News, Thought Leadership January 22, 2024

Integrated care systems: learnings through a Whānau Ora lens

By Cate Mentink

As integrated care systems mature, there is much the UK can learn from New Zealand’s holistic approach to understand the true impact of health and social care services.

The WHO defines health as “a state of complete physical, mental, and societal well-being, not just the absence of disease or infirmity.” Despite this comprehensive definition, a significant portion of healthcare prioritises physical health, overlooking other vital determinants that significantly influence individuals’ overall health and wellbeing.

The introduction of integrated care systems (ICSs) in the UK and the growing emphasis on a more holistic approach provide an opportune moment to better address needs and improve healthcare outcomes. Holistic healthcare delivery has been shown to lead to better patient outcomes, reduced barriers to access, and overall superior health.

Whānau Ora, a holistic health and social care model originating from New Zealand, serves as an exemplary, culturally grounded, integrated approach that is driving positive outcomes across the country. By embedding a holistic health and social care focus, it aims to provide wraparound services centred on supporting not only the individual but also the whānau (extended family) that surrounds them.

While the path to developing and implementing Whānau Ora has been iterative and not without its challenges, there is much that can be learnt and adopted in the UK and worldwide from Whānau Ora’s efforts in developing, defining, and implementing this model and its underlying philosophy.

Social determinants of health: prevention is promotion

The social determinants of health, the conditions in the environments we inhabit, play a crucial role in shaping our health and wellbeing. Understanding and addressing these environmental influences is essential to enhance health outcomes and reduce disparities. Studies indicate that social determinants may exert a more profound impact on health than individual lifestyle choices.

A hallmark of Whānau Ora is its emphasis on the individual’s broader context, recognising that their health is influenced by their surroundings. By promoting and improving health and social outcomes across a collective, rather than solely focusing on the individual, better health outcomes can be achieved. Whānau Ora has demonstrated positive and meaningful results across a spectrum of health and social determinants. By encompassing all dimensions of health and wellbeing, rather than a more medicalised, linear approach concentrated primarily on physical health, Whānau Ora has ensured that outcomes address the diverse needs of individuals across a range of key factors.

Within ICSs, a deeper understanding of an individual’s unique circumstances and environments is vital in reducing disparities and supporting positive health outcomes. Shifting towards long-term change and prevention, as opposed to treatment, is paramount. Developing a model of care that incorporates a more holistic approach is crucial for the NHS to advance and deliver better long-term outcomes for the UK.

Navigating the grey: connectors across services and support

Ensuring service users are connected with the right support at the right time can be a challenge across any health system. Those who are vulnerable or facing disadvantage often face greater difficulty in accessing services, translating to greater disparities in outcomes.

Kaiārahi (navigators) play an integral role in Whānau Ora service delivery, acting as a key connector, helping families to identify needs, prepare, plan, and use services effectively. Here, navigators act as a broker in accessing services; ones that meet the unique needs of the person accessing them. They also work as a go-between, understanding service demands and identifying opportunities for intervention to better meet ongoing needs.

The use of navigators has been shown to be an effective tool in improving identification of needs, access to care and navigation of care services across a range of different settings. This is particularly prevalent for indigenous groups and those facing barriers to accessing services and support.

A recent study showed that a third of people in England lacked confidence in accessing care through the NHS. With this in mind, it’s crucial to consider the ways in which the health system is being navigated, and whether further support could be beneficial – not only to help users connect with the right care and support, but also to help reduce the burden on the healthcare system of those accessing services that don’t meet their needs.

Measuring the true impact of health and social services

Worldwide, much of health care provision focuses on easily quantifiable outputs, with the focus primarily on physical health through measurable metrics, while ignoring other key determinants that can impact on wellbeing. The siloed treatment and measurement of physical health without consideration of the other factors means that often, outcomes of health and social care are not as effective as they could be.

Whānau Ora measures success through outcomes, focussing on the key changes that matter to families and using an outcomes framework to understand the impact of interventions. Over the last 10 years, there has been a shift towards assessing and understanding social value in health and social services.

Measuring based on outputs simply evaluates the activities undertaken by an organisation, but it fails to assess whether these activities are indeed effective or meet patient needs or intended outcomes. Measuring based on outcomes, on the other hand, enables systems to grasp the actual changes experienced and the impact they have created. Outcomes represent the positive differences brought about by the outputs.

However, measuring based on outcomes can present challenges in defining “success” and identifying suitable metrics. When encompassing a broad spectrum of health and social indicators, success will manifest differently for each individual and community.

Whānau Ora has established a comprehensive outcomes framework that tracks progress in alignment with both individual aspirations and broader societal indicators. This approach facilitates a more comprehensive evaluation of service effectiveness and support.

The NHS is also adopting a social value focus. This entails considering the impact of its services on individuals and communities, alongside traditional health outcomes measures. Developing and implementing an outcomes framework would be a significant step for the NHS in measuring and comprehending the genuine impact of its services. This data could then be utilised to guide decision-making and enhance services for the future.

Investing in relationships

The establishment and cultivation of strong relationships are paramount to the success of an integrated model and the forging of meaningful connections with the community. Whanaungatanga, a cornerstone of Māori culture and a core principle of the Whānau Ora approach, underscores the importance of building, nurturing, and maintaining connections within the community. Within an integrated system, robust relationships and trust serve as indispensable foundations for achieving shared objectives, strategies, and outcomes.

However, these enduring connections do not develop overnight. Investing, particularly in the form of time, is essential for nurturing these relationships and fostering ongoing trust and support across the system. ICSs within the NHS confront multiple challenges in collaborating across providers and organisations, with the workforce facing significant pressure and a lack of funding for long-term investment in outcomes.

Despite these hurdles, concerted efforts must be made to foster collaboration, strengthen partnerships, and cultivate trust within integrated care systems. A fundamental aspect of building any meaningful partnership lies in dedicating time, energy, and commitment to fostering trust and a shared understanding of common goals and objectives. For integrated care services to truly embody the essence of integration, this must be a cornerstone of the NHS’s approach.

Working towards a more integrated future

Integrated care models worldwide offer a wealth of insights and practises that can be leveraged to support the NHS ICSs’ ongoing objectives and vision.

While no system is perfect, the Whānau Ora model exemplifies key attributes that can be learnt from and adapted to meet the NHS’s evolving requirements. Embracing a more holistic approach, considering the social determinants of health, optimising service navigation, evaluating the impact of interventions by measuring outcomes, and investing in strengthening relationships all contribute to ongoing advancement and improvement in the delivery of integrated care, ultimately driving the crucial goal of improved health and care outcomes.

Cate Mentink is a Healthcare Strategy and Planning Consultant at Lexica

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Internal staff banks help trusts meet 40% rise in demand

By Integrated Care Journal

New analysis has revealed that the number of shifts being successfully filled by internal staff banks has increased over the last year, helping to meet a simultaneous sharp rise in demand for temporary staffing in 2023.

Healthcare staffing specialists Patchwork Health analysed temporary staffing data from 17 NHS trusts that use digital staff banks. The analysis compared shift fill rates from the staff banks between January-September 2022 and January-September 2023.

The data revealed a 40 per cent year-on-year increase in demand for additional staff to fill vacant shifts, as the NHS has grappled with rising patient waiting lists alongside staff sickness and absences.

Despite this significant increase in the number of vacancies being advertised, data from trusts using a digital staff bank showed that shift fill rates were not only maintained in comparison to 2022 levels, but increased. Fill rates rose to 77 per cent in 2023, up from 75 per cent the year before, meaning that more than 3 in 4 vacant shifts advertised were successfully filled by staff registered to internal banks. This demonstrates the ability of a temporary staff bank to help trusts meet a significant rise in demand.

The data from Patchwork Health also showed that during the period for 2023, the top 20 busiest days in terms of demand for additional staff were all strike days, when increased staff absence left the trusts with a higher number of workforce gaps to fill. The strike days accounted for 13 per cent of all temporary staffing demand in the nine-month period.

Trusts that can rely on internal digital staff banks to fill short and long-term vacancies can reduce their over-reliance on (and the costs associated with) sourcing clinical staff through third-party locum agencies. The NHS pays more than £3bn a year to locum agencies to provide doctors and nurses at short notice.

Dr Anas Nader, CEO and Co-Founder of Patchwork Health, commented: “The NHS has faced a significant rise in both patient demand and staff shortages over the past year. A marked increase in the number of temporary staffing vacancies is reflective of just how far this demand has intensified.

“It’s so encouraging to see the shift fill rate from digital staff banks simultaneously rising, helping trusts to effectively tackle and meet this growing challenge, and keep services safely staffed. It’s a promising indication that the consistent use of an effective, dynamic staff bank can help us to remain resilient and weather fluctuating demand, while reducing over-reliance on costly locum agencies to plug staffing gaps.”

Social care system in sustained crisis despite ‘record’ investment, report finds

By Integrated Care Journal

2023 Sector Pulse Check report describes the current situation in social care as “arguably more perilous than ever”.

Unsustainable financial and workforce pressures are forcing adult social care providers to turn down new admissions and close services, as government grants are not reaching the people who need them most, according to a new report commissioned by Care England and the learning disability charity, Hft.

Based on a large-scale survey of adult social care providers, the 2023 Sector Pulse Check report finds that despite the sector receiving a £7.5bn funding boost in Chancellor Jeremy Hunt’s 2022 Autumn Statement, there has been little progress in the key challenges facing social care.

In a statement, Care England described the current social care environment as “arguably more perilous than ever.”

Professor Martin Green OBE, Chief Executive of Care England, commented: “The narrative that social care is under pressure is not a new one. What’s disappointing is that we find ourselves in a worsening crisis amid the Government’s narrative of ‘record investment’ into the sector.

“While the Government did make substantial commitments in the 2022 Autumn Budget, the outcomes have not matched the ambition. The new money into the sector has not led to tangible change or any significant progress towards ‘fixing adult social care’.

The report highlights how headwinds facing the social care sector include rapid and dramatic energy cost increases and unfunded rises in the National Living Wage, which contributed to 40 per cent of adult social care providers ending 2023 in deficit, the report says.

Recent funding initiatives from the government, such as the Market Sustainability and Improvement Fund and the International Recruitment Fund, have failed to mitigate funding concerns for the majority of providers, the report states; 84 per cent of care providers surveyed said that these measures made no difference to their organisation’s overall financial sustainability over the past year.

This has resulted in a reduced capacity for the sector to deliver care across providers, and the report finds that:

43 per cent of providers closed services or handed back contracts;
18 per cent offered care to fewer people;
39 per cent considered exiting the market altogether.

Workforce challenges remain widespread

The findings are concerning for a sector already facing deep-rooted and systemic challenges, particularly around workforce retention and recruitment. Despite a recent rise in international recruitment, staffing shortages remain widespread across the sector, with approximately one in 10 posts vacant in 2023/23. Nearly half (44 per cent) of organisations had to turn down admissions due to a lack of staff in 2023, the report finds.

Care England’s statement argues that the government’s approach to mitigate workforce are not working, and cites the recent tightening of overseas care staff and growing concern over the state of local government finances. Hft and Care England are calling on the government to implement immediate measures to support the care sector, including improving commissioning practice, revising VAT arrangements and removing barriers to ethical international recruitment.

Professor Martin Green OBE added: “It’s clear that the way our system is funded needs a rethink. For years, adult social care providers have absorbed increased costs and inflationary pressures without corresponding funding. When money is made available it simply isn’t cutting through. Recent changes to immigration rules and an insufficient Local Government Finance Settlement this year further suggest a government that is heading in the wrong direction. The sector’s needs are now on red alert.

“Our long-term vision remains one of a sustainable sector that is financially viable and an attractive destination for staff. While this may seem a distant reality, there are a range of policies at the Government’s disposal that would help turn the tide and put us on the path towards a sustainable future. As we count down to a general election, the Government must now make good on their promise to fix our sector.”

Steve Veevers, Chief Executive of Hft, said: “It is difficult to offer words of hope and motivation when the past 12 months have seen the adult social care sector engulfed in a sustained state of crisis.

“Despite moving away from the immediate challenges posed by the COVID-19 pandemic, there has been little respite from the fundamental financial and workforce pressures that have faced our sector for many years. The fact that 43% of providers told us they closed a part of their organisation or handed back contracts last year is testament to this.

“Our report provides several realistic, practical and impactful suggestions – including reforming VAT, revisiting the new visa laws for international workers and establishment of national commissioning standards – which we shouldn’t delay in implementing if we want to see real change from the next Government.”

Speaking to ICJ at the launch event, Veevers argued that ICSs, with their remit for joining local services, present an ideal avenue through which to improve access to social care. However, in line with recommendation area four in this year’s Sector Pulse report, he stressed that social care representation on integrated care boards and integrated care partnerships needs to increase in order to adequately reform the sector.

The full 2023 Sector Pulse Check report can be accessed here.

Integrated Care Journal announced as media partner for Our Health Heroes Awards 2024

By Integrated Care Journal

Integrated Care Journal joins NHS England, NHS Employers, NHS Race & Health Observatory and more in supporting the awards for 2024.

Integrated Care Journal is proud to be supporting the 2024 Our Health Heroes Awards, delivered by Skills for Health, as the award programme’s sole and exclusive media partner.

Now in its eighth year, Our Health Heroes Awards celebrates the wider healthcare workforce that supports our NHS doctors and nurses on the frontline.

From porters and cleaners to receptionists, gardeners and security guards, these often unsung heroes make up roughly 40 per cent of the NHS’s million plus workforce; Our Health Heroes Awards is a national celebration of their achievements and an opportunity to give thanks for the important role that they play in keeping our health service functioning.

Having received hundreds of nominations from across the UK, judging for the Our Health Heroes Awards is now well underway for the eleven categories that feature in this year’s award.

Of those categories, five which recognise the outstanding achievements of individuals in healthcare will go to a public vote in order to decide the eventual gold, silver and bronze award winners.

Voting for the Apprentice of the Year, Clinical Support Worker of the Year, Operational Support Worker of the Year, Volunteer of the Year and the Outstanding Lifetime Contribution to Healthcare awards will open for three weeks on 20 February.

The remaining categories, which are awarded to teams and organisations for their achievements in digital innovation, collaboration and more, will be decided by an expert panel of judges and announced at a glittering awards ceremony held at the QEII Centre in London on 16 April.

On the day, senior figures from across the NHS and health sector will join together to give thanks and award the Our Health Heroes finalists their prizes, with NHS Employers’ Danny Mortimer, NHS England’s Navina Evans, NHS Business Services Authority’s Michael Brodie and Dame Elizabeth Anionwu all confirmed to attend.

Integrated Care Journal joins NHS England, NHS Employers, NHS Race & Health Observatory and more in supporting the awards for 2024.

To find out more, and to register your interest in Our Health Heroes Awards, visit: www.skillsforhealth.org.uk/awards

The need for innovation in ocular care

By Andy Hill

Andy Hill, CEO at NuVision Biotherapies, explains why innovating ophthalmology could contribute to recovering NHS waiting lists and help to establish the UK as a global player in the development of cutting-edge solutions in ocular care.

There are currently 630,000 people awaiting ophthalmology treatment on the NHS in England alone, which is the second-highest waitlist. This becomes an increasing concern when considering that ophthalmology is noted as the busiest outpatient service in the NHS and is struggling to cope with demand.

It was recently reported that NHS patients are being forced to pay for urgent eye care or risk going blind because of long waitlists. There is a huge need to support the NHS in the management of eye conditions to reduce the burden on patients, healthcare professionals and taxpayers. But is there anything that can be done to support the recovery of the ophthalmology waiting list?

The impact of poor eye care

It’s well known that good eye health and access to effective care have a direct impact on multiple stakeholders. Patients are of course the first to feel the repercussions of long waitlists and deteriorating eye health, but healthcare professionals, organisations and the taxpayer are also at high risk of being negatively affected.

According to a recent study, around 1.93 million people in the UK are affected by sight loss and blindness caused by a range of conditions, including age-related macular degeneration, cataracts, diabetic retinopathy, glaucoma and under-corrected refractive error. The economic consequence in the UK adult population has been valued at anywhere between £7.2 and £19.5 billion, with costs directly affecting the healthcare system reaching £3 billion at the time of the study.

One important factor to consider which, if fully understood and investigated could lead to a notable reduction in that burden, is that a significant proportion of sight loss and blindness is preventable. If we can secure greater investment from public and private organisations, new innovative therapies will be developed which can directly improve eye health through better access to early intervention and prevention.

Let’s take a look at the National Eye Health Strategy Bill that calls on the Secretary of State to publish a national eye health strategy for England. The objectives of the Bill are clear; to improve eye health outcomes, reduce waiting times for eye health care, ensure providers of eye health care work together in an efficient way, increase the capacity and skills of the eye health care workforce, and make more effective use of research and innovation in eye health care. Despite the many barriers that are in place, there is hope that the objectives set out in this Bill are achievable.

Accessing innovations in ocular care

Across the globe, great strides in innovating ocular care continue to be made. According to Dr Peter McDonnell, Director of The Wilmer Eye Institute and Professor of Ophthalmology at Johns Hopkins University, who co-chaired the December 2023 EyeCon conference; “There’s so much innovation going on in ophthalmology that it’s really impossible…for anybody to read all the journals and see all the articles that are coming out.”

Recently in the UK, the Association of Optometrists (AOP) updated clinical guidelines to include the application of amniotic membranes for dry eye disease patients, which opened up treatment access through optometrists in an outpatient setting. But what does this mean for the industry in practice and the NHS waiting list?

Optometrists have a new therapeutic option to support patient care with a treatment that integrates easily into existing clinical practice and effectively supports healing, limits inflammation formation, and reduces pain. Our OmniLenzⓇ, a specialised bandage contact lens enables our amniotic membrane, Omnigen®, to be loaded onto the ocular surface in a four-to-six-minute procedure without the need for surgery. In the longer-term, the availability of an amniotic membrane-based treatment in primary care will take the pressure off scarce NHS resources, allowing secondary-based care to reduce the current ophthalmology waiting list by focusing on patients who can only be treated in a hospital setting.

Clearly innovations can have a positive impact on every stakeholder involved in the provision, delivery and receipt of quality eye care. And to continue driving the UK’s world-leading innovations in this industry, we must remain open to knowledge sharing and collaborative practices. This will be supported by keeping up-to-date on the latest clinical studies and available resources on the range of eye conditions that global populations are facing, and the potential solutions.

What next?

It appears that we’re currently balancing on a precipice. On one side, we have an ever-worsening waiting list, while on the other we have an ongoing commitment to innovation that could transform ocular care for the better. In the UK and across the globe we’re seeing professionals in the public and private sectors scoping out new solutions to ocular conditions and treatments. For example, the use of AI to train surgeons remotely and monitor eye health with smartphone apps. And in May 2023, the NHS published new clinical guidance with the aim of reducing waiting times for eye care services for patients in England.

If you know where to look, organisations across the UK are advancing world-leading innovations in ocular care. But it’s important that we stay open to learning from other countries. For example, in the US significant ophthalmology-related FDA approvals have occurred or are due to occur imminently. Intraocular injections will be deployed to treat geographic atrophy, an advanced form of age-related macular degeneration, which previously had no treatment. Meanwhile, new data suggests that low-dose atropine can be very effective in reducing the magnitude of myopic progression in young children.

I’m very hopeful for the future of eye care in the UK and globally, and that as an industry we remain committed to supporting patients, professionals and our healthcare systems in overcoming the barriers and pressures that they are currently facing in the delivery of effective ocular care.

For more information on the innovative therapies that are being developed in ocular care, please visit: https://www.nu-vision.co.uk/patients/.

Women’s health, and why 51% are overlooked so often

By MaryAnn Ferreux and Melissa Ream

Women’s health has historically faced challenges and disparities, with issues often overlooked across all sectors.

Inequalities within women’s healthcare do not only impact conditions solely affecting women, but also our understanding of the different physiological responses that women have in areas such as cardiac disease and immune responses. It is also known that women use health technology differently to men, presenting clear opportunities to deliver measurable health benefits to more than half of the population, as well as a huge market opportunity for businesses to target.

Femtech and women’s health innovation are increasingly growing areas, however there is a risk that the promise of these areas is not realised without recognising the challenges that remain. Dr MaryAnn Ferreux, Medical Director at Health Innovation Kent Surrey Sussex (HIKSS), and Melissa Ream, Specialist Commercial Advisor, HIKSS, share their perspectives on the potential opportunities in femtech and women’s health, and how we can work together to reap the benefits.

What are the major challenges facing women’s health in the UK?

MaryAnn Ferreux: The main challenges in women’s health stem from decades, if not centuries, of gender bias and discrimination. In the past, many women’s health complaints were attributed to being emotional or hysterical and these gender stereotypes often led to doctors mistreating women’s symptoms as a mental health condition, rather than a physical condition.

While that has changed, much of this inherent gender bias remains, with many clinical trials and research studies not assessing the impact on women. We have recognised that there is a gender-based data gap but now we need to overcome this. Data sets are very rarely analysed by gender, and yet it is almost universally recorded, so the disparities in how genders respond in different disease groups could and should be analysed routinely.

Melissa Ream: We often think about women’s health in terms of women’s conditions, be that menstrual health, maternity or menopause. But women’s health care is general health care too. The cardiac symptoms and risks for women are different to men, yet these are not widely known. And this comes down to under representation of women in data sets as well as unconscious bias in the wider world. If you search for images of people having a heart attack on Google, most of the images will be of men. Cardiovascular disease in women is a bigger killer than breast cancer and we need to start taking this more seriously, looking at how clinical services are designed, delivered and promoted.

Do you think AI has the power to change this or do these concerns remain?

MaryAnn Ferreux: AI has a lot of potential to improve the health experiences of women, but there is a risk of building in more inequality if we do not address gender bias in data sets. More and more innovators are wanting to use AI in their technologies but some of them are not thinking about bias until it’s too late. A global analysis of AI systems found that 44 per cent demonstrated a gender bias. We need to ensure that the data sets used are comprehensively analysed and shown to be relevant to the target population and this comes down to the decision makers asking the right questions, whether that’s innovators, regulators, funders or purchasers. I’m also concerned about a lack of leadership in AI regulation and who is at the decision-making table. Without diversity at that top level, it is unlikely that the right questions will be asked early enough – retrofitting later on just won’t work!

Learning from experience presents a huge opportunity, but one that we haven’t been previously good at. As an example, a lack of ethnicity data incorporated into skin algorithms resulted in racial bias in pulse oximetry, ensuring that the device was not as effective for black and ethnic minority people. This disparity has been observed since the 90s and yet the device was still used during the Covid-19 pandemic, resulting in worse outcomes for black and ethnic minority people. We didn’t address the problem when we had the chance, and we need to ensure this doesn’t happen again.

So, what do we need to do to support equality in healthcare?

Melissa Ream: As MaryAnn says, having people at the decision-making table is vital to ensure that equality is incorporated into our systems. There is still a shortage of women in leadership roles even in the femtech industry and this needs to change, from more women at C-level, to more women investors. With women making up just 22 per cent of AI workers, we need active engagement from all sides to help make this change. Role models are a powerful tool; if you can’t look above for inspiration then you’re unlikely to move in that direction. It’s therefore so important that we build networks to support this.

Innovation hubs like Discovery Park play a powerful role in this, providing a network to support women in leadership positions and a platform that draws attention to the issues and also to those overcoming them. When we see good practice, let’s talk about it!

MaryAnn Ferreux: To make change happen, we need to use both a stick and a carrot. There must be something built into our structures and processes that sets out expectations and ensures compliance with health equity. But we also need to use financial levers as a carrot, with investors and purchasers demonstrating an interest in this area and making decisions that reflect a commitment to reducing health inequalities.

What would be on your women’s health manifesto to help guide this change?

MaryAnn Ferreux and Melissa Ream: There are three areas to focus on that we believe will see real results:

Leadership – Women currently make up just 20-25% of leadership in digital, tech and AI. This needs to change to reflect the wider population and their healthcare needs. We also need to promote and support women innovators to enter femtech and maximise commercial opportunities that improve women’s health.

Policy and Commissioning – Those determining the focus of our health and care policies need to be inclusive and incorporate diversity requirements, ensure that a wide range of women’s voices are heard, and that commissioning reduces gender health gaps.

Data sets – Data sets need to reflect their target audience and not exclude minority groups. Existing data sets may not be inclusive, so trials and data sets need to be designed and analysed with this in mind. This also presents an opportunity where having a comprehensive understanding of the data can result in the development of more tailored care including personalised interventions with the potential to reduce health inequalities.

How important do you think local networks are to support these changes?

Melissa Ream: Change doesn’t exist in a vacuum, it takes work across the entire system, and local hubs are an excellent starting point. By working together locally to understand the problems and bringing together groups to address these problems, we can see real impact. There are important roles for everyone within the industry, from the NHS to individual companies, hubs like Discovery Park and national networks like Barclays Eagle Labs and Health Innovation Networks. If we collaborate, we can make health care more equitable, close the gap and reduce inequalities.

MaryAnn Ferreux: Discovery Park is in an exciting position, embedded in the start-up community but with close links to the NHS and academia, there is opportunity to set a standard and drive this campaign forward. Discovery Park Ventures is already investing in women led femtech companies, and I enjoyed joining the team at Giant Health to discuss the challenges and opportunities in this space.

Discovery Park recently hosted a panel at Giant Health on ‘Unlocking Opportunities in Women’s Healthcare’. The panel was moderated by Sylvia Stevenson, Founder, Absolute Diversity, and featured Dr MaryAnn Ferreux, Medical Director, Health Innovation Kent Surrey Sussex, Lina Chan, Holland & Barrett General Manager Wellness Ventures and CEO, Founder at Parla, Melisa Guven, Associate, Monograph Capital and Karina Vazirova, Co-Founder & CEO, Femtech Lab.

Why value-based procurement is key to cutting costs and improving outcomes: learning from Lincolnshire

By Alison Wileman

Alison Wileman is a Market Access Specialist – Continence at health and hygiene product provider, Essity, Specialist Nurse at Bladder and Bowel UK, and Trustee at ERIC, The Children’s Bowel and Bladder Charity. She is also former chair of the Royal College of Nursing’s Bladder and Bowel Forum.

For as long as universal healthcare has existed in Britain, the debate between the cost and quality of care has simmered – and at times – raged on.

Depending on how well the government of the day has balanced the books, the needle would often oscillate between cost-cutting measures for a cash-strapped services – in which quality of care is inevitably among the first casualties – or a healthier healthcare system where positive patient outcomes are prioritised.

But, as the NHS continues to suffer unprecedented pressures in the wake of the global pandemic and systemic shortages in resources and capacity, it’s clear, at present, where the needle is firmly pointed.

And while the crisis in our healthcare system undoubtedly demands a degree of money-saving measures, there does often exist a false economy in this equation which needlessly sacrifices patient outcomes only to return a higher bill for the taxpayer.

Redefining ‘value’

Take the endemic issue of incontinence, for example, which affects an estimated 14 million people in the UK today. A groundbreaking pilot conducted at care homes by the Lincolnshire Community Health Services (LCHS) in partnership with global hygiene and health company, Essity, revealed that ‘the NHS is leaking more than half a billion a year through substandard incontinence care’.

At the crux of the eight-week study was the crucial finding that the cheaper, blanket provision of generic absorbent pads – chosen on their low upfront cost and prescribed en masse to manage incontinence – resulted in a higher overall cost of care than more premium, yet clinically more appropriate, products.

This was because, as researchers found, patients using so-called “cost-effective” pads were far more likely on average to suffer up to 2.5 leakages per day, requiring the use of more products, and in turn – a greater time demand on typically overstretched carers and community nursing teams to replace patients’ pads, laundry of bedding and clothes, as well as other sanitising costs.

By contrast, continence pads prescribed based on an individual assessment of patient need, while generally resulted in the use of more expensive products, delivered a drastic reduction in overall service spend across participating care homes – bringing the average cost of daily care down from £15.33 to £6.68 per patient. Through appropriately prescribed products, patients experienced an average of just 0.5 leakages per day, which significantly reduced carer time and associated costs.

Equally important were the significant health improvements experienced by patients. The pronounced reduction in leakages had the welcome effect of a decrease in urinary tract infections, falls and hospital admissions linked to urinary urgency, as well as poor fluid intake that typically afflicts elderly patients with continence challenges. Quality of life was also enhanced, as fewer leakages led to an 18 per cent increase in patient self-toileting.

Delivering long-term value

This plethora of positive patient outcomes as a result of appropriately prescribed pads also, unsurprisingly, translated into greater carer satisfaction. Across several core functions, including ease of product application and removal, and whether the pad helped avoid unnecessary patient moving, the pilot’s core aim to replace cheaper products with more clinically appropriate pads saw a surge in satisfaction scores among carers.

This approach, modelled on the principles of ‘value-based procurement’, is key to understanding the resounding success in cutting costs and improving patient outcomes across participating care homes in Lincolnshire. By centring patient needs and considering the overall cost of care across the patient pathway – as opposed to the procurement orthodoxy’s obsession with the lowest possible price tag – services can significantly reduce outlays in a budgetary crunch. And, critically, not only does the typical trade-off between costs and patient care disappear entirely – but the latter is in effect considerably improved.

With more than 160,000 people in the UK with continence challenges living in care and nursing homes, it is vital that the instructional lessons from Lincolnshire are learned, generalised and adapted across the country.

While the government has committed to the adoption of value-based procurement across the health and care system, in reality, uptake by purchasing and procurement managers and individual integrated care systems has been far too sluggish, and at the continued expense of patients.

And while news of government’s further exploration of value-based procurement for continence care is welcome, more must be done practically to accelerate the institutional shift towards a practice that prioritises patient care and outcomes as well as service costs.

Further clear and consistent guidance from the Department for Health and Social Care and NHS England would no doubt strengthen this strategic steer. While at the granular level, reform of the NHS procurement framework to prioritise patient outcomes and the overall cost of care would supercharge the transition.

Lincolnshire’s pilot has proven beyond doubt that a value-based procurement approach to continence care delivers for patients and services. It’s crucial now that the wider health and care system follows the evidence and changes for good the way continence care is provided across the country.

£30m study offers new hope for people with cirrhosis

By Integrated Care Journal

The most extensive clinical study into liver cirrhosis ever conducted worldwide has been announced by Newcastle University, University of Edinburgh and research-driven global biopharmaceutical company, Boehringer Ingelheim.

The ADVANCE (Accelerating Discovery: Actionable NASH Cirrhosis Endpoints) study will be the most detailed observational study of its kind, enrolling the largest number of patients and providing a detailed analysis of liver health.

Approximately 444 million people worldwide are estimated to live with a condition referred to as non-alcoholic or metabolic dysfunction-associated steatohepatitis (NASH/MASH), an inflammatory liver disease that is caused by accumulation of fat in the liver. Over time, NASH causes the formation of scar tissue leading in many cases to liver cirrhosis.

This can result in serious complications, including liver failure or liver cancer and may result in the patient needing a liver transplant. Currently there are no approved medicines for cirrhosis and so there is an urgent need for earlier diagnosis and new medicines to prevent MASH cirrhosis progression to liver failure, or to reverse the scarring of the liver once cirrhosis is established.

This £30M study is funded by Boehringer Ingelheim and will be led by researchers at Newcastle University and the University of Edinburgh, along with collaborators across Europe. It will aim to not only enhance the understanding of NASH cirrhosis, but also help to identify translational biomarkers that will accelerate the development of future therapies.

The study will include 200 patients with cirrhosis. Participating patients will be recruited at specialist liver clinics at hospitals across the UK and Europe or through referral by their treating physician. This study will enrol patients, who have been diagnosed with or are thought to be at risk of advanced fibrosis or cirrhosis due to fatty liver disease (Metabolic-dysfunction Associated Steatotic Liver Disease (MASLD), formerly termed Non-Alcoholic Fatty Liver Disease (NAFLD)).

Professor Quentin Anstee, Professor of Experimental Hepatology at Newcastle University and Consultant Hepatologist at Newcastle Hospitals NHS Foundation Trust who is coordinating the global study said: “Building on Newcastle’s internationally recognised expertise in translational liver research, this study will reveal the fundamental disease processes driving cirrhosis.

“We aim to work out why, even at the most advanced stages of liver disease, there is substantial variation in how the disease progresses with some people remaining well for many years whilst others rapidly experience liver failure or develop liver cancer. Working internationally with our collaborators, we will then use this knowledge to improve how patients are diagnosed, and to help develop new medicines.”

Lykke Hinsch Gylvin, M.D., Chief Medical Officer at Boehringer Ingelheim, said: “Cardiovascular, renal, and metabolic diseases are the leading cause of death worldwide, accounting for up to 20 million deaths annually. At Boehringer Ingelheim we are focusing on understanding the whole patient and how to target specific disease mechanisms to address interconnected CRM diseases. We are very excited to work with our partners in the ADVANCE study to better understand the underlying disease processes and to bring much needed new treatments to patients with liver cirrhosis.”

Professor Neil Henderson, Professor of Tissue Repair and Regeneration at the University of Edinburgh and co-lead on the study, said: “Liver disease has reached epidemic proportions worldwide. Therefore, there is a huge need to develop potent, new treatments for liver scarring. To help address this, over the last several years we have harnessed a new technology in Edinburgh called single cell RNA sequencing. Using this new technology has allowed us to study human liver scarring in high definition for the first time, and we hope that this state-of-the-art approach will allow us to accelerate the discovery of much-needed new treatments for patients with liver disease.”

His team is being supported by Edinburgh Innovations, the University’s commercialisation service.

Participants will initially undergo a biopsy to collect a small sample of liver tissue so that detailed changes in gene expression in the liver can be assessed using advanced scientific techniques. They will then have blood tests and state-of-the-art MRI scans performed at regular time points over the next two years. The data generated will be combined to allow researchers to see how disease-related changes evolve in the body as cirrhosis progresses.

The international research consortium is led by doctors at Newcastle University (UK) and Edinburgh University (UK), working closely with scientists at Boehringer-Ingelheim, and includes specialist doctors and researchers at universities and hospitals across Europe from Antwerp University Hospital (Belgium), Assistance Publique Hopitaux de Paris (France), Edinburgh Royal Infirmary (UK), Newcastle upon Tyne Hospitals NHS Trust (UK), University of Seville (Spain), University of Turin (Italy), and Vall d’Hebron University Hospital (Spain).

Anyone interested in taking part should discuss it with their treating physician.

Report highlights potential of pharmacy sector in tackling health inequalities

By Gabriel Blaazer

The report from Optum identifies the barriers holding the pharmacy sector back from an enhanced role in addressing health inequalities and issues recommendations to allow the sector to take a more prominent role in tackling persistent disparities.

A report from health service innovation company, Optum, has called for an enhanced role for the pharmacy sector to help drive progress on health inequalities. The report, Action on health inequalities: Perspectives from the pharmacy profession, finds that there is an appetite within the sector to contribute more to the health inequality agenda, but that it is stymied by systemic issues and day-to-day challenges which make it difficult to go beyond day-to-day functions.

The report describes the key insights garnered from a roundtable discussion that took place in October 2023. Around 30 senior pharmacy professionals attended the roundtable from across primary and secondary care, integrated care board (ICB) leadership and community pharmacy to answer the question “how can pharmacy and medicines teams take a leading role to close the gap on health inequalities in their communities?”.

Participants were asked to give their views on a range of subjects, including how to define pharmacy’s role in tackling health inequalities; the opportunities for pharmacy professionals to achieve better outcomes for marginalised groups; the barriers from preventing pharmacy from making a broader contribution within their integrated care systems; and possible measures that would enhance the sector’s influence on the health inequalities agenda.

The report makes five recommendations to the pharmacy sector around how it can be empowered, and its role enhanced to help deliver health inequality improvements. These are:

Create a stronger, system-wide understanding of the value pharmacy can bring.
Achieve greater coherence and impact by building a single professional voice.
Give pharmacists the means to make better use of data in a safe, smart and sensible way.
Enhance the training and continuous professional development opportunities available for pharmacists.
Put patients and citizens at the heart of everything we do.

Reframing the value of pharmacy

Pharmacy and medicines management have assumed increasingly prominent roles in recent years, and the two have been placed at the heart of the drive to improve preventative services and tackle health inequalities in the NHS in both the Major Conditions Strategy and NHS England’s Core20PLUS5 programme.

However, the report finds that pharmacy’s potential impact on health inequalities is hampered by the fact that medicines management is too often perceived as a “cost-saving opportunity” by NHS England and ICB financial teams. It calls for a reframing of the debate around pharmacy’s offering, arguing it should centre on the role of pharmacy in creating value for systems, rather than a short-term approach focusing on cost-reduction.

While short-term savings can be found in many areas, the report finds that these savings could be eclipsed were substantive action on health inequalities taken today. It cites figures that the cost of socio-economic inequalities to the NHS acute sector is £4.8bn every year, while people in the most deprived fifth of neighbourhoods account for 72 per cent more emergency admissions than the most affluent fifth. Addressing these trends, the report contends, would contribute more to the health inequalities agenda than any efficiency savings could over the long-term.

The report notes that ICSs, through the work of integrated care partnerships (ICPs), have a clear mandate to reduce the health inequalities gap and that pharmacy has a key role to play in achieving this. However, it identifies a lack of influence of the pharmacy profession at senior levels within ICSs, typified by the fact that not all ICSs have appointed a Chief Pharmacist and not all have full board representation. The report calls on the pharmacy sector itself to organise and come to resemble a single, coherent professional group to strengthen its voice and the impact of its advocacy. It also suggests that the development of “pharmacy collaboratives”, mirroring structures that exist in the provider and primary care sectors, would help the sector to improve its collective presence and impact.

Among other barriers discussed was the sector’s ability to access high-quality patient data from which it can generate meaningful population intelligence about specific cohorts or groups. Data linkage – drawing together data from multiple sources – was identified as being of particular concern, but this remains a troublesome issue across many ICSs. It was noted, however, that data alone cannot tell the whole story about a patient or population group, and that data insights must be paired with community intelligence and co-production to develop truly impactful interventions that will shift the dial on health inequalities.

In his foreword to the report, Chief Medical Officer at Optum UK, Dr Martin McShane, said: “My experience has shown me that the pharmacy profession is one of the NHS’s hidden jewels: agile, inventive, wholly focused on the needs of their patients, pharmacists do so much across primary and secondary care to keep people safe and supported. The recognition they are now getting — as key agents in the national drive to address health inequalities and drive up-stream improvements in preventative care — is both long overdue and a testament to their unique skill set.

“Yet if we want our pharmacist colleagues to make the fullest possible contribution to this agenda, we need to do something the NHS hasn’t always been very good at over the course of my career. And that is, to listen to them, act on their concerns and make them a genuine partner in change.”

The full report can be accessed here.

Primary care network to adopt new digital pathway for heart health

By Integrated Care Journal

New approach to heart failure care will enhance provision of digital services to patients across Widnes primary care network.

Widnes PCN, a locality in NHS Cheshire and Merseyside, has launched a new digital health pathway for heart health. It will support healthcare professionals (HCPs) “to feel confident in prescribing trusted and assessed digital health apps for patients living with heart and circulatory diseases” across the locality.

The digital care pathway will provide HCPs across primary, secondary and tertiary care with the most appropriate apps to prescribe to patients as a digital adjunct to treatment, aiming to improve outcomes for patients who have, or will be diagnosed with, heart failure.

Heart failure affects more than 900,000 people in the UK, accounting for 5 per cent of all emergency hospital admissions. 200,000 new cases are diagnosed annually, and it is the leading cause of hospital admissions among over 65s. Care for heart failure patients meanwhile accounts for 2 per cent of the total NHS budget and it is estimated that hospital admissions for heart failure will rise by more than 50 per cent over the next 25 years.

Five-year survival rates for heart failure are worse than breast or prostate cancer and it is a strategic priority in Chesire and Merseyside. In the Halton locality, heart disease accounts for 10 per cent of all deaths, giving it a higher prevalence than the national average.

Widnes PCN has launched the new digital care pathway in partnership with Boehringer Ingelheim and the Organisation for the Review and Care of Health Apps (ORCHA) for the NHS. There are more than 350,000 digital health technologies on the market, including apps that can help prevent, diagnose and monitor heart health, as well as educational apps. However, only 20 per cent of apps currently meet ORCHA’s set quality thresholds.

The apps included in the pathway have been assessed, critiqued and selected after a three-month period of testing conducted by NHS Cheshire and Merseyside, ORCHA and Boehringer Ingelheim. Staff working across heart health services in the locality have received training on how to use the pathway and the apps within it.

Both the digital care pathway and the featured apps are held in NHS Cheshire and Merseyside’s Digital Health Formulary – a single platform where staff can quickly find and recommend approved apps to patients. Once an HCP prescribes a tool, the patient receives a text or email with a link to download the app and access it via a website.

“Heart failure is a prevalent and incurable condition that requires a focus on managing symptoms and slowing its progression,” said Dr Henry Chan, GP and Heart Failure Lead in Widnes. “Unfortunately, it leads to early mortality and often results in emergency hospital admissions, placing a significant long-term demand on healthcare and social services.

“We are delighted to introduce this innovative digital pathway for heart health to recommend the most appropriate digital tools to support patients throughout their care journey.”

Liz Ashall-Payne, CEO of ORCHA, commented: “Increasing the adoption of digital health is the key to creating a more sustainable healthcare system and has vast potential to save lives. All apps available have been assessed and approved against ORCHA’s standards, so they are only directed to quality-assured tools and this ensures the most effective are recommended consistently across the system.”

Country Managing Director and Head of Human Pharma at Boehringer Ingelheim UK & Ireland, Vani Manja, said: “This project was led by a deep understanding from heart failure patients and clinicians themselves about their experiences and we collaboratively generated solutions that underpin this new pathway. I am hopeful that we can improve the experience and outcomes for patients across heart failure pathways, with a view to offering it more widely in other regions.”