Integrated Care for Optum, noted the subtle differences between strategic commissioning and previous approaches: “I think strategic Commissioning puts population health management at the heart of strategy…ICBs have a critical role as strategic commissioners that will enable neighbourhood working, whether that’s through creating the sort of right conditions through technology enablers, data sharing, financial flows, commissioning across a pathway or for a population.”

Clear from the day’s discussion was that the best integration still happens on the frontline, when different teams are given the means to collaborate effectively together to deliver care.

Reform fatigue

Christine O’Connor reminded attendees of a hard truth: “Reorganisations do not improve the delivery at the point of care and are often disruptive to it.” Despite the promise of structural reform, what matters to frontline staff and service users is whether delivery actually improves.

ICSs were established to enable a more integrated approach to commissioning and delivering services. Yet meaningful engagement with key system partners remains inconsistent.

Nowhere is this clearer than in social care. The conference took place in the context of yet more deflating news for the sector. Nadra Ahmed, Chair of the National Care Association, powerfully highlighted the ongoing marginalisation of social care. “We put £68 billion into the economy with a 1.7 million-strong workforce, but we cannot get a seat at the decision-making table, locally or nationally.”

David Morris, PwC’s UK Central Market Head, bluntly summarised the disconnect between rhetoric and reality regarding integration: “We have a long way to go before integrating properly.”

Cllr David Fothergill, Deputy Chair of the Local Government Association, was keen to point out that, while we are in the middle a significant period of reform for the health sector, local government is going through a once in a generation period of change following the Devolution White Paper last year. “There are 317 councils across England, about 170 of those are awaiting reorganisation,” Fothergill continued. “We recognise the scale and urgency of the challenges currently facing health services, but we must not miss the opportunity to rewire change together. Integration and joint work in a system, place and neighbourhood is vital if we are to design and deliver services that put citizens at the heart of everything.”

Optimising financial flow to unlock transformation

Financial flows will be key to enabling this new approach to commissioning and to empowering providers to transform services on the ground. Andrew Moore, Joint Chair of University Hospitals of Northamptonshire NHS Group and University Hospitals of Leicester NHS Trust, highlighted the contrast with the retail sector, where financial and workforce control mechanisms are far stronger. In health and care, however, over-reliance on agency staffing and weak grip on costs make transformation harder to deliver.

Technology remains an underused lever. Alex Crossley, Director of Transformation and Finance at NHS England, called for deeper partnerships with industry and smarter use of tech to overcome persistent productivity challenges. Strategic commissioning must include strategic deployment of digital tools.

A familiar destination despite the new language

There is a risk that ‘strategic commissioning’ turns out to be just commissioning with the word “strategic” tacked on. Policy leaders have a remarkable ability to rename old ideas and repackage them as innovations.

This tendency can frustrate frontline professionals and system leaders alike. Yet, as PPP Chair Stephen Dorrell noted in his closing remarks, it also suggests consistency in the direction of travel that should be built upon. The structures and language may change, but the core goals of integration, prevention, and efficiency remain. The challenge, as ever, is in finally delivering them.

You can read select insights from the Integrated Care Delivery Forum Medicines and Care Pathways Theatre here.

For more information on the Integrated Care Delivery Forum, please write to david.duffy@pppinsight.com.

AXREM launches Service and Operations Manifesto to strengthen NHS partnerships, drive constistent care

By Integrated Care Journal

AXREM’s manfesto calls for for higher standards, greater consistency, and smarter investment in the service and maintenance of medical equipment.

AXREM, the UK Trade association representing the interests of suppliers of diagnostic medical imaging, radiotherapy, healthcare IT and care equipment including patient monitoring in the UK, has launched its latest manifesto aimed driving collaboration and consistency across NHS services.

In the Services and Operations Manifesto, AXREM call for policy makers, NHS leaders and collaborators to make improvements to service delivery, promote consistency across NHS Trusts, strengthen cyber security, and support better patient outcomes, arguing that collaboration and consistency are key enablers if these outcomes.

AXREM members supply the majority of diagnostic medical imaging and radiotherapy equipment installed in UK hospitals. In doing so, AXREM member companies and their employees work side-by-side with radiologists, radiographers, practitioners, oncologists and a wide range of healthcare professionals in delivering healthcare to patients using our technologies.

The manifesto recognises the need to reduce inefficiencies and protect NHS investment, some of which can be achieved by the promotion of secure remote support to minimise downtime and reduce environmental impact as well as a standardised, low-cost credentialing that is recognised across all NHS trusts. AXREM’s Member Accreditation (AMA) Scheme achieves this by easing cost pressures on suppliers and the NHS.

AXREM also promotes high quality maintenance of medical devices, and has outlined recommendations to ensure service quality. With this as a key focus, AXREM supports the Good Maintenance Services – A Practical Guideline from COCIR.

Richard Coldrick, Senior Operations Manager at Elekta Limited, Convenor of the AXREM Service & Operations Special Focus and one of the authors of the document, said upon its release: “I am pleased to announce that this Manifesto will further AXREM’s goal of finding solutions to problems and challenges which face manufacturers, the NHS and patients by setting best practice and ensuring high industry standards”.

Jeevan Gunaratnam, AXREM Vice Chair, said: “This manifesto represents a clear and unified industry voice calling for higher standards, greater consistency, and smarter investment in the service and maintenance of medical equipment—because safe, reliable healthcare infrastructure is not a luxury, it is a necessity.

“I am particularly pleased that the manifesto supports the NHS’s strategic shift from analogue to digital, treatment to prevention, and hospital to community by ensuring that vital medical technologies are safe, secure, and always available—driving performance, reducing waiting times, and ultimately improving the health of our population.”

Sally Edgington, AXREM Chief Executive Officer, said: “The Service and Operations Special Focus Group stands as one of the longest-established groups within AXREM, consistently delivering valuable guidance documents and position statements that keep members well informed and ensure clarity in our external positioning on key industry issues. The launch of this manifesto marks an exciting development, broadening the industry’s perspective and strengthening our collective voice. I look forward to joining members and key stakeholders later today as we formally unveil this important initiative”.

You can read the manifesto in full here.

Primary care collaborative launches COPD early detection clinic

By Integrated Care Journal

Wirral Primary Care Collaborative and Chiesi partners have launched the community-based COMET clinic to accelerate COPD assessment and diagnosis, reduce system burden and improve patient outcomes.

A primary care collaborative has launched a new initiative aimed at improving early diagnosis and management of Chronic Obstructive Pulmonary Disease (COPD) in the Wirral area. Wirral Primary Care Collaborative (WPCC) and Chiesi UK and Ireland have collaborated to deliver the COMET clinic (COPD Targeted Management, Early Intervention and Treatment) in an effort to ease pressure on primary care and A&E services by offering early diagnosis and evidence-based interventions to at-risk populations.

COPD is a leading cause of emergency hospital admissions, with an average stay of seven days. It is estimated that up to 5,000 people are living with undiagnosed COPD on the Wirral, where prevalence is more than 40 per cent higher than the national average.¹

Individuals identified as high risk of COPD will be invited to attend a community diagnostic centre (CDC) for spirometry assessment and then a diagnostic clinic for immediate management (if diagnosed). These services will be delivered directly within the community, ensuring timely access to care.

*A patient in consultation at the COMET clinic*

Rachel Voller, Advanced Nurse Practitioner at Moreton & Meols PCN, said: “An estimated two million people live with undiagnosed COPD in the UK, with symptoms like breathlessness and chronic cough often mistaken for fatigue or ageing. These delays in diagnosis lead to reduced quality of life for patients, costly emergency hospital admissions and irreversible lung damage.

“The lack of resources and funding across the UK means diagnostics in COPD, such as spirometry, are not always readily available in primary care. By establishing COMET, we’re equipping the NHS and supporting patients to take control of their lung health, improving early diagnosis and accelerating access to care.”

COPD is not only debilitating for patients, but also places a growing burden on the NHS, costing an estimated £1.9 billion annually in England alone. The UK continues to have some of the poorest respiratory health outcomes in Europe, with higher mortality rates from COPD than in comparable countries. Despite the scale and severity of the disease, COPD can often be overlooked, meaning opportunities for early diagnosis are frequently missed.

Many cases are identified incidentally, through initiatives such as NHS lung health checks, or during emergency admissions for other conditions, by which point irreversible lung damage may already have occurred. On the Wirral, where COPD prevalence is 2.6 per cent compared to the national average of 1.8 per cent, the COMET initiative aims to address this challenge by proactively identifying those at risk and providing timely access to spirometry and clinical assessment.

COMET enables those with symptoms and/or CT scan findings consistent with emphysema to be referred for spirometry at local Community Diagnostic Centres before inviting them to the COMET clinic for a full clinical assessment and follow-up. Designed to deliver equitable, community-based care to over 1,000 people, the programme aims to equip patients with the support they need to take control of their lung health while also helping ease the pressure on overstretched GP practices and emergency departments in the Wirral, while identifying feasible approaches that the NHS can embed in the future.

The partnership builds on insights from FRONTIER, a hospital-based programme in Hull which demonstrated that targeted screening can tackle underdiagnosed COPD by improving access to testing and care. By contrast, COMET brings diagnostic assessment and management into Primary Care for patients taking part in the NHS Lung Cancer Screening Programme on the Wirral, expanding early detection and intervention beyond the hospital setting.

Harriet Lewis, Senior Director of Public Affairs and Communications at Chiesi UK and Ireland, said: “At Chiesi, we believe early action is key to improving outcomes for people living with COPD. COMET has been designed to ensure access to diagnostic services is simple, breaking the cycle of delayed diagnosis and avoidable hospital admissions. By delivering care directly within the community, this partnership is integral to improving access to testing and care, easing NHS pressures and demonstrating how partnerships can drive scalable and sustainable change.”

¹ Public Health Profiles: Public health profiles – OHID. Available at: phe.org.uk. Last Accessed April 2025.

Nearly half of trusts scaling back activity amid cuts, say trust leaders

By Integrated Care Journal

Cuts to clinical and non-clinical jobs will have consequences for frontline care according to survey of trust leaders, who will face competing priorities boosting performance while trying to balance the books.

NHS trusts are determined to protect patient safety as a new survey by NHS Providers reveals services are being scaled back and jobs cut as the demands of the NHS financial ‘reset’ become clear.

With the NHS looking to recover a predicted financial shortfall that reached nearly £7bn this year, trusts have been asked to drastically reduce running costs while improving performance against key targets.

With the 10-Year Health Plan due to be published in the coming months, nearly half of trust leaders (47 per cent) surveyed warned they are scaling back services to deliver tough financial plans, with a further 43 per cent considering this option. Virtual wards, rehabilitation centres, talking therapies and diabetes services for young people are among services identified at risk, demonstrating the extremely tough choices being faced by NHS leaders.

More than a third (37 per cent) said their organisation is cutting clinical posts as they try to balance their books, with a further 40 per cent considering this option. With trusts told to halve corporate cost growth, 86 per cent of trust leaders said their organisation is going to have to cut posts in non-clinical teams – such as HR, finance, estates, digital and communications – potentially risking efforts to deliver services, innovate, and improve productivity.

The scale of job cuts is becoming clear with a number of trusts aiming to take out 500 posts or more and one organisation planning to cut around 1000 jobs.

The interim Chief Executive of NHS Providers, Saffron Cordery, said “It’s really worrying to hear trust leaders tell us highly valued staff and services including vital work to address health inequalities and prevention could be among the early casualties of budget cuts. These decisions are never taken lightly and will always be a last resort.”

With further reductions to temporary staffing costs (91 per cent) and a recruitment freeze (85 per cent) also on the cards, the impact of these changes on hardworking and overstretched front-line teams is a major concern for trust leaders. More than nine in ten (94 per cent) said the steps needed to deliver financial plans would have a negative impact on staff wellbeing and culture at a time when morale, burnout and vacancies are taking their toll, and disquiet over pay and conditions is rising.

Now trust leaders have called on the government to recognise the difficult decisions and competing priorities trusts face as they try to improve patient services while trying to balance the books.

The survey by NHS Providers, which represents hospital, mental health, community, and ambulance services also found:

More than one in four (26 per cent) said they will need to close some services (a further 55 per cent are considering this)
45 per cent are moderately or extremely concerned their actions will compromise patient experience
Close to three in five respondents said patient experience (61 per cent) work to address health inequalities (60 per cent) and access to timely care (57 per cent) were most at risk of being impacted
Nearly nine in ten (88 per cent) said they don’t have enough funding to invest in prevention

Saffron Cordery added: “Trust leaders will always put patient safety and quality of care first. They’re acutely aware of pressures on the public purse, the scale of the challenge they’re facing and their duty to make the most of every pound that goes into the NHS. They’re working hard every day to find efficiencies, cut costs and make savings without compromising safety. They’re at the forefront of efforts to shift care from hospitals to the community, from analogue to digital and from treating sickness to preventing ill-health.

“Trust leaders have also heard loud and clear that overspending will not be tolerated and have made major inroads in tackling the huge financial deficit facing the NHS.

“But let’s also be clear: cuts have consequences. NHS trusts face competing priorities of improving services for patients and boosting performance while trying to balance the books with ever-tighter budgets. National leaders must appreciate that makes a hard job even harder.

“[Trust leaders] are committed to working with the government to build a better health service but fear immediate financial pressures could undermine plans to transform the NHS.”

Nearly half of NHS staff say role is affecting their mental health, charity warns

By Integrated Care Journal

Nearly half of NHS staff say their job harms their mental health, with many citing chronic pressure, staff shortages, and emotional strain. NHS Charities Together is calling for urgent support to expand vital mental health services for a workforce in crisis.

Nearly half of NHS staff (47 per cent) say their job is negatively affecting their mental health, according to a new survey of more than 1,000 NHS employees, carried out by NHS Charities Together. While this is a slight improvement from last year’s figure of 51 per cent, the prevalence of poor mental health among the NHS workforce remains stubbornly high, and highlights the urgent need for continued investment in staff wellbeing.

When asked which factors have negatively impacted their mental health in the workplace in the last 12 months, the most commonly cited causes among NHS staff surveyed included staff shortages (49 per cent), not feeling able to provide the best possible care (35 per cent), rising patient numbers (29 per cent), and exposure to traumatic situations at work (15 per cent). Despite this clear and growing need, just one in four (25 per cent) said they had accessed any form of mental health support in the past year.#

The survey findings also add to the existing evidence that the incidence of mental health problems is higher among NHS workers than it is among the general population. Half (51 per cent) reported experiencing anxiety, and nearly one in four (23 per cent) said they had experienced depression. By comparison, recent national data suggests that around one in six adults (16 per cent) in England met the criteria for a common mental disorder – such as anxiety or depression – within the past week.

Other health challenges experienced by staff in the last 12 months include exhaustion (44 per cent), burnout (35 per cent), and – perhaps most alarmingly – suicidal thoughts, reported by almost one in ten NHS employees (9 per cent).

In response, NHS Charities Together is calling for urgent public support to fund expanded mental health services for staff – services that are already making a difference, but are struggling to meet demand.

Ellie Orton OBE, Chief Executive at NHS Charities Together, said: “NHS staff are facing relentless pressure, working in some of the most challenging conditions the health service has ever seen. Chronic staff shortages, rising demand, and the emotional toll of not being able to deliver the care they want to give are seriously affecting their mental health.

“Given these daily pressures, it’s sadly no surprise that mental health issues among NHS workers are so widespread. If we want the NHS to thrive, we must take better care of the people who keep it running.”

Despite the growing pressure, almost four in five staff (78 per cent) say they’re proud to work for the NHS, underlining the passion and commitment of the workforce even in times of challenge, while 43 per cent would still recommend it as a career.

NHS Charities Together, the national charity caring for the NHS, helps provide vital mental health and wellbeing services to the NHS’s 1.7 million-strong workforce. Thanks to public donations, these services include staff psychologists, peer support programmes, wellbeing hubs, and more.

The charity has also announced a new Workforce Wellbeing Programme, including an initial investment of £6 million, with a further £5 million provided by NHS England. NHS Charities Together intends to raise a further £5 million over the course of the programme to drive much needed action across the UK and create positive, lasting change. Funds will be invested where there is the greatest need, and where charities can make the biggest and most sustainable difference to the workforce.

When asked what support they felt would benefit them most, nearly three in ten NHS staff (29 per cent) said access to psychological support or counselling services. Approximately a quarter (26 per cent) said respite or wellbeing sessions, one in five (22 per cent) said they would value access to a rest space or garden, and about one in eight (13 per cent) identified the need for intensive trauma-informed support.

Sarah*, a nurse who wanted to remain anonymous, said: “It was my ultimate goal to become part of the NHS, it’s an incredible institution and I’m proud to work there. However, nothing could have prepared me for my role. The pressure is unrelenting. Our patients and their loved ones are upset and frustrated because they have been stuck in the waiting room for hours. I wish I could do more, but I have no power to change the situation. We barely get breaks. We’re expected to power through, finish your shift, go home, and ‘pull yourself together’ for the next day. On my days off, I’m too drained to do anything but rest. I don’t want to socialise; I just want to switch off. It becomes a vicious cycle: work, home, and then back to another shift. It’s taking a toll on my relationships too.

“Due to funding cuts, we’ve lost our wellbeing hub – a safe haven for staff to take a moment of respite. Since it closed, I’ve watched many colleagues go on sick leave due to mental health issues. Skilled and experienced staff have left because the pressure has become too much, leaving us severely short-staffed. It’s heartbreaking to see team members becoming patients themselves. We need more support for staff, including training managers in how best to support their teams– things can’t go on as they are.”

Adam Kay, former doctor and bestselling author of This Is Going to Hurt, said: “Perhaps the most miserable part of reading these statistics for me was how unsurprising they are. It has never been tougher to work in the NHS than today, and there is simply not the support for staff. I welcome any efforts to support the mental wellbeing of NHS staff – this is a system in crisis.”

Ellie Orton OBE added: “Thanks to the generosity of the public, we’ve already been able to help over a million NHS staff with access to counselling, wellbeing spaces, and other crucial initiatives. But, despite their impact, these types of initiatives can’t currently be funded indefinitely; and the need is growing. With many staff struggling and unable to access support, we’re urging everyone who can to continue backing our work, so we can keep backing the NHS workforce.”

NHS Charities Together is the national charity caring for the NHS. To find out more or donate, visit nhscharitiestogether.co.uk.