Study of digital self-management service evidences a 50% reduction in A&E attendances for COPD patients
By Integrated Care Journal
A study of a COPD digital supported self-management service delivered in Hull has achieved a 50 per cent reduction in A&E attendances and admissions for patients, resulting in significant savings for the local NHS Trust.
The study team were evaluating the Lenus Treat: COPD Supported Self-Management Service and have released early evaluation data, alongside an economic model, which indicate the service is both less costly and more effective than standard care.
COPD (chronic obstructive pulmonary disease) is a long-term progressive lung disease, which causes narrowing of the airways, making it difficult to breathe. It affects more than 1.7 million people across the UK, with almost 30,000 dying from it annually. Exacerbations caused by COPD are the second most common cause of emergency hospital admissions, accounting for 1 in 8 of all UK hospital admissions. The disease is predicted to cost the NHS £2.5 billion each year by 2030, largely because of the expense of these emergency admissions.
In Hull, emergency admissions for COPD patients over the age of 35 are nearly twice the national average, with 259.2 admissions per 100,000 compared to the national figure of 133.5 in the last available records during the pandemic. The city is one of the 20 most deprived districts/unitary authorities in England, with some neighbourhoods among the most deprived in the whole country according to the ONS.
However, researchers at Hull University Teaching Hospitals NHS Trust (HUTH), part of NHS Humber Health Partnership, have discovered early signs that offering patients Lenus Health’s digital support service, can reduce hospital admissions, with further potential to decrease the amount of time patients spend in hospital each year.
The Dynamic Rose study, funded by the Small Business Research Initiative (SBRI), recruited more than 100 patients from HUTH following an admission. Patients were then provided with a digital service to help them to recognise and self-report their symptoms, access self-management resources, and to directly communicate with the clinical team if there was cause for concern.
This potentially helped patients to identify when they were at early risk of exacerbation, so appropriate interventions could be actioned by clinicians, informed by the data captured from the patient, and shared in the service’s clinical dashboard.
Significant reduction in hospital admissions
In addition to the 50 per cent reduction in A&E attendance, interim results of the Dynamic Rose study also indicated a number of other impressive benefits as a result of the Lenus Treat: COPD Supported Self-Management Service. These included a reduction in hospital admissions of more than 50 per cent after the first month and a sustained reduction in hospital admissions of 45 per cent after three months compared to historic controls.
As part of an independent health economic evaluation undertaken by the York Health Economic Consortium funded through the project, the digital support service was modelled to be more effective and £1,749 less costly than standard care, per patient per annum.
By addressing the healthcare needs of COPD patients effectively, the digital support service from Lenus Health approach has been shown to improve patient outcomes but also reduce unscheduled healthcare resource use.
Paul McGinness, CEO of Lenus Health, said: “These results demonstrate that providing care teams with the right digital tools to virtually manage patients can improve health outcomes and release clinical capacity back into the system by reducing unscheduled hospital admissions. Our service was designed with patients and clinicians to align to their needs. It provides a supporting ‘digital hand on the shoulder’ of patients, while not being onerous for care workers to monitor and intervene when risk rises.”
Prof Michael Crooks, Respiratory Consultant at HUTH, said: “One of the characteristics of COPD is periods of worsening symptoms, called exacerbations. COPD exacerbations are a common reason for hospital attendance, admission and negatively affect sufferers’ quality of life. The Dynamic Rose study has provided early additional evidence, that builds on the work in Glasgow, that Lenus’s digital service can help to reduce the frequency of COPD exacerbations that require hospital treatment and admission. This has great potential to maintain patients’ wellbeing and also free-up valuable hospital resources.’’
Allyson, a 61 year-old patient using the service in Hull, said: “My confidence has increased since I’ve come under the team and on the app, it makes me more thoughtful, and I tend to not push it any more. Since I’ve learnt the breathing techniques, started filling out my daily questions, thinking about my condition, it has made a big difference. I’ve never gone so long without an antibiotic.”
The Lenus Health collaboration with HUTH follows a study with similarly impressive results of a 50 per cent reduction in hospital admissions and respiratory-related occupied bed days for participants at NHS Greater Glasgow and Clyde in Scotland. Full results and evidence from Hull will be published in clinical journals in due course.
Harnessing innovation to deliver medicines optimisation at scale
By Meera Parkash
In this case study, Meera Parkash, Clinical Facilitator, Population Health Management at Optum UK, discusses how medicines optimisation can help free up pharmacy capacity and deliver key improvements to population health management.
At a time when the health system is urgently seeking new ways to cut costs, improve outcomes and reduce health inequalities, there are three areas where medicines optimisation can make an important contribution.
The first is non-adherence to medicines. It is estimated that half of all patients are non-adherent to their prescribed medication, costing the NHS £500m every year. The second concerns over-ordering and over-prescribing. About £300m worth of medicines go unused each year, and around half of this cost is believed to be recoverable. The third and final relates to adverse drug events (ADEs) in primary care, leading to hospital admissions. An estimated 72 per cent of ADEs are avoidable, costing the NHS £100m every year.
Traditionally, clinicians have had to manually search for patients who may need changes to their medication approach. This is extremely time-consuming and may not always be accurate if the data being used is out of date.
Population360® changes this. By integrating fully with clinical systems, it automatically finds and presents opportunities to improve medication safety, non-adherence and cost-effectiveness all in one place – transforming the speed, accuracy and scale of these processes.
Other prescribing decision support tools focus mainly on acute prescriptions and can only process them one patient at a time, whereas Population360 can proactively manage an entire patient population for an ICS at once. It does this by providing safety and adherence alerts for high-risk cases while surfacing lists of patients who may benefit from medication changes.
In light of resourcing pressures on pharmacy teams – which limit the number of structured medication reviews, programme switches, or high-risk drugs monitoring they can undertake using traditional methods – Population360 frees up capacity and helps them cover more ground. This demonstrates that it can be an important enabler for delivering medicines optimisation strategies at scale.
Evidence of success
Working with a GP practice covering 10,000 patients, Population360 flagged opportunities to save £82,376 through simple medication switches and recommended 1,171 patients for an adherence or safety intervention over a three-month period.
Based on these, a single pharmacy technician successfully reviewed 16 patients in less than 30 minutes, actively booking tests for 14 patients and initiating a patient consultation and de-prescribe for another.
Another pharmacist reviewed all female patients prescribed sodium valproate based on a targeted clinical rule. The pharmacist contacted patients, reminding them to follow up with their consultant to ensure Annual Risk Acknowledgement Forms were up to date (most of which were not) and contraception was in place.
Both examples demonstrate clinicians working proactively, supporting structured medication reviews, and closing important gaps in care.
The lead pharmacist at the GP surgery said: “It (Population360) gives us these patients very, very quickly and we can review them and take appropriate action – some of these patients are hard to reach people which is also an advantage.”
To see how Optum advances medicines optimisation (MO) and to learn more about proactive prescribing at scale, please click here.
Vic Townshend: ‘Whole person’ understanding is reliant on intelligence-informed decisions
By Ameneh Saatchi
Vic Townshend, Programme Director for Population Health Management (PHM) at Lincolnshire ICS, speaks with Public Policy Projects’ Ameneh Saatchi.
Building capacity and capability for population health management (PHM) is perhaps one of the single most significant enablers of truly integrated care and ambitions for England’s 42 integrated care systems (ICSs). But while every ICS will place significant priority on establishing comprehensive PHM, immediate service pressures and restricted resources have led to mixed results across the country.
In Lincolnshire, the ICS has established the Lincolnshire ICS Population Health Management Programme, which uses a ground-breaking person-level linked dataset, recognised as one of the most extensive in the country. The Lincolnshire Joined Intelligence Dataset covers 100 per cent of the local GP registered population. It encompasses a range of data sources, including primary and secondary care, adult social care, elective waiting lists, deprivation indices, social vulnerability and isolation measures from the Office for National Statistics, Census data, and community asset registers.
This initiative originated with the NHS England sponsored Population Health Management development programme, which allowed for the system to test what PHM offered and supported the first linked dataset to be created for a proportion of the county’s population. Other systems do have linked datasets, but there are none currently known that have the same extent of sources and population coverage.
“I worked closely with the Director of Intelligence and Analytics [Katy Hardwick],” says Vic, explaining that the team entered a partnership with Optum UK, to build the first ever linked data set in 2019, which initially covered about 30 per cent of the population. “This gave us data joined at the personal level, allowing us to see a person’s journey through health and ill-health and how they interacted with services across Lincolnshire to support their needs.”
The data science tool employed by Lincolnshire ICS focuses primarily on measuring health and care utilisation across different contexts, emphasising unit of activity and associated indicative costs. Traditional metrics, such as length of stay are incorporated, offering a comprehensive view of resource utilisation. Moreover, the tool’s versatility allows for customised presentations of intelligence, enabling users to tailor insights to their specific needs. Insights into health inequalities are facilitated by comparing cohorts of individuals, shedding light on variation in outcomes and contributing to high quality decision-making.
In addition to traditional metrics and the sources listed above, the Lincolnshire dataset also encompasses prescribing and medicines utilisation data, facilitating a holistic, system-wide understanding of health and care activities, service utilisation and outcomes. The dataset captures activity from all community, acute and mental health services, drawing from data recorded in trusts’ National Minimum Data Sets. This ensures seamless integration of data, irrespective of where individuals receive treatment – even if that treatment is outside of Lincolnshire ICS.
In healthcare, intelligence-informed decision-making stands as a crucial factor in navigating complex systems effectively. Vic emphasises the importance of this approach, highlighting how linked data allows for a comprehensive understanding of the impact of interventions across healthcare settings.
“The linked data set allows us to identify where opportunities are for intervention and change [and] where we’re doing well,” Vic explains. “What it doesn’t tell us is what we should do with it, but it starts to prompt leaders to ask the right questions… there’s nobody in our system that just has diabetes, which brings into question why we are providing services for diabetics in silo when they have more than one long-term condition and are subject to many other wider determinants of health, such as deprivation.”
This enhanced visibility helps stakeholders to identify both direct and indirect benefits and drawbacks of interventions, leading to better-informed decisions.
“The linked data set allows intelligence-informed decision-making, [meaning] we can now see the impact of our actions across our organisational borders and identify indirect benefits and disbenefits. So, we can track how changes in general practice are improving outcomes across other services, or vice versa.”
The inclusion of indicative costing within the linked data set also provides insights into resource allocation and workforce interactions. This allows for a more subtle understanding of how resources are utilised within the healthcare system, facilitating efficient resource management and optimisation.
Evaluation plays a pivotal role in assessing the effectiveness of interventions and changes in healthcare delivery. Vic underscores the necessity of robust evaluation, encompassing both qualitative and quantitative measures. However, Vic also acknowledges the challenge of maintaining the usability of the linked dataset while incorporating qualitative elements, emphasising the need for flexibility in its development and usage.
“Intelligence-informed decision-making becomes your North Star; you’re all following the same intelligence that steers in the same direction, wherever you work within the system. It has allowed us to robustly evaluate qualitative and quantitative outcomes, so it’s not just about what we can measure in the dataset, but working with personalisation, understanding what outcomes are important to people.”
Overall, the linked data set serves as a valuable tool for identifying opportunities for intervention and making informed decisions that lead to improved outcomes for patient and wider health system.
Vic’s journey into PHM stems from a diverse background, transitioning from the RAF as a meteorology officer, to a decade in general management in healthcare, to change management in complex systems. A keen interest in data analysis has been the nexus between various positions throughout her career.
More recently, Vic has begun addressing performance improvement challenges in healthcare, focusing on the interconnectedness of prescribing practices and care pathways. As Director of the Population Health Management programme in Lincolnshire ICS, she emphasises the need for comprehensive, intelligence-informed decision-making in healthcare leadership, seeing it as pivotal for driving systemic change and improving outcomes. For Vic, PHM represents a transformative tool with the potential to fundamentally change healthcare systems and improve outcomes for all.
The inequality challenge
Intelligence Leads and Chief Analysts working within ICSs will have increasingly important roles in navigating the complexities of health inequalities. Such roles require skill sets that can play a crucial role in generating intelligence to inform various inquiries regarding clinical care outcomes, health and wellbeing, and wider determinants of health. By fostering relationships with them, healthcare professionals can gain access to previously untapped data sets or intelligence that can address longstanding questions or concerns.
While population health itself is not a new concept, the current level of focus being placed on PHM requires significant new infrastructure support, the need for which may not yet be universally recognised within individual health systems. Therefore, she advises initiating discussions with intelligence teams to explore existing available data and infrastructure.
Vic stresses the importance of incorporating intelligence specialists or analysts into discussions alongside clinicians and decision-makers. This tripartite arrangement ensures that data-driven insights inform decision-making processes effectively, leading to more informed and impactful strategy.
Wound care from the lens of population health management
Vic underscores several key priorities essential for improving Wound Care outcomes:
Consistent documentation on electronic systems
Vic emphasises the importance of developing consistent documentation of wound care activities on electronic systems across frontline services and at strategic level. This consistency ensures accurate data collection that is crucial, not only for clinical records, but also for evidence-based decision-making and outcome evaluation. This is something Lincolnshire ICS will be working to develop further, as Vic identifies a challenge in ensuring consistency across local teams to capture all necessary data for wound care. Addressing this challenge is fundamental for systems to improve efficiency and workforce challenges in the community but may require additional resources and strategies to improve documentation practices.
Personalised care approach
Vic discusses the need to personalise wound care, highlighting that different individuals may require different approaches based on their specific needs and preferences for self-care. This personalised approach ensures that care is tailored to everyone’s circumstances, improving overall outcomes.
Training and applying best practices
Ensuring that clinical teams involved in wound care across various organisations are trained in, and consistently utilise, best practices. This helps standardise care delivery with the aim of adhering to established standards and protocols and improves overall quality of care.
Evaluation and continuous improvement
Establishing mechanisms for evaluating the effectiveness of changes made in wound care practices and processes. This iterative approach to improvement allows for ongoing refinement and optimisation of care delivery. This involves identifying what works, what doesn’t, and adjusting accordingly to continuously improve care delivery.
Communication and engagement
Vic underscores the necessity of effective communication and engagement strategies to drive change and improve outcomes for individuals. Engaging the workforce and the population is essential for raising awareness about available treatments and promoting better understanding of wound care options.
Extending pharmacy services – the pros and cons
Vic acknowledges the potential of community pharmacists in wound care as they are in the heart of communities, close to the patients, and can have a further role in early intervention. But she raises concerns about the sustainability and consistency of extending their roles. Vic highlights challenges such as increased workload, inconsistent sign-up to extended services, and competing priorities within the pharmacy profession.
Vic also provides recommendations to apply population health management techniques to diabetes care for comprehensive support
Vic asserts the need to shift away from treating diabetes as a standalone condition and to instead adopt a holistic approach that addresses individuals’ overall health needs. She advocates for integrated care models that offer comprehensive support, ensuring that individuals receive assistance beyond diabetes management alone. This approach aims to improve overall health outcomes and reduce the likelihood of complications associated with diabetes, such as leg ulcers and amputations.
Empowering prevention strategies
Furthermore, Vic highlights the importance of prevention strategies in combating diabetes. She stresses the need for a cohesive and proactive focus on prevention, encompassing primary, secondary, and tertiary prevention efforts. By investing in preventive measures and proactive interventions, such as health and wellbeing initiatives and collaborations with voluntary sectors, individuals can be empowered to manage their diabetes effectively and avoid frequent visits to healthcare providers.
Personalised care: addressing individual needs
Lastly, Vic underscores the significance of a personalised approach to diabetes care. She advocates for a strengths-based conversation that empowers individuals to take charge of their health while ensuring that healthcare systems meet their personal needs. By tailoring care plans to individual circumstances and preferences, healthcare providers can address inequalities and deliver more effective and meaningful support. This collaborative approach involves engaging individuals in decision-making processes and considering factors such as housing, employment, and social support to create sustainable and equitable healthcare services. Figure 1 below demonstrates how population health analytics tools can improve outcomes and efficiency.
Figure 1: Population Health Management Tools, the bridge between the person and the system strategy (click to englarge)
Conclusion
Vic emphasises the critical need for consistent documentation of wound care activities across all levels of healthcare delivery. This ensures accurate data collection, essential for evidence-based decision-making and evaluating outcomes. Additionally, she underscores the importance of a personalised care approach, recognising that individual needs may vary significantly. Training in best practices, continuous evaluation, and effective communication and engagement strategies are identified as key priorities to drive improvements in wound care delivery.
However, a significant challenge arises from the inconsistent capture of data by community nurses. This gap in documentation poses a barrier to comprehensive data analysis and evidence-based decision-making. Addressing this challenge will require focused efforts to improve documentation practices and ensure that all relevant data are captured accurately. By prioritising efforts to enhance data collection consistency, healthcare providers can strengthen the foundation for effective wound care delivery and evaluation.
What’s next?
Diabetes and wound care are the second and third highest expense to the health system respectively, and impact millions of people in the United Kingdom. Public Policy Projects is launching the second part of its Diabetes Care programme in the autumn of 2024 called ‘Holistic approaches to diabetes care – treating the whole patient’. Vic Townshend will be presenting on 2nd December, in London at the PPP Wound Care conference.
Contact Ameneh Saatchi, Director of Market Access for Diabetes and Wound Care, should you wish to learn more about these programmes: ameneh.saatchi@publicpolicyprojects.com
Developing a life sciences superpower – how the General Election will shape support for the medical technology and pharmaceutical sectors
By Seb Phillips, Senior Account Manager, PLMR Healthcomms
The life sciences industry’s contribution to the UK economy cannot be understated. One in every 121 employed people in the UK work in the sector, which is worth more than £90 billion to the UK economy, and is responsible for world-leading vaccines, robots, medicines and scanners.
Medical technology and pharmaceutical solutions cover almost all medical diagnosis and treatment, and share a mission to improve health outcomes, right the way through from prevention to treatment and aftercare. Medical technology covers everything from syringes and sticking plasters to replacement joints and surgical robotics; with pharmaceuticals ranging from paracetamol and over-the-counter cold and flu powder to the world’s most innovative cell and gene therapies and MRNA vaccines.
Medical technologies and pharmaceuticals hold the promise to support both the health and wealth of the nation, but face a range of barriers to enabling the UK to become a life sciences superpower.
Given the importance of the life sciences sector for the national health and economy, and the need for strong local links between the medical technology and pharmaceutical sectors and their future MPs, PLMR Healthcomms has developed the Clusters of Change: Key Electoral Battlegrounds for the Life Sciences Sector insights report.
This report maps the hotspots of the pharmaceutical and medical technology across the country, linking them to the constituencies being fought in the general election. Using the PLMR Candidates Portal the report paints a picture of the MPs who will be representing constituencies with the largest life sciences footprints after the General Election.
Why this election matters for the life sciences sector
While they have their operational differences, both MedTech and pharma function through similar prisms, sharing objectives around regulation, support for innovation, and better adoption pathways through the NHS.
As such, the outcome for this General Election is particularly important to both, with the elected representatives due to take their places in Parliament for the first time – and there will be a large number of new MPs – due to hold some power over how the life sciences landscape is shaped and supported over the next five years.
It is these incoming Parliamentarians who can advocate and help to deliver better regulation, support better adoption, and help drive the Department of Health and Social Care, the Department for Science, Innovation and Technology and the NHS to deliver for patients through better use of the life sciences sector.
The life sciences sector is critical to the long-term prosperity and health of the nation, and it is therefore vital that the incoming Parliamentarians are aware of the impact that they have on their own constituencies and the country as a whole.
Political ambition for the sector
Although both the Conservative and Labour Parties have pledged to make the UK a life sciences superpower, there are differences in how all parties pledge to support the sector. The Conservatives have pledged to drive capital investment; deliver a well-equipped MHRA; support more commercial clinical trials; and deliver a new MedTech pathway that rapidly adopts cost-effective tech.
Labour have promised to launch a new Regulatory Innovation Office; oversee an NHS innovation and adoption Strategy; and support a reduction in the re-evaluation of products shown to be clinically safe and cost effective by NICE.
The smaller parties have also recognised the importance of innovation and life sciences in their approach the NHS; but with both the major parties supporting the sector explicitly, this potential to truly deliver a life sciences superpower is within reach.
To realise that vision, each part of the life sciences sector must ensure that they are building advocates across Parliament, who can promote the benefits of innovation, medical technologies and pharmaceuticals; push Government for action on support for the sector; advocate for policies to ensure there is an appropriate regulatory and adoption landscape to support greater investment, development and deployment of the tools that support the NHS and drive further economic growth.
Thinking afresh as to how to support new ways of thinking and working
The NHS in the UK faces many challenges and at the same time, is guided by an ambition to reform itself to become more geared towards – and responsive to – the needs of the population.
However, there is limited time and space for those who work in the NHS to think creatively about how to respond to these circumstances. The service is extremely busy and it feels as though staff – particularly those responsible for managing and leading – are caught up in a permacrisis, which limits their capacity to think differently and to test out new ways of doing things.
This has led to a fresh corporate imperative for people to embrace systems thinking – and, in practice, to apply the precepts of systems leadership. However, this raises a crucial issue: there are myriad approaches to business leadership these days, as a cursory glance at the groaning shelves of the Airport Academy demonstrates, which can sometimes make systems leadership feel like yet another fad.
As with all fashions, of course, people are sucked into it, partly out of a personal fear of missing out and partly because everyone around them seems to be saying that it’s a trend into which they need to buy.
Current systems thinking
However, approaching the challenges and ambitions of health and social care systemically makes absolute sense. It is a perspective that acknowledges that the whole is greater than the sum of its parts and that a system relies upon meaningful connectivity between agencies – and individual agents – to maximise that effect.
All of which has led to a busy market of workshops, courses, and programmes that aim to induct people into systems thinking. However, these tend to take place at a distance from the practicalities of what it is like to make sense of systemic working in practice and to navigate it in a positive fashion.
There is a paradox at the heart of this. The busyness that managers and leaders in the NHS face at this time denies them the headspace to think systemically in the context of their systems. They are frantically doggy paddling in order to keep their heads above water, which prevents them from learning in the pool the swimming strokes that would make the situation smoother and easier.
On the other hand, there is an effort to teach people about systems – but this is taking place away from the practicalities of work in a quite abstract fashion. It’s as if people are stepping out of the pool to sit in a classroom to be shown the theory behind other swim strokes that might support them better in the water.
Crisis and leadership
Why is proximity to practice so important in this instance? Primarily because our organisational focus in most instances is on structure: we focus constantly on the scaffolding that envelops the work that we are asked to do. Yet the latter occurs systemically, with a passing relationship to the structure but in many ways independently of it.
Importantly, it is arguable that recent experience shows us that systems become apparent, and we are better able to acknowledge their presence, at times when we face crisis. There are examples cited by Rhiannon Firth in her book Disaster Anarchy – for instance, the aftermath of Hurricane Sandy in the US – where disasters outstripped the state’s capacity to respond, due to its structural emphasis, but out of which arose mutual aid arrangements, which were systemic responses.
A clinician with whom I spoke at the peak of the Covid 19 pandemic explained that it used to take her at least three days to organise a patient transfer. Invariably, to action it, she would need to involve people above her in the hierarchy. However, with the arrival of coronavirus, she found it necessary to step into leadership – and she quickly found that she could network with opposite numbers in other agencies at a grassroots level…and suddenly transfers could be achieved in around half a day.
This is important learning about how structures can often constrain innovative approaches to getting things done – and that an experience of crisis can create a tendency for systemic working to come to the fore. The challenge, however, is to preserve that learning about systems that arises out of difficult practice, when organisational elasticity tends to see things snap back into place, with bureaucratic structure reasserting itself.
Learning about systems from systems
Over the course of the past six months, I have been in conversation with my colleague and co-thinker Eitan Reich as to how best to help people with systems thinking and practice. This piece is a summary of a longer and more detailed white paper, which can be accessed HERE.
We have generated several foundational precepts in terms of thinking about this challenge:
Crises tend to cause structures to buckle, which has the positive effect of allowing the systemic underpinning of the workplace to become more apparent – and hence more widely applicable.
Seeking to “teach” people about systems at a distance from the systems is too abstract an approach – which will make it feel like an imposition for many leaders.
A useful starting point is to explore people’s recent experiences of crisis, in terms of what they saw happen; what they initially considered doing, and what eventually emerged as a way forward, which may well have been wholly unexpected but needs now to be acknowledged as a different way of working.
Knowingly engaging with the experience of working systemically that arises inadvertently out of extreme circumstances will give people the permission to unlearn traditional leadership thought and practice and to allow a new way of being and doing at work to emerge. For example, the structural mindset requires us to think about directing: to embrace a systemic perspective means that we focus instead of finding ways of connecting.
Next steps?
Eitan and I are now extremely eager to identify a couple of partners who are interested to work alongside us in collaboration to continue this exploration and development of a way of helping people to think and practice more systemically in the public sector. If this is something that you might be interested to discuss with us, please drop us a line at radicalod@colefellows.co.uk and we’ll schedule an exploratory call.
Professor Mahendra Patel OBE: Reimagining the role of community pharmacy
By Samantha Semmeling
ICJ recently spoke to Professor Mahendra Patel OBE, leading pharmacy expert and Director for the Centre for Research Equity at the University of Oxford, about his vision for community pharmacy, and how multi-professional collaboration can help the underutilised sector play a key role in the fight against health inequalities.
Public Policy Projects (PPP) is hosting its inaugural Medicines and Care Pathways theatre as part of the Integrated Care Delivery Forum in 2024. The first iteration of the event took place in Birmingham on 9 May where pharmacy professionals joined wider ICS leadership to discuss pharmacy’s contribution to the integrated care agenda.
Professor Mahendra Patel OBE, Director for the Centre for Research Equity at the University of Oxford, and a recently appointed Independent Expert Member to the UK Professional Pharmacy Leadership Advisory Board (UK PPLAB), joined the theatre and highlighted the untapped potential of pharmacy to further contribute to system priorities.
PPP spoke to Mahendra about the current developments in UK pharmacy leadership, multi-professional collaboration, and the role pharmacy professionals can play in reducing health inequalities.
The evolving landscape of pharmacy leadership
In 2023, Mahendra brought his expertise to the UK Commission on Pharmacy Professional Leadership acting as Vice Chair of the Leadership, Policy and Professionalism working group. The Commission’s report concluded that there is ‘insufficient collective leadership’ for pharmacy in the UK, and that pharmacy professionals are generally disengaged from professional leadership bodies (PLBs).
The findings prompted the Commission to recommend the formation by the Department of Health and Social Care of the UK PPLAB, as an independent public body. The board has since appointed its chair and independent expert members, involving representatives from both PLBs and specialist professional groups (SPGs). The board will be implementing the Commission’s recommendations over the next 3 years, including the development of new arrangements for pharmacy leadership in the UK.
On the formation of the UK PPLAB, Mahendra says: “The new leadership board, through its broad-based range of independent experts from across the four nations, provides a robust and meaningful structure to steer the line of professional pharmacy leadership moving forward. Whether that is a royal college with different faculties, or two or three professional bodies under one umbrella – that’s for the UK PPLAB to decide.”
Equally, it’s an exciting time for community pharmacy with emerging new services and the increasingly advanced roles of pharmacists and pharmacy technicians. However, Mahendra warns of potential hurdles when it comes to determining new leadership structures. “There are going to be challenges when uniting all pertinent groups under one umbrella, as they are all resourced differently and to varying extents,” he adds.
Despite this, Mahendra remains excited and optimistic that “representation in this new setting will inspire and instil a breath of fresh air, so that those often disengaged, including a significant number from the community pharmacy sector, will come to believe that there is something in it for everyone across the pharmacy spectrum. The board creates a whole new arena of expertise, voice, and experience, including the patient and public opinion, making it a unique place to strengthen the present and shape the future.”
Multi-professional collaboration – bringing community pharmacy to the table
Beyond the Commission and implementing its recommendations, Mahendra seeks to help further elevate the role of community pharmacy. Using the Sigma conference in South Africa as a platform, he brought together pharmacy, nursing, medical and dentistry leaders from across the four UK nations to discuss the opportunity for multi-professional collaboration in the newly integrated NHS.
Using the implementation of the Pharmacy First service in England as an example, the session underscored the potential for pharmacy to engage in multi-professional collaboration. The service involves collaborative working across pharmacy and general practice to free up GP appointments and demonstrates untapped value in cross-sector working within primary care.
For example, the NHS Chief Dental Officer speaking at the event outlined exciting possibilities for the role of community pharmacy in preventative dental care, especially in reducing the levels of tooth decay in children – an increasingly pressing issue in the UK over recent years.
Mahendra feels that “community pharmacy can play a huge role in the prevention agenda. If we have the prevention agenda better resourced while we are coping with a shortage of dentists, at least we are considering longer-term perspectives.”
He concludes that the professions within healthcare are “united by providing the highest standards of health and care. They are all talking about the same problems but shout about them separately.” He calls for multi-professional collaboration for the benefit of patients and the public to ensure that health and care professionals are communicating to government with one clear voice.
Addressing health inequalities through research equity – the role of pharmacy
Throughout a diverse portfolio career, working to reduce health inequalities, especially in cardiovascular disease and type 2 diabetes, has been an underpinning focus for Mahendra. As Director for the Centre for Research Equity (CfRE), his work aims to target underserved communities and black and ethnic minorities through championing inclusivity and community engagement in health research.
Decades of work have exposed deep inequalities in the health of the UK population. As Mahendra explains, “we have seen the same results time and time again, as far back as the Black Report, two consecutive ten-year Marmot reviews, and most recently with Public Health England’s COVID-19 Report”. The Health Foundation has also pointed out that health inequalities in England are some of the worst among developed countries and are likely to persist without sufficient intervention.
Mahendra argues that engaging communities who are most impacted is essential if we want to prevent this projected widening of inequality. He stresses the role of research equity is a key piece of the puzzle and the role of pharmacy within this is crucially important.
He uses the case of the drug Clopidogrel, an anti-platelet medication used to prevent heart attacks, as an example. “One study showed that those from Bangladeshi or Pakistani origin were 30 per cent less likely to activate the drug once taken. These populations are those more likely to die of heart attacks compared to the white population.”
Garnering evidence which is generalisable across all populations is essential for reducing health inequality. The CfRE aims to achieve this by ensuring representative and more equitable health research.
Where does pharmacy come in?
Nearly 90 per cent of the population in England can access a community pharmacy within a 20-minute walk, and importantly, the ‘Positive Pharmacy Care Law’ exists, mandating that access to pharmacies increases to 100 per cent in areas of greatest deprivation. This makes community pharmacy a uniquely placed asset to engage with communities where health inequalities are most stark.
NHS England is supporting pharmacy to leverage this position. The recently published Report of a UK survey of pharmacy professional’s involvement in research has spearheaded the formation of a Pharmacy Research Advisory Group to implement the report’s recommendations. These include aims to “embed a research culture in pharmacy careers, develop a clinical academic pathway for pharmacy and provide a pipeline of pharmacy research leaders”.
This, in addition to the recognition provided to pharmacy in supporting inclusive research by the CfRE at Oxford University, a world class academic research institution, and the formation of the UK PPLAB, provides a huge boost for the sector.
Mahendra concludes that this recognition “demonstrates the ability of pharmacy to shift the dial of healthcare in many directions, inspiring the next generation of pharmacy professionals as well as those who may not have previously considered it as a career”.
PPP will be hosting the Medicines and Care Pathways theatre at the Integrated Care Delivery Forum in London on 5 November.
The Integrated Care Delivery Forum connects system leaders with on the ground innovators and industry experts to highlight exactly how ICSs are making place based, personalised care a reality. Rather than discuss issues such as health inequalities in broad framing and terminology, the Forum asks local systems leaders and stakeholders to demonstrate exactly how integrated care systems can affect change in key health and care challenges.
For further information about the Delivery Forum theatres, please contact:
£16m Workforce Wellbeing Programme launched to support NHS staff
By Integrated Care Journal
The co-designed wellbeing programme will run for three years and will be match-funded by NHS England.
NHS Charities Together, the national, independent charity caring for the NHS, has launched a £16m Workforce Wellbeing Programme to support NHS staff across the UK. The programme, which was announced at the charity’s annual member conference for more than 230 NHS charities, aims to improve NHS staff health and wellbeing, in turn making sure patients are provided with the care they need.
NHS Charities Together will commit an initial £6.0152m to support healthcare staff across the UK, with the fund being shared proportionately across the four nations, along with aspirations to fund a further £5 million over the duration of the programme.
In England the independent charity’s contribution will be match-funded by NHS England, which will contribute £5 million to the programme as part of its People Plan to support staff wellbeing.
The Workforce Wellbeing Programme will run for three years, with initiatives co-designed and co-led by NHS staff. Support will be tailored to the individual needs of the NHS organisations and their workforces, supplementing existing support provided to staff.
After a period of co-design with NHS staff, NHS England and others throughout the summer, the charity will invite NHS charities in partnership with their associated NHS Trusts or Health Boards to apply for grants from the Autumn. The impact of projects will be monitored and evaluated so that learnings can be shared and scaled across the UK.
NHS Charities Together has, to date, allocated more than £153 million in funding for projects supporting NHS staff, patients and volunteers. These include counselling services, helplines, and other mental health support services for NHS staff, as well as training for emergency responders and research into long Covid. It has also funded more than 325 community organisations to tackle health inequalities and prevention services.
Ellie Orton OBE, CEO of NHS Charities Together, said: “NHS staff work under immense pressure with unprecedented staff shortages and vacancies and the extra help we provide to support their wellbeing and mental health is now more important than ever. The NHS needs to be able to attract and retain the caring workforce to look after the ageing population and meet the growing needs of the public, who face more complex and long-term conditions than ever before.
“There’s lot of work going on across Trusts to support the wellbeing and mental health of NHS staff but more needs to be done. We’re delighted that NHS England has matched our £5m investment in support across England, and we are also putting proportionate investment across the devolved nations. We have ambitions for this programme to grow so that we can make sure we continue to deliver this important and much-needed support for as long as it’s needed.”
Amanda Pritchard, Chief Executive of NHS England said: “Our hardworking NHS staff are busier than ever but go the extra mile for patients every day, so it’s right that we look to do everything we can as employers to support their health and wellbeing.
“As part of our NHS Long Term Workforce Plan every local employer should have a comprehensive offer for their staff to help them stay well and stay within the health service, but this new programme will support those small, extra improvements which staff tell us will make a big difference to their working lives.
“Charities have played an important role alongside the NHS throughout our 76-year history, and it’s great to take that relationship to the next level with this first-of-its-kind national partnership, with thanks to NHS Charities Together and all those who have donated or raised funds.”
Making a lasting impact
One example of where previous rounds of funding are having a lasting impact on staff wellbeing is expanding and renovating the faith facilities at Royal Bolton Hospital in recognition of the role spiritual wellbeing plays in staff experience and satisfaction.
Revd. Neville Markham, Head Chaplain at Bolton NHS Foundation Trust, said: “The original prayer rooms were no longer adequately serving the needs of hospital staff and patients, so the new facilities have been transformational. Everyone is just so pleased to have the space they always wanted. Colleagues consistently tell us the quality of the faith facilities conveys a powerful message about how the Trust values and cares for them, and that positivity ripples back into the care and services they provide to patients, families and communities.”
Tahira Hussain, Volunteer Chaplain at Bolton NHS Foundation Trust, added: “We live in a fast-paced world. The things you see and experience through the day can take their toll, so having this space gives people chance to take some time out. Visiting for the first time, I actually felt special. The fact that someone had made the effort to provide a facility for me to reflect, to prayer, to connect, makes a massive difference.”
Another example is the Oasis Health and Wellbeing Centre and Garden in Berkshire – a central, vital wellbeing hub for NHS staff. Jointly funded by the Royal Berks Charity and the Royal Berkshire NHS Foundation Trust, and supported by a grant from NHS Charities Together, it offers a range of activities and services aimed at promoting staff health and wellbeing.
Don Fairley, Chief People Officer at Royal Berkshire NHS Foundation Trust, said: “The Oasis Health and Wellbeing Centre and Garden includes a free gym, wellbeing classes and a vibrant green space where staff can relax and unwind. The centre is also used for events to reward and recognise staff and promote inclusivity, recently commemorating International Day of the Midwife and hosting our cultural diversity celebration event.
“The Oasis campus also provides staff health checks and counselling services, which can be a lifeline. One member of staff was able to access invaluable help and understanding and face to face counselling which prevented them from self-harming and potentially going on to take their own life. We’ve seen a 40 per cent increase in positive responses to staff surveys regarding our support for health and wellbeing since the campus opened, with RBFT now proudly one of the top-performing acute NHS Trusts in this area. With over 3,400 staff accessing the centre and garden over 36,000 times in 2023 alone, its role in boosting staff wellbeing, and consequently enhancing patient care, is clear.”
The NHS is to change its procurement criteria for all medical supplies – which is set to save billions of pounds a year.
New guidance will be issued to all NHS Trusts later this year which for the first time will stipulate that patient experience and outcomes must be considered ahead of cost.
The change comes after an 18-month campaign by hygiene and health company Essity to demonstrate that choosing the cheapest incontinence products alone costs the NHS an extra £520,418,989 annually.
Dealing with incontinence. Source: Essity (click to enlarge)
A pilot scheme in Lincolnshire care homes discovered that, despite higher up-front cost, better-quality and more appropriate products save money in the long run.
Patient experience is improved in terms of independence, dignity and relapses, and resources are freed-up as demand on healthcare staff is reduced.
The campaign was driven by Essity in the UK who have met with and presented to multiple MPs who upon seeing the evidence have subsequently then supported the call for change.
The policy change was announced by House of Lords member Lord Philip Hunt, a passionate advocate for Essity’s proposal for Value-Based Procurement (VBP) since meeting with members the company in 2023.
“In announcing the change of policy, Lord Hunt commented: “Who would have thought that the humble absorbent continence pad could have such an impact, so quickly, on something as important as NHS procurement policy and practice – but it shows what can be delivered when a campaign for change is built upon irrefutable evidence that a change will be a win-win for patients, for carers and for NHS and social care providers alike, particularly when it is taken forward in a constructive, cross-party campaign.”
While the change in policy will become guidance for NHS Trusts from this autumn, it will become a mandatory requirement during the procurement process from autumn 2025.
Karen McNamara, business director for Essity’s Health and Medical division in the UK, said: “This is wonderful news for our NHS. Finally, patients can look forward to a better quality of care no matter their illness or condition. Put simply, better quality medical products are more reliable, you need fewer of them, and as a result the associated costs of care are reduced.
“With poorer quality incontinence products, patients were experiencing more leaks and were having to be changed more regularly which not only impacts the dignity for the patient, but for each change a healthcare professional is required and they need disposable gloves, an apron, then linen has to be washed more regularly and very quickly the associated costs add up.
“We have been able to demonstrate how better quality incontinence care products not only improve the lives of patients and the healthcare professionals that care for them but save the NHS money as well. This change in policy is a huge win for patients and for the NHS.”
Symptom-based testing and digital pathway tools combatting delayed breathlessness diagnosis
By Integrated Care Journal
Project in Leicester, Leicestershire and Rutland ICB working to reduce pressure on acute units through improved diagnosis of breathlessness, a symptom affecting around 10 per cent of the UK population.
A new collaboration between Leicester and Hinckley Community Diagnostic Centres (CDCs) and Lenus Health is seeking to digitally transform the breathlessness diagnostic pathway to enhance patient care and streamline healthcare delivery.
Breathlessness is a distressing symptom which affects around 10 per cent of the UK population. It is often notoriously complex to diagnose and can result in long delays to treatment for patients, with over 66 per cent of cases caused by underlying cardiorespiratory diseases.
The project will transform an existing symptom-based care pathway, using digital tools, to reduce delays to diagnosis. It will combine triage, parallel testing and a streamlined, integrated and structured approach to diagnosis data capture. By configuring the Lenus Diagnose pathway product, supplied by Lenus Health, the project aims to evidence significant reductions in time to diagnosis and treatment by bringing in remote specialist input earlier into decision making.
Jim McNair, Director, Lenus Health said: “Breathlessness diagnosis is complex and we are delighted to be working in partnership across Leicestershire healthcare providers to optimise activities and join up data to speed up diagnosis and time to treatment.
“This not only helps the patients themselves but reduces pressure at our hospital front doors because of undiagnosed and untreated disease.”
The project, led by Leicester, Leicestershire and Rutland Integrated Care Board, includes primary care, secondary care and academia to support its implementation. At the forefront of this initiative will be the utilisation of the existing Leicester CDC and the new Hinckley CDC when the latter becomes operational in early 2025, both of which are run by University Hospitals of Leicester NHS Trust. Patients’ test results will be integrated into the pathway aligning with the GP Direct Access guidelines.
Dr Louise Ryan, GP and clinical lead for respiratory illness at Leicester, Leicestershire and Rutland (LLR) ICB, said: “Breathing difficulties affect many patients in our local area and this initiative will help us, in many cases, to diagnose the underlying cause in GP practices, without having to refer patients to secondary care. This will speed up diagnosis for patients and means that they can be treated sooner, without having to visit a hospital.”
Dr Rachael Evans, respiratory Consultant Physician and clinical lead for the existing breathlessness LLR pathway at University Hospitals of Leicester NHS Trust, said: “Our research at University of Leicester shows delays to diagnosis are associated with worse patient outcomes and hospital admissions, and that earlier parallel testing can help. This project has the potential to improve the local situation by effective implementation of the diagnostic breathlessness pathway through the CDC and Lenus software enabling remote earlier specialist input where needed.”
To complement the CDC project, an InnovateUK funded AKT2i project between the University of Leicester and Lenus Health will support, among other activities, evidence generation of the benefits of different interventions.
Dr Gillian Doe, research programme manager and respiratory physiotherapist at the University of Leicester, concluded: “Our team is committed to research in improving the pathway to diagnosis and symptom management for individuals living with breathlessness. The Innovate UK and CDC funding will support the digital optimisation of the Breathlessness pathway in Leicester, Leicestershire and Rutland. We are excited to work in partnership with Lenus and NHS partners to deliver this project.”
The project builds on the Lenus Diagnose product successfully implemented in Heart Failure, wider CVD, and COPD pathways where it has significantly reduced time to diagnosis and treatment and delivered service efficiencies to the healthcare system.
Hep C U Later offers new resources to help eliminate hepatitis C
By Integrated Care Journal
The national elimination campaign is now looking for the estimated 70,000 people living with untreated hepatitis C.
Hep C U Later has been commissioned by NHS England to provide resources to help encourage testing among patients, to provide information to the public and update knowledge among clinical teams.
NHS England’s successful national elimination programme for hepatitis C has so far seen over 80,000 people found and treated through extensive work within drug and alcohol services and other areas of healthcare such as emergency departments. The elimination programme is now seeking to find the estimated 70,000 remaining people believed to be living with hepatitis C.
Risk factors for Hepatitis C can include:
Sharing equipment for injecting drugs
Having a blood transfusion prior to Sept 1991
Had a piercing, tattoo, or acupuncture using unsterilised equipment
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