Elderly and vulnerable at risk from extreme cold at home, new data shows

By Integrated Care Journal

Temperature data from remote monitoring solution Lilli reveals adults in care at risk of fuel poverty, living in temperatures as low as 5 degrees

Interventions are needed to urgently prevent elderly and vulnerable people from putting their health at risk, with temperatures inside some homes reaching as low as 5C last winter, according to SaaS company, Lilli.

This stark warning comes off the back of analysis of anonymised data from December 2022 and January 2023, which showed 61 per cent of people monitored by Lilli were at risk from low home temperatures during the winter. For some individuals, this meant spending prolonged periods in homes where the temperature was below 10C, with some plummeting to 5C.

Data from all people using the technology across the UK during the time period shows that 42 per cent of days were spent at risk, with an average temperature of 14C. This is significantly below the minimum 18C recommended as safe for the general population by the WHO and UK authorities.

The findings correlate strongly with a survey published by the consumer group Which? in August this year , which found that 13 million UK households struggled with fuel poverty and did not switch on their heating when it was cold last winter in an effort to save money as heating costs soared. The risk is further evidenced by 1,000 people dying in England as a result of living in cold and damp homes in December 2022 alone. Lower income households and those between the ages of 45 and 64 years of age were more likely to avoid putting on the heating, leading to calls for a social tariff on energy costs to alleviate the impact on vulnerable individuals.

A growing body of evidence suggests cold homes lead to increased likelihood of dampness and mold, causing ill-health in elderly people and those with chronic health problems. As well as hypothermia, potential ill-effects include cardiovascular and respiratory problems, sleep disruption, depression, anxiety and isolation. Older people are also less able to detect lower temperatures that could potentially put them at risk.

Considering this evidence, some integrated care systems have initiated schemes to support vulnerable people in paying their energy bills. Last winter, NHS Gloucestershire ICB’s Warm Home Prescription scheme paid the heating bills for around 150 individuals identified as having cold-sensitive health conditions and in danger of not being able to pay their heating bills.

A number of local authorities across the UK, including Nottingham, Reading and North Tyneside are now adopting remote lifestyle monitoring technology like Lilli to detect key indicators of health and wellbeing including movement, hydration and home temperature. This provides carers, local authorities and adult social services teams with the evidence to see when people might be facing tough decisions when it comes to heating their homes.

Fiona Brown, Chief Care Officer at Lilli said: “As cold weather approaches, energy costs remain high and inflation continues to take its toll, forcing individuals to make difficult decisions. Our own data sadly shows it is almost a certainty that many elderly and vulnerable people are at risk and will either keep the heating too low or avoid turning it on at all again this winter.

“Without intervention, they will be putting their health at serious risk from temperature-related illnesses such as hypothermia. A social tariff for energy costs may be one solution but the NHS and social care organisations need the ability to spot when people are at risk from low temperatures so they can intervene earlier and ensure people are able to live safely in their own homes, preventing even greater pressure on over-stretched services this winter through emergency hospital admissions.”

Melissa Wise, Executive Director – Community & Adult Social Care Services at Reading Borough Council, commented: “Having access to data and insights around temperature allows care professionals to get a clearer picture of the conditions in service users’ homes even when their carers are not there. It helps us spot quickly when low temperatures in someone’s home pose a threat to their health, allowing us to intervene and concentrate our strained resources where they are most needed.”

“Early warning of health issues can help prevent a hospital visit to treat hypothermia or respiratory illness. This also relieves pressure on beds and D2A (Discharge to assess) pathways as less people are admitted as patients. Additionally, for decision-makers, remote monitoring technology can ensure resources are properly allocated to where they are most needed, ensuring the delivery of care is not adversely affected at peak times.”

How to improve patient and taxpayer outcomes with innovation

By Stuart Watkins

Stuart Watkins, Strategy Manager for Health at Crown Commercial Service (CCS), explains the 3 main stages of buying digital transformation solutions in the NHS, with a clear breakdown of programme stages and projects along the way.

Digital transformation solutions in the NHS can help health and care professionals communicate better and enable patients to access the care they need quickly and easily, when it suits them. It’s vital that our NHS health services, staff and patients are ready.

How, where, and when patient care is given is evolving towards smart healthcare services, where technology is embedded across clinical pathways and the digital patient is the new normal.

From websites and apps that make care and advice easy to access wherever you are, to connected computer systems that give staff the test results, history and evidence they need to make the best decisions for patients, technology can support improvements in patient care.

Innovative technology procurement

Technology procurement in the NHS touches on everything from network refreshes to artificial intelligence, virtual wards and patient self-referral. Health organisations, at whatever stage of their smart healthcare journey, require a robust technology procurement strategy that builds close collaboration between their procurement and ICT functions.

They also need to achieve value for money through their procurements, delivering against clear integrated care system requirements and cost improvement programmes – all while keeping social value and carbon net zero agendas front of mind.

A 3-step guide to digital transformation

To help the NHS meet these objectives for procurements, CCS has developed a step-by-step guide, setting out the three main stages of buying digital transformation solutions in the NHS, with a clear breakdown of programme stages and projects along the way.

Aimed at clinicians, ICT professionals, procurement professionals, CEOs and board executives, the guide supports NHS England’s ‘digital first’ guidance and makes a process that can all too easily go wrong more straightforward.

NHS trusts and ICS digital programmes that need to rationalise suppliers, save money, secure value, and ensure interoperability requirements are met will benefit from using the guide.

Covering a comprehensive programme of projects, the guide makes it straightforward for the NHS ICT functions to assimilate into their own ‘live’ digital programmes today. It is organised around the 3 key phrases of digital transformation (Prepare, Transform, Enhance).

Let’s take a brief look at these 3 phases:

1. Prepare

The first step is to develop a technology strategy that aligns with the trust’s organisational development plan and its intended outcomes. From here, you can develop your programme, create your design and delivery structure, prepare outline and full business cases, and allocate budgets.

Next, it is important to review existing assets with the aim of getting the “maximum value from what you already have”. Start by looking at where your core infrastructure and networks need refreshing. Then, explore how unified communications can bring together phone, email, and instant messaging to complement each other and encourage collaboration.

This is also the stage to consider how devices, applications, and databases will be rolled out and managed, and how cyber security requirements can be met.

2. Transform

The ‘transform’ stage invites users to consider how best to digitise patient records: these can be integrated into software and clinical systems, facilitating the delivery and receipt of patient data digitally at the point of service.

For example, if you need to scan historic paper records, consider what further processes and resources are required. You’ll need a validation process to check that scanned documents match the original paper versions and create new workflows to ensure they are available securely.

Smart technologies can also be deployed to enable patient participation and empowerment throughout their clinical pathways. You could integrate systems such as picture archiving and communication (PACS), radiology, pathology, pharmacy, and bedside monitoring, focusing on interconnection and sharing of data, using unified messaging standards such as Health Level Seven. This is also a good time to:

Review data warehousing, looking at how a central data store could improve reporting and analysis.
Build integration into your solutions.
Consider how to extend use securely to other organisations, such as primary, acute, mental health, and social services.

3. Enhance

In the ‘enhance’ stage of the digital transformation process, the focus should be on early intervention and prevention initiatives, in partnership with other healthcare providers in the integrated care system. Everyone involved in the technology procurement should be thinking about people, not tech. At this stage, you should be aiming to put the digital patient at the heart of everything you do.

Smart “champions” who take ownership of the process can help keep the focus on the people who are supposed to benefit from the transformation, while training providers can create bespoke training programmes that empower users and tackle change resistance.
You may even want to consider how apps could help improve the patient experience and provide easy access to clinical services.

The guide suggests that the “enthusiasm” of patients who are already using smart technologies to manage their health can be utilised to encourage widespread change. But it also emphasises the importance of ensuring that digital healthcare solutions are inclusive and accessible to the most vulnerable and disadvantaged people.

There is danger in assuming that all patients and their carers have the necessary digital skills to benefit from new digital healthcare services. This is not always the case and why you should consider how to provide support to anyone who cannot access digital services independently, helping them to find information and complete transactions.

Finally, it’s vital to ensure digital inclusion by helping patients and their carers gain basic digital skills so that they can access these digital services in order to benefit from better healthcare.

You can download the guide from the CCS website.

*Stuart Watkins, Strategy Manager for Health at Crown Commercial Service*

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

By Integrated Care Journal

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

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

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

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

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

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

Benefits to patients and the NHS

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

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

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

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

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

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

By Sara Hazzard

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

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

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

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

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

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

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

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

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

The evidence for needing this shift is clear to see.

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

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

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

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

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

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

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

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

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

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

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

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

NHS optimising dermatology care with telemedicine technology

By Integrated Care Journal

Teledermatology platform is giving GPs across the UK rapid access to advice from consultant dermatologists.

The technology from Consultant Connect, called PhotoSAF, allows GPs to take, store, and forward photos and files directly to specialist NHS dermatology specialists for pre-referral advice and guidance.

PhotoSAF is the UK’s most widely used teledermatology platform, covering more than half of the NHS across England, Scotland, and Wales. 3,500 NHS organisations, including GP practices and Trusts, use the service.

In 2023, usage of the tech has increased by 2,400 per cent compared to 2019. More than two-thirds of patient cases avoid unnecessary secondary care appointments on average, meaning that approximately 550,000 patient cases have benefited from the platform being used.

The platform already integrates directly into primary care patient records in England and with the NHS e-Referral Service. This means that GPs do not have to manually process referrals, freeing up valuable clinical and administrative time, and saving the NHS about £16 million annually.

In addition to saving time and money, PhotoSAF can also help diagnose various skin cancers faster, supporting the two-week wait skin cancer pathway that ensures patients with suspected skin cancer are seen by a specialist within two weeks of referral.

The success of PhotoSAF is a testament to the potential of telemedicine to improve patient care and reduce costs. By providing GPs with rapid access to specialist advice, PhotoSAF is helping to ensure that patients receive the right care at the right time.

Jonathan Patrick, CEO of Consultant Connect, said: “PhotoSAF teledermatology is already having a massive impact on patients, clinicians and the NHS. It means that patients get the treatment they need quickly, often without having to go to hospital. We’re not surprised at how usage has exploded, it’s another example of the NHS making pioneering use of technology to improve care for taxpayers.”

Dr Emamoke Ubogu, GP and Partner at Swan Medical Centre said: “What stood out to me when I initially used it was getting advice from dermatology experts. As a GP, our training in dermatology is quite limited unless you undergo training to become a GP with a special interest in dermatology. This is why being able to communicate with a dermatologist is so helpful. The specialist often only needs to see photos in addition to the medical history in order to make a diagnosis.”

News October 16, 2023

How can the NHS make cell and gene therapies more accessible to patients?

By Dr Chris Rice

Last week, ICJ attended the RAREsummit23, organised by the Cambridge Rare Disease Network.

Hosted at the Wellcome Genome Campus in Hinxton, the RAREsummit23 was an event that brought together the rare disease community, including patients, caregivers, clinicians, and service-providers, and highlighted the experiences of people living with rare conditions.

At a session entitled “Advanced Therapies: Navigating Challenges and Fostering Collaboration for Patient Access”, the panellists and audience discussed the myriad challenges of providing novel cell and gene therapies (CGTs) for rare diseases in the UK. CGTs are a new and rapidly developing class of medicines that have the potential to revolutionise the treatment of rare diseases. CGTs involve using a patient’s own cells or genes to develop therapeutics that treat or cure their disease, and have the potential to offer life-changing treatments for patients with rare diseases. As Karen Harrison from Alex, The Leukodystrophy Charity (TLC) stated at the panel discussion, “CGTs bring hope to families where, historically, there’s been no hope at all.”

Public Policy Projects has recently highlighted some of the barriers to the adoption of CGTs in the UK, citing the current dearth of skills, training and development in the sector in the report, The future of cell and gene therapies in the UK: Skills, training and development. At the RAREsummit23, panellists highlighted several other challenges that need to be addressed in order to make CGT more widely available to patients.

Panellists discuss the myriad challenges of providing novel cell and gene therapies for rare diseases in the UK

One major challenge that received much attention was the need for appropriate infrastructure for the production of these advanced therapeutics. CGTs are often manufactured in specialised facilities that require expensive equipment and highly trained staff. In addition, after production, CGTs need to be transported and stored in special conditions to ensure their safety and efficacy. The lack of appropriate infrastructure in the UK makes it difficult to scale up manufacturing and to deliver treatments to patients in a timely and efficient manner.

To ensure CGT manufacturing sites are complying with regulations, they must receive suitable accreditation and, according to Darren Walsh, CEO at Orchard Therapeutics, it takes at least 18 months to get a CGT manufacturing site accredited. Even after this has been accomplished, any potential manufacturer needs to build a supply chain of trusted contractors covering all aspects of the production, transport, storage – and then ensure that this supply chain is closely managed.

Getting these novel treatments into the NHS

In addition to issues around the production infrastructure, panellists highlighted a number of other challenges that need to be addressed to increase the availability of CGTs. Chief among these are how more of these treatments can be adopted by the NHS, a process that currently involves assessment by NICE. In its role, NICE assesses novel therapeutics for adoption by the NHS based on two criteria: overall clinical effectiveness (safety, efficacy, and quality of life improvements), and cost-effectiveness. Clinical effectiveness is judged primarily on the results of clinical trials, something that is particularly challenging for therapeutics for rare conditions, as there are only limited numbers of volunteers to participate in each clinical trial. To encourage as many volunteers to be recruited for a clinical trial, it is important that trials are made as easy for participants to access as possible.

“When you design a clinical trial, the participants need to be placed front and centre”, reiterated Darren Walsh at Orchard Therapeutics.

This means that the administration of the putative treatment should be as simple and possible, and follow-up examinations must not be laborious or time-consuming. Similarly, the regulatory requirements for companies conducting these clinical trials must be made easy to follow and as unburdensome as possible. On this point, there has been some reform around clinical trials, with the Medicines and Healthcare products Regulatory Agency (MHRA) announcing earlier this year that it wants it to be faster and easier for novel therapies to gain approval and for clinical trials to be run in the UK.

The other NICE criterion, cost-effectiveness, represents a particular challenge for manufacturers. On a per-patient basis, CGTs are unavoidably expensive to develop, manufacture and deliver to clinical settings. This is due both to the complexity of the technology, and the relatively small number of patients who are eligible to receive them. When discussing cost-benefits of these treatments with NICE, panellists highlighted the importance of amplifying the rare disease patient voice and discussing the ‘lived experience’ when making the case to NICE for the adoption of a novel CGT.

Ensuring “equity of access”

With such focus needed for the development and delivery of novel therapeutics, it is crucial that the impact of a CGT on the patient is not forgotten during the process. Paul Selby from East Genomics raised the concern that there are currently not enough CGT centres for rare disease patients to receive the required treatments. “It’s about equity of access,” agreed Finn Willingham, Head of ATTC Network Coordination at the Cell and Gene Catapult, referring to the long distances that patients and their families must travel to reach a treatment centre, and then return to, for follow-up tests.

It’s also important that patients and their families understand everything that is required after a novel treatment has been administered. “Patients need to understand that they will need to stay in hospital, and there may be additional chemotherapy associated with the CGT,” stressed Karen Harrison at Alex TLC. “It’s not just a pill. And it’s important to educate the families [of rare disease patients] of this as well,” she explained.

Families are a crucial resource to understand the types of treatments that work well and the amount of work that goes into administering these treatments at home, as well as in clinical settings. This feedback forms a key part of the horizon scanning undertaken by NHS England, according to Fiona Marley who heads up the organisation’s Highly Specialised Commissioning Team.

Despite the challenges, there is a growing movement to make CGTs more widely available for patients with rare diseases. A number of initiatives are underway to address the challenges of infrastructure, cost, and patient access. A great example of a potential referral pathway for gene therapy clinical trials in the UK, based on the case study of Duchenne muscular dystrophy (DMD), was published recently in a white paper by the DMD Hub, in collaboration with the Cell and Gene Therapy Catapult and the Northern Alliance Advanced Therapies Treatment Centre. Among several of its recommendations, the white paper highlighted the need to ensure that adequate and sustainable infrastructures are in place, as well as specific gene therapy training and education opportunities, and the provision of additional clinical trials sites for future gene therapy trials.

Panellists were in agreement that there are lessons to be taken from the UK’s response to Covid-19 that can be applied to rare diseases. During the pandemic, industry, the Government, and academia came together to form a taskforce for the delivery of a novel ‘game-changing’ vaccine.

As Paul Selby made clear, “We have the technical expertise in the UK to produce these life-changing therapies; we just need better processes to aid in the delivery.”

To continue these important conversations, in 2024, Public Policy Projects will be running a series on the delivery of effective treatments to rare disease patients. This programme will convene an expert audience from across the rare disease landscape, including rare diseases patients, to understand how the UK can harness its life sciences expertise to deliver novel therapeutics to patients. To find out more about this programme, and how to be involved, contact the Partnerships Lead, Dr Chris Rice at chris.rice@publicpolicyprojects.com.

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12 questions that NHS IT buyers should ask communications technology vendors

By Dave O'Shaughnessy

While digital communications solutions are plentiful, budgetary constraints mean that asking the right questions of technology vendors is more important than ever, writes Dave O’Shaughnessy.

Today’s experience economy is not only applicable to customer-facing businesses. In the NHS, patients are the equivalent of customers and staff wellbeing is as important as in any other organisation. This means that putting experiences at the centre of NHS trusts and ICSs —for both patients and healthcare professionals—matters more than ever.

Because good communication and collaboration is at the heart of positive human experiences, every healthcare provider should aspire to an ICS-wide communications and collaboration layer. As NHS IT buyers look to realise the potential of transforming communications and collaboration efficiencies – not least improving their platforms’ ability to speak to one another and deliver service interoperability – what questions should they be asking their technology vendors? Here are some suggestions:

1. Innovation without disruption to day-to-day operations – it’s important to maximise the value and benefit from legacy investments by integrating modern communication solutions with existing technology. Ask technology vendors if they can layer on innovative and valuable features – that address real challenges and meet short-term objectives and long-term goals – without disruption to day-to-day operations.

2. Availability – check if a technology vendor is committed to delivering 99.999 per cent availability for communication services. This is important because, when it comes to hospitals, the availability of timely and dependable communications services can be seen as a matter of life and death. If systems drop or become unavailable because of cloud failure, lives are potentially at risk.

3. Security – the NHS needs the same security and reliability in its communications and collaboration solutions as those enjoyed by similarly sized government organisations worldwide, so a key question for vendors is: where will any cloud or hybrid cloud data reside?

4. Existing system interoperability – a new system must be able to push and pull data from the NHS trust’s current systems, including Patient CRMs or Electronic Health Records but if custom integrated work is needed, time-to-value can exacerbate project costs. This means that it’s important to ask if vendors have out-of-the-box connectors for current systems and how interoperability of digital systems and apps for previous clients has been ensured.

5. Single sign-on – ask if a vendor’s solutions are able to integrate with the current credentials system because single sign-on means staff can use their existing trust credentials to access new systems, minimising security-threats and vulnerabilities, while additionally reducing any complex technology-overhead on staff for accessing multiple applications and services.

6. Legacy device retirement – ask if a new system can take over functions presently performed by pagers, alarms, and notification systems. This matters because Trusts still using pagers and other legacy alerting and communication devices need modern solutions that enable legacy devices to be retired when ready and for modern communications and notifications technology to be rolled out.

7. Workflow automation – the NHS needs technology to help automate as many of its existing manual and time-consuming workflows and processes as is suitably possible. Therefore, a key question for vendors is: can you integrate with a hospital’s CRM or EHR systems so as to facilitate automated or self-service patient and staff services?

8. Remote/WFH capability – facilitating high-quality care even when employees aren’t onsite reduces the need for patients to travel to hospital, improving infection control. At the same time, suitable staff must be able to work remotely or from home without service disruption, so vendors should be asked how they would enable staff to communicate and collaborate remotely without hampering productivity.

9. Mobile experience – smart mobile devices that enable staff to access patient data while making a one-touch call to an on-call specialist accelerate traditionally disparate, time-consuming tasks, so be sure to ask vendors how they have integrated healthcare and communication systems using mobile solutions for previous clients.

10. Multilingual capability – the NHS needs healthcare applications that provide their complete set of features and services in as many languages as possible because it’s important to provide services to all who need them in a language they understand. This means that a key question for vendors is: how easy would it be for a patient to select their preferred language using your application?

11. Device and OS agnosticism – it’s important that digital services for staff and patients are available and deliverable across all access interfaces, so be sure to ask vendors if staff and patients will be able access services over various devices, browsers, and operating systems.

12. Video capability – integrated video calls improve engagement, enhance collaboration, and optimise services delivery, so ask vendors how staff and patients will be able to make video calls using their chosen device, and if the calls will be integrated with other digital applications.

Modern integrated unified communications can make the NHS more collaborative across all trusts, departments, and practice areas, enabling healthcare professionals to overcome frustrating pain points, by optimising every communication and collaboration experience for staff and patients alike.

Taking an Innovation Maturity Model assessment can help trusts and ICSs benchmark themselves against industry standards and visualise their readiness and capacity to maximise the use of existing technology and where holes need to be plugged. A great place to start a digitisation journey is to work with a trusted leader in customer experience. This helps leverage existing communications and collaboration investments and adds capabilities from advanced solutions that deliver enhanced experiences across a patient’s experience lifecycle.

Dave O’Shaughnessy, Healthcare Practice Leader, Avaya International

Belfast Health and Social Care Trust and Siemens Healthineers announce 20-year Value Partnership

By Integrated Care Journal

20-year Value Partnership signed between Royal Victoria Hospital Belfast and Siemens Healthineers to ensure access to the latest technology and drive improvement in healthcare outcomes across Belfast and surrounding areas.

Royal Victoria Hospital (RVH), part of Belfast Health and Social Care Trust, and Siemens Healthineers have announced a multi-million, 20-year partnership to streamline clinical workflows and boost patient care from October 2023.

The partnership replaces the Trust’s previous Managed Equipment Service arrangement and will deliver on the provision, maintenance and replacement of over 650 assets from multiple vendors, including a range of smaller devices such as patient monitors and syringe pumps as well as select diagnostic and interventional radiology equipment. Workforce development and clinical services optimisation programmes will help to address workflow and resource constraints, transforming patient care across Belfast and surrounding areas.

Focusing on multi-vendor equipment choice, the partnership will aim to ensure delivery of solutions that best fit the clinical needs and preferences of the hospital which sees more than 430,000 patients treated annually. Dedicated management of a full range of imaging and medical electronic equipment will offer access to the latest technology, supporting local care across Belfast as well as regional services for patients across Northern Ireland, including specialist surgery, critical care and the Regional Trauma Centre.

Support from Siemens Healthineers Consulting will include a Clinical Services Optimisation Programme (CSOP), designed to alleviate workforce challenges, expand capabilities and drive innovation. Through a collaborative and flexible approach, the programme will ensure the equipment and facility design are optimised to improve workflow efficiency and clinical outcomes. The CSOP will also support RVH in aligning with the strategic transformation of health and social care services taking place across Northern Ireland.

Additionally, the hospital will introduce a Workforce Development Programme (WDP) which will play a pivotal role in bolstering the healthcare workforce, thereby enhancing overall efficiency and patient care. Lasting the lifetime of the Value Partnership, the bespoke WPD will include a range of training, education and hands-on learning experiences from Siemens Healthineers covering both vendor-specific and vendor-neutral learnings. The WDP is set to support successful recruitment and retention while enhancing development and overall experience for RVH staff.

Commenting on the partnership announcement, Dr Cathy Jack, Chief Executive of Belfast Health and Social Care Trust said: “Belfast Trust is delighted to enter into this new managed equipment service partnership with Siemens Healthineers, a worldwide provider of healthcare solutions with an established track record in high level technological services.

“This investment, over a 20-year period, will ensure the Royal Victoria Hospital continues to provide the highest standard of care to our patients and service users and we will remain at the leading edge of technological advancements in imaging and medical equipment. We look forward to developing our partnership in the years ahead, with patient safety and experience the central focus.”

Ghada Trotabas, Managing Director of Siemens Healthineers Great Britain & Ireland, said: “Our partnership with Royal Victoria Hospital underscores our mutual commitment to providing quality care and making a positive impact on the lives of patients in Belfast and its local communities. We will offer Royal Victoria Hospital access to some of the latest innovations in imaging and medical equipment, as well as enhanced technology and software. We look forward to working side by side on improving care delivery and training the next generation of healthcare professionals.”

Bernie Owens – Deputy Chief Executive at Belfast Health and Social Care Trust [Left] and Ghada Trotabas – Managing Director at Siemens Healthineers Great Britain and Ireland with imaging system from Siemens Healthineers at Royal Victoria Hospital [Right].

Headline image caption: [from left to right] Mark Borley – Head of ES Sales at Siemens Healthineers Great Britain and Ireland, Maureen Edwards – Director of Finance, Estates & Capital Development at Belfast Health and Social Care Trust, Grania Heal – Country Head of Ireland, Alex Bryne – Head of Asset Management Services, Ghada Trotabas – Managing Director, Andy Wilks – Head of Enterprise Services at Siemens Healthineers Great Britain and Ireland, Bernie Owens – Deputy Chief Executive, Adrienne Martin-Poots – Co-Director of Finance, Lesley Johnston – Business Support Manager, Philip Frizzell – Royal Victoria Hospital Imaging Site Lead at Belfast Health and Social Care Trust, Sam Morton – UK Director at VAMED celebrate the start of a 20-year Value Partnership at Royal Victoria Hospital.

RIVIAM Digital Care’s Hospital Discharge: ready for NHSE’s Care Traffic Control Centre roll out

By Claire Hopkins, RIVIAM Digital Care

Delayed discharge cost the NHS an estimated £1.7 billion in 2022/23. RIVIAM’s Hospital Discharge service connects third sector partners and NHS trusts with the data they need, speeding up discharge, reducing readmission rates and supporting system-wide efficiency.

In 2023, RIVIAM introduced its Hospital Discharge service which is currently being piloted at the Royal United Hospitals Bath NHS Foundation Trust (RUH). Following the pilot, the service will be available on all wards to fast-track patient hospital discharge. The service enables RUH ward teams to make patient referrals simultaneously to multiple community, housing and voluntary sector services working together using RIVIAM at the Community Wellbeing Hub (CWH) in Bath and North East Somerset.¹

Staff at the RUH can then see the status of the care in real time via RIVIAM’s Care Control Dashboard. NHS England plans to expand such Care Traffic Control Centres across England to boostcapacity and improve patient flow^.2 RIVIAM’s Hospital Discharge service is a ready-made digital solution to support this ambition.

The challenge

According to NHS England, there are “more than 12,000 patients every day in hospital despite being medically fit for discharge.”³ Data from The King’s Fund also suggests that discharge delays in England increased throughout 2022 and that the cost of delays in 2022/2023 was at least £1.7 billion, at a time when the NHS is pushing to find cost savings.⁴ For patients, being stuck in hospital when they are fit enough to leave is also upsetting.

One of the challenges with reducing delayed discharges is how to access capacity in the care system provided by social care, community, housing and voluntary sector organisations. To make and coordinate discharge dependent referrals to these services often means multiple different referral routes and phone calls – this takes time that hinders patient flow and could be better spent delivering care.

For community, housing and voluntary sector services receiving referrals, it’s hard to access the latest patient information and to co-ordinate referrals for the best follow up care.

RIVIAM’s Solution

With RIVIAM’s Hospital Discharge service, ward teams at the RUH complete an Onward Admission Referral form giving them one place to refer a patient to a wide range of available community, housing and voluntary sector services at the CWH. This includes commissioned discharge dependent services which cross local authority boundaries.

Immediately reducing admin burden, the referral process is quick and seamless. RIVIAM also auto checks the patient’s details against the NHS Spine Mini service ensuring a high level of data accuracy is captured during the referral process.

Ward teams then use a Care Control Dashboard to see in real time what’s happening regarding the care they have requested for a person. Status updates and useful information are easily accessible. Online communication reduces the need for phone calls and emails which introduce time delays to a patient’s discharge.

A view of the dashboard is also available for the 20 different partners at the CWH so staff can easily see the person’s most recent ward, their expected discharge date and the different services requested.

Integration with the hospital’s Electronic Health Record (EHR), Cerner Millennium®, means that the dashboard data is seamlessly updated in near real time providing timely visibility of this critical information.

For CWH partners, RIVIAM makes it easy to co-ordinate care for a person with each other, reducing duplication, providing efficiencies, and improving the person’s experience.

Benefits of using RIVIAM’s Hospital Discharge service:

Improves patient care and prevents readmission. People leave hospital as soon as they are medically fit with the right support in place.
Frees up beds. Patient flow of those who are Clinically Ready for Discharge is improved, relieving pressure on hospital beds.
Utilises community and voluntary sector capacity. People can recover from a hospital visit at home, with access to local services.
Increases team productivity through data-driven decision making. There is one place for ward staff to see the latest information about the community care lined up for a person, communicate with them more easily and make quick decisions about discharge.
Delivers integrated care. Health, social care and voluntary sector providers can receive, manage and co-ordinate and care delivery and communicate with hospital ward teams.
Greater system-wide efficiency. Real time integration with electronic health records (EHR) provides seamless information flows and insights to reduce time delays, duplication and enable improved care.

“The impact of this digital transformation is plain to see. For ward staff, the ability to easily make referrals to multiple organisations at the click of a button is revolutionary. However, the ability for Discharge Co-ordinators to then easily see when support has been put in place gives much more assurance that a person can return home safely. This platform is not just a tool; it’s a conduit for change, enabling us to reach those who need us most,right when they need us.” – Simon Allen, CEO, Age UK Bath and North East Somerset

To find out how RIVIAM can support your organisation via hello@riviam.com or 01225 945020.

Visit www.riviam.com

¹ The CWH uses RIVIAM’s Multi-agency Referral Hub service to receive and manage referrals in Bath and North East Somerset for 20 social care, community, housing and voluntary sector organisations.

² https://www.england.nhs.uk/2023/07/nhs-sets-out-plans-for-winter-with-new-measures-to-help-speed-up-discharge-for-patients-and-improve-care

³ https://www.england.nhs.uk/2023/07/nhs-sets-out-plans-for-winter-with-new-measures-to-help-speed-up-discharge-for-patients-and-improve-care

⁴ https://www.kingsfund.org.uk/blog/2023/03/hidden-problems-behind-delayed-discharges#:~:text=That%20means%20that%20the%20direct,at%20least%20%C2%A31.7%20billion

Using digital across adult social care to enable independence for longer

By Integrated Care Journal

This content is supported by Access Group.

In January of this year, PPP published their report, A care system for the future: how digital development can transform adult social care. The report examined the status of the social care system, focusing on the use of technology to support services, and the steps that need to be taken to support the full digital transformation of the sector for improved care, increased efficiency, and workforce satisfaction.

Recommendations from the report covered enabling DHSC to ease the burden of social care providers operating in multiple ICS footprints who deal with a variety of Shared Care Record formats, the support of digital inclusion among people receiving adult social care by local authorities and mandatory basic digital training for adult social care professionals.

The government has recently announced that £600 million is to be allocated to the adult social care sector to boost winter capacity, fund a research programme to determine future policies for social care, and follow through on commitments made in the Next Steps to Put People at the Heart of Care white paper. In order to achieve these goals, DHSC should not undermine the importance of investing in digital technologies within the social care sector, which will increase efficiencies and reduce pressure on frontline staff.

Examples of this type of technology are provided by The Access Group and include Access Assure and Oysta Technology – part of their Technology Enabled Care (TEC) solutions. The Health, Support and Care division (HSC), of which Access TEC is a part, works with more than 10,000 registered care providers, more than 200 local authority departments, and 50 NHS trusts, providing technology that helps these organisations deliver more efficient and personalised care.

Access Assure is a key pioneering technology supporting the adult social care sector by allowing vulnerable individuals to live independently for as long as possible and giving their loved ones peace of mind that they are safe, even when alone in their homes.

Alex Nash founded Alcuris – now Access Assure – in 2015 following his grandfather’s diagnosis with dementia, after noticing a lack of sufficient updates on his wellbeing. He developed a digital care solution that learns the behaviours of individuals and supports their independent living, while also providing the necessary information to the relevant health and care professionals.

The platform uses insights from social alarm and smart sensor technology to enable caregivers to provide proactive care by seeing where anomalies in data could be caused by health complications. These can include notifying carers if someone hasn’t been mobile, which could be due to a potential fall, or if they haven’t been going to the toilet regularly, which may be a symptom of a urinary tract infection (UTI), which is one of the biggest causes of hospital admissions for older people in the UK.

NHS East Lothian has been using the product since 2019 to review patient data and make decisions about the care of each individual. The system has enabled them to change care packages by identifying issues such as UTIs, making their delivery of care preventive of larger issues. By connecting direct costs in care to the use of Access Assure at NHS Lothian, it can be seen that each UTI avoided, or detected early on, produces a cost avoidance of around £3,000 per event.

A 2020 white paper titled Next Generation Telecare: The evidence to date, focusing on 29 family members users using Access Assure, also showed that 83 per cent of families felt it provided increased reassurance because even when not with their loved ones, they can still support them remotely and check-in.

Across the Access Assure customer base, staff have reported significant improvements to their work experience since using the technology. Tools embedded within the system have streamlined administration processes, helping staff cut admin time from 4 hours to a few minutes per individual, releasing time to care. Local authorities can also access the data to intervene swiftly, reducing the need for emergency care and improving quality of life for individuals. When the average wait time for an ambulance is 56 minutes and each callout costs the NHS around £252, the ability to pinpoint potential health complications early with platforms like Access Assure can prove significant in alleviating current pressures on emergency care.

Plus, the Access Assure dashboard, which has been developed over the last year, allows all Access Assure devices and their data to be pulled together into a single resource. Considering the insights provided by Access Assure, the Next Generation Telecare white paper also highlighted that over 40 per cent of care plans were amended after close interrogation of the data, resulting in better care for individuals and a reduction in hospital visits. The dashboard highlights information which can be saved as a PDF so that local authorities can quickly recognise any anomalies and spot where intervention may be needed.

Using Access Assure, patients can be supported to live independently for longer, and care providers and staff are able to drive care management forward. And collectively, with Access’ other technology enabled care solution, Oysta Technology, and wider HSC portfolio of technology, health and care professionals can take a more proactive and preventative approac h to person-centred and participatory care. Access TEC supports NHS, local government and registered care organisation customers wishing to ensure service-users maintain and enhance their independence and confidence, while having dignity, security, and reassurance. These solutions also prevent, reduce or delay hospital admissions or the need to access care home settings and improve the quality of life for the cared for as well as family members and informal carers so that people are supported to stay safe, happy, and healthy in the communities they call home.