Benefits of single-handed care highlighted at new qualification launch

By Integrated Care Journal

Level 2 Proportionate Single-Handed Care qualification formalises single-handed care principles into Ofqual regulated training for the first time. The qualification counters the misconception that it is unlawful to provide moving and handling care activities with less than two handlers.

Leading figures in the social care sector, including representatives from Care England, Department of Health and Social Care and the NHS, came together at the House of Lords on Wednesday 2 April for the launch of the Level 2 Proportionate Single-Handed Care Qualification, developed by the Royal Society for the Prevention of Accidents (RoSPA) and A1 Risk Solutions Ltd.

The event was hosted by RoSPA Vice President Baroness Watkins of Tavistock, who reflected on how her own background in nursing has demonstrated both the importance of greater recognition of care workers’ skills, and the need for improved pathways to developing them.

Watkins said: “Working as a nurse myself gave me firsthand experience of how care workers are the backbone of our health and social care system, delivering care, kindness and support to hundreds of thousands of people on a daily basis. Despite the increasing demand for social care, with requests for support from new clients reaching over two million in 2023-24, the vital contributions of care workers often go unrecognised.

“The qualification not only benefits individual care workers by enhancing their skills and job satisfaction but also promotes privacy, independence, and flexibility for service users. It ensures that care is delivered effectively, safely, and with dignity, without compromising the health and wellbeing of either party.

“By investing in our care workers, we are investing in the future of our health and social care system.”

In her keynote address, RoSPA Chief Executive Rebecca Hickman explained how the new qualification builds on the charity’s commitment to ensuring the highest health and safety standards across the whole of society.

Rebecca Hickman said: “The Level 2 Proportionate Single-Handed Care Qualification is a new addition to RoSPA’s suite of highly respected training qualifications for the social care sector, such as our Level 2 Adult Social Care Certificate and our Level 3 Award for Safer People Handling Trainers.

“Developed in collaboration with key partners and supported by sector leaders, this qualification is designed to enhance the skills and knowledge of professionals, empowering them to deliver safer and more effective care.

“This qualification is based on the latest evidence and best practice. By setting high standards, recognising excellence, and delivering comprehensive training, RoSPA continues to lead the agenda in making society safer for everyone.”

The Level 2 Proportionate Single-Handed Care qualification is the first time the principles of single-handed care has been formalised into an Ofqual regulated training programme.

Proportionate/single-handed care encourages a more personalised approach to supporting a person’s moving and handling requirements. This ensures the person receives the optimum amount of care and support in the correct environment. By enabling individuals to do as much for themselves as possible, proportionate/single-handed care reduces the likelihood of them becoming deconditioned and being readmitted to hospital or admitted to long-term care. This also has the benefit of freeing up capacity across the wider health and social care system.

Alongside training staff in areas such as risk assessment and the practical delivery of safe moving and handling, the qualification counters the misconception that it is unlawful to provide moving and handling care activities with less than two handlers. Care should not be over prescribed and should be proportionate to the needs of each person to ensure that it does not foster dependency.

Find out more about the Level 2 Proportionate Single-Handed Care qualification.

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 Connecting Prevention in Specialist Pathways

Barts Health and TPHC 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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BSI to deliver quality assessment across the Age UK Network through new partnership

By Integrated Care Journal

A new partnership designed to assess quality across the Age UK network, in order to ensure the safety and well-being of older people, has been agreed by BSI and Age UK.

Business standards and improvement company BSI will support Age UK, a leading charity for older people, with the delivery of quality assessment services as part of a new partnership agreed between the two organisations. The partnership will see BSI provide an external quality assessment programme for organisations that use the name ‘Age UK’ against the Age UK Network Charity Quality Standard (CQS). Previously, this had been conducted by a different assessment company.

With a rapidly ageing society in the UK, the services and support the Age UK network provides to older people are increasingly important to managing demand on health and care services. This also comes at a time when a reported nine in 10 charities face increased demand, meaning it has never been more crucial to ensure that a consistent level of quality is offered across the country.

The Age UK network includes 118 Local Age UK Partners, as well as four National Partners – Age UK, Age Scotland, Age Cymru and Age Northern Ireland. While all organisations that are part of the Age UK network are independent charities with their own funding, governance and management arrangements in place, they are all required to meet an agreed set of quality expectations which are outlined in the Age UK Network Quality Assurance Framework.

The CQS is one of several quality standards within the Quality Assurance Framework, which is designed to help charities operate more effectively and efficiently. The standard covers 13 quality areas including governance, managing people, managing money and safeguarding. It also focuses on ensuring that each member of the Age UK Network is legally compliant and practices effective risk management to ensure quality and consistency, alignment with strategy, and the effective use of resources in the provision of services to ensure the well-being and safety of older people.

BSI has designed the assessment programme to ensure that all members of the Age UK Network meet the requirements of the CQS. The initial programme will commence from April 2025 for three years with BSI.

Simon Healey, UK&I Operations and System Certification Director at BSI, said: “BSI is delighted to be partnering with Age UK, a fellow purpose driven organization, on this important initiative, which aims to help make a positive impact on society. As an organization committed to driving quality and ensuring positive outcomes, we are proud to be running an assessment program that will support Age UK in its mission to improve the lives of older people across the country. We look forward to working closely with the team to help them achieve their goals and continue their vital work in the community.”

Victoria MacGregor, Chief Network Officer at Age UK, said: “We are thrilled to be working with BSI to deliver our Charity Quality Standard assessment programme. We consulted with our Partners to select the new assessment provider and were all impressed by BSI’s partnership approach in which they work with their clients to have a positive impact and offer solutions that enhance continual improvement and meet best practice.

“We are also pleased that the BSI ‘mark’ will provide external recognition and demonstrate that we take quality seriously through our standard now being assessed by these external experts.”

“Overwhelmingly positive” results for early years tool pilot

By Integrated Care Journal

Health visitors trialling the Alarm Distress Baby Scale tool reported enhanced understanding of babies’ behaviour and greater confidence in supporting parents to bond with their children.

A new trial testing the feasibility of a novel baby observation tool has taken place at Humber Teaching NHS Foundation Trust, funded by The Royal Foundation Centre for Early Childhood. The tool is intended to support parent-child interactions and increase the ability of a health visitor to interpret baby behaviour.

The four-month trial ran from July to November 2023 and saw participating health visitors receive training to use the tool, known as the Alarm Distress Baby Scale (ADBB). The ADBB looks for social behaviours in babies, including eye contact, facial expressions, vocalisation and levels of activity and seeks to help parents and practitioners understand the ways in which babies express themselves and their feelings.

Health Visitors conduct a number of regular checks on babies during their first years and the ADBB tool is typically drawn upon within the 6-8 week check. Health visitors who undertook the training reported it had helped enhance their understanding and that they had continued to draw upon those skills throughout all their contact with families.

The pilot ran in two areas initially, Humber and South Warwickshire, but the outcome of this trial is the recommendation that training be expanded to further areas. The findings of the trial have been set out in an evaluation report published by The Institute of Health Visiting and The University of Oxford.

Quantitative and qualitative data were collected over the trial period, and health visitors described their experiences of using the ADBB as “hugely beneficial” and “of great importance” to their work. They reported that the tool allowed them to:

Have more meaningful conversations with parents and carers about the emotional wellbeing of their baby;
Promote positive parent-infant interactions, attachment, and bonding; and
Identify those babies and families in need of greater support during this critical period of development.

Karen Hardy, Specialist Health Visitor at Humber Teaching NHS Foundation Trust said: “We were delighted to have been asked by The Royal Foundation for Early Childhood to take part in this trial. Our Health Visitors have found the training extremely useful and an additional element for them to draw upon throughout all their interactions with babies and parents. Having received the training myself, I can speak to its effectiveness at identifying needs of the baby and parent during those early weeks.

We know that babies are born ready to relate and can communicate how they are feeling from a very young age. The ADDB really adds to the health visitor’s skills repertoire aiding observation and interpretation of babies’ social cues and communication. This not only highlights when things are going well but enables early identification of babies that may be experiencing distress associated with adverse or challenging family circumstances, so that we can put appropriate support in place as early on as possible. It is great to hear that the report is recommending the extension of this training to more Health Visitors”.

Executive Director of The Centre for Early Childhood, Christian Guy, said: “The results of the initial phase of testing are so encouraging. We now want to move quickly to ensure we build on this work, bringing the benefits of this model to more health visitors across the country so that, ultimately, more babies and their families get the support they need to thrive.”

It has been noted that during the trial, the health visitors involved identified behavioural concerns in 10 per cent of the babies they met while using the tool. All identified families were subsequently offered additional support, which ranged from follow-up visits, emotional wellbeing visits and video interaction guidance, as well as connections to Child and Family Centres and referrals to Specialist Perinatal Mental Health and other support services.

Dr Jane Barlow, Professor of Evidence Based Intervention and Policy Evaluation at The University of Oxford, who oversaw the evaluation of the trial said: “Babies are born with amazing social abilities. They are ready to relate and engage with the world around them, communicating how they feel through their behaviours.

Whereas previous approaches have focused on the parents’ perspective, this training has really helped health visitors to ‘read’ the baby during interactions and develop greater sensitivity in terms of the observation of potential attachment and bonding issues that would not have been identified without the training.”

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

By Paddy Markey

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

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

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

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

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

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

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

Why clarity and consistency are essential to realise the benefits of integrated urgent and community care

By Lisa Harrigan

For the NHS to truly address pressures on emergency care, the integration and standardisation of urgent community response services is essential, writes Lisa Harrigan, Senior Consultant at NHS Arden & GEM CSU.

All integrated care systems (ICSs) are required to provide an urgent community response (UCR) service which delivers urgent crisis support to people in their own homes. Alongside the development of urgent treatment centres (UTCs), these services are a core part of national efforts to alleviate pressure on accident and emergency (A&E), ambulance services and primary care. Well-intentioned national guidance has helped to shape more community-based urgent care services, but the nature and maturity of these services, and the way they are delivered, varies considerably, limiting the potential for systems to realise much needed benefits.

Identifying inconsistencies

UCR is designed to deliver clinical support to patients who might otherwise face a long wait for an ambulance and for whom there is no immediate threat to life. UCR provides a response within two hours, to assess the patient, make them comfortable, administer pain relief and fluids, and, where appropriate, stand the ambulance down. Integrated care boards (ICBs) are finding, however, that the efficacy of this service can vary considerably across their system, with multiple providers operating in different areas, all delivering a slightly different service. While they may all meet the minimum national standards, lack of consistency means use of the service is inconsistent.

UCR should be set up to take referrals from 999, 111, ambulance crews, GPs, pendant alarm companies, care homes and, in specific cases, directly from patients. In our experience, however, this is rarely the case. Some providers take regular referrals from out of hours GPs but have no relationship with their local ambulance service. Others work closely with the ambulance service but have limited contact with GPs or care homes, limiting the community-level support they are able to provide.

Clinical support varies too. Some providers are GP or senior nurse-led, while others are staffed by more junior nurses. Simple elements such as opening hours can also be inconsistent, all of which impacts the level of care the UCR is able to provide. Collectively, these inconsistencies make it challenging, both for ICBs to understand the quality and consistency of provision across their system, and for individual services to make best use of UCR support.

Similar challenges exist when it comes to UTCs. Some centres are nurse-led, some GP-led, some offer a wide range of diagnostics while some provide much more limited services. Yet they are generally grouped under one definition, making it more complex for broader services such as 111 and alarm companies to provide confident signposting to patients. If these and other referrers are not confident in their knowledge of what is available, where and when, they will be less inclined to refer patients to these community-based services and opt to rely on more familiar services such as A&E and the ambulance service.

Addressing the challenge

In developing more consistent solutions, systems require a clear understanding of their local needs, existing provision and what will be required to make meaningful impact. The first step is to understand your starting point. For example, we worked with NHS Humber and North Yorkshire ICB to conduct a detailed review across the seven providers operating within their system to give a detailed picture of their overall UCR service, with recommendations on how the service could be strengthened. This has enabled the ICB to identify gaps and variation and consider a way forward which will provide a more consistent service for patients.

Engaging directly with providers and referrers can help identify and resolve hidden barriers. For example, we discovered that direct patient referrals were limited due to a lack of understanding of the ask. Once providers understood this would only be for previously known users, such as those with long-term conditions that may require frequent urgent support, those limits were addressed.

But this is also about identifying where the ICB can play a role in supporting providers to deliver a more consistent service. In Humber and North Yorkshire, our recommendations included developing a workforce plan to support providers with recruitment challenges, access to professionals, skill mix variation, competency updates and training with the aim of providing a more resilient, consistent service.

Providing clear, up to date information to all referrers about the services available in their area, including clinical and diagnostic variations and available referral routes, can also help to address barriers and enable better take-up of community-based urgent care services.

A holistic approach

There is much to be gained by taking a more holistic approach in integrating urgent and emergency care with community care, looking beyond the necessary to consider what achievable enhancements could significantly improve outcomes. For example, while national guidance suggests that UCR is delivered using a multidisciplinary team approach with staff ranging from a Band three to a Band seven nurse, data shows that more senior clinical expertise, especially where there is medical input, is likely to result in a greater reduction in conveyances to A&E, which can improve patient experience, alleviate system pressures and save money.

Furthermore, understanding what similar services are already available that can support the wider demand on urgent and emergency care can further enhance impact and reduce duplication. UCR and UTCs, for example, often prioritise physical health needs but the huge growth in mental ill health and subsequent pressure on community services contributes to patients attending GP practices and A&E where access and/or specialist support is often limited. Charities such as Age Concern and Samaritans offer experienced preventative care and crisis response services which systems could look to tap into as part of an integrated approach to urgent and community care, making best use of existing resources and reducing duplication. In taking a broad view of urgent care needs, commissioners have an opportunity to draw together expertise across all system partners to provide more joined-up services.

The NHS is constantly looking at different ways to address some of its most pressing challenges, and opportunities to alleviate pressure on the ambulance service and A&E are high on the priority list. However, there is a danger that this results in a series of siloed solutions, rather than a more cohesive, consistent approach. As systems mature, taking time to fully assess, adjust and integrate existing services will help reduce unnecessary duplication and create the headroom needed to enhance care quality and consistency for patients and staff in the face of growing demand.

*Lisa Harrigan, Senior Consultant at NHS Arden & GEM*

Case study: Improving diabetes care in Norfolk and Waveney

By Integrated Care Journal

How collaboration between DUET diabetes and Norfolk and Waveney ICB is helping to upskill healthcare professionals involved in conducting primary care diabetes reviews.

DUET diabetes was founded to improve the understanding and knowledge of those looking after adults with diabetes. The service offered is designed to improve the skills and confidence of professionals working in health and social care roles and the standards of diabetes care they provide; ultimately benefiting the people (adults) they look after.

DUET has been working with Norfolk and Waveney integrated care board (ICB) to develop a face-to-face workshop programme as part of their creation of a Diabetes Training Academy. Through the creation of a central diabetes training hub, the ICB aimed to:

Drive excellence in diabetes care, ensuring healthcare professionals (HCPs) had the competencies they require to improve the management of diabetes.
Reduce potential complications that arise from more uncontrolled diabetes.

The workshop programme was designed for HCPs involved with conducting diabetes reviews within primary care practices. The content focussed on laying the foundations of understanding diabetes and its management and then built upon these to include the ‘eight key care processes’ and the importance of a ‘holistic diabetes review’. A key aspect was to ensure that learners could confidently and competently undertake a diabetic foot screening examination and be aware of the local footcare pathways.

Representatives of the ICB involved with driving this initiative also attended the workshops to further understand the challenges taking place in primary care (looking specifically at local issues) as well as better understand the inconsistencies.

The workshops have been attended by 55 HCPs (additional funding is being sought to roll out further training), with overwhelmingly positive results:

100 per cent of learners recommended the workshops.
100 per cent also felt their knowledge and skills had improved because of the training.
More than 80 per cent of learners indicated a preference for learning in small groups that are interactive and led by a professional.
Fewer than 2 per cent indicated a preference for E-learning.

*HCP knowledge satisfaction scores pre-training*

*HCP knowledge satisfaction scores post-training*

The training has helped HCPs to understand how to be more person-centred by understanding the impact diabetes can have; such as the importance of pre-conceptual care and availability of additional local services. Being better educated, knowing when and where to refer concerns, providing a person-centred, safe and responsive service enables HCPs to provide appropriate support (and education) to people living with diabetes in a caring and effective manner. The ultimate beneficiaries are the people living with diabetes.

“Very happy with this course! One of the best courses in healthcare I have done. I have learnt so much, and gained lots of confidence in diabetic reviews and foot checks.” Tiffany Ellis Healthcare Assistant, Primary Care

“It was a lovely small group and we all engaged in the activities, as well as ask and answer questions.” Sam Chapman Healthcare Assistant, Primary Care

For more information about DUET diabetes, click here.

Why value-based procurement is key to cutting costs and improving outcomes: learning from Lincolnshire

By Alison Wileman

Alison Wileman is a Market Access Specialist – Continence at health and hygiene product provider, Essity, Specialist Nurse at Bladder and Bowel UK, and Trustee at ERIC, The Children’s Bowel and Bladder Charity. She is also former chair of the Royal College of Nursing’s Bladder and Bowel Forum.

For as long as universal healthcare has existed in Britain, the debate between the cost and quality of care has simmered – and at times – raged on.

Depending on how well the government of the day has balanced the books, the needle would often oscillate between cost-cutting measures for a cash-strapped services – in which quality of care is inevitably among the first casualties – or a healthier healthcare system where positive patient outcomes are prioritised.

But, as the NHS continues to suffer unprecedented pressures in the wake of the global pandemic and systemic shortages in resources and capacity, it’s clear, at present, where the needle is firmly pointed.

And while the crisis in our healthcare system undoubtedly demands a degree of money-saving measures, there does often exist a false economy in this equation which needlessly sacrifices patient outcomes only to return a higher bill for the taxpayer.

Redefining ‘value’

Take the endemic issue of incontinence, for example, which affects an estimated 14 million people in the UK today. A groundbreaking pilot conducted at care homes by the Lincolnshire Community Health Services (LCHS) in partnership with global hygiene and health company, Essity, revealed that ‘the NHS is leaking more than half a billion a year through substandard incontinence care’.

At the crux of the eight-week study was the crucial finding that the cheaper, blanket provision of generic absorbent pads – chosen on their low upfront cost and prescribed en masse to manage incontinence – resulted in a higher overall cost of care than more premium, yet clinically more appropriate, products.

This was because, as researchers found, patients using so-called “cost-effective” pads were far more likely on average to suffer up to 2.5 leakages per day, requiring the use of more products, and in turn – a greater time demand on typically overstretched carers and community nursing teams to replace patients’ pads, laundry of bedding and clothes, as well as other sanitising costs.

By contrast, continence pads prescribed based on an individual assessment of patient need, while generally resulted in the use of more expensive products, delivered a drastic reduction in overall service spend across participating care homes – bringing the average cost of daily care down from £15.33 to £6.68 per patient. Through appropriately prescribed products, patients experienced an average of just 0.5 leakages per day, which significantly reduced carer time and associated costs.

Equally important were the significant health improvements experienced by patients. The pronounced reduction in leakages had the welcome effect of a decrease in urinary tract infections, falls and hospital admissions linked to urinary urgency, as well as poor fluid intake that typically afflicts elderly patients with continence challenges. Quality of life was also enhanced, as fewer leakages led to an 18 per cent increase in patient self-toileting.

Delivering long-term value

This plethora of positive patient outcomes as a result of appropriately prescribed pads also, unsurprisingly, translated into greater carer satisfaction. Across several core functions, including ease of product application and removal, and whether the pad helped avoid unnecessary patient moving, the pilot’s core aim to replace cheaper products with more clinically appropriate pads saw a surge in satisfaction scores among carers.

This approach, modelled on the principles of ‘value-based procurement’, is key to understanding the resounding success in cutting costs and improving patient outcomes across participating care homes in Lincolnshire. By centring patient needs and considering the overall cost of care across the patient pathway – as opposed to the procurement orthodoxy’s obsession with the lowest possible price tag – services can significantly reduce outlays in a budgetary crunch. And, critically, not only does the typical trade-off between costs and patient care disappear entirely – but the latter is in effect considerably improved.

With more than 160,000 people in the UK with continence challenges living in care and nursing homes, it is vital that the instructional lessons from Lincolnshire are learned, generalised and adapted across the country.

While the government has committed to the adoption of value-based procurement across the health and care system, in reality, uptake by purchasing and procurement managers and individual integrated care systems has been far too sluggish, and at the continued expense of patients.

And while news of government’s further exploration of value-based procurement for continence care is welcome, more must be done practically to accelerate the institutional shift towards a practice that prioritises patient care and outcomes as well as service costs.

Further clear and consistent guidance from the Department for Health and Social Care and NHS England would no doubt strengthen this strategic steer. While at the granular level, reform of the NHS procurement framework to prioritise patient outcomes and the overall cost of care would supercharge the transition.

Lincolnshire’s pilot has proven beyond doubt that a value-based procurement approach to continence care delivers for patients and services. It’s crucial now that the wider health and care system follows the evidence and changes for good the way continence care is provided across the country.

Pharmacy First service agreed as Recovery Plan set to launch

By Gabriel Blaazer

Negotiations have concluded around the implementation of the Pharmacy First scheme, which is now set to launch in full on 31st January 2024.

The government, NHS England, and Community Pharmacy England (CPE), which represents all community pharmacy owners in England, have reached agreement regarding the launch of the new national Pharmacy First service, set out in this year’s Delivery plan for recovering access to primary care.

CPE’s Committee unanimously accepted the proposed deal, which outlines how the £645 million investment pledged in the Delivery plan will be used to support the rollout of expanded community pharmacy services. The agreement was reached following months of negotiation between CPE, the Department of Health and Social Care and NHS England.

Public Policy Projects has recently advocated for an expansion of pharmacy services in England in its report, Driving true value from medicines and pharmacy, which was chaired by Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation at Frimley Health and Care Integrated Care System.

It is now confirmed that the Pharmacy First services will be launched on 31st January 2024 as an Advanced Service, subject to the required IT infrastructure being in place. Under the new service, pharmacists will be able to offer advice and prescribe treatment for seven minor ailments, including sore throats, insect bites and uncomplicated urinary tract infections for women. Patients will be able to access the service without an appointment, as well as via referrals from NHS 111 and GPs.

Following consultations with pharmacists, patients with symptoms indicative of the seven conditions covered will be offered advice and prescription-only treatments where necessary, under a Patient Group Direction (PGD). CPE hopes that in the future, independent prescribers will be empowered to complete episodes of care without requiring a PGD.

As per CPE, the following stipulations have also been agreed:

The writing-off of previous funding over-delivery worth £112 million for CPCF Years 3, 4 and 5. If this money had been re-claimed from pharmacy owners over a year, it would have resulted in a reduction in the Single Activity Fee of around 10 pence per item.
Protecting baseline CPCF funding: the new money will be accessible as soon as possible rather than risk further over-delivery against Year 5 CPCF funding – the writing off of some Year 5 projected over-delivery supports this.
The inclusion of an upfront payment for of £2000 for Pharmacy First to support pharmacy owners to prepare and build capacity for the new service.
Increasing service fees to support ongoing capacity to deliver Pharmacy First, and for an uplift in fees across all services.
Reducing activity thresholds at the start of the scheme to “more achievable levels”.

The National Pharmacy Association (NPA) has welcomed the announcement, while also repeating calls for an increase in core funding for the community pharmacy contract to underpin sustainable future growth for the sector. NPA Chair, Nick Kaye, said: “We welcome this commitment to invest in a nationwide Pharmacy First service for common conditions. The new funding, whilst welcome, will not in itself solve the financial crisis in community pharmacy, but it is a substantial investment in a key service that could be a stepping stone to more.

“NHS England have put their faith in us, having seen community pharmacy successfully deliver other clinical services at scale. I’ve no doubt that pharmacies will once again deliver an impressive return on investment for the health service.

Highstreet pharmacist Boots has also welcomed the announcement pharmacy reforms. The chain announced today that it will roll out the NHS Pharmacy Contraception Service, allowing pharmacists to provide contraceptive advice and prescriptions, in the coming months. The service has already been successfully piloted in 22 stores in England.

The NHS Blood Pressure Check Service will also be expanded to most Boots stores in England, allowing pharmacists to check patients’ blood pressure and provide advice on reducing their risk of cardiovascular disease. Boots has said that the new and expanded NHS services will be good news for patients, pharmacy teams and GPs alike.

Seb James, Managing Director of Boots UK & Ireland, said: “We welcome the government’s announcement of plans to launch new contraception and minor ailments services in England, which will make life easier for patients to access the care and medicines they need quickly and help reduce GP wait lists.

“We have been working with our pharmacy teams in stores to roll out these new services to patients in England. We are already commissioned to deliver similar services for the NHS in Scotland and Wales and these are very popular with our patients and pharmacy team members.

“The free NHS blood pressure checks that we offer at most of our stores in England can save lives by spotting potential cardiovascular problems at an early stage, which also helps to reduce the burden on the NHS longer term.”

Not just for Christmas: Winter clinics a shining example of innovation we cannot overlook

By Dr Owain Rhys Hughes

Amid news that no funding is expected for community acute respiratory hubs this winter, Dr Owain Rhys Hughes explains why these are a shining beacon of innovation that the NHS cannot afford to overlook.

As winter fast approaches, the NHS is gearing up for another incredibly tough season. Waiting lists have hit a new record high of 7.8 million people and ongoing staff shortages continue to pile pressure on overstretched services. Innovation has a vital role to play in supporting the NHS to navigate these periods of intensified pressure. The winter clinics that provided lifeline support during last year’s winter months, which are yet to receive repeat funding for this year, are a shining example of the importance of such innovation – and the danger in overlooking it.

While primary care services deal with an existing backlog of appointments and referrals, the additional influx of patients expected to hit GP surgeries during the winter months – due to spikes in cold and flu complaints, for example – threatens to be overwhelming. Expanding the capacity and resources of primary, community and secondary care during this period is therefore essential. Winter clinics provided a crucial first line of defence for patients experiencing cold and flu symptoms last year. This deflected pressure from GPs and emergency services, boosting their capacity to see the patients they really needed to see.

Without initiatives like these, which facilitate the joined-up collaboration desperately needed to ease pressure on individual services and streamline patient triage, the NHS is facing a winter of unprecedented strain. A lack of capacity within primary care could leave many patients turning to A&E for support. In turn, this could place excessive pressure on secondary care, pushing up wait times for those in most urgent need of treatment.

We cannot afford to overlook the vital necessity of innovation that can unlock and support more collaborative care delivery and boost clinical capacity where it is needed most.

Winter clinics are just one example of the value and potential of such innovation during times of excessive pressure and need. There is a wealth of holistic and tech-powered solutions offering the tools for wider collaboration and more effective clinical communication. Harnessing these is essential to providing the infrastructure and support needed to ensure that the NHS can continue delivering exceptional levels of care amid growing strain.

Streamlining referrals into secondary care and introducing new sites for care delivery and diagnosis is a key way in which innovation is helping to do this. The rapid rollout of Community Diagnostic Centres (CDCs) across the health service is providing additional capacity and working to help reduce the number of patients being sent into secondary care for diagnostic tests and consultation. This is not only helping to diagnose illnesses such as cancer sooner, but is also allowing for triage to a wider range of services, ensuring only those who really need to be seen in urgent care are sent into hospital.

Another way in which diagnosis and referrals are being streamlined to free up capacity is through the introduction of digital advice and guidance. The use of digital tools to connect clinicians across different services can enable GPs and community clinicians to contact specialist consultants in real-time. This allows for advice and guidance to be easily and securely shared, and joint referral decisions to be made. As a result, the number of unnecessary referrals into secondary care can be reduced. Meanwhile, patients can be triaged to the most appropriate form of care sooner, avoiding repeat referrals and additional admin for GPs, boosting their capacity to spend with patients.

In my role at Cinapsis, I’ve seen this have an incredibly positive impact. Through our work in Norfolk and Waveney, for example, we’ve seen the use of digital advice and guidance reduce the wait time for specialist advice from 50 weeks to just 48 hours. This benefit has a knock-on effect by reducing the number of patients entering secondary care when they don’t need to. It also saves GPs time previously spent on copious admin and processing unnecessary referrals, freeing them up to see a higher number of patients.

As each new winter brings a fresh wave of increased pressure on our NHS, we must do everything we can to brace for and reduce the strain it puts services under. We cannot remove this pressure altogether; but we must embrace innovation wherever possible to facilitate the cross-service collaboration and vital communication needed to help clinicians unlock capacity and manage heightened patient demand.

Dr Owain Rhys Hughes, Founder and CEO, Cynapsis