A People Powered NHS – A call to all health leaders

By Dr Allison Smith

Dr Allison E Smith, Director of Research & Insight at the Royal Voluntary Service discusses the key role that volunteers can play in delivering on core NHS goals.

The Prime Minister’s speech on 11th September 2024 pledged that this would be the ‘biggest reimagining of the NHS since its birth’. Hence, as we reflect on the plan for the future, we should challenge ourselves to think differently and work in ways which prioritise patient care and staff wellbeing. We should be bold and ambitious as the founders of NHS were in 1948.

In the original blueprint of the NHS, it was always intended to be a partnership between the state, the citizen and their communities. Public participation in the NHS e.g. via volunteering, informal carers and patient groups, has always played a vital role in the delivery of better health care. But in many ways, public involvement is a postcode lottery – a few areas do it really well, some do it (not well), and others have nothing. From the perspective of a volunteer-involving charity like Royal Voluntary Service – who have been supporting the NHS since before it was even founded – it is hard to get volunteering truly embedded in healthcare delivery. It still feels as if we are on the outside looking in or ‘pushing water uphill’. The purview of ‘integration’ appears largely limited to that of the NHS with social care.

With the public consultation on the 10-Year Health Plan, now is the time to rethink how the NHS – and wider healthcare system – works collaboratively with the public for the common good. System leaders need to stop putting up barriers to public participation and think ‘how can I build inclusive blended teams of staff and volunteers?’. Leaders should be embracing and nurturing the public interest and love for the NHS; 66 per cent of those signing up for the NHS and Care Volunteer Responders programme do so because they ‘want to support the NHS’.¹

The business case – in terms of the impact of volunteers on the NHS and wider healthcare system – we feel has been made.² The NHS and Care Volunteer Responders (NHSCVR) programme – first launched during the pandemic – has continuously proved its effectiveness, from driving system efficiencies to better patient care, workforce recruitment, and staff morale. For system leaders and frontline staff that embed NHSCVR within their local delivery there are big gains to be had.

For those unfamiliar with NHSCVR, this programme is a unique partnership between a charity (Royal Voluntary Service), a public service (NHSE) and a tech company (GoodSAM). It can match, via an App in real-time, requests for support from staff or patients with members of the public that can lend a hand. The programme is a key auxiliary service supporting the NHS and patients to expedite patient discharge, provide practical support to patients at home, deliver equipment for virtual wards, and provide support to ambulance crews waiting outside A&E. It is a free resource for local areas, is NHS approved, and can provide a critical safety net to mobilise volunteers at scale at times of high demand on the system.

In the past four years the programme has achieved significant scale; more than 2.6 million activities have been delivered in support of patients and the NHS, 221,000 individuals have been supported, and over 1 million members of the public responded. And while these numbers are indeed impressive, on the ground in local areas the programme delivers significant benefits for the system, staff, and patients – see table below.

The data also finds that those who volunteer report higher wellbeing. In a 2021 study by the London School of Economics, those that volunteered experienced statistically significant higher wellbeing compared to those who did not volunteer, and this wellbeing impact lasted for at least 3 months.⁶

This article is a call to all NHS system leaders; the breadth of impact – from this programme – plus others (see Helpforce) surely warrant the immediate integration of volunteers in NHS ‘BAU’, and centre stage in our reimagining of the NHS over the next 10 years.

Royal Voluntary Service will be attending the Integrated Care Delivery Forum in London on the 5th November.

For more information or to connect with a member of our team, please reach out to your Regional Relationship Manager. Contact details are available at nhscarevolunteerresponders.org.

References

¹ NHSCVR baseline survey, n=8481)

² See King’s Fund 2018 Views from the Frontline, Helpforce, 2020, Volunteer Innovators Programme

³ Programme data & Volunteer Annual Survey March, n=6302

⁴ Staff Annual Survey October 2024, n=345

⁵ Client/Patient Survey June/July 2024, n=687

⁶ https://blogs.lse.ac.uk/covid19/2021/06/02/happy-to-help-how-a-uk-micro-volunteering-programme-increased-peoples-wellbeing/

10-Year Health Plan must address cancer care failings identified by Darzi

By Gabriel Blaazer

From improving access to care and diagnosis to addressing treatment delays, Lord Darzi’s recent independent investigation highlights the complex web of challenges facing the NHS. In doing so, it also offers a series of starting points for the upcoming 10-Year Health Plan to address.

Cancer remains one of the leading causes of avoidable death in the UK, and despite improvements in survival rates over the past decades, the country still lags behind others in cancer care. Lord Darzi’s recent independent investigation into the NHS in England offers a comprehensive review of the current state of cancer treatment within the NHS and points to several factors that have contributed to its struggles. These include funding constraints, the aftermath of the Covid-19 pandemic, and systemic issues within healthcare management.

Using the failings identified by Lord Darzi as a basis, the upcoming 10-Year Health Plan for the NHS has the chance to radically transform cancer care provision in the NHS.

Rising cancer waits and slowing survival rate improvements

Cancer cases in England have steadily risen, increasing by approximately 1.7 per cent per year from 2001 to 2021. When adjusted for age, the rise is still significant at 0.6 per cent annually. This translates to around 96,000 more cases in 2019 than in 2001. Although survival rates for one-year, five-year, and ten-year intervals have improved, the rate of improvement slowed considerably in the 2010s.

The UK also continues to record substantially higher cancer mortality rates than its peers. International comparisons show the country falling behind not only European neighbours but also the Nordic countries and other English-speaking nations. While survival rates have inched upwards, “no progress whatsoever” was made in early-stage (stage I and II) cancer detection from 2013 to 2021. However, this has recently changed, with detection rates improving from 54 per cent in 2021 to 58 per cent by 2023, partly driven by the success of the targeted lung health check programme. This initiative has helped identify more than 4,000 cases of lung cancer, with over 76 per cent caught at stage I or II, significantly boosting early intervention efforts.

Nonetheless, challenges remain in treatment selection, particularly for brain cancer patients. While genomic testing, critical for tailoring treatments, is now more widespread, only five per cent of eligible brain cancer patients can access whole-genome sequencing. A recent Public Policy Projects (PPP) report has highlighted the inequalities in access to genomic sequencing. Moreover, turnaround times for genomic tests – only 60 per cent of which are processed on time – further hinder timely treatment for many patients.

Access delays and missed treatment targets

One of the key areas within the Darzi investigation is the NHS’ ongoing struggle to meet its cancer treatment targets. The 62-day target from referral to the first treatment has not been met since 2015, and as of May 2024, only 65.8 per cent of patients received treatment within this window. Similarly, over 30 per cent of patients now wait more than 31 days for radical radiotherapy, reflecting growing delays in critical care pathways. Given the importance of timely cancer treatment, the upcoming Plan must consider how to reduce delays in access to treatment.

While the number of cancers diagnosed through emergency presentations has decreased, with the percentage falling from nearly 25 per cent in 2006 to under 20 per cent in 2019, access to primary care services continues to be “uneven”. This affects the timeliness of cancer referrals, especially as the proportion of patients waiting more than a week for a GP appointment rose from 16 per cent in 2021 to 33 per cent per cent by 2024. Darzi notes that declining access to general healthcare services directly reduces the likelihood of timely cancer detection and treatment.

The drivers behind performance issues

Several factors have compounded the challenges facing the NHS’s cancer care system, as identified by Lord Darzi, which the 10-Year Health Plan must seek to address:

Austerity and capital starvation: Funding restrictions and limited capital investments over the past decade have led to under-resourced healthcare infrastructure, making it difficult to accommodate growing patient demand. The underinvestment in estates and facilities is also preventing the NHS from making full use of diagnostic advancements; in many cases, hospitals may be able to purchase new state-of-the-art diagnostic and imaging equipment, but not have a suitable site in which to use it. PPP has explored this topic in detail in a previous report.
Covid-19 pandemic: The pandemic severely disrupted healthcare services, creating a backlog of cases and delaying non-Covid-related care, including cancer treatments. Although efforts have been made to prioritise long-waiting patients, the effects of the pandemic still ripple through the healthcare system, contributing to worsened performance.
Lack of patient voice and staff engagement: The investigation highlights that the perspectives of both patients and healthcare staff have often been overlooked in decision-making processes, resulting in management structures that are out of touch with the realities on the ground. A more engaged and responsive system would likely yield better outcomes. The need for coproduction was reiterated at PPP’s recent Cancer Care Conference, and is increasingly being recognised in Cancer Alliances’ health inequalities strategies.
Management structures and systems: The report also points to inefficiencies within the NHS’ management structures. These systems are often seen as bureaucratic, which slows down decision-making and the rollout of new treatments. Disparities in the adoption of new systemic anti-cancer therapies highlight these inefficiencies, as some regions wait over a year for access to drugs approved by NICE, while others see the same drugs introduced within a month. This inequality in access to drugs is a key driver of the postcode lottery that is seen in cancer care.

The importance of early diagnosis and screening

A clear priority identified by Lord Darzi is the need for more effective early diagnosis strategies. Cancers detected at stages I and II are much more treatable, and early intervention is strongly associated with better survival outcomes, as well as substantially lower treatment costs. Darzi notes, however, that progress in this area had been stagnant until recent years, with no gains between 2013 and 2021. The improvements seen in early-stage detection from 2021 to 2023 offer hope, but Darzi cautions that further efforts are needed.

The 10-Year Health Plan must also seek to address the UK’s lack of CT and MRI scanners relative to other comparative companies – a major inhibitor of greater diagnostic capacity in the NHS.

Screening participation rates have also declined, with breast and cervical cancer screening coverage falling since 2010. Yet there are signs of promise. For example, the bowel cancer screening programme has been highly successful and provides a model that could be replicated for other types of cancer.

However, hopes for improved early diagnosis cannot rely solely on the establishment of national screening programmes. Poor levels of health literacy, particularly among underserved communities, must also be addressed to ensure that people know which signs and symptoms to be aware of, and to seek treatment if necessary.

More sophisticated treatments but growing delays

The development of more sophisticated treatments is a key area of progress, but the availability of these treatments is often constrained by capacity issues. While the NHS is a world leader in incorporating genomic testing as part of routine cancer care, delays in processing these tests and long waiting times for treatments like radiotherapy undermine their potential impact and can lead to poorer outcomes.

As Darzi points out, “turnaround times are poor… [which] can delay the start of treatment,” especially when coupled with the system’s failure to meet its 62-day target for referral to treatment. In a healthcare system already stretched by rising demand and workforce shortages, delays in treatment can make the difference between life and death for many cancer patients.

Addressing the challenges ahead

Lord Darzi’s investigation underscores the critical need for systemic reforms within the NHS to address the growing cancer burden. From improving access to care and speeding up diagnosis to addressing treatment delays, the report highlights the complex web of challenges facing the NHS. In doing so, it also offers a series of starting points for the upcoming 10-Year Health Plan to address.

While recent advancements in genomic testing and early detection programmes offer hope, the NHS must tackle its systemic inefficiencies, funding shortfalls, and management issues if it is to close the gap with its international counterparts and improve outcomes for cancer patients.

For more information about PPP’s Cancer Care Programme, or to request further discussions, please contact: Rachel Millar, Programme Lead for Cancer Care: rachel.millar@publicpolicyprojects.com

Dr Chris Rice, Director of Partnerships for Cancer Care and Life Sciences: chris.rice@publicpolicyprojects.com

Bridging language gaps could be crucial for safer maternity care

By Dr Rachael Grimaldi

Dr Rachael Grimaldi, a practicing anaesthetist and co-founder & CEO of the healthcare translation app CardMedic, has witnessed first-hand the critical need for language support within the NHS. Following the CQC’s review of maternity services, she delves into the alarming normalisation of harm in maternity services and how communication barriers contribute significantly to this concerning issue.

The CQC’s review of maternity services published recently has highlighted how quality and safety across England are suffering. Patients don’t feel listened to, people with poor English report much worse experiences of care and accessing interpreting support can be a challenge. What’s more, harm in maternity services seems to be being normalised and communication barriers play a significant part in this.

Technology as a bridge for the language gap

Many people are doing excellent work to break down communication barriers, but we need action and accountability to prevent harm in maternity services. Staff need access to interpretation and translation support 24/7 to provide good quality patient care. Technology can help, it’s here and it’s working.

Communication issues are rife across the NHS, yet access to interpreting services can be challenging, even when this is directly linked to devastating outcomes. As midwife and inclusivity champion Maria Rowntree has found, pregnant people who don’t speak English are 25 times more likely to die in NHS maternity care.

The statistics cited by Maria Rowntree are alarming. This statistic alone should be a wake-up call for the entire healthcare system. It highlights the urgent need for accessible, reliable and culturally competent language support services.

Effective communication is essential for providing safe maternity care

One of the most concerning aspects of the CQC review is the normalisation of harm within maternity services. When adverse events and poor patient experiences become accepted as an inevitable part of the system, it is a clear indication that fundamental changes are needed. This normalisation is particularly dangerous in a setting where clear communication is literally a matter of life and death.

Effective communication is essential for providing safe and high-quality maternity care. It is the foundation upon which trust, understanding and informed decision-making are built. When language barriers exist, this foundation is compromised and the risk of misunderstandings, missed critical information and ultimately, harm, increases significantly.

Even though the NHS has tried to offer interpretation services, getting access to them is still a major struggle for a lot of people. Interpreters may not be available when needed, or the quality of interpretation may be inadequate, leading to crucial information being lost in translation.

Technology can play a crucial role in addressing these communication barriers. Digital translation and interpreting solutions like CardMedic can provide immediate access to professional interpreters and accurate translations, bridging the language gap and ensuring that every patient receives the care they deserve, regardless of their language proficiency.

However, technology alone is not a panacea. It must be accompanied by a broader cultural shift within the healthcare system, one that prioritises effective communication and recognises it as a fundamental aspect of patient safety and quality care.

The call for a maternity commissioner and accountability

We support the call for a maternity commissioner to bring much needed accountability and to address the issues raised in the report. And while NICE guidance says that reliable interpreting services should be available when needed, we support Maria’s call to make communication a protected characteristic within healthcare. Organisations have to take communication challenges seriously. These shameful events have to stop.

The findings of the CQC review are deeply troubling, but unfortunately not surprising to those working on the frontlines of maternity care. For too long, communication barriers have been an unaddressed issue, leading to preventable harm and tragic outcomes. It is a systemic problem that requires urgent attention and comprehensive solutions.

A maternity commissioner is a step in the right direction, as it can bring much-needed accountability and oversight to address the issues raised in the CQC review. However, this must be coupled with a commitment to investing in language support services, training healthcare professionals in cultural competency, and fostering an environment where communication barriers are not only acknowledged but actively addressed.

Seizing the opportunity for systemic change

Ultimately, the normalisation of harm in maternity services is a symptom of a larger systemic issue – the failure to prioritise effective communication as a cornerstone of patient care. By recognising communication as a protected characteristic within healthcare, as Maria Rowntree suggests, we can begin to shift the paradigm and ensure that every patient, regardless of their language proficiency, receives the high-quality, compassionate care they deserve.

CardMedic works with maternity teams nationally to provide a highly effective digital translation and interpreting solutions to hospitals across the country. Like them, we are deeply concerned to see the results of this review.

The events highlighted in the CQC review are indeed shameful, but they also present an opportunity for meaningful change. By addressing communication barriers head-on, investing in language support services, and fostering a culture of accountability and patient-centred care, we can work towards a future where harm is no longer normalised, and every patient’s voice is heard, understood, and respected.

How EDI can support NHS staff by creating a psychologically safe environment

By Dr Melissa Carr

In the face of increasing pressures, equality, diversity and inclusion offers NHS managers a pathway to foster supportive, inclusive environments that allow healthcare workers to thrive and patients to receive better care, writes Dr Melissa Carr for ICJ.

An ageing population with complex needs. Long waiting lists and over-stretched services. Disengaged and demotivated staff. The recent Darzi report highlighted in grim detail the challenges facing the NHS.

With healthcare workers on the front line under huge pressure, it’s unsurprising to see high rates of burnout, stress and staff turnover.

With the Long Term Workforce Plan predicting a potential shortfall of between 260,000 and 360,000 NHS staff by 2036/37, retaining an engaged workforce is an organisational priority.

One crucial solution lies in the training and development of NHS managers who are equipped to lead teams within this challenging environment.

By using Equality, Diversity and Inclusion (EDI) practices, managers can create psychologically safe environments where team members can ask questions, raise concerns, admit mistakes and suggest improvements without fear of negative consequences.

How a culture of psychological safety can improve outcomes for staff and patients

Think back to a time when you worked in a team where finger-pointing and blame was the default. How would you have felt about reporting a mistake? Or suggesting a better way to do something?

Creating a safe workplace where colleagues can raise issues and share best practice is essential within any healthcare setting. As previous failings of care, and the inquiries that followed them show, toxic cultures can silence legitimate concerns.

EDI practices enhance and enable psychological safety in teams. The NHS equality, diversity and improvement plan highlights the importance of managers that can model inclusive leadership behaviours, guard against workplace bullying and discrimination, and create channels through which staff can speak up and highlight problems.

What research into psychological safety tells us about failure

More than 20 years of research has found that organisations with higher levels of psychological safety, often achieved through the implementation of EDI practices, consistently achieve better outcomes.

They don’t just protect staff from discrimination, stress and burnout. They can also have a transformative effect on how teams function.

Professor Amy Edmonson, who pioneered the idea of team psychological safety in the 1990s, discovered something interesting during her early research. Edmonson examined the relationship between error making and teamwork in hospitals but, rather than showing that more effective teams made fewer mistakes, the results found the opposite. Teams who reported better teamwork apparently experienced more errors.

A dive into the data explained why. It established that more effective teams reported more mistakes because they talked openly about them. It can feel challenging to hold your failures up to the light, but it’s the most effective way to troubleshoot systematic errors and drive positive change.

As a practical guide to improving patient safety culture published by the NHS in 2023 confirmed, team environments that allow for ‘intelligent failures’ which lead to reflection and improvement usually achieve the best patient safety outcomes. Psychological safety provides the environment in which this can work effectively.

As Amy Edmonson says: “Psychological safety is not about being nice. It’s about giving candid feedback, openly admitting mistakes, and learning from each other.”¹

How integrated care systems can support safer workplaces

Within a culture of robust psychological safety and leaders trained in EDI processes, teams can openly challenge the status quo and flag fixable mistakes. Importantly, they are also empowered to suggest innovations that can improve the systems they work within.

One of the key functions of integrated care systems (ICSs) is to identify pockets of best practice across services and provide a platform where they can be widely shared. The repository of case studies on the NHS England website is a treasure trove of success stories – from social prescribing initiatives to fast-tracking cancer diagnoses by using AI.

ICS leaders must continue to create open channels for feedback. These help to foster team collaboration and trust, encouraging a no-blame culture, and shared aims and ambitions.

In a culture of collaboration rather than competition, this focus on knowledge-sharing encourages learning and improvement at all levels.

Using EDI practices to ensure psychological safety

Individual managers can make a big difference to their immediate teams but change on a larger scale can’t happen without clear organisational frameworks.

Equality, diversity and inclusion practices go hand in hand with psychologically safe workspaces. They provide the safety nets and support networks which allow people of all ages, ethnicities, sexualities and genders to share their lived experiences and raise concerns. They also work to erase the bullying and discrimination that makes workplaces fundamentally unsafe and silence the voices of staff.

In an organisation as multi-layered, complex and hierarchical as the NHS, inclusivity must be prized as highly as productivity. This means that everyone is given a platform to speak up, no matter their discipline, experience level or pay grade.

EDI frameworks aren’t a silver bullet for the complex issues facing the NHS. But they can tackle the significant problem of staff disengagement and enable a culture where diversity of thought is prized.

Empowering managers to lead teams

Psychologically safe workplace are as important to staff wellbeing as they are to patient safety. When employees feel valued, supported and – crucially – listened to, they experience lower levels of stress and burnout.

At Henley, we recognise that inspiring leaders can make a huge difference. That’s why we’ve partnered with NHS England to launch the first cohort for NHS colleagues pursuing careers in EDI.

Professionals at the beginning of their leadership journey, with no more than three years of experience within a management role, will learn the skills to create positive, inclusive and transparent working environments for their teams.

Dr Melissa Carr, Director of EDI at Henley’s World of Work Institute

Council of Deans of Health announces the Digital Summit 2025

By Integrated Care Journal

This content was published in partnership with the Council of Deans of Health

The Council of Deans of Health is delighted to announce the Digital Summit 2025, set to take place at Woburn House in London. This prestigious event will convene leaders from the healthcare higher education sector to explore and address the challenges and opportunities presented by the digital age.

The summit will delve into the transformative impact of artificial intelligence (AI) and other technological advancements on healthcare higher education and research. Attendees will have the unique opportunity to hear from esteemed speakers, engage in dynamic panel discussions, and participate in thought-provoking conversations. The event is designed to foster collaboration and highlight innovative solutions poised to revolutionise healthcare delivery and education.

Throughout the Summit, healthcare educators, innovators, and partners will collaborate to address pressing issues and learn how to effectively implement digital solutions that support the health and care workforce while enhancing services for individuals seeking health and care.

The Digital Summit will examine the future of healthcare higher education in the era of digitisation and AI, focusing on the impact of AI on education, research, health services, and the broader healthcare system. Guided by leading experts, attendees will gain valuable insights into the latest developments and engage in discussions on critical questions facing the sector and society.

Confirmed speakers

Professor Sultan Mahmud, Director of Healthcare, Business, BT Group PLC
Professor Neil Maiden, Director of CebAI, the National Centre for Creativity enabled by AI at City, University of London, and Chief Product Officer at JECT.AI
Michael Webb, Director of AI, JISC
Helen Balsdon, Interim CNIO, NHS England

Key topics to be discussed

Benefits, opportunities and challenges of AI
Research and evidence surrounding AI
Regulation of AI
Advances in simulation and digital pedagogical methods

Target audience:

Senior strategic leaders from the healthcare higher education sector
Professors and researchers
Senior government officials
Representatives from regulatory and professional bodies

Join us at the Digital Summit 2025 to be part of the conversation shaping the future of healthcare higher education. For more information and to register, please visit this link.

Contact: If you have any questions, please email events@cod-health.ac.uk.

NHS-backed study shows 73% reduction in GP waiting times using AI triage system

By Integrated Care Journal

An independent, NHS-funded evaluation has validated the transformative impact of an AI-powered Smart Triage system on primary care delivery in England.

The Groves Medical Centre, a leading family GP practice in Surrey and South West London, has achieved unprecedented improvements to patient access, practice capacity and sustainable staff working patterns after implementing Smart Triage.

Smart Triage, an AI-powered autonomous patient triaging system developed by health technology company Rapid Health, was implemented at The Groves Medical Centre in October 2023. The system has transformed patient access, enabling equitable and safe care based on clinical need rather than on a first-come-first-served basis.

An independent real-world evaluation, funded by Health Innovation Kent Surrey Sussex – one of 15 health innovation networks across England – and conducted by Unity Insights, has measured the impact of autonomous patient triage between October 2023 and February 2024. The evaluation assessed the system’s acceptability, implementation, effectiveness, and impact on health inequalities.

Key findings of the evaluation include:

Patient waiting times reduced by 73 per cent, from 11 to 3 days, for pre-bookable appointments
The practice had 47 per cent fewer phone calls at peak hours, with a 58 per cent reduction in the maximum number of calls, all but eliminating the “8am rush”
Same-day appointment requests fell from over 62 per cent to 19 per cent, significantly expanding the capacity for pre-bookable appointments
70 per cent fewer patients needed a repeat appointment, having received the right care on their first visit
85 per cent of appointments booked via the new system were delivered face-to-face, a 60 per cent increase compared to the pre-implementation period
Only 18 per cent of all patient requests were initiated over the phone after the system was implemented versus 88 per cent prior to it being implemented
91 per cent of appointments were automatically allocated without staff or clinical intervention

These changes have culminated in a better overall experience for patients at The Groves Medical Centre. GPs now spend 15 minutes with patients, rather than 10 – a 50 per cent increase. Additionally, the practice has achieved an 8 per cent increase in the number of appointments delivered per working day without hiring additional staff. Patients now have a wider selection of appointment slots to choose from, with an average of 61 slots available per patient appointment request. This has resulted in a 14 per cent reduction in patient no-shows, despite the practice already maintaining low DNA (did not attend) rates.

In contrast to traditional online consultation and triage tools that only collect information, Smart Triage fully automates the patient navigation process from the initial contact with their GP practice. Whether requesting care online, by phone, or in person, patients are guided through a series of questions based on their concerns. The system then assesses their symptoms and directs the patient to the most suitable care, even enabling immediate self-booking into the right appointments. This streamlined process empowers patients to access care at their convenience while relieving the practice from direct involvement in each request. This is the first time a study has proven an autonomous clinical system is safe and effective in doing this process end to end.

Dr Andrea Fensom, GP Partner at Groves Medical Centre, remarked: “Smart Triage has completely changed how we work. It has not only optimised our resources but increased patient access. Feedback shows that patients find it easy to use our online tool and it’s convenient for them, giving them multiple options for appointments where safe to do so and booking them with the most appropriate clinician for their problem. We are all very proud of these results.”

Jake Kennerson, Group Manager at Groves Medical Centre, added, “The positive outcomes we’ve seen in such a short period are a testament to the effectiveness of this innovative system. There’s been a significant decrease in the number of patients requiring same-day appointments and wait times have been drastically reduced. All of this change was achieved during the peak winter months and without any additional staff. If others were to adopt a similar approach, it could lead to transformative results for patients and the NHS as a whole”.

Carmelo Insalaco, CEO of Rapid Health, expressed his pride in the system’s success: “We’re really proud to see the extraordinary impact of autonomous patient triage at The Groves Medical Centre. These results reflect what we consistently observe with our customers across the country – the remarkable potential for Smart Triage to dramatically enhance patient access and choice, while solving the persistent challenges of lengthy waiting lists and disruptive morning bottlenecks. We look forward to further collaboration and expansion across the wider NHS to benefit more patients and healthcare providers”.

By implementing the software, GP practices and Primary Care Networks (PCNs) can improve patient access, reduce workload, unlock capacity and manage patient demand more effectively. With better access for patients online, call volumes are reduced and peaks in demand can be smoothed out, eventually eliminating the ‘8am rush’. This ultimately enhances and automates the Modern General Practice Access Model which was introduced by NHS England last year.

Greater Manchester lauded for approach to population health

By Integrated Care Journal

A new report from the King’s Fund had praised Greater Manchester’s progress on improving population health, emphasising the importance of addressing the wider determinants of health.

The King’s Fund has praised Greater Manchester for its work improving key measures of health and health inequalities. The influential national charity has called Greater Manchester “the poster child for devolution” in England and has recognised the time, effort and resources put in place helping people to live good lives, improve wellbeing and prevent illness.

The new report, published this week, shows how health is influenced by wider determinants such as high‑quality and secure housing, a good job and a healthy environment. It highlights the vital link between health, and the communities we live in as well as the value in aligning strategies to ensure improvement of both the economic and health status of the population.

Since 2015, Greater Manchester has had a wide-ranging devolution deal with Government on health which has led to improvements in life expectancy and other measures (see here for information). Greater Manchester’s model was integral to the creation of statutory integrated care systems in 2022 with improving outcomes in population health and health care a key aim.

The King’s Fund report reiterates the importance of population health being a core goal of integrated care systems and the value in different government departments below the national level working more closely together, including at mayoral level. It underpins Greater Manchester’s ‘live well model’ that aims to transform the relationship between work and health.

While this new publication recognises the financial challenges that the NHS and other public sector organisations face, it makes the case for continuing with a population health approach and the strong evidence that improvements in health can have for the economy at large.

Andy Burnham, Mayor of Greater Manchester and NHS Greater Manchester Integrated Care Partnership co-chair, said: “Greater Manchester’s health devolution journey has a simple but fundamental principle at its heart: that more local decision-making can deliver better outcomes for people.

“This report from the King’s Fund sets out clearly the wider social factors that impact people’s health and wellbeing, but also the power of devolution to draw the connections between those issues and tackle them systematically.

“That is the strength of our devolved approach, and the mission of the new Live Well service that we want to pioneer here in our city-region. There are still challenges and pressures that we face. But we’ve made progress already, including on healthy life expectancy, and by bringing together partners and joining up the support offer for residents – whether that’s health and social prescribing, housing advice, or employment support – we can deliver better, more efficient public services, and improve people’s life chances.”

Jane Pilkington, Director of Population Health for NHS Greater Manchester Integrated Care said: “The King’s Fund spotlighting Greater Manchester as leading the way in population health is pivotal to re-emphasise the important role the NHS plays in improving the health and wellbeing of residents, by focusing on preventing ill-health in the first instance rather than just treating sickness, as well as relentlessly working to reduce health inequalities.

In Greater Manchester we need to continue to work together with communities and the voluntary sector, local government, and the NHS to help create a place where everyone can live a good life, growing up, getting on and growing old in a greener, fairer more prosperous city-region – focusing on improving both the health and economic circumstances of our residents.”

News, Thought Leadership October 9, 2024

Lord Hunt: Wound care is pivotal to “tackle some of the malaise in the NHS”

By Fredrik Matre

Public Policy Projects’ (PPP) Ameneh Saatchi sat down with long-standing ally, the Rt Hon Lord Hunt of Kings Heath OBE, former President of the Royal Society for Public Health and newly appointed Minister for Energy Security and Net Zero. Having been an early and vocal supporter of PPP’s Wound Care Programme, Lord Hunt discussed with Saatchi how his campaigning has informed the mission to bring wound care reform up on the political agenda.

PPP is continuing its 2024 Wound Care Programme following a successful inaugural year. Their 2023 Insights Report, Going further for wound healing, was endorsed as “excellent” by Lord Hunt, who described it as “essential that Government and the NHS take note and act on the report’s recommendations.” With the new government working to enact its legislative agenda, we reflect on Lord Hunt’s desires for wound care reform and how PPP’s Wound Care Programme is facilitating the necessary discussions about how to build a consistent national experience of wound care.

Recently appointed Minister for Energy Security and Net Zero, Lord Hunt served as President of the Royal Society for Public Health from 2010 to 2018. In 2017, he put wound care on the parliamentary agenda when he called for a debate to ask the government for its plans “to develop a strategy for improving the standards of wound care in the NHS”. He continued his advocacy for wound care reform even after his presidential tenure at the Royal Society of Health, being an early supporter in the establishment of PPP’s Wound Care Programme.

Now in its second year, PPP’s Wound Care Programme is building on last year’s success, further challenging the status quo in wound care provision. Ahead of the Wound Care 2024 Conference, we look back at the conversation between the Director of PPP’s Wound Care Programme, Ameneh Saatchi, and Lord Hunt, discussing what is needed to secure political buy-in for wound care reform.

Need for political recognition

Having raised the issue of wound care in the House of Lords in 2017, Lord Hunt has since pushed for greater recognition of wound care from NHS leaders and policymakers. A lack of political will from the previous government has led to inaction in improving wound care provision.

“If ministers or the top of NHS England are convinced that dealing with wound care would be one of the ways to improve the efficiency and effectiveness of outcomes of the NHS, then they will devise the method by which you do it. But I don’t think there’s any evidence that they believe that”.

A focus for Lord Hunt in the run up to the general election was to elevate wound care on the political agenda. While Saatchi’s suggestion to establish an NHS England National Clinical Director for wound care is welcomed by Lord Hunt, he argues further that establishment of such a role “is less important than whether you have some political direction or direction from the top of NHS England” convinced of the need to tackle wound care.

The National Wound Care Strategy Programme was set up to provide such direction, though its continued operation is under fiscal scrutiny and buy-in from NHS leaders is required to act on its recommendations. Without such direction, insufficient attention is paid to how wound care is provided across the NHS, leading to major inefficiencies.

“The evidence is pretty convincing that we do a pretty poor job now, [and] that there is enormous cost to the NHS, because we don’t deal with wound care properly.”

The problems don’t necessarily lie in a lack of solutions; “we know what to do,” says Lord Hunt. Rather, he insists, it requires buy-in from government and the NHS to recognise the need to reform wound care.

‘Big spenders’ in health

Lord Darzi’s recent Independent Investigation of the National Health Service in England found that “the NHS budget is not being spent where it should be”. PPP’s Insights from 2023 Wound Care report was accepted as evidence by Lord Darzi. Wes Streeting has committed to being “honest about the problems the NHS faces and serious about fixing them”. Lord Hunt is conscious that the Health Secretary would likely welcome the identification of “a limited number of clinical areas where you could have a big impact on outcomes and finances”. Wound care, he argues, is just such an area.

Lord Hunt emphasises that “one of the ways to tackle some of the malaise in health is to tackle some of these ‘big spenders’ in health”. With 67 per cent of wound care expenditure spent on unhealed wounds, a focus on prevention and early intervention (echoing Labour’s desire for a “prevention first” approach) could make significant savings in costs avoided. Lord Darzi echoes Hunt’s sentiment that “that many of the measures needed to tackle the current malaise are already well known” and what is needed is implementation rather than invention.

By tackling particular clinical areas — with wound care seen by Lord Hunt as an obvious candidate — “in a cohesive way”, major savings can be made, simultaneously improving patient outcomes in a consistent manner across the country. Wound care is, in fact, an NHS ‘big spender’: it’s the third biggest clinical expense across the NHS, only after cancer and diabetes. Health economists have calculated that patient management cost for chronic wounds increased by 48 per cent in real terms between 2012/13 and 2017/18. Since wound care happens across systems (though predominantly in community settings), joined up working for integrated care could improve patient experiences and potentially streamline resource use.

Of the £8.3 billion spent by the NHS on wound management in 2017/18, 67 per cent was spent on managing unhealed wounds. The Prime Minister made it clear in his response to Lord Darzi’s investigation that there will be “no more money without reform”. If wounds are seen to quickly and treated according to standardised best practice, the need for longer and more complex treatment in future can be prevented. While only six per cent of NHS wound care expenditure goes towards treatment products, more than 70 per cent is associated with nurse, doctor, or healthcare assistant visits. Savings here would therefore be both fiscal and temporal, freeing up valuable workforce capacity.

Coalition-building

Wound care is currently, by virtue of affecting patients with a wide range of ailments, underrepresented in patient advocacy. Patients with chronic wounds can be found across health and care settings and are represented by many condition-specific charities. Yet, the lack of an overarching voice to represent wound care patients hinders efforts to bring about policy change. Lord Hunt notes that there is no all-party parliamentary group for wound care and sees the need for a “wound care alliance” representing the estimated 4.6 million people in the UK living with a wound, to rally political attention.

“Building an alliance is one way to get a better voice and also to get some outside external people, prominent external people to perhaps [come onto] the board of trustees or something like that.”

To elevate wound care on the political agenda, Lord Hunt envisages the need for “an alliance of charities looking at it from the point of view of the patient and their family, starting to ask questions about poor outcomes.” PPP is taking on Lord Hunt’s challenge, convening stakeholders to form a “wound care alliance” at its upcoming Wound Care Conference in London on 2 December.

Convening such stakeholders as the Queen’s Nursing Institute, the European Wound Management Association, the Society of Tissue Viability, the Royal College of Podiatry, the Lindsay Leg Club Foundation and more, the future of wound care is being discussed at PPP events with patients alongside. While it’s the patients that Lord Hunt wants to foreground, there are pertinent questions about “how much can be patient-led”.

With a myriad of “quite small charities that have usually been set up by relatives of people affected by a particular condition,” it can be hard to present a cohesive message reflective of diverse experiences. But these patients deserve a voice and should inform the future of wound care, given their lived experience.

The way forward for wound care action

Lord Hunt has been a wound care advocate for many years, and that is unlikely to change. Having “trod this territory some years ago,” he finds the lack of political progress “so frustrating”, but he is not one for giving up:

“The evidence, I think, is convincing, although the work that has been done over the years […] one should never sort of say you’ve ever completed the work. That work always needs updating.”

In Lord Hunt’s own words: “we know what to do”. With a new government in charge looking to rebuild an NHS classified as “broken” by Wes Streeting, there is a significant opportunity to not only save money by reforming wound care; reforming wound care can improve patient outcomes and transform peoples’ lives.

The way forward is clear and defined, as Lord Hunt points out. The political motivation should be obvious and apt for politicians to seize upon, with substantial opportunities for cost savings, improvement in clinical outcomes and patients’ quality of life identified. The potential returns on investment, both financial and social, could alleviate pressures in an NHS already overstretched, thereby supporting Wes Streeting’s mission to fix the “broken” NHS.

Prime Minister Sir Keir Starmer is keen to move health policy away from “sticking plaster politics” that implements short-term emergency measures to avoid the breakdown of the NHS, while neglecting the need for long-term reform. As anyone familiar with wound care will know, there’s more to it than a plaster. As the government implements its agenda for healthcare reform, wound care will (as a system-wide action area) need to be addressed.

PPP’s Wound Care programme brings together key stakeholders across the NHS, industry, charity and politics to advance the conversation on reform and innovation of wound care provision in the UK. Building on the foundation of a solid first year that identified the major obstacles, PPP is continuing to gather nuanced insights on possible futures for patients and healthcare providers alike.

On 2 December, PPP will be hosting an all-day Wound Care Conference in London, convening national health and care experts to discuss all aspects of wound care provision and forging a path forward for innovation and reform. Reflecting on the insights presented during the programme and facilitating conversations on the latest developments in UK wound care provision, it is a prime opportunity to gain a comprehensive understanding of sector developments.

Free to attend for NHS staff and other public sector workers, you can register for the conference here.

For further information about PPP’s Wound Care programme, please contact:
Director of Market Access & Policy – Ameneh Saatchi (ameneh.saatchi@publicpolicyprojects.com)
Programme Executive – Fredrik Matre (fredrik.matre@publicpolicyprojects.com)

All news

Dartford and Gravesham NHS Trust goes live with ‘big bang’ EPMA deployment

By Integrated Care Journal

The implementation of the Better Meds electronic prescribing and medication management system took place over a single weekend, thanks to the efforts of more than 200 staff from across the NHS Kent and Medway Integrated Care System.

Dartford and Gravesham NHS Trust has successfully implemented the Better Meds electronic prescribing and medicine management (EPMA) system across all 18 adult inpatient wards at Darent Valley Hospital. The system, integrated with the trust’s electronic patient records (EPR) provided by Alcidion, was deployed over a single weekend to enhance medication safety and efficiency.

During the two-day transition, more than 500 paper drug charts and 8,000 prescriptions were digitised by a dedicated clinical team, with a team of healthcare staff and digital support assisting throughout the process.

Dr Guy Sisson, Chief Clinical Informatics Officer at the trust, highlighted the collaborative effort: “The implementation was an incredible effort with months of planning which led to over 200 healthcare staff from across the integrated care system joining forces to support the go-live weekend.”

The EPMA system is designed to streamline medication administration and prescribing, reducing time spent on these tasks and improving workflows for both nurses and doctors. Early feedback from staff indicates faster medication rounds and more efficient prescribing. The system also features decision support, including drug interaction alerts, high-dose alerts and allergy checks, enhancing patient safety and offering reassurance to staff providing care.

Additionally, the EPMA system provides real-time access to dose-level data, which was previously data-based, enabling the trust to analyse and improve medication safety practices, further improving patient care quality.

Julia Scott, Pharmacist and Senior Responsible Owner for the EPR Programme said: “This Better Meds implementation will allow us to deliver medication safety improvements on a whole-system scale. EPMA allows us to implement strong barriers to error for high-risk medication, whereas in the past we were reliant on weak barriers such as training and guidelines. We can also build data-driven safety nets to allow us to rapidly identify potential high-risk prescribing and intervene quickly. It is genuinely transformative when it comes to a human factor’s approach to safety”.

Dr Guy Sisson added: “Our vision is to be an outstanding hospital trust providing the best possible care for our patients that is safe, well-coordinated, in the right place and designed around the person’s needs. Our new EPMA system is perfectly aligned and a true digital representation of our aspirations. I want to congratulate everyone involved and personally thank them for getting the system over the line, which is a monumental step towards where we want to be.”

In 2019, Dartford and Gravesham procured Alcidion’s Miya Precision to advance its digital maturity. By integrating Better Meds’ electronic prescribing into the Alcidion EPR, drug information is now seamlessly connected with patient assessments, allergies, key lab results, and more. This enhances safety for prescribers and saves clinicians time by offering standardised order sets and allowing multiple users to view and use the medication record simultaneously.

Future phases of the implementation will include outpatient clinics and other speciality areas, such as maternity and paediatrics. It will also be rolled out across inpatient wards at the trust’s other main site, Queen Mary’s Hospital, to support surgical elective care.

Alja Babič, Better Meds Implementation Consultancy Lead at Better, said: “It’s been a pleasure supporting Dartford and Gravesham NHS Trust to optimise prescribing and medicine management. The ‘big bang’ rollout was one of the best we’ve been involved in. It was smooth, well-planned and expertly managed, and the team should be extremely pleased with the progress made. Dartford and Gravesham’s commitment and great energy have been clear while working together. We are celebrating this being our 9th Better Meds go-live in the UK and look forward to working further on improving medication management processes.”

Kate Quirke, Alcidion CEO, said: “It was inspiring to witness the dedication and extensive collaboration that led to the success of this rollout. We are proud to support Dartford and Gravesham NHS Trust as they continue to expand and improve upon their digital infrastructure. We are also grateful for our partners like Better, who share in our belief that smart technology can drive meaningful change. We look forward to continuing this journey together, building on our joint commitment to innovation and progress.”

NHS failing in mental health support for kidney cancer patients

By Integrated Care Journal

A new report from Kidney Cancer UK reveals a failure in providing vital mental health support for those diagnosed with kidney cancer in the UK.

A new report combining ten years of data from the Kidney Cancer UK Annual Patient Survey has highlighted ongoing failures in providing vital mental health support to those diagnosed with kidney cancer – currently the 7th most common cancer in UK adults. The findings show that many patients are being let down in some of the most basic areas, impacting their ability to navigate their kidney cancer diagnosis and treatment journey with resilience and hope.

However, the charity believes support services can be improved at minimal cost through greater collaboration with charities that have experience in counselling and supporting kidney cancer patients.

The report, titled ‘Navigating the impact of kidney cancer: A decade insight into patient care and mental health’, is asking for simple changes such as:

Providing patients with the contact details of their CNS (clinical nurse specialist) for direct support.
Signposting to reliable information on treatments and surgery options
Advising patients on how to access counselling to help with the shock of a cancer diagnosis.

Many patients are being failed in some of the most basic areas. For example, 37 per cent of those surveyed were unhappy with the way they were told they had kidney cancer, 30 per cent were not given the name of a CNS and an average of 29 per cent felt abandoned after surgery. Given the minimal cost needed to improve services, the charity is calling for the NHS to implement policies to ensure charities are a higher priority in the healthcare professionals support pathway.

With over 3,200 patients taking part in the Kidney Cancer UK Patient Surveys across the past decade, this is one of the most extensive independent kidney cancer surveys ever undertaken and has led the charity to call for the NHS to implement policies ensuring that charities are more of a priority in the healthcare professionals support pathway.

Malcolm Packer, CEO of Kidney Cancer UK, commented: “We need a nuanced approach to patient care, one that prioritises mental health – as well as physical health. The role of timely, relevant information to individuals with kidney cancer cannot be underestimated, and as a charity we consistently see those who have their information needs met after the shock of diagnosis or following treatment generally experience far better mental health outcomes.

“This comprehensive report combining a decade’s worth of data from kidney cancer patients provides valuable insights into how healthcare professionals and patient organisations can collaborate to meet the complex needs of kidney cancer patients, ensuring they receive the support necessary to navigate their diagnosis and treatment journey with resilience and hope.”

Dr Kate Fife, Consultant Clinical Oncologist at Addenbrooke’s Hospital Cambridge, added: “It is very disappointing to see that 37 per cent of patients are unhappy with the way they were given their kidney cancer diagnosis. Sensitive and clear patient communication is very much a priority for healthcare professionals, but despite training in communication, delivering news of a cancer diagnosis has not improved over the last 10 years of surveys.

“Couple this with the news that there is no change in the amount of information and support shared following diagnosis, the message to healthcare professionals everywhere is that we need to be more sensitive in our actions and work closer with Charities to help better support all cancer patients. There is clearly much room for improvement.”
The 11th annual Kidney Cancer UK Patient Survey is now open, and the Charity is calling for all kidney cancer patients, past or present, to complete the survey. To take the latest annual survey click here.

You can read the full report here. For support and information relating to kidney cancer visit www.kcuk.org.uk.