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.

All news

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.

Gypsy, Roma and Traveller communities subject to stark access and mental health outcome inequalities, report finds

By Integrated Care Journal and Gabriel Blaazer

Suicide rate among Gypsy, Roma and Traveller community is up to seven times higher than for all other communities in England, with poor service provision identified as major factor.

A report published last week says that Gypsy, Roma and Traveller communities experience among the starkest inequalities in access to healthcare of any community in England. The report was commissioned by the NHS Race and Health Observatory and was led by The University of Worcester.

It addresses a marked lack of mental health care provision and captures first-hand insights from service users and providers, as well as examples of good practice from six effective services. Most of these services are run by voluntary organisations from within the Gypsy, Roma, and Traveller community themselves.

Inequalities in Mental Health Care for Gypsy, Roma, and Traveller Communities estimates that the suicide rate among this group is up to seven times higher for this community than for others, and that life expectancy among the Gypsy, Roma and Traveller community is up to 10 years lower than the national average.

It further identifies a lack of access to digital services, low literacy levels, shortage of local and national data collection, and limited financial investment as presenting significant barriers to accessing to local health services and preventing the development of customised services.

Considerable stigma is still attached to mental health concerns within many communities, and a lack of granular data to support tailored services is contributing to the problem of poor access for Gypsy, Roma and Traveller communities.

Data was difficult to fully assess regarding the uptake and impact of services, due in part to the organisations studied not having the resources to collect and analyse such data and also to non-reporting of ethnicity (for fear of discrimination).

In response, Joan Saddler, who is Director of Partnerships and Equality at the NHS Confederation, said: “Leaders will be increasingly concerned about the troubling findings this report has illustrated which show a huge disparity in access, experiences and outcomes for gyspy, roma and traveller communities. These are people’s lives – impacted and in some cases shortened by preventable inequalities.

“We have known for some time that Gypsy, Roma and Traveller communities experience poorer care access, experience, and outcomes as a result of discrimination. The Race and Health Observatory report helpfully builds on this, but we must now focus on action. We would welcome the opportunity to be part of a coalition working with NHS England to reduce such inequalities particularly with Gypsy, Roma and Traveller communities at the heart of creating solutions, so we can take the first step to finally eradicating discrimination.”

National strategy lacking

Professionals’ lack of expertise and knowledge about Gypsy, Roma, and Traveller cultures was further identified as a significant deterrent to take-up of mainstream services. In 2022, Friends, Families and Travellers noted that out of 89 suicide prevention plans in England, only five mentioned Gypsy, Roma, and Traveller communities and only two listed any action plan strategy.

The government’s latest England Suicide Strategy (2023-2028) mentions the Gypsy, Roma and Traveller community twice, but does not afford these communities priority status nor mention them in its associated Action Plan.

Despite the lack of national investment in national mental health care provision, there are many examples of locally organised services doing targeted work with these communities. Researchers visited effective services run in Hertfordshire, Leeds, Lincolnshire, York, Cambridgeshire, and Ireland (the latter due to its provision for young people). Each site represents an example of novel, progressive initiatives which have broken down barriers for Gypsy, Roma, and Traveller communities in need of mental health support.

These, and more findings, were presented at an online report launch of Inequalities in Mental Health Care for Gypsy, Roma, and Traveller Communities, Identifying Best Practice, on Thursday September 28.

The launch included a presentation of the research around the significant mental health needs of these communities; first-hand experience and insight from those involved in the case study sites; a Q&A and practical recommendations for health and mental health providers to action around the country.

Panellists included representatives of the Observatory’s Mental Health working group, the Gypsy, Roma and Traveller Social Work Association and the University of Worcester. Insight gathered over 12 months of research was undertaken in collaboration with research co-authors, Gypsy and Traveller Empowerment Hertfordshire UK (GATE Herts), and the Gypsy, Roma, Traveller Social Work Association (GRTSWA) and involved 70 community and 21 staff members.

“Deeply concerning”

Speaking ahead of the launch, Dr Habib Naqvi, Chief Executive of the NHS Race and Health Observatory said: “We know that Gypsy, Roma, and Traveller communities face stark challenges in accessing psychological therapies and other mental health services. This report lays bare the mental health issues and stigma faced by these communities first hand. We are pleased to have co-produced with these communities, a clear set of practical, tangible actions and recommendations for more equitable mental healthcare provision.”

Dr Peter Unwin, Principal Lecturer in Social Work, University of Worcester, said: “It has been a pleasure to carry out this research in co- production with community members and to have met so many inspiring people who have developed mental health services against the odds. We should all now work together to ensure that this report on the health inequalities in Gypsy, Roma and Traveller communities leads to real change and equality of opportunity.”

Responding to the Race and Health Observatory report, Saffron Cordery, Deputy Chief Executive at NHS Providers, said: “Gypsy, Roma and Traveller (GRT) people’s experiences of health services are dented severely by discrimination. It is deeply concerning to see how GRT communities struggle to access mental health services they need.

“There should be no ‘winners and losers’ when it comes to physical and mental health provision. NHS trusts work hard to reduce health inequalities but years of funding cuts to councils’ public health and preventative services mean that already stretched NHS services face more strain.

“Government must tackle the root causes of why some minorities are more likely to have worse physical and mental health outcomes and address barriers and discrimination facing too many groups of people including GRT communities.”

Government launches pilot pathway to accelerate access to innovative medical technologies

By Integrated Care Journal

The new Innovative Devices Access Pathway (IDAP) pilot is an initiative to bring new technologies and solutions to the NHS faster and will focus on addressing unmet needs.

The government has launched the pilot of IDAP, a new initiative aiming to accelerate the adoption of “innovative and transformative medical devices” within the NHS. Supported by £10m of government funding, the IDAP is a multi-partner pathway that offers product developers and manufacturers access to tailored support and scientific advice from a team of experts. The latter will in turn develop a bespoke Target Development Profile (TDP) roadmap for successful applicants to help bring their products to market more quickly.

The TDP roadmap will define the regulatory and access touchpoints pertaining to each product’s development, which can include:

Quality management system support
Advice on system navigation
A fast-tracked clinical investigation
Joint scientific advice with partners
Support with Health Technology Assessments (HTA) for product realisation and adoption
Safe-harbour meetings to discuss adoption within the NHS
Exceptional use authorisation granted by the Medicines and Healthcare products Regulatory Agency (MHRA), provided necessary safety standards are met

The IDAP is open to applications from UK and international commercial and non-commercial technology developers, subject to eligibility criteria. During the pilot phase, the IDAP partners, which include the Department of Health and Social Care, the MHRA, NICE and the Office of Life Sciences, will select eight products that best meet the eligibility criteria and that are most likely to benefit from the support and advice available. The pilot will see the main elements of the pathway tested and used to inform the future development of the IDAP.

Dr Marc Bailey, MHRA Chief Science and Innovation Officer, said: “The IDAP launch marks an exciting step in accelerating the delivery of cutting-edge medical technologies safely to patients across the UK. The insights gained during the pilot phase will be crucial in shaping the future direction of this new pathway.

“We encourage medical technology innovators in the UK and abroad to submit their applications and benefit from this combined support service. By working together, we can fast-track access to the most advanced technologies for those in urgent need.”

Mark Chapman, interim Director of Medical Technology and Digital Evaluations at NICE, commented: “We look forward to working with industry to continue the acceleration of our evaluations and with the MHRA to align our work for the benefit of patients.”

Tackle microaggressions to transform services

By Ishmael Beckford

Ishmael Beckford is the Chair of Council at the Chartered Society of Physiotherapy. Here, he writes about the impact of microaggressions on both staff and patients, and says that tackling the issue should be a priority for the NHS.

“But where are you really from?”

I doubt there can be many NHS staff of colour who have not been asked this question at some point.

The insinuation – whether conscious or not – is that our ethnicity means we cannot be from the UK, an alienating statement that tells us we don’t belong. It’s an example of what’s known as a microaggression, an often-overlooked form of discrimination and one that NHS system leaders could deliver a transformative effect on by tackling.

It won’t be easy.

The professional body and trade union that I chair, the Chartered Society of Physiotherapy, sought testimony from its members with marginalised protected characteristics, such as ethnicity, disability and sexual orientation, about their experiences of microaggressions – and the findings were stark, yet unsurprising.

Members spoke of regular incidents where they felt belittled, othered or insulted through the words or actions of someone in their workplace. Examples given by minority ethnic physiotherapy staff included repeatedly mispronounced names and being asked who the decision-maker was, despite it clearly being them – something I experience myself.

Members of our LGBTQIA+ community said they often heard the pejorative phrase, “that’s so gay”, and were told they “didn’t look gay”, while trans physio staff were asked for their “real name”. Physio staff with disabilities, meanwhile, spoke of being excluded from everyday activities and having their status questioned.

It seems highly unlikely that the experiences of physiotherapy staff differ from those of any other profession working in the NHS. And while this is, of course, a societal issue and not one exclusive to the NHS, the UK’s biggest employer has a responsibility to protect its staff – and its patients – from experiencing these behaviours in its settings.

More than a quarter of NHS workers are from an ethnic minority, while nearly 5 per cent have a disability and at least the same number identify as LGBTQIA+. Obviously there will be intersectionality across those numbers but that’s a hugely significant part of the workforce facing painful, damaging experiences in the workplace on a regular basis.

We also need to be honest and acknowledge that patients experience these behaviours when receiving NHS care. The evidence base demonstrating the poorer health outcomes among marginalised groups is well established. Those outcomes are shown to be made worse by communities experiencing poorer care due to racism, ableism, homophobia and transphobia.

Microaggressions form part of those experiences and will undoubtably deter some patients from seeking the care they need.

So, this is an issue facing staff and patients alike, and during a workforce crisis when retention is of such importance – and with record numbers of people waiting for care – the case for action on microaggressions is overwhelming.

But what should that action involve?

Education for staff and patients is important, clearly. There remains low awareness of the term microaggressions and, from the regularity that they occur, a limited understanding of their impact.

Our campaign includes posters and an animation that services may find helpful to display in public spaces and staffrooms. But crucially, our members also reported significant concerns about reporting microaggressions, fearing they wouldn’t be taken seriously and no action would be taken. There were also concerns about consequences for them of making a complaint and, dispiritingly, the idea that they happen so regularly that they aren’t worth reporting.

So, it is essential that systems, and specifically managers, create environments where people feel supported, heard and confident to report. These workplaces must be inclusive, culturally sensitive, and no longer somewhere microaggressions can go unchallenged. Our campaign includes training, guides and resources for managers to deliver that and encouragingly, after the first phase of the CSP’s campaign, members reported increased confidence to report microaggressions.

So change is possible. It just needs to be a priority.

Because don’t let the name fool you – microaggressions can have an enormous impact on the physical and mental health of those on the receiving end.

They chip away at you, bit by bit, day by day.

The constant challenge is how to navigate these experiences but still be yourself, because often a response to being exposed to these forms of prejudice is to dilute yourself, not be authentic and to conform to reduce the opportunity for people to point out that you’re different.

You start to see the world in a different light which can result in you feeling like you have to put armour on to go to work and this is a heavy weight to carry every day. Many people will never know that invisible armour exists for a lot of people.

That’s why it’s so important to bring the issue into the light and the enormous pressures facing the NHS cannot be used as an excuse for inaction.

Tackling microaggressions is not an add-on to easing those pressures.

It’s essential for delivering a workplace where staff feel valued and want to remain and where patients can feel confident they will receive equitable, quality care.

Access guides, resources and training for managers and staff at www.csp.org.uk/microaggressions.

Ishmael is the Chair of Council at the Chartered Society of Physiotherapy, the trade union and professional body representing 64,000 physiotherapists, support staff and students across the UK. He is also a director at Vita Health Group, an independent provider of physical and mental health services, where his current remit covers Equality, Diversity and Inclusion and Sustainability. His clinical background is in MSK physiotherapy, primarily within private practice and occupational health settings. Ishmael has undertaken leadership roles including as a clinical manager and operations lead and has worked away from physiotherapy as a Talking Therapies service lead.

Transforming leg ulcer service provision

By Leanne Stevens, Abbe Ruston, Laura Hallas Hoyes

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

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

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

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

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

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

Evidence of success

95 patients were enrolled into the service evaluation, and:

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

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

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

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

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