“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.

Community Care, News March 21, 2024

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*

All news

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

Recognising the value and impact of AHP support workers within healthcare

By Integrated Care Journal

This week the Chartered Society of Physiotherapy, along with a coalition of 13 other allied health professional (AHP) bodies, is celebrating Support Worker Awareness Week.

AHP support workers are an integral part of multidisciplinary teams. They are relied upon for the transformative role they have to play across many different services, including physiotherapy. They work within their scope of practice to carry out a wide range of tasks and are supervised by a registered healthcare professional who retains responsibility for patient care.

The value of support workers cannot be underestimated. The contribution to services by support workers, both in the NHS and the independent sector, enhances patient outcomes, improves patient experience and increases service efficiency. They also provide immeasurable guidance and support to the wider health and care team.

Currently, we see increasing numbers of support workers playing a vital role in facilitating education by supporting physiotherapy students with their learning. By supporting physiotherapy students with practice-based learning during their placements, support workers offer a safe and supportive space, and contribute to the growth of the profession.

During the pandemic, support workers demonstrated great flexibility and brought new skills to the role. Their responsibilities increased and elements of their practice developed to meet the extraordinary pressures on the system.

Need for more support workers

More physiotherapy support workers are needed within the NHS, but this demand can’t be met by increasing the registered workforce alone. With ever-increasing physiotherapy waiting lists, an ageing population and more patients living with multiple conditions, more support workers are needed to fulfil population, patient and service delivery needs in safe, effective ways.

The CSP has recently conducted a physiotherapy workforce review in England and is calling for 6,500 additional non-registered physio posts in the NHS over the next five years. Additionally, the recent NHSE intermediate care framework recommends maximising the use of skilled support workers. If utilised at the right points in intermediate care pathways, their skills and expertise will improve access to high quality rehab that is timely, safe and person-centred.

In Northern Ireland, we want to see the implementation of the recommendations outlined in the Physiotherapy Workforce Review Report published in 2020, including the establishment of apprenticeships for physiotherapy support workers. In Scotland, we are calling for funded ‘earn and learn’ routes to be established and in Wales, the expansion of the level 4 apprenticeship scheme for support workers.

The support worker role is evolving, with increased opportunity to carry out additional responsibilities in practice. Higher-level support workers have additional responsibilities across the four pillars of practice. These roles are important to provide a positive impact on patient flow, quality of patient care and to meet new national policy developments.

What support workers need

Support workers need clear opportunities and pathways to develop capabilities and pursue career development. Each UK country should have a programme of work to develop support worker roles including those at higher level. This should both develop CPD opportunities, a greater consistency in levels of practice, capabilities and governance arrangements.

Higher-level support worker roles are one example of career development and provide opportunity for managers to think creatively about the skills mix within their teams.

With the right systems and support in place, support workers can do so much more.

Looking to the future

With the opening of the National Rehabilitation Centre (NRC) in East Midlands planned in early 2025, there is a new pioneering role.

The centre will offer a foundation degree apprenticeship for a rehab assistant practitioner role (band 4 equivalent). The rehab assistant practitioner will work across OT, physio and nursing with an evidence and training base behind them.

The NRC plans to offer around three to four hours a day of rehab as opposed to the 30-40 mins per day rehab normally offered in the NHS. Rehab Assistant Practitioners will be key in meeting these ambitious targets.

It is clearly time to recognise and shine a spotlight on the vital role of support workers but also most crucially to invest in their pathway and career opportunities.

Spirit Health’s innovative solutions in wound care: A path to improved patient outcomes and NHS savings

By Clare Leek

Wound care is an often complex therapy area with thousands of product options. Spirit Health’s wound care range focuses on simplicity, and could help deliver millions in saved costs for ICBs.

This article is sponsored by Spirit Health.

For more than 14 years, Spirit Health has proudly served as an independent service provider to the NHS. Specialising in close collaboration with NHS Medicines Optimisation teams, Spirit Health offers a wide range of products and clinical services that deliver cost efficiencies and improvements in patient outcomes. Spirit Health has many examples of lasting partnerships which support the NHS to achieve its priorities.

Active Implementation is the service that lies at the heart of Spirit Health’s commitment. This involves providing the resource needed to carry out the prescribing changes desired at primary care level. This ensures that the hard-pressed general practice and pharmacy workforces aren’t distracted or burdened further while integrated care boards (ICBs) benefit from quickly realising the outcomes of their review services.

While Spirit Health offers Active Implementation across most therapy areas, it also has its own product portfolios that are available for ICBs to take advantage of. These products are of high quality but also provided at a cost-effective price to enable the NHS to save money. At the centre of this offering is Spirit Health’s Simple^TM wound care range. By prescribing the wound care range, it could result in annual prescribing savings of over £18m across the NHS.*

Wound care is an often complex therapy area with thousands of product options. Spirit Health’s wound care range focuses on simplicity. Its Simple^TM Wound Care range is designed specifically for non-complex wound care needs and when utilised, produces significant savings in prescribing expenditure.

The range offers a variety of dressings from foams to hydrogels to alginates. Each product has unique features to ensure an optimal healing environment and enhanced patient comfort. Spirit wound care includes dressings across these categories:

Alginate Dressing
Hydrocolloid dressings
Amorphous hydrogel
Hydrogel dressings
Non-woven absorbent
Super absorbent dressings
Vapour-permeable dressings
Breathable, absorbent island dressings

Furthermore, the Spirit portfolio is accompanied by a programme of support and training for healthcare professional teams, ensuring changes are managed optimally. Through its team of clinical pharmacists and nurse educators, Spirit Health provides bespoke and flexible training, tailored to meet local needs. Spirit Health also work with primary care and community nursing teams to ensure they are supported through changes and the appropriate patient benefits are realised.

Contact Spirit Health to find out how they could help your organisation to achieve savings and efficient implementation.

Meds-op@spirit-health.com

0800 881 5423

Spirit-health.com/medicines-optimisation

* Savings based on ICB prescribing data from Sept 2022-Aug 2023 with a 70 per cent switch from current prescribing to comparable products from Spirit Health. 

Free joint pain programme shows promise in reducing GP visits and improving health outcomes

By Integrated Care Journal

New report shows Nuffield Health’s Joint Pain Programme has reduced annual GP visits by nearly a third, improving quality of life for patients and realising millions in savings for the NHS nationally.

Musculoskeletal (MSK) conditions, such as arthritis and joint pain, are some of the most common and debilitating health conditions in the UK. Affecting more than 20 million people, MSK conditions can have a significant impact on an individual’s quality of life, ability to work, and social interactions.

Almost 8 million people currently sit on NHS waiting lists, many of whom are living with an MSK condition, while chronic MSK conditions account for one in seven GP appointments in England. It is estimated that MSK conditions cost the NHS around £6.3 billion in 2022-23.

In recent years, there has been a growing recognition of the importance of exercise and physical activity in managing MSK conditions. However, engaging patients to make long-term lifestyle changes can be challenging.

Nuffield Health’s Joint Pain Programme is a free, 12-week programme that aims to help people with MSK conditions self-manage their pain and improve their overall health and wellbeing. The programme is delivered by trained Rehabilitation Specialists at Nuffield’s 114 health and wellbeing locations across the UK. The charity also runs 37 hospitals throughout the UK.

The programme is designed to be holistic, addressing the physical, psychological, and social aspects of living with an MSK condition. In groups of around 12, participants learn about the importance of exercise and physical activity, as well as strategies for coping with pain and fatigue. They are also given the opportunity to meet and socialise with other people who are living with similar conditions, addressing the ‘biopsychosocial’ needs of patients. As of October 2023, the programme has been delivered to more than 20,000 patients.

Benefits to patients and the NHS

A new report from Nuffield Health, Moving for Musculoskeletal Health, provides an overview of the programme’s approach and impact since it began in 2018, alongside testimony from former participants. The report shows that on average, the Joint Pain Programme reduced the number of GP visits for participants by nearly a third, helping to relieve burden on local health systems and furthering long-term prevention strategies.

Participants also reported significant improvements to their health and wellbeing, including an average 36 per cent reduction in overall joint pain, a 37 per cent increase in joint function, and a 28 per cent reduction in joint stiffness.

Further, participants reported an average 13 per cent increase in ‘life satisfaction’ after completing the programme, a 26 per cent improvement in anxiety scores, and 9 per cent increase in overall happiness.

To evaluate the programme’s wider impact on local economies and health systems, Nuffield Health has also developed a Social Return on Investment (SROI) framework, alongside Frontier Economics. This demonstrates that since the programme’s inception, more than £52 million in social value has been realised, equating to approximately £12,000 for every participant who completed the programme. These savings include an average decrease of 1.44 hours of weekly care hours from family or carers, the aforementioned decrease in GP visits required, and an average annual decrease of 1.12 sick days taken by each participant.

To find out more about Nuffield Health’s Joint Pain Programme, visit www.nuffieldhealth.com.