Acute Care, Community Care, Featured, News, Secondary Care April 10, 2025

Embedding social prescribing in secondary care: A toolkit from Barts Health

By Gabriel Blaazer

Barts Health NHS Trust and its partner organisation, Transformation Partners in Health and Care, have released a toolkit detailing their pioneering work embedding social prescribing in secondary care and specialist acute pathways. The toolkit aims to help providers address unmet social needs, improve patient outcomes and reduce demand on acute services, shaping a holistic, prevention-focused model for the future NHS.

Social prescribing attempts to address the social determinants of health. These are the non-medical factors influencing 84 per cent of a person’s total health, with clinical care impacting the remainder. Social determinants of heath include income security and employment, education, housing and food insecurity, or social isolation.

Introduced in England in 2018, it typically involves signposting or referrals to appropriate services, but can also include emotional and mental health support for people experiencing social isolation or low-level mental health issues. Social prescribing is a holistic, person-centred and preventative approach and as such, is a key enabler of the government’s efforts to shift more care into the community and bolster prevention initiatives.

Emerging evidence suggests that social prescribing is an effective, yet low-cost, preventative intervention. However, its implementation has been more frequent in primary and community care, compared to secondary care. In 2023, Barts Health NHS Trust (Barts Health), one of Europe’s largest acute healthcare providers, started implementing social prescribing across multiple pathways, using different integration models to support a whole system approach to prevention and personalised care.

These services, delivered by social prescribers in collaboration with clinical and wider multi-disciplinary teams, support residents with their social needs while aiming to reduce demand on high-pressure services, including cardiovascular (CVD), renal, emergency care, and children and young people’s (CYP) services.

Encouraged by positive outcome data, the Trust and its partner organisation, Transformation Partners in Health and Care (TPHC), have developed a toolkit to help secondary care services embed social prescribing, public health and other community-led prevention initiatives within their specialties and pathways. The toolkit serves as a practical guide and checklist for secondary care providers looking to implement social prescribing and explore integrated, whole-system approaches to prevention.

Addressing unmet needs

While NHS England has established a standard model for embedding social prescribing, this has primarily focused on integration within primary care. In 2023, Barts Hospital’s Endovascular Team, led by Vascular Surgeon Dr Tara Mastracci, identified a high prevalence of unmet social need among patients in the hospital’s cardiovascular pathway – a well-evidenced correlation. Given that CVD disproportionately affects socially deprived populations, Dr Mastracci theorised that integrating social prescribing could benefit those at highest risk, simultaneously alleviating pressure on the pathway and improving patient outcomes.

A key data point supporting the use of social prescribing in secondary care was the gender split between typical users of social prescribing services and those presenting with acute cardiovascular issues. While 84 per cent of patients within cardiovascular pathways were men, 60 per cent of social prescribing users were women. Research has shown that women consult primary care services 32 per cent more frequently than men, suggesting that secondary care could play a central role in engaging men, who might otherwise remain underserved by traditional social prescribing models.

“Overall, we have found that we encounter a different group of patients compared with those who access social prescribing in primary care.”

Dr Tara Mastracci, Endovascular Lead for Complex Aortic Surgery, Barts Health

This reinforced Dr Mastracci’s belief in the merit of social prescribing within secondary care – clearly, more effort was needed to engage men, particularly for CVD patients who could benefit from greater social support.

Building a collaborative approach

Several specialties within the Trust had also identified unmet social needs as a key driver of service demand, and had begun implementing social prescribing programmes within their pathways. However, these initiatives were siloed, staff-led and reliant on temporary funding or fixed grants. To enhance collaboration and sustainability, Dr Mastracci established a multidisciplinary network of staff across primary and secondary care to drive a more integrated and formalised approach.

Finding limited guidance on implementing social prescribing within secondary care, Dr Mastracci’s CVD team set out to develop a replicable model for implementing it as part of secondary care pathways. Keen to apply the same rigorous standards as with a medical intervention, the team partnered with health economists at the University of East London. They incorporated EQ-5D instruments and QALY (quality-adjusted life years) metrics to evaluate the potential impact of social prescribing on both patients and the wider health and care system.

Recognising the need for greater institutional knowledge and community expertise, the team also partnered with the Bromley by Bow Centre (now Bromley by Bow Health), a leading VCSFE (Voluntary, Community, Social, and Faith Enterprise) community health organisation. This collaboration led to the embedding of a social prescriber within the hospital’s heart attack pathway, screening patients entering the pathway for financial or other social needs.

Implementation and outcomes

Once identified, social prescribers provided patients with six to eight support sessions, connecting them to local services and community groups tailored to their specific social needs. Beyond financial deprivation, patients received support for needs including housing, talking therapies, and healthy lifestyle support such as smoking and alcohol cessation, or physical activity and weight management – all of which play key roles in determining a person’s risk of developing CVD-related conditions.

The social prescribers were drawn from diverse backgrounds and communities, to work in collaboration with clinicians and consultants from secondary care, patient advocate groups, VSCFE organisations and others. This multidisciplinary approach facilitated a holistic and patient-centred approach. The experiences and lessons from creating the CVD social prescribing pathway were later used to inform other specialties as they implemented similar services within their pathways.

“We believe strongly in the importance of ‘place’ and thus many of our social prescribers meet patients in the community where they live to engage and provide support.”

Dr Tara Mastracci, Endovascular Lead for Complex Aortic Surgery, Barts Health

Dr Mastracci acknowledges that it will take years to fully assess the impact of Barts Health’s social prescribing programmes. “We know these target groups are admitted at higher rates than their peers,” Dr Mastracci told ICJ, “but it will take years to evaluate the long-term effects.”

Despite this, early results have been promising, notably within children and young people’s (CYP) diabetes services. Led by Dr Myuri Moorthy, Diabetes Consultant and Clinical Lead for Young Adult Diabetes (YAD) at Barts Health, clinicians in the pathway had noticed a concerning increase in non-adherence to self-management protocols, often linked to concurrent financial and psychosocial issues. The service also saw high numbers of patients not attending appointments (DNAs), largely due to distress, burnout, and the intense mental health toll associated with diabetes.

Poor diabetes self-management is well known to increase the likelihood of complications. This prompted the diabetes team to adopt a co-designed and personalised model, including a multi-disciplinary team of social prescribers, youth workers and a psychologist. The aim of the YAD Social Prescribing Service was to improve patient engagement, reduce DNAs and maximise the impact of each clinical appointment.

Together with service users, the team co-developed a series of interventions, including monthly peer support meetings, a WhatsApp group and a ‘walk and talk’ group, securing funding from NHSE for two and a half years. During this time, the team successfully:

Reduced the DNA rate across the Trust from 39 per cent to 12.5 per cent
Cut diabetes-related hospital admissions of CYP by 36 per cent across all Barts sites
Generated financial savings of an estimated £62,500 per year across the Trust

More outcomes from the prevention initiatives across Barts Health, including economic and demand savings, stronger integrated community networks and improved outcomes and patient experience, can be found on pages 26-30 of the toolkit.

Gaining leadership buy-in

As with many prevention-based interventions, the impact of social prescribing on health and care systems can take years to fully assess. In its paper on integrated neighbourhood teams (within which social prescribers typically sit), The National Association of Primary Care suggests that “savings will be non-cash releasing, but this is not as issue as what is required is capacity and health improvement.” However, this long-term approach does not easily align with NHS funding cycles, which typically require demonstrable return on investment within 12 months.

Currently, all of Barts Health’s social prescribing pathways are funded individually, on an ad hoc basis. The CVD project, for example, was initially funded by NHSE, but is now supported by Barts Charity. To move towards trust-wide funding, TPHC’s Secondary Care Project Manager, Mollie McCormick, emphasises the need to develop:

Robust databases and coding frameworks to accurately track interventions and outcomes over time
Qualitative data collection from patients benefiting from social prescribing, with an emphasis on reduced need for healthcare services and thus cost savings

Bridging the gap between identifying social needs that drive demand and demonstrating short-term cost savings remains a challenge. However, securing the backing and support of senior clinical leadership is critical in building the case for long-term investment.

For social prescribing initiatives to gain trust-wide funding in future, structural changes are needed to prioritise long-term prevention and strengthen outcomes-based commissioning. Different approaches could involve integrated care systems incentivising prevention by:

Setting realistic and appropriate prevention targets for NHS trusts to influence commissioning decisions towards the implementation of personalised care and prevention initiatives
Introducing penalties for avoidable readmissions

These targets could be assessed by monitoring readmission rates for specific condition cohorts or high-demand service areas, ensuring a measurable focus on prevention.

The toolkit: Embedding and Connection Prevention in Specialist Care

Barts Health and Transformation Partners in Health in Care have now published their toolkit, Embedding and Connecting Prevention in Specialist Pathways. Along with background information on the benefits of social prescribing and community-led prevention, the toolkit addresses some of the key systemic barriers that Barts Health encountered while implementing initiatives across various pathways and specialties.

Using case studies and the first-hand insights from patients, social prescribers and clinicians, the toolkit offers practical guidance for those looking to implement community-led prevention approaches, such as social prescribing, in secondary care. It also provides an overview of key Barts Health prevention networks and identifies the leaders driving this work across the Trust. The toolkit offers a valuable resource for anyone working in an acute setting wanting to embed social prescribing into their services or to prioritise the prevention of ill health in NHS Trusts across London and nationally.

Social prescribing: A key enabler of NHS prevention goals

Emerging evidence strongly supports social prescribing as a cost-effective intervention for tackling the wider determinants of health and addressing the often-overlapping health inequalities that contribute to high demand for NHS services.

Further, as the government seeks to move more care from hospitals to communities as part of its ‘three shifts’, initiatives like social prescribing will be increasingly vital. By reducing pressure on secondary care services and helping local systems meet their financial and operational goals, social prescribing plays a crucial role in shaping the future of preventative, person-centred and sustainable healthcare.

Special thanks to Dr Tara Mastracci, Endovascular Lead for Complex Aortic Surgery at Barts Health, and Mollie McCormick, Secondary Care Project Manager at Transformation Partners in Health and Care, for their time and input in developing this article.

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Innovative financing: Unlocking the potential of digital health and technology

By Stephen McMillan, Solutions Leader, Europe and UK & Ireland at Philips

With traditional medical equipment financing models becoming unsustainable, flexible financing options are increasingly helping healthcare providers improve their financial efficiency and supporting long-term digital health transformation.

The UK healthcare industry is undergoing a major digital transformation, with innovation already improving care in many areas from reducing waiting times and enabling earlier diagnoses, to delivering better access to care and outcomes for patients. Embracing new technology can help to unlock productivity, giving staff more time to focus on patient care, while also having a positive impact on the planet.

But for many healthcare providers, the high cost of traditional commercial models makes adopting cutting-edge technology a challenge. In fact, according to the Philips UK Future Health Index, a staggering 92 per cent of healthcare leaders say financial pressures are impacting their ability to deliver timely, high-quality care. Even more concerning, 77 per cent report that these financial strains have forced them to delay, scale back, or even cancel investments in medical equipment and technology – worsening existing bottlenecks and slowing down patient care.

Innovative financing approaches, such as pay-per-use (PPU) and “as-a-service” models, integrated into managed service agreements, give healthcare providers flexible, cost-effective access to technology, without large upfront investments. These models also de-risk investment and can help to enhance productivity, improve financial efficiency, and support long-term digital health sustainability.

Flexibility that adapts to demand

As demand for diagnostic and treatment procedures grows, healthcare providers face squeezed budgets and rising costs. IFRS16 (the International Financial Reporting Standard on Leases) now requires leasing costs to be counted as ‘capital’ on balance sheets, and CDEL (Capital Departmental Expenditure Limit) limits capital spend, even when cash is available. Traditional equipment financing, like leasing, is becoming less sustainable.

This is where flexible financing options such as PPU and “as-a-service” models are transforming how hospitals access and use technology. These models enable hospitals to only pay for what they use, reducing financial risk while ensuring access to the latest innovations. This flexibility helps them scale technology adoption based on patient demand and operational needs, keeping systems up to date and healthcare more adaptable.

Boosting productivity with managed services

Managing complex healthcare technology in-house can be time-consuming and resource intensive. The Future Health Index reports that 80 per cent of healthcare leaders have seen increased incidence of burnout, stress and mental health issues among their staff, with knock-on effects for patient care. A renewed focus on supporting staff is needed.

Managed services offer an alternative approach, where healthcare providers partner with experts to oversee equipment, IT infrastructure, and digital health solutions. This ensures technology runs at peak efficiency, reducing downtime and administrative burdens, freeing up staff to focus on patient care instead of maintenance. At the same time predictable cost structures improve financial planning. Ultimately, managed services can improve productivity, reliability, and performance in healthcare.

Smarter spending through outsourcing

Beyond operational benefits, outsourcing healthcare services can also provide significant tax advantages. Managed services can help hospitals identify and recover VAT from eligible equipment purchases, leading to greater tax efficiencies and improved cash flow.

This financial flexibility means hospitals can maximise use of their budgets, ensure compliance and redirect savings toward critical patient services.

Sustaining technology for the future

Sustainability is becoming a key priority for healthcare providers, and innovative financing can support long-term technology longevity. Lifecycle management solutions will extend the useful life of medical devices and IT systems through proactive upgrades, maintenance, and refurbishments.

This approach not only reduces electronic waste – such as outdated or discarded medical devices and IT equipment – and environmental impact, but also ensures that hospitals are always working with the latest, most efficient technology. By adopting sustainable financing and lifecycle strategies, healthcare organisations can reduce costs, improve operational resilience, and align with NHS net zero goals.

A new approach to healthcare technology

Innovative financing is reshaping how hospitals access and manage technology. Flexible models such as pay-per-use and “as a service”, combined with tax benefits and lifecycle management in managed services, help providers to stay ahead in the digital health revolution – without the financial strain of traditional procurement. At the same time, sustainable technology management ensures long-term value and cost-effectiveness.

By embracing these innovative financing strategies, organisations can boost efficiency, improve patient care, and achieve financial sustainability, ultimately unlocking the full potential of digital health and technology.

This article was kindly supported by Philips

New AI initiative to reduce demand on urgent and emergency care in North East London

By Integrated Care Journal

Thousands of patients across North East London are set to benefit from new initiative, using artificial intelligence (AI) and personalised clinical coaching, easing pressure on NHS services.

NHS North East London Integrated Care System, in collaboration with Health Navigator and UCLPartners, this week (Thursday 12 December) launched a new, three-year programme, providing preventative care for patients with long-term conditions. This comes as urgent and emergency care services in North East London are facing unprecedented pressure and all-time high demand.

Through advanced AI screening technology and targeted, phone-based clinical coaching, patients at high risk of needing unplanned emergency care will be identified and offered personalised support from healthcare professionals trained in delivering preventative care and self-management techniques.

The initiative is designed to identify and better support people with long-term conditions, like asthma, by taking a proactive and preventative approach to healthcare delivery.

Forecasting models estimate that the programme will save 26,673 unplanned bed days in North East London hospitals across the three years of the programme, with an anticipated reduction of 13,000 A&E attendances annually.

Dr Paul Gilluley, Chief Medical Officer at NHS North East London, said: “More than 15 million people in England live with one or more long-term conditions, accounting for 50 per cent of all GP appointments, 64 per cent of outpatient visits, and over 70 per cent of inpatient bed days. This new approach represents a landmark step in harnessing technology for preventative care to better support these patients before they reach crisis points.”

Supported by the largest randomised controlled trial to date on AI-assisted preventative care, the initiative has shown significant impact when piloted in Staffordshire. Notable results include a 46 per cent reduction in deaths among men over 75, a 34 per cent reduction in emergency attendances and 25 per cent reduction in bed days, and a 26 per cent reduction in GP referrals to secondary care, further supporting sustainable healthcare delivery.

Tim, who benefited from clinical coaching when it was piloted in Staffordshire, said of the programme: “If you are brave enough to take control with the help of the coach, you truly can make a difference to the immediate crises as they turn up. In my case I went from being an asthmatic, to someone who happens to have asthma. I went from six admissions to hospital to none within a couple of months.”

Waltham Forest will be the first area to receive this new initiative through Barts Health NHS Trust and Barking, Havering and Redbridge University Hospitals NHS Trust, with plans to expand across North East London in the coming weeks. The AI technology and clinical coaching will then be implemented throughout the rest of North East London in the coming months.

Shane DeGaris, Group Chief Executive at Barts Health NHS Trust, added: “As winter approaches, the pressure on A&E services is rising. By predicting demand and providing earlier interventions, we can improve patient outcomes and reduce the burden on the NHS.”

Dr Chris Laing, Chief Executive Officer of UCLPartners, said: “This project provides a template for how the NHS can use modern technology to deliver predictive, proactive and preventive care that is customised for local communities and prioritises those most in need of our help. Our collaboration with Health Navigator and NHS North East London will not only enhance the lives of at-risk patients but will also relieve critical pressure on our healthcare system too, aligning with the government’s prevention priority.”

Dr Simon Swift, Chief Executive of Health Navigator said: “Our AI-driven technology, combined with personalised clinical coaching, has consistently demonstrated its ability to improve patient lives and shift care, allowing hospitals to be more productive. This collaboration represents a major step forward in proactive, preventative healthcare. We’re confident that this program will enhance the quality of life for patients and contribute to a more efficient and sustainable healthcare system.”

NHS braced for “toughest winter” – NHS Providers report

By Integrated Care Journal

New state of the provider sector report finds trust leaders anticipating “toughest winter”, with low morale and high levels of burnout fuelling concerns.

More strikes, staff burnout and relentlessly rising demand for care amid a severe funding squeeze could put paid to further progress in cutting delays for patients, health leaders have warned, according to a new survey by NHS Providers.

The State of the provider sector survey, which provides a yearly snapshot of the hopes and fears of leaders of hospital, mental health, community and ambulance services across England, found that:

Eight in ten leaders (80 per cent) say this winter will be tougher than last year (66 per cent said last year was the most challenging they had ever seen).
95 per cent are concerned about the impact of winter pressures.
Most (78 per cent) are worried about having enough capacity to meet demand over the next 12 months – higher than before the pandemic in 2019 (61 per cent).
Most are concerned about the current level of burnout (84 per cent) and morale (83 per cent) in the workforce.
Almost nine in 10 (89 per cent) are worried that not enough national investment is being made in social care in their local area.
Fewer than one in three (30 per cent) think that the quality of health care they can provide in the next two years will be high.

The survey also found that without exception, trust leaders said more industrial action would harm their ability to hit targets for reducing backlogs and delays in planned and emergency care, with a knock-on effect for services right across the NHS.

Commenting on the release of this year’s State of the provider sector survey, Sir Julian Hartley, Chief Executive of NHS Providers, said: “These results paint a very concerning picture about the challenges the health and care sector faces. Patient care and safety are front and centre in everything that trusts do. But the stark reality is that NHS trusts are facing their toughest test yet.

“As we head into what’s expected to be another gruelling winter, the spectre of more strike action continues to loom large over the health service. Efforts to bear down on waiting lists – a government priority – have been hit hard by industrial action. With targets to tackle record waiting lists already being watered down, any further walkouts would compromise the NHS’ ability to deliver efforts to reduce care backlogs and lead to more delays in planned and emergency care.

Money worries continue to mount with more than three in four trust leaders (76 per cent) saying they are set to be in a worse financial position than last year. Funding pressures are fuelling concerns about future patient safety and the quality of care as well as threatening to hit trusts’ ability to ramp up services as they brace for winter.

Steps to date to curb costs have included shelving plans for more beds, having to put on hold recruitment to plug gaps in the workforce, and reducing investment in community and mental health facilities.

Healthcare leaders say that the toughest test yet for trusts is coming, as winter and budget pressures bite. More strikes would undermine efforts to cut waiting lists, and a sustained focus on the quality of patient care is essential, said respondents.

Despite the huge challenges, the survey showed an undiminished determination to keep improving patient care, giving them the right care in the right place. Trusts’ commitment to addressing race and health inequalities remains as strong as ever, the report finds, with 86 per cent of trusts surveyed prioritising race equality and tackling discrimination.

However, the survey also found that trust leaders are deeply concerned about the impact of winter pressures on their ability to meet demand and provide high-quality care. They are calling for urgent government action to address the funding squeeze and support the workforce, as well as to invest in social care.

Without this action, they warn that further progress in cutting delays for patients will be put at risk.

“Ultimately, it’s patients who will suffer”

Sir Julian Harley added: “The NHS can’t afford further strikes. Talks between the government and doctors’ union are promising and it’s absolutely vital that ministers pull every lever they can to break the deadlock.

“The major, systemic financial pressures providers continue to face are adding to trust leaders’ worries alongside widespread staff shortages with more than 125,000 vacancies in the NHS in England, and soaring demand for many NHS services.

“The direct costs of hiring temporary cover for striking staff and the indirect costs of rescheduled appointments and procedures are having major knock-on consequences for trusts, including weakening their ability to recover care backlogs for hospitals, community and mental health services.

“Trusts are having to tighten their belts to find unprecedented efficiency savings while inflation squeezes already strained budgets, leaving little in reserve to invest in the extra capacity they need to deal with winter demand. There is palpable frustration at the Treasury’s unwillingness to provide extra funding to tackle the fallout from nearly a year of industrial action.

“The consequences of forcing NHS England and the DHSC to raid their budgets to make up this funding shortfall will be felt far and wide, putting the core NHS budget under further strain and much needed projects, including digital transformation, on the back burner. Ultimately, it’s patients who pay the price.

“Despite these multiple challenges, credit must go to trust leaders and their staff who have reduced the longest waits for treatment and continue to work flat out to see patients as quickly as they can.

“Their determination to deliver timely, high-quality care for patients is unshakeable. Their desire to improve services and build on the achievements of the NHS is undimmed. They are doing great work, often in the most difficult circumstances, but it’s clear that they face their toughest test yet as winter and budgets bite.”

The full ‘State of the provider sector’ report can be accessed here.

Winter is coming: how Doccla’s virtual ward pathways support Urgent and Emergency Care

By Tara Donnelly

Tara Donnelly, Founder of Digital Care Limited, explains how Doccla is supporting NHS Urgent and Emergency Care through an innovative suite of virtual ward and remote patient monitoring technologies.

Emergency Departments (EDs) across the NHS in England have experienced another record-breaking year, both in terms of increased volumes of patients attending – more than 24 million emergency attendances – and decreases in performance against waiting time standards. Pressures on EDs are no longer seasonal but exist all year round, leading to adverse patient experiences. It is imperative that all those involved reimagine how Urgent and Emergency Care (UEC) services are delivered to support NHS colleagues who are bracing for a challenging winter ahead.

There is increased recognition that digital solutions could help to alleviate some of this burden. NHS England’s latest guidance to deliver the UEC Recovery Plan spotlights the expansion of virtual wards as a high impact intervention this winter. Doccla, a leading provider of virtual wards and remote patient monitoring, is working closely with its NHS partners to provide alternatives to admission and to relieve bed congestion by supporting early discharge. The team works with more than a third of integrated care boards, providing:

A customised suite of technology to help clinicians and carers monitor patients at home.
Clinical dashboards that enhance caseload management through holistic views of patient cohorts and visualisations of patient data trends over time.
Integration with electronic patient records to enable flow of coded data from the Doccla dashboard to the patient’s medical record during their stay on the virtual ward.
Access to multi-disciplinary clinicians with specialist training in remote monitoring.
An end-to-end logistics service that task-shifts administrative and non-clinical activity from busy clinicians.
Access to a patient support team, which uses a variety of accessibility tools to ensure patients from all demographics are aptly supported on virtual wards, from onboarding through to discharge.

Doccla’s technology has been pivotal in enhancing various admission avoidance pathways within UEC settings.

Remote monitoring available to community urgent response teams

Doccla’s technology is integrated within Hertfordshire Community NHS Trust’s (HCT) virtual ward service. Under the guidance of HCT’s Medical Director, Dr. Elizabeth Kendrick, the service has enabled the rapid assessment, diagnosis, early treatment and discharge of over 4,000 patients – recently winning a Parliamentary Award for its work.

Hertforshire Community Trust’s Hospital at Home service, using Doccla technology, has recently won a Parliamentary Award for its work.

Most recently, the technology has been deployed to HCT’s urgent care and response teams tackling ambulance wait times. Rather alarmingly, one in 10 ambulances spend more than an hour waiting outside hospitals. Joining forces with the East of England Ambulance Service, HCT equipped its community urgent response service with Doccla remote monitoring boxes so they could have an additional tool to support people to stay at home. Early evaluation of the pilot showed promising results, including:

Reduced ambulance conveyance rate to 33 per cent (from an anticipated 100per cent conveyance rate).
Reduced ambulance attendances by 18 per cent at East and North Herts NHS Trust.
Increased time available for crew to respond to acute emergency calls.
Reduced handover delays outside hospital.

Tackling surges in respiratory admissions this winter

Seasonal variations in respiratory admissions are a major contributor to pressures within emergency care settings over winter. There are 80 per cent more lung disease admissions in the winter months of December, January and February than there are in the warmer spring months of March, April and May.

Virtual wards provide an alternative mechanism for services to manage patient flow and to cope with the surge in respiratory admissions. The Doccla-supported ARI pathway at Northampton General Hospital (NGH) has demonstrated considerable efficiencies for the delivery of care. By supporting early discharge, NGH’s virtual ward service achieved:

11 per cent reduction in length of stay.
30 per cent reduction in bed days.

Likewise, tech-enabled remote monitoring enabled earlier detection of, and interventions for, deteriorating patients, resulting in a 15 per cent reduction in readmission.

While additional UEC funding has been injected into integrated care systems, allocation of monies is challenging when there are competing needs across care settings. It is paramount that the additional funding is maximised. NGH’s virtual ward service demonstrates a £13,000 per month saving (associated with the reduction in bed days) and more broadly, has enabled workforce capacity savings. Analysis in 2021 showed on non-tech enabled wards, there is 1 nurse per 8.3 patients on average. Doccla’s tech efficiency gains have expanded this to 1 nurse per 10 patients.

Augmenting SDEC services

Bristol, North Somerset and South Gloucestershire (BNSSG) is another example of how effective partnership between clinical and operational teams, in conjunction with Doccla’s innovative technology, can reduce admission rates. Between February and May this year alone, BNSSG’s NHS@Home service:

Provided an alternative to admission or supported earlier discharge 487 times.
Enabled local people to be cared for at home for an additional 4442 days
Supported cost savings of £1,479,186.
Avoided readmission for 87 per cent of patients.

In collaboration with Doccla’s remote monitoring technology, BNSSG NHS@Home teams are pioneering the use of remote monitoring for same day emergency care (SDEC) patients to avoid inpatient stays within North Bristol Trust – with the SDEC model contributing approximately 20 per cent of NBT’s weekly referrals to the NHS@Home service.

An example of a presenting condition being cared for in this way is the bacterial infection Cellulitis, which results in more than 100,000 hospital admissions per year in England alone. The new pathway has the patient set up for remote monitoring while in the hospital; they are given a Doccla box to take home and asked to send in their readings over the next few days, to indicate to the clinical teams whether or not the infection is under control. Given that 1.6 per cent of all NHS hospital admissions are due to Cellulitis, enabling speedy discharge or reduction of inpatient stays for patients with the condition has the potential to shift the dial on bed pressures this winter.

Conclusion

It feels important both for patients and the sustainability of the NHS that we do everything in our power to rapidly scale innovative solutions that are demonstrating impact in tackling pressures in Urgent and Emergency Care pressures.

As a trusted partner to health systems and providers, Doccla’s technology is being flexed in agile and impactful ways to support urgent care pathways this winter.

If this has sparked ideas that you are keen to action locally, please reach out to the Doccla team here. Doccla will be attending Public Policy Projects’ ICS Delivery Forum on 4th October to continue the conversation.

Tara Donnelly, Founder of Digital Care Limited

New drug combination twice as effective for some ovarian cancer patients as next best treatment

By Integrated Care Journal

Findings suggest new hope for patients suffering with disease that has a poor response rate to current treatments.

A targeted drug combination for patients with a type of ovarian cancer could be nearly twice as effective as the next best treatment, according to interim results from a Phase 2 study.

The international RAMP-201 study, has been led by researchers from The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, and sponsored by Verastem Oncology. The study has tested avutometinib alone and in combination with defactinib in 29 patients with low-grade serous ovarian cancer (LGSOC). Both drugs are designed to block signals that encourage cancer cells to grow.

Researchers hope these results, which are being presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting, will lead to a new option for patients with advanced LGSOC, a rare form of the disease that has a poor response rate to current treatments.

Approved treatment options available for patients with advanced LGSOC in the UK are currently limited to chemotherapy and hormone therapy, with response rates typically ranging from 0-14 per cent. Alongside standard treatment, LGSOC patients in England can access trametinib, a targeted treatment, via the Cancer Drug Fund, which has a response rate of 26 per cent.

Improvement on current treatments

According to the study’s interim results, nearly half (45 per cent) of patients treated with avutometinib in combination with defactinib saw their tumours shrink significantly, suggesting the new combination could be almost twice as effective as the next best treatment.

Responses to the drug combination were particularly promising in those with a mutation in a gene called KRAS, with six in 10 (60 per cent) patients experiencing significant tumour shrinkage. However, nearly a third (29 per cent) of patients without the mutation also had an encouraging response, which is also an improvement on standard treatment.

Patients previously treated with other types of targeted therapies, including MEK inhibitors, also saw their tumours shrink following treatment with the drug combination.

Avutometinib is a dual RAF and MEK inhibitor, a type of targeted drug that blocks certain proteins that help control cancer growth and survival. Studies have shown the drug can become ineffective over time as tumours develop resistance to treatment.

However, when combined with defactinib – which is designed to combat a protein that encourages drug resistance – researchers believe avutometinib works more efficiently. This is confirmed by these results, which demonstrate that the drug combination is over four times more effective than avutometinib alone.

RAMP-201 follows the phase 1 FRAME trial, which tested avutometinib (then known as VS-6766) and defactinib on a slightly smaller cohort of patients with advanced LGSOC and was led by researchers from the Oak Foundation Drug Development Unit at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London. While survival data is not yet available from RAMP-201, results from FRAME indicate that this patient group lives an average of 23 months following treatment with this drug combination before their cancer progresses.

LGSOC accounts for about one in 10 cases of ovarian cancer, with around 700 women in the UK and 80,000 worldwide diagnosed each year. Compared with other forms of the disease, LGSOC tends to affect younger women.

Global lead investigator of the study, Dr Susana Banerjee, Consultant Medical Oncologist and Research Lead for The Royal Marsden NHS Foundation Trust Gynaecology Unit and Team Leader in Women’s Cancers at The Institute of Cancer Research, London, said: “These initial results could be fantastic news for women with low grade serous ovarian cancer, indicating a far more effective option than current treatments may be on the horizon.

“It’s wonderful to see so many patients experience a meaningful response to this innovative drug combination and I’m so grateful to all who joined the trial, making this research possible. Low grade serous ovarian cancer does not respond well to currently approved treatments, so these results could represent a significant breakthrough in treating the disease.

“We are hopeful this drug combination will one day become a standard of care for women with low grade serous ovarian cancer.”

Trusts driving progress on patient flow through collaboration and innovation

By Integrated Care Journal

New report from NHS Providers features practical approaches taken by trusts and partners to improve patient flow and quality of care.

NHS trusts are driving significant improvements to patient flow through in the face of significant system pressures, a new report by NHS Providers has found. Providers Deliver: Patient flow presents a series of case studies where trusts across the acute, community, mental health and ambulance sectors have developed effective approaches to improve patient flow in the face of unparalleled system pressures, including unprecedented workforce shortages, rises in poor health and in complex conditions, and a lack of funding.

These types of approaches will be central to plans to recover core performance standards across the whole health and care system. The report sets out the wider context behind obstacles to patient flow that cause delays, and argues that work to address them requires a joined-up approach based on close partnerships between different types of providers.

Key themes that have emerged from the case studies include:

Admission avoidance – delivering more out of hospital procedures and walk-in (ambulatory) care to reduce unnecessary admissions, freeing up hospital capacity for those who need it.
Care at home – virtual wards, remote monitoring of patients and developing the mental health and community care workforce.
Working to improve health as well as treating illness.
Collaborative working with other providers.
Leadership that protects and promotes the autonomy of clinical staff.

The report includes a contribution from NHS England’s national director of urgent and emergency care and deputy chief operating officer, Sarah-Jane Marsh, who wrote: “It will take strong partnerships between acute, community and mental health providers, primary care, social care and the voluntary sector, to ensure a system that provides more, and better, care in people’s homes; gets ambulances to people more quickly when they need them, sees people faster when they go to hospital and helps people safely leave hospital having received the care they need.”

In a foreword for the report, the Chief Executive of NHS Providers, Sir Julian Hartley, said: “All too often attention is drawn exclusively to headline waiting times in urgent and emergency care, but we know the drivers of long waits and delays are extremely complex with no one, single solution.

“The case studies in this report show how trusts are working collaboratively to prevent avoidable admissions, manage demand more effectively, build additional capacity sustainably, use technology to deliver more care outside of a hospital setting and deliver real improvements in the health of the populations they serve.

“In the most challenging of circumstances trusts have shown great resilience and innovation. As the NHS works towards sustainable recovery from the pandemic and to reduce waiting times for core services, it is clear a preventative, whole-system approach will be key and that trusts are well positioned to deliver.”

Elective backlog and care priorities: a call for localised solutions

By George Batchelor and Lucia De Santis

Edge Health’s George Batchelor and Lucia De Santis explain the need to develop localised solutions to drive the NHS’s elective care recovery.

March 2020 marked an unprecedented change in the NHS and healthcare provision. As resources were diverted to the pandemic response, virtually all elective activity ceased, and the healthcare system transformed into a huge acute response machinery. We knew this would not be a sacrifice without consequences, but it was worthy of the stakes at play – millions of lives affected by COVID-19.

Fast-forward three years: the pandemic is now over for many people, but its impact on the NHS remains. This impact goes beyond the ever-growing elective backlog to include a fundamental shift in how care is provided, as well as a host of top-down targets that place increasing challenges on care providers.

The state of the elective recovery

Many will be familiar with the dire state of waiting lists for consultant-led elective care that topped 7.2m in October 2022 – a 64 per cent increase from March 2020 and with a median waiting time of 102 days.

Amid efforts to tackle the backlog, the recovery strategy has pushed for “doing more” with an ever-increasing range of performance measures to drive increased throughput and avoid adverse incentives, including: achieving zero 65-week waits by March 2024, increasing completed pathways by 110 per cent, increasing valued activity by 104 per cent, performing all diagnostic tests within 6 weeks, and several more.

Competing targets can be confusing to navigate and add pressures to already stretched systems, but they also fail to account for novel care challenges and regional variation. Working closely with trusts and ICBs, Edge Health has encountered, again and again, a stark increase in patient complexity since the pandemic and the consequences of a depleted, exhausted workforce that don’t show up in figures and targets.

To add to this, Covid has also prompted a greater focus on prioritisation and clinical urgency in allocating care, as opposed to a first come, first served system, which poses added challenges in correctly allocating services when some patients have been on a waiting list for more than two years.

How targets fuel a new hierarchy of care: emergencies, long-waiters, then everyone else

Despite the impressive efforts and successes of restoring elective activity after the pandemic, as well as the rise of innovative ways to provide care and promote collaboration among providers, we are still far from having room to breathe. In this context of significant mismatch between demand and capacity, the limitations of national targets that would encourage efficient management in a balanced system are laid bare.

A pertinent example of this is elective waiting lists, which have been the object of various targets to reduce long waits. The good intentions behind these targets are undeniable; no one should be made to wait for care for more than a year. In a system where demand is matched with capacity, such long waits should never be an issue. In principle, a sudden surge in capacity directed at these long waiters might be enough – at least for some trusts – to clear them. However, this is problematic for two key reasons: it fails to account for clinical urgency and the resources that must be reserved for the sickest patients, and it directs disproportionate energy to 2 per cent of the waiting list.

Previous experience shows that initiatives to address targets are incredibly energy-consuming for trusts. They may also fail to gain buy-in when they don’t match local clinical priorities. What we have seen at large trusts is that the backlog of elective diagnostics does not stand a chance in front of the volume of emergency and two-week-wait cancer referrals. As patients approach waiting targets, however, they are pushed to the front of the queue to avoid missing them. This is not solving the backlog issue – it merely adds another pressure point.

Perhaps more throughput-focused national targets, such as setting a maximum number of waiting-list per head of population, would be more effective while allowing trusts to decide how to manage their own waiting lists.

ICBs create an opportunity to focus on local priorities

If there is one thing that the pandemic has demonstrated about the NHS, it is that when empowered, trusts and local systems are pioneers of innovation and can rise to unprecedented challenges. From the London Ambulance Service, which partnered with the London Fire Brigade to deal with rising ambulance demand, to the Royal Surrey NHS Foundation Trust that partnered with a local private hospital to provide excellent palliative care despite the pandemic (NHS Providers, 2020), the pandemic bore witness to numerous examples of unparalleled collaboration and innovation.

There is an inevitability about some targets in that they reflect national priorities and are a way of tracking progress and holding systems to account. There is some evidence to suggest they motivate change and can be a catalyst for improvement. But the flipside is that blanket targets don’t take into account local need and they penalise providers that are otherwise making huge progress on elective recovery. They’re also not particularly good at motivating staff in a positive way—health and care professionals understand that targets are organisationally important, but they’re not always aligned with what professionals and patients think is important. If ICBs are to be held accountable for delivering on targets, it only seems fair that they should have a say in what the targets might be and it can be expected that priorities might change from one locality to another.

This should not be seen as a limitation, but as an opportunity. We think ICBs are the key for a more nuanced approach to designing and setting priorities that might catch two (or more!) birds with one stone: managing the elective backlog and addressing local need with highly relevant targets.

ICBs could set their own targets, that are in line with national priorities but refined to fit local circumstances. Local systems could engage their workforce and patient voices in agreeing what these look like. This approach still creates accountability and sets a direction for change (the point of targets) but also gets buy-in from the teams charged with meeting the targets—targets that reflect their priorities and what they see in their own practice.

It doesn’t have to mean a free-for-all or ducking difficult problems. National bodies can still ensure local systems are ambitious, hold them to account, and provide support and guidance to deliver change. Programmes such as GIRFT do this very successfully. Instead, what we propose would allow local systems to have more freedom to invest in novel care strategies to tackle their unique challenges. Importantly, it could be a mechanism to engage with, value and retain the workforce.

Of course, the counter is that differences will emerge across localities. But the truth is that this is the current reality, demonstrated by the charts above. And those differences would likely start to narrow if – and this is critical – ICBs are given time to flourish, work to meet local priorities and learn from one another.

About the authors

George Bachelor is Co-Founder and Director of Edge Health s

Lucia De Santis is a qualified medical doctor and Analyst at Edge Health, providing

For more information about Edge Health, please visit www.edgehealth.co.uk.

The NHS must break the cycle on heart failure

By David Duffy

Integrated Care Journal recently spoke to Dr Ashton Harper, Head of Medical Affairs (UK & Ireland) at Roche Diagnostics, to examine the heart failure diagnostic pathway and identify where the biggest opportunities in NHS diagnostics exist.

In the midst of its most challenging period of pressure, diagnostics have a significant role to play in helping to alleviate patient backlogs and free up vital resources across the sector – and nowhere is this more critical than with heart failure.

The health challenge that heart failure, a serious and chronic disease that prevents the heart from pumping blood through the body, poses to the NHS is both immense and relentless. An estimated one million people live with heart failure in the UK, with approximately 200,000 developing the condition every year, creating a profound and multifaceted set of health challenges for the NHS.

Writing in a recently published report by PPP for Roche Diagnostics UK & Ireland, Professor Sir Mike Richards described diagnostics as a “Cinderella” service within the NHS. Yet the UK’s capacity to diagnose heart failure has been consistently hampered by broader capacity challenges in NHS diagnostic service provision, as well as the lack of uptake of, and access to, innovation. A combination of workforce shortages and outdated facilities have historically contributed to late diagnosis and poorer health outcomes. This realisation directly informed Professor Richard’s 2019 report, which led to the introduction of community diagnostic centres (CDCs).

A ‘silent epidemic’

Heart failure is notoriously difficult to diagnose, in part because its key symptoms – breathlessness, exhaustion and ankle swelling – can be caused by a number of other conditions. As a result, late diagnosis of heart failure is unfortunately common, often only occurring once a patient has presented in secondary care following the onset of severe symptoms.

“If heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better”

“Current estimates are that 80 per cent of patients are diagnosed [with heart failure] after a hospital admission,” explains Dr Harper, “and a significant proportion of those will be emergency cases, and so these patients are at the late stage, requiring more intense and complex treatment.” This matters because heart failure patients who require hospitalisation account for “somewhere in the region of a million inpatient days every year, which is about 2 per cent of total NHS annual bed days”. It is also estimated that between 2-4 per cent of the total annual NHS budget is spent managing patients with heart failure (up to £6 billion in 2022/23) and according to Dr Harper, “the majority of this burden is due to hospitalisation – and hospital admissions for heart failure have increased by 50 per cent in the last decade alone”.

“Somewhere in the region of 70 per cent of the total annual cost [of managing heart failure] is actually utilised by the management of stage four patients alone,” says Dr Harper, “but if heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better; they have a better quality of life; and significantly reduced requirements of both primary and secondary care services ongoing.”

Diagnostic reform

“The NHS must look to adopt innovative diagnostic tools at a faster rate”

As was made clear in Professor Richards’ report, the NHS must conduct a wholesale rethink of diagnostic service provision. “Early diagnosis is key to effective management and better outcomes for these patients”, explains Dr Harper, “but while the use of medicines which are deemed to be beneficial and cost effective is mandated in the UK, diagnostics aren’t. It can often take 10 or more years for a diagnostic test to be widely adopted across the NHS.” As such, the NHS must look to adopt innovative diagnostic tools at a faster rate.

NT-proBNP tests are fast, cost-effective, non-invasive and recommended by NICE for the diagnosis of heart failure. Recently updated NICE Quality Standards, recommend that this test be conducted on all patients presenting to primary care with a possible heart failure diagnosis, but this guidance is not universally followed with recent data showing that only 18.3 per cent of heart failure patients had an NT-proBNP test recorded.

“Following the NICE guidance for NT-proBNP testing can reduce unnecessary referrals and allow GPs to better identify patients that do need more urgent referrals for echocardiograms”, Dr Harper notes, which is important because “we’ve got massive echocardiogram backlogs, with patients waiting months”, many of whom may not need one at all. The ability to preclude a heart failure diagnosis early would reduce the echocardiogram bottleneck, meaning those who really need one can access one sooner. “I think mandated funding for NT-proBNP would go a long way,” says Dr Harper. “This approach could help to potentially flip the site of primary diagnosis from 80 per cent in hospital to 80 per cent in the community, and therefore reduce pressure on the NHS.”

Reprioritising and reframing the issue of heart failure

Dr Harper believes that “there’s a strong case for heart failure to be prioritised by NHS England in the upcoming NHS Long Term plan refresh with clearly defined targets, such as exist for stroke and cardiac arrest.” Accordingly, “there needs to be increased collaboration between the NHS, industry and patient organisations to tackle inequalities in the diagnosis and management of patients.”

Much of this comes down to a need to educate and raise awareness of heart failure and its symptoms. “It has been described as a ‘silent epidemic’ because it hasn’t received as much attention as other pressing healthcare issues,” Dr Harper remarks. This lack of awareness has produced some alarming disparities, particularly around gender and misdiagnosis.

“Clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list”

“There is an historical presumption that heart failure is a more male-dominated disease rather than female,” he explains, “when actually it’s about a 50/50 split.” Despite this, women are more likely to be misdiagnosed than men or to wait for much longer than men for their diagnosis. Dr Harper continued, “clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list.”

Echoing recommendation three of Breaking the cycle, Dr Harper also encourages widespread adoption of the Pumping Marvellous Foundation’s BEAT symptom tracker. If shared with the wider public, this checklist – Breathlessness, Exhaustion, Ankle Swelling, Time for a simple blood test – could increase heart failure symptom awareness and ensure that more cases are identified sooner and treated more effectively.

Conclusion

“Ensuring primary and secondary care professionals share a common goal is key”

A coherent and system-wide approach will be needed if capacity is to be increased across all diagnostic modalities, but especially in heart failure. “Ensuring primary and secondary care professionals share a common goal is key,” Dr Harper says, “[and] the introduction of integrated care systems is a great opportunity to foster this collaboration.”

“By increasing diagnostic capacity in the community, we might be able to reduce the pressure on hospital admissions and NHS bed days,” and the use of NT-proBNP tests to confirm or rule out suspected cases of heart failure will be crucial. Taking the present opportunity to radically overhaul the heart failure diagnosis pathway will help to decrease the societal burden of the disease, create extra capacity for the NHS and, most importantly, help heart failure patients lead longer, healthier lives.

Breaking the cycle: Tackling late heart failure diagnosis in the UK, finds that late diagnosis of heart failure is a significant hindrance to the effective management of heart failure. It makes a series of recommendations to NHS England, Health Education England, and integrated care systems, as well as patient groups and industry to come together to improve heart failure diagnosis across the entire healthcare system.

Finding the right support to provide the NHS with the capacity needed

By David Duffy

Dr Jean Challiner, Medical Director for Medinet, outlines how the NHS must harness spare capacity from all corners of the health and care sector to meet this period of unprecedented service demand.

As has been made abundantly clear by the Prime Minister earlier this month, the NHS is suffering from a severe capacity crisis. In addition to emergency departments tackling the toughest winter on record, 7.21 million people are currently on an elective care waiting list and staff shortages are crippling service delivery.

The Prime Minister himself acknowledged that these trends existed prior to Covid-19 but the pandemic has escalated the problem beyond what the NHS is able to tackle without added support. “With so many people waiting longer and longer for elective care, patients’ conditions are worsening and becoming urgent for some,” reflects Dr Jean Challiner, Medical Director for independent healthcare provider, Medinet.

Dr Challiner stresses that for Medinet, who have a two decade history of providing dedicated ‘insourcing’ for NHS trusts to boost capacity, the time patients are spending waiting for treatment is having a drastic impact on their work. “We used to almost exclusively offer capacity in the NHS for low complexity day cases, but now the priorities within the NHS are very different, and there is a growing need for us to address more urgent and more complex cases.”

Medinet holds the country’s largest pool of expert clinicians across 20 different specialties, and supplies teams to provide additional clinical capacity to enable hospitals to meet waiting times targets and then work with them to ensure these are not breached. In the last 12 months, 170,000 patients have been seen and treated by Medinet’s clinical teams.

The fact that Medinet teams work in close conjunction with NHS clinical teams and within existing estates means that they can adapt their service offering to include more complex surgery when needed. This includes cancer surgery and other procedures that fall under the realm of specialised commissioning. Medinet’s large pool of consultants, often made up of part-time NHS doctors or recent retirees, can perform most procedures, although they rarely tackle acute emergency procedures.

Reforming the referral process

Beyond directly boosting capacity with additional staff, Medinet have looked to enhance NHS efficiency and bring down backlog figures by reducing time to referral for patients. With cataract surgery, (accounting for one of the largest elements of the elective waiting list with 600,000 patients waiting for a procedure) patients are now having to wait up to two years to have their cataracts assessed.

“We are seeing some trusts getting twice as many referrals in certain areas as before and you can’t instantly train the necessary staff to meet this demand in the short term,” says Dr Challiner. “Part of our process is to not only bring in additional direct expert capacity where required but also help enhance overall efficiency or perhaps deploy existing resource differently.”

Based on a study conducted with a customer in Scotland, Medinet consultants have recently put forward recommendations to bring down cataract wait times across England, particularly for low risk patients. The study set out to determine the suitability of community cataract referrals for a one-stop cataract surgery service and the target areas for referral refinement. The results of the study showed that waiting time was significantly reduced – an average of 30 weeks for one-stop patients. Approximately one quarter of referrals were considered suitable for the one-stop service and many more may have been suitable if there had been more information in their referrals.

Capitalising on system reform

While Medinet services are still primarily commissioned by individual NHS trusts, the development of integrated care and closer collaboration between individual providers could potentially create opportunities for Medinet to expand its service offering elsewhere. “There is a huge opportunity within ICSs to change the model of harnessing spare capacity and applying [it] to other parts of the system. ICSs must provide the framework for providers to break out of regional, professional and organisational silos and boundaries to alleviate the capacity crisis currently being faced by the NHS.

“As providers evolve their service offerings to meet new challenges, they must be able to highlight where new capacity where is required without fear of reprimand.”

Encouraging active dialogue

Under no illusions, Dr Challiner acknowledges that the Medinet model is not a magic bullet to NHS capacity pressures as there are fundamental obstacles that can restrict impact. “Operating within existing NHS estate allows us to work much closer with NHS teams,” she says, “but we face regular challenges with bed availability, as we cannot conduct day case surgery unless there are beds available for recovery if needed. We also often have difficulty in simply finding the space within a trust for Medinet to operate in work or having a trust staff lead on hand to provide trouble shooting assistance or can locate replacement equipment if required.

“We encourage trusts to highlight new ways in which we can boost capacity. We are seeing an NHS that is working tremendously hard, and we want to help them. Nothing is off bounds for us, to help tackle what is most important, so we need the NHS to talk to us, and engage in discussions to look for possible solutions that are risk assessed and will work.”

Medinet’s position as a capacity booster has placed it in a unique position to reflect on the various challenges that lie within the NHS backlog. Last year, the organisation released its Manifesto for Better, outlining how they plan on supporting hospitals across the country to support commitments to improve access to treatment, empower patient choice, and provide the capacity required in response to the growing backlog of elective services.