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.

Transforming rehabilitation services in England: A new model for community rehab

By Sara Hazzard

By Sara Hazzard, Assistant Director Strategic Communications at The Chartered Society of Physiotherapy (CSP) and Co-Chair Community Rehabilitation Alliance

Change is in the air when it comes to rehabilitation in NHS England.

And while the word ‘change’ may send shivers up the spines of many, the change that is underway in the rehab space must be seen as positive, if we are to safeguard the future of the service for current and future generations.

At the Chartered Society of Physiotherapy, we have long been calling for change and transformation when it comes to rehabilitation. Our Right To Rehab campaigning has made significant progress in pushing this issue up the agenda. And we are not alone. As part of the Community Rehabilitation Alliance (CRA), which we are proud to convene and co-chair, 60 health and care charities and professional bodies are also united in seeing rehabilitation become a central part of NHS thinking and future planning.

So, what does the most recent change, when it comes to rehab, mean?

For the answer, we need to look at two landmark publications from NHS England: the Integrated Care Framework and a new model for community rehabilitation.

Issued in September this year, this framework and model, read together, signal a step-change in the way community rehabilitation is regarded at a system-level within the NHS. While rehab has been steadily growing in prominence over the last few years, to have tangible, clear policy setting out the expectations for what good rehab looks like is a seminal moment.

What is hugely encouraging is that the ICF and new model for rehabilitation reflect strongly the rehab best practice standards, which were developed and endorsed by the CRA. This again shows that there are many voices all calling for the same thing, and for everyone’s right to rehabilitation to be realised.

Significant, too, is that before looking at the detail of the ICF and new rehab model, their very existence is an acknowledgement from the top of the service in England that rehabilitation must be taken seriously and delivered comprehensively to improve patient and population health outcomes. It is a pillar of health care as important as medicines and surgery.

The evidence for needing this shift is clear to see.

Stroke rehabilitation for example, delivered at the optimum time, reduces the risk of a further stroke by 35 per cent. It enables people to regain function and independence yet only 32 per cent get the recommended amount of rehab.

Updated guidance from NICE in October 2023 (the month of this publication) has further bolstered the importance of rehab, by advising that the level of rehab offered is increased to at least three hours a day at least five days a week. This is significant because NICE are guided by effectiveness and cost.

Roughly one in four emergency hospital admissions and ambulance call outs are due to a fall.

Falls prevention saves the NHS £3.26 for every £1 invested because it reduces admissions and bed days. Preventive rehab such as Fracture Liaison Services (FLS) are therefore a cost-effective intervention.

COPD exacerbations are the 2nd largest cause of emergency hospital admissions. Rehab is vital and can reduce admissions by 14 per cent and hospital bed days by 50 per cent yet less than 40 per cent of eligible people are offered rehab.

It is the same with cardiovascular disease and heart attacks. Only 50 per cent of eligible patients receive cardiac rehab. There would be 50,000 fewer hospital admissions if access was 85 per cent.

The release of the ICF and new model for community rehabilitation could therefore not come soon enough.

But with publication, all efforts must now ensure that the actions set out in them, including an adequate rehab workforce, are delivered at pace. We need roles created in the community. It is where people need the help and support. The Chartered Society of Physiotherapy stands ready, alongside our partners in the Community Rehabilitation Alliance, to work with the NHS to make this happen.

The good news is that maximising the rehabilitation workforce is a key feature of the ICF and rehab model, as it highlights AHP leadership at system level to lead implementation. This focus to make the best use of the workforce ensures that individual expertise is used to best effect and has a potential valuable knock-on impact when it comes to the progression and retention of staff.

Also of key importance is the use of data to make the best decisions about service delivery. While there is some data available, much of it is condition specific and/or held in just one place. Now work must develop to ensure that information is shared, and silos broken down.

We must at minimum collect information to identify who needs rehab, who gets rehab and the outcomes.

We therefore have an opportunity, with the momentum and appetite for rehabilitation firmly behind us from the top of the NHS. We must not waste this moment and instead work together, understand what this new approach to rehab means for us in practical terms and then forge a way forward. We owe this effort to the more than one million people waiting for NHS community services, of which rehabilitation makes up a large part.

Transforming leg ulcer service provision

By Leanne Stevens, Abbe Ruston, Laura Hallas Hoyes

It is estimated that more than a million people in the UK have lower limb ulceration. With their 160 years’ experience in developing wound care solutions, L&R hypothesised that a self-care delivery model could both improve outcomes and ease the burden on the healthcare system.

L&R has more than 160 years of experience in developing outstanding wound care and compression therapy solutions. They are passionate about transforming outcomes in leg ulcer service provision to support the NHS, the nursing workforce, and patients. Working in partnership with organisations, L&R supports them to drive the self-care agenda, which frees up resources, reduces appointment times and clinic costs, and releases nursing time to care.

Lower limb ulceration is a common cause of suffering in patients and its management poses a significant burden on the NHS, with venous leg ulcers (VLUs) being the most common hard-to-heal wound in the UK. It is estimated that more than one million people in the UK have lower limb ulceration, of which 560,000 are categorised as VLUs. Much of burden of VLUs currently sits within the community and primary nursing workforce, with up to 50 per cent of community nursing workload being taken up by chronic wound management.

In South West Yorkshire Partnership Trust (SWYPT), it was hypothesised that a self-care delivery model, in partnership with the Leg Ulcer Pathway could reduce wound care burden on the health service and improve patient empowerment, with little or no reduction in healing outcomes.¹ Therefore, L&R, in partnership with SWYPT, created a project called the “Big Squeeze”, with the aim of delivering transformative outcomes for venous leg ulcer care, achieving a big squeeze on its financial burden and unwarranted variation in treatment and outcomes.

This was implemented through L&R’s three-step approach:

Implementation of a best practice leg ulcer pathway¹ – ensuring the right treatment for the right patient at the right time in line with the National Wound Care Strategy Programme recommendations.
Service efficiencies – driving clinical and health economic outcomes through adoption of the self-care delivery model.
An education and coaching programme – for patients and clinical workforce to embed sustainable practice.

Evidence of success

95 patients were enrolled into the service evaluation, and:

VLUs of 84 patients had healed by week 24 on the pathway.
VLUs in a further 10 had healed by week 42.
One remaining patient reached 42 weeks without healing.

Comparing the results of implementing the Best Practice Leg Ulcer Pathway in isolation and the Best Practice Leg Ulcer Pathway and the Self Care Delivery Model combined:

Nursing hours per patient reduced from 24.5 to 1.3, releasing up to 95 per cent in nursing hours.
Total cost per patient reduced from £2,168 to £361, saving up to 83 per cent in total cost of care per patient.
Product cost per patient reduced from £629 to £177, saving up to 72 per cent in product costs per patient.

In addition to healing and financial outcomes, improvements in staff motivation and wellbeing were recorded through survey feedback, as well as 1,471kg saving in C0₂ per 100 patients through a reduction in miles driven by the community workforce.

¹ Leanne Atkin and Joy Tickle (2016). Wounds UK, A new pathway for lower limb ulceration. Available from: https://www.researchgate.net/publication/304989292_A_new_pathway_for_lower_limb_ulceration

Acute Care, Community Care, Digital Implementation, News September 13, 2023

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

By Tara Donnelly

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

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

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

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

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

Remote monitoring available to community urgent response teams

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

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

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

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

Tackling surges in respiratory admissions this winter

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

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

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

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

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

Augmenting SDEC services

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

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

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

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

Conclusion

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

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

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

Tara Donnelly, Founder of Digital Care Limited

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