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.

Non-emergency transport is crucial for winter resilience

By Andrew Pooley and Simon Smith

Seasonal pressures and existing backlogs look set to increase demand for non-emergency transport this winter. Writing for ICJ, ERS Medical’s Chief Executive Andrew Pooley, and Quality and Governance Director Simon Smith, outline why they are pushing hard for winter transport resilience.

The NHS was already experiencing significant pressures, even before this winter’s challenges. Although a smaller component of the NHS, non-emergency transport services (NEPTS), which provide transportation for patients with non-urgent conditions but who would struggle to travel independently, play a pivotal role in maintaining smooth patient flow.

Last year, ERS Medical launched a campaign to raise awareness of non-emergency transport. The aim of this, in part, is to emphasise the importance of non-emergency transport and more importantly, to encourage the earlier booking of contingency winter patient transport shifts to support hospitals with patient discharge and alleviate some of the anticipated winter challenges.

Easing system pressure

Delays to patient discharge cause significant patient flow issues, and these are well documented. News headlines often focus on bottlenecks and delays via front door admissions, such as A&E, and the significant pressures being faced by emergency departments.

However, if beds are not available in hospital wards where patients can be treated after assessment in A&E, there is less capacity for newer patients to be admitted. The traffic jam at the exit route now becomes a problem at the entry points for patients, as well as preventing ambulances from returning to the community, increasing already dangerously long ambulance response times.

One of the main reasons for the patient flow crisis is the availability of social care. There is a direct correlation between the absence of an ongoing care package and higher rates of readmission. Further, discharging patients too early without any ongoing care and proper safeguards in place will often mean the patient is readmitted sooner or later. Poor discharge protocols can also lead to an increase in complaints and reputational damage for hospitals. It is no surprise then that discharge coordinators and healthcare staff have such a tough balancing act to manage, in addition to their workload challenges.

The role of transport

Transport can play a huge role in addressing the discharge backlog, and booking transport early is vital. This may sound simple enough, but transport is an often-overlooked aspect of the discharge process. When patients are ‘made ready’ for discharge, this is often the first point at which transport is considered. However, booking transport in advance, preferably the day or so before the patient will be ready to leave, is usually more efficient. While it is difficult to be a hundred per cent certain that a patient will be ready for discharge on a particular day, clinicians often have a good indication of when discharge might be feasible and appropriate.

To this end, planning and communication are essential. Planning the transport in advance, booking it and then communicating with the provider if the plans change for any reason are crucial elements in the efficient discharge of patients. This ensures there are enough resources available in the system for trusts and integrated care systems to keep the patient flow running smoothly.

One solution that is showing promise is to appoint specialist patient transport liaison officers (PTLOs) in hospitals. This “human” point of contact is a specially trained individual who can assess transport needs and then recommend the best approach on a case-by-case basis, often communicating with patients, hospital staff and families to keep everyone informed.

Lessons from previous spikes in demand

Contrary to conventional wisdom, one of the key insights from looking at our data (as illustrated below) is that spikes in winter demand often arise, not because of increased activity levels, but because of changes in booking behaviour, patient mobility, an increase in aborted journeys, and the subsequent need for more resources to accommodate these changes.

Let’s take a hypothetical fleet of 10 vehicles servicing a local acute hospital. With the “normal” commissioned pre-planned booking behaviour and mobility mix, the activity matches resource and there are no service issues. Add in just one complex journey – for example, an obese patient that requires an additional crew to assess the property and support the journey – very quickly, that can reduce 10 per cent of available resource for more than half a day.

Add in multiple issues – for example, bookings made at the last minute, or with incorrect mobility requirements, or patients’ drugs not being ready at the pickup time – and it is possible to see how demand outstrips built-in spare capacity and pressures build in the system. Integrated care boards (ICBs) should act with caution when being presented with supposedly easy fixes. The Uber model does not work with a regulated service that relies on trained staff and specialist equipment, and simply drawing on resources from outside the contract often fails because other services will also be under pressure, as they rarely hold spare capacity. The simple answer is to plan well in advance – it takes time to mobilise a fully compliant NEPTS ambulance crew, communicate with all stakeholders and educate healthcare staff about the correct use and limitations of the NEPTS service.

Providers should also re-examine the point at which mobility assessments are carried out. When hospitals carry out patient mobility assessments, this is often done at a fixed, predetermined point. If a patient is independently mobile, but has been sitting and waiting for a doctor’s assessment, the patient’s mobility levels could deteriorate. When crews arrive to pick up a patient that has been booked on a seated vehicle to accommodate four patients, the crews undertake what is called a dynamic mobility assessment of the patient. They then establish whether or not the patient can walk independently, and whether they might now require a wheelchair or stretcher. This means that the vehicle originally booked to transport the patient is no longer suitable, and more, or different, resources are required.

The reality is often different to the perceived activity levels within NEPTS, where the ideal scenario is multiple patients in the same mobility category travelling in one vehicle. If transport is planned at the last minute for patients with the lowest mobility (patients who need stretchers), this blocks out a significant number of vehicles in one go, thereby increasing delays and placing a greater strain on existing resources.

Of course, effectively balancing these factors comes down to proper planning, communication and funding contracts on actual resources needed, not just activity levels. This does not mean simply communicating with transport providers, but also between hospital departments.

Acute Care, Digital Implementation, Thought Leadership October 25, 2022

How the ICS can unify data and relieve elective care

By David Duffy

In taking decisive action to bring down elective care backlogs, Mid and South Essex Integrated Care System has demonstrated the value of industry collaboration – made possible by the new ICS construct.

With over seven million people on elective care waiting lists, unifying data strategies and enhancing visibility across health providers has never been more important. UK health and care transformation has long been hampered by historically fragmented approaches to data infrastructure and these complex vulnerabilities were laid bare nationally throughout the Covid-19 pandemic and the resulting aftermath.

With such vast numbers of people stranded on backlogs, providers need data infrastructure to illuminate patient waiting lists, to provide absolute clarity as to who is waiting for what and to ensure that those who are in most urgent need are prioritised.

“There are opportunities for a partnership-based approach to care reform, allowing innovators to innovate as part of a cross-sector team”

In many respects, the development of integrated care systems (ICSs) has been fortunately timed to deal with such an issue. Central to the population health mission of ICSs is integrating data strategies and overcoming the obstacles posed by legacy data systems. There is also an opportunity for a revitalised provider-supplier relationship – with the ICS onus on collaboration over competition, there are opportunities for a partnership-based approach to care reform, allowing innovators to innovate as part of a cross-sector team.

This is in part the mindset that has defined the approach from Mid and South Essex Integrated Care System (MSE) to deal with its own elective care backlogs. MSE is responsible for the care of 1.2 million people, across Basildon and Brentwood, Mid Essex, South East Essex and Thurrock. According to the latest referral to treatment data from NHS England, there were 153,000 people across MSE waiting for non-urgent surgery in August 2022. Like in many other systems, MSE’s backlog covers multiple disciplines and as such requires a multifaceted solution to aid with prioritising those in most urgent need while pushing for further optimisation wherever possible.

To meet this challenge, system leaders across MSE have harnessed the new ICS framework to lead a data led transformation. In May 2022, system leaders kickstarted a partnership with leading NHS data solution specialists, Insource Ltd, to combine data from three acute sites to optimise waiting list management across the MSE system.

Articulating the problem

The core objective of the project is one of visibility. Historically siloed approaches to health data infrastructure have left a fragmented data landscape across the NHS, and this is no different for MSE. Competing legacy Patient Administration Systems (PAS), used under the former CCG constructs, had made it more difficult for providers to develop holistic plans to deal with issues such as elective backlogs.

“You can’t address the backlog if you do not fundamentally understand the nature of the problem”

PAS systems support the automation of patient management across hospitals, allowing them to track patients and manage admissions, ward attendances and appointments and as such are crucial for managing waiting lists. “Tracking and managing patients along complex elective pathways is technically difficult even with one PAS. Today’s NHS needs to manage patients safely across several hospitals in one ICS, making that challenge even bigger,” says Dr Rob Findlay, Director of Strategic Solutions at Insource. MSE has three different PAS systems in use across its acute sites, as well as three different theatre systems.

Insource have begun implementing its data management platform to unify and enhance data visibility across these three hospitals, creating a unified data foundation for system wide recovery, and has now created a unified Patient Tracking List (PTL) across the MSE system. In layman’s terms, the PTL provides a single view for all clinicians and operational managers across the ICS, detailing exactly who is waiting for acute care, for how long, for which specialty and what their clinical priority is – allowing for those with the most urgent needs and those waiting longest to be treated first.

“You can’t address the backlog if you do not fundamentally understand the nature of the problem,” says Barry Frostick, Chief Digital and Information Officer for MSE, who has spearheaded the project alongside Dr Rob Findlay. Reflecting on MSE’s enhanced backlog visibility Rob says, “when the NHS approaches us with a problem, our goal is to help the system clearly think through the challenges and accurately articulate the nature of the challenges they are facing, this way, the potential solutions that could be applied start to become obvious.”

A strategic partnership approach

The size and scope of MSE’s backlog necessitates a truly collaborative approach that develops holistic solutions to reflect the needs of all stakeholders and voices. “The project so far has benefitted from a clear alignment between the provider and supplier. This relationship is far more of a partnership than your typical supplier-provider relationship,” says Barry.

“There is a rich level of intellectual engagement and respect for these challenges across MSE”

From an Insource perspective, this type of relationship allows for a much richer dialogue between provider and supplier – necessary to deal with complex data issues. As Rob explains, “from talking to consultants, medical staff, and managers, it is clear that there is a rich level of intellectual engagement and respect for these challenges across MSE – this engagement has been a hugely enjoyable and rewarding part of this project and has been central to its success so far.”

While Insource have decades of experience in unifying operational data, a system wide, automated PTL is new to the NHS and the fact that MSE have managed to implement such a solution after only being in official existence for a few months is a remarkable achievement. However, despite the initial success, neither Barry nor Rob are getting ahead of themselves – both insist that this is not “miracle working”, but rather harnessing the new ICS structure and laying strong groundwork though effective leadership to create a fruitful partnership.

How has the ICS enabled this change?

‘Partnership’ has become an oft-repeated term in the context of integrated care, so much so that it can at times become an abstract concept. But the relationship between MSE and Insource has already borne tangible, significant fruit in the form of a PTL that now acts as a “single source of truth” on waiting lists across the system. Progress has been down in part to the renewed ICS focus on collaboration over competition (the latter defined much of the approach taken by former CCGs toward industry partners).

“There’s a higher level of involvement and a much higher level of accountability than the commissioner function used to have”

The partnership ethos visible here is in part down to the new ICS structures. Previous provider/supplier relationships under the CCG structure were simply based on providing a service, “whereas today,” says Barry, “the ICS has allowed us to stand shoulder-to-shoulder with our industry partners.”

For this project, the new ICS structure for MSE has allowed system leaders to take a step back from the day-to-day operational grind of service delivery. “The ICS acts as a critical friend to NHS services on the ground, making more impartial decisions, taking a step back and seeing the impact that a potential solution would have across the system” explains Barry.

Rob argues that the ICS is much closer to the frontline than the old commissioners were within CCGs, giving them “more skin in the game”. He says, “there’s a higher level of involvement and a much higher level of accountability than the commissioner function used to have. This allows us to harness the huge potential that the ICB has to intelligently bring together the different sectors, including the mental health, social, community and primary care sectors, as well as the acute sector, which tends to get the attention and is the initial focus”

Ultimately, the initial success of this project will be judged upon how MSE’s elective care backlog figures change over the coming months and years. However, with the new sense of visibility offered by the PTL – few could argue that its impact will be anything but positive. In fact, those closely involved in the project are already looking ahead. There is serious expectation that this new bank of centralised data, accessible system wide, will enable revolutionary improvements across the MSE system.

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Virtual wards are failing patients and clinicians: we must bridge the gaps before winter

By Elliott Engers; Tom Whicher; Elina Naydenova

With virtual wards vital to the NHS’s ability to function this winter, three experts assess what is needed to bridge the gaps in provision ahead of increased demand.

In early August, NHS England unveiled its new plan to increase the NHS’s capacity and resilience ahead of winter’s inevitable pressures. An increased use of virtual wards featured prominently in this plan, in line with their national target of 25,000 virtual beds to be operational by 2023.

With hospitals overwhelmed like never before, it’s not hard to understand why transferring patient care into the home – in a safe and controlled way – is an extremely beneficial proposition. But existing solutions are missing the mark. Despite much innovation, delays in adoption mean that the full transformative potential of the tech-enabled hospital at home has not yet been realised. We are now at a tipping point: on the heels of a global pandemic and one of the busiest summers yet, a tough winter is looming. It is time to get virtual wards right; for patients, for healthcare professionals and for the NHS.

Existing solutions don’t go far enough

‘Virtual wards’ are not new and versions of the concept – including ‘Hospital at Home’ – are already being used to support unwell and deteriorating patients to stay at home, as well as to discharge patients from hospital sooner.

What is generally considered to be a virtual ward often extends to little more than remote monitoring at home. While this does free up hospital beds, the impact on both clinical time saving and patient outcomes falls well short of potential.

This is because, overwhelmingly, staff must use old, inappropriate tools to manage remote patients – tools that weren’t built for this new paradigm. Many approaches are manual, slow, admin-intensive, and not advanced enough to scale.

New ways of working need new solutions

Remote care requires an entirely different way of working, and needs new technologies to manage it and make it scalable. Right now, communication and the flow of critical information is blocked. Electronic task lists and care coordination features are not flexible enough to fulfil the unique needs of virtual wards, where patients are not co-located with healthcare staff. Integration is near non-existent, and workflows are not built for mobile access, nor do they allow tasks to be allocated and tracked in real-time.

We must go further for patients or clinicians. A true virtual ward solution can do more – should do more – to protect patients and make clinicians’ jobs more manageable.

Creating a true virtual ward

If virtual wards are to be done correctly, and their potential fully realised, innovation and action must focus on six areas:

1. The right information at the right time

For virtual wards to save valuable clinical time and ensure high quality care, data generated in patients’ homes must be of equivalent quality to that captured in hospital. It should also be distilled into actionable insights to save clinicians from filtering large amounts of data. And here lies the problem.

The 2019 Topol Review emphasised that large volumes of unfiltered data can be immensely overwhelming for an already overworked workforce. We know that conventional remote monitoring generates noisy data that wastes clinical time and can mislead clinical assessments, introducing risk.

To overcome this, advanced tools are needed, such as those utilising AI, to take on the time-consuming task of reviewing millions of data points to ensure quality and translate data into insights.

2. Seamless patient engagement

Patient engagement tools must be a core component of virtual wards, ensuring patients have a positive experience and feel confident that they can contact the clinical team if they need.

Good patient engagement provides a seamless experience whether a patient is co-located with clinicians in an acute hospital setting, or in the community.

Patients should receive ad hoc or scheduled contact via a method that suits them. This could be a digital assessment form sent to the patient, providing a low cost but highly effective method that complements data gathered from remote monitoring devices.

Patients should also be able to easily request a phone, video, or in-person appointment at a time that suits them.

In combination with care coordination and remote monitoring tools, effective patient communications are a powerful way to keep patients safe and them and their families reassured.

3. Proactive rather than reactive management of health

Moving from reactive to proactive management of patients’ health means two things for virtual wards:

Firstly, care must be targeted to patients pre-admission to hospital instead of post-discharge. This means initiating virtual care in the community to minimise the risk of admission, especially for ambulatory care sensitive conditions. More importantly, when it comes to avoidable admissions to hospital and frail patients, this could prevent a deterioration in their condition, which could happen off the back of a hospitalisation and could cost them their independence.

Secondly, mechanisms must be in place for early detection of deterioration. Therefore, being able to identify early signs and intervene before complications and readmissions to hospital become inevitable.

4. Health equity by design

The pandemic has revealed the multi-layered inequities that impact healthcare access and healthcare outcomes. One way in which virtual wards must address these is by investing in scalable community workforce models – that include healthcare assistants – to support care delivery to patients who cannot self-administer.

A second way to promote equity is by ensuring that no one is digitally excluded due to, for example, poor WiFi connectivity or lack of digital confidence or capability. Equally important is to look beyond physical symptoms to integrate social determinants of health into the modelling, planning and delivery of virtual wards.

5. Effective skill-mixing and empowerment

Enabling a diverse network of multidisciplinary staff to participate in the delivery of virtual wards is critical to resourcing these new models of care without adding to doctors’ and nurses’ workloads.

From healthcare assistants, to patients, to their friends and family members, different stakeholders should be empowered to fuel a proactive model of care at home. This includes training, decision-support tools and streamlined workflow management – and requires tools to handover and assign the right tasks to the right healthcare professionals – to cover the effective identification and appropriate escalation of health issues.

6. Effective task management

The best outcomes from virtual wards will result from multidisciplinary staff having secure access to a shared list of patients and the tasks that need to be done for them. They should be able to review the list in virtual ward rounds or whenever required, add and allocate tasks, and mark them as accepted, in-progress, or completed for colleagues to see or track. The entire team ought to have visibility and be able to collaborate and coordinate care remotely, ensuring caseload management is efficient and safe.

Automated workflows can make it easy for staff to identify where readings from intelligent remote monitoring devices fall outside of set ranges, supporting safer and more effective clinical decision-making.

Enabling a new era of care delivery

At this moment, NHS organisations have a unique opportunity to begin the virtual wards roll out on the strongest possible footing, with the best solutions in place. A focus on the six pillars that encompass care coordination, patient communication and remote monitoring, will accelerate a successful transition to a new era for care delivery, and help establish virtual wards as a credible, scalable alternative to acute hospital admissions.

Elliott Engers is CEO at Infinity Health.

Tom Whicher is CEO at DrDoctor.

Elina Naydenova is CEO at Feebris.