People with severe eczema face a hidden cost of living crisis

By Rippon Ubhi, Sanofi Specialty Care General Manager

New report from Sanofi shines a light on the hidden financial burden faced by sufferers of severe atopic eczema.

Nearly everybody has felt the pressures of the cost-of-living crisis. Prices rising, bills soaring, and having to do more with less. This is a real concern for so many, but it’s even worse for people living with uncontrolled atopic eczema, who have to contend with additional costs, both direct and indirect, which are causing a significant strain on both individuals and the healthcare system.

Atopic eczema – known medically as atopic dermatitis (AD) – is the most common form of eczema in the UK, affecting 5-10 per cent of all adults, and causing the skin to become itchy; during a flare-up it can become red, cracked and sore. From the financial costs of medications to an increased risk of developing depression, the costs of uncontrolled eczema to many people living with the condition are wide-ranging and detrimental to their quality of life, particularly for people from lower socioeconomic backgrounds.

Eczema can often be overlooked as a healthcare issue by the general public, and Sanofi recognises the significance of highlighting the genuine effects on the individual that it can cause. Sanofi’s aim is to increase awareness and shine a light on the true cost of the condition. So, we commissioned leading cross-party think tank Demos to produce a report which analyses the impact that uncontrolled atopic eczema has on patients, the NHS and wider society.

The Costs of Atopic Dermatitis report, published in April 2023, draws on an evidence review of UK and international literature, interviews with clinicians in England and the experiences of people living with eczema to examine the costs, the current state of patient care and how patient care can be improved.

The financial burden of eczema

The report provides insights into the costs borne by people living with uncontrolled eczema. This financial burden is far more significant than many might expect. One clinician Demos interviewed said that sometimes patients with lower socioeconomic status have to make a choice between paying for medication or buying food. This cost to society goes beyond just the healthcare system, hitting the economy as a whole. In the UK, the indirect costs of work impairment to the economy for adult patients with moderate-to-severe atopic eczema is estimated to be between £6,741-£14,166 per patient, per year.

But why does it cost so much? Firstly, people living with severe eczema have to spend money on both medical and non-medical item s such as medicines, emollients and moisturizers. The impact the condition has on their ability to work also adds to the personal financial cost. Patients with severe, uncontrolled atopic eczema often need to take additional sick days and they may even lose work because of their condition. Then there are the intangible costs: people living with eczema may have to deal with sleep impairment and other mental health issues exacerbated by the irritation and appearance of their skin.

There is an impact on the NHS too. The direct cost of mild-to-moderate eczema to the health service was estimated as being at least £257m in 2020, though there have been no comprehensive studies encompassing the costs of severe atopic eczema. It is estimated that around 15-20 per cent of GPs’ workload is dermatology, with a large quantity of that work being eczema.

Reforming dermatology pathways

The Costs of Atopic Dermatitis report has shone a light on the problem. We now need to focus on how we can alleviate this financial burden. That means investment in improvements to the standard of care for people living with atopic eczema, to drive positive outcomes for patients and reduce long-term costs to the health service and the economy.

If integrated care systems develop dermatology strategies and ensure that psychological support is commissioned as part of the dermatology pathway, these costs can be significantly reduced, by lessening the mental burden of eczema. We as a country need to do more to ensure that healthcare professionals know about the full range of support available to patients. It is vital that patients feel supported by their doctors to access mental health care where appropriate, and that GPs have the training and resources needed to provide the best care possible to their patients with eczema.

Through commissioning this report, Sanofi hopes it has played some small part in bringing the issue of atopic eczema and its cost to us all into relief. The next steps, however, need to be taken by decision makers as they decide whether they want to act to rescue the costs of eczema to patients and our healthcare system.

This article was written by Sanofi.

Job bag code: MAT-XU-2304180 (V1.0)
Date of prep: Sept 2023

Report finds doctors and nurses ready to embrace generative AI

By Integrated Care Journal

Elsevier Health’s landmark Clinician of the Future 2023 report highlights new opportunities technology will play in providing relief for healthcare workers and geographical differences in opinion

Global information and data analytics leader, Elsevier Health, has today released its Clinician of the Future 2023 report, offering a snapshot view on what doctors and nurses think about the changes and current challenges in healthcare, including the rapid rise of generative AI products and platforms.

The report finds that nearly half of all doctors and nurses surveyed are eager to make use of these new technologies to support their clinical decision-making. While only 11 per cent of today’s clinical decisions are assisted by generative AI tools, 48 per cent of respondents said that doctors using these tools to help make clinical decisions will be ‘desirable’ within two-three years’ time.

The current study comes one year after the launch of the inaugural Clinician of the Future report, which aimed to provide a voice for clinicians and a mandate for change to help ‘future-proof’ the global health industry. This new report canvassed the views and opinions of 2,607 doctors and nurses worldwide, building upon the understanding of healthcare workforce challenges highlighted in the original survey, but now putting an additional lens on the future of generative AI technologies across global healthcare.

Participants across both Clinician of the Future reports spotlight concerns around overwhelming resource issues for healthcare systems worldwide, even as they face substantial treatment backlogs. Clinician shortages remain the top concern in North America and Europe, with 54 per cent of clinicians surveyed for the 2023 report identifying nurse shortages as a pressing health priority.

“73 per cent of doctors surveyed believe they themselves will need to be experts in the use of digital health technologies…within the next two-three years.”

45 per cent similarly reported the need to tackle doctor shortages, reinforcing the urgent need for innovative solutions, such as generative AI, to address clinician shortages, as well as identifying opportunities for efficiencies and training to both enhance clinical readiness and provide much needed clinician support.

Additionally, doctors surveyed believe that they will themselves need to be experts in the use of digital health technologies, with 73 per cent of clinicians agreeing that these skills will be ‘desirable’ within the next two-three years. Accordingly, 55 per cent expressed as ‘desirable’ the transition towards ‘telehealth’, agreeing that remote routine checkups should form the majority of patient-clinician interactions within the next 2-3 years.

While more than half (51 per cent) of clinicians welcomed the prospect of medical students using generative AI-powered tools as part of their medical education in the next 2-3 years, clinicians from the UK and the US were found to be more reserved about generative AI technologies supporting medical students; only 33 per cent in the UK and 40 per cent in the US found this ‘desirable’.

Jan Herzhoff, President of Elsevier Health said: “As healthcare systems continue to face significant challenges, we must raise the voices of doctors and nurses worldwide to understand how we can best support them and the patients they care for. In this pursuit, advanced technology combined with trusted medical content emerges as a powerful ally, and generative AI, particularly, shows immense promise in helping clinicians.”

Mr. Herzhoff added: “By equipping clinicians with advanced tools and training to support their clinical decision-making, doctors and nurses will be empowered to allocate more time to the human aspect of patient care.”

As global healthcare systems progress towards a more digital-first approach, the findings in the Clinician of the Future 2023 report demonstrate that the workforce not only recognises the potential new technologies like generative AI can provide to innovate global healthcare, but also their beneficial impacts on patient care.

Josh Schoeller, President, Global Clinical Solutions at Elsevier and CEO, Healthcare at LexisNexis Risk Solutions said, “Elsevier is renowned for powerful point-of-care solutions that support clinicians throughout their workday. We have been at the forefront of developing clinical solutions tools, prioritising the responsible use of AI, while anticipating and staying ahead of the latest technology trends. We are deeply committed to listening to the needs of clinicians so we can continuously enhance our products to create efficiencies, enabling clinicians to prioritise delivering life-saving care.

For the full ‘Clinician of the Future 2023’ report, which includes robust data on global attitudes on the future of healthcare, important insights on training and development and more, click here.

Addressing whistleblower concerns in the NHS

By Chancelle Blakey

Building a culture of transparency and accountability will be essential steps to encourage and protect whistleblowers in the speak-up system.

The NHS has been grappling with concerns surrounding its whistleblowing systems and cultural health. This has been highlighted repeatedly in the press over the last week with coverage of the Lucy Letby trial, within which there were shown to be multiple failures in internal reporting processes.

This demonstrates the need for an independent reporting line for employees across the organisation. NHS employees must have the opportunity to speak with an entirely impartial party who can process their concern and pass on the information to the appropriate team for further investigation.

Whistleblowers within the NHS have often faced challenges, making them hesitant to report wrongdoing due to fears of retaliation and detrimental treatment. Despite these obstacles, 2023-23 saw a significant increase in NHS whistleblowers coming forward compared to the previous year, highlighting the urgent need for reform in the whistleblowing process.

In fact, a record 25,000 plus NHS whistleblowers came forward last year. Of these cases, as has been reported by Freedom to Speak Up Guardians office, the most common reports were of inappropriate behaviours and attitudes (30 per cent), followed by worker safety and wellbeing (27 per cent) and bullying and harassment (22 per cent).

Reports indicate that NHS employees are lacking confidence in the current speak -up system, with many feeling labelled as troublemakers when they raise concerns. This detrimental culture not only deters individuals from speaking up but also hinders the NHS’s ability to identify and address wrongdoing, potentially endangering both patients and employees. And that’s before the damage to the NHS’s reputation is considered.

Improving the speak-up system

For optimal trust and confidence in a speak-up system, employees must feel that their concerns will be taken seriously and investigated appropriately.

Unfortunately, this most recent case is the most extreme example of that not happening, with Dr Stephen Brearey stating that if hospital executives had acted on concerns about nurse Lucy Letby earlier, lives may have been saved.

To address these pressing issues, steps need to be taken to: improve employee confidence; identify and combat wrongdoing; and protect those who come forward to report concerns.

One crucial measure is to review and audit the NHS’s whistleblowing policy, processes, and operations to understand the reasons for the breakdown of trust. Identifying and holding accountable those responsible for retaliating against whistleblowers is essential to foster a culture of transparency and accountability.

Providing whistleblowing training to both employees and managers is another critical step to improve the speak-up culture. When employees are aware of how to raise concerns, and the legal protections they have under the Public Interest Disclosure Act (PIDA), they are more likely to come forward without fear of retribution. Additionally, providing training to managers on how to receive and handle disclosures appropriately can help deter misconduct.

The current Freedom to Speak Up (FTSU) Guardian scheme, while a positive step towards improving whistleblowing culture, appears to lack confidence among NHS employees, with many remaining hesitant to report serious concerns through an internal system due to doubts about confidentiality and impartiality. One worker told the FTSU Guardians that “the Guardian was excellent, but nothing has been resolved”. The Guardians themselves have said that managers need to be trained about their obligations once they receive a report.

Taking affirmative action to instil trust

To build trust, the NHS can consider offering an alternative means of disclosure, such as a dedicated, outsourced whistleblowing hotline provider, ensuring true anonymity and independence in the reporting process. Safecall already works alongside several NHS Trusts helping make their processes more robust and transparent. Employees are much more confident speaking to, and reporting through, a third party.

It is vital that the investigation procedure is handled in a fair and balanced fashion, and not conducted in a way that undermines the whistleblowers’ concerns. To instil confidence in the reporting process, investigations should be conducted in an independent and confidential manner. Outsourcing the investigation process or ensuring that internal investigators undergo proper training and possess the necessary experience can help safeguard employees’ wellbeing and protect the NHS’s reputation.

It is paramount for the NHS to take affirmative action in protecting whistleblowers and fostering a culture of transparency and accountability. No healthcare professional should face detrimental treatment for raising concerns that may impact patient safety. To achieve this, the NHS must review its systems, provide comprehensive training, and offer reliable and independent reporting avenues.

The NHS must strive to offer confidentiality, impartiality, and independence when receiving and investigating concerns. These efforts should be continuous and consistent to create effective and sustainable change within the organisation.

In conclusion, addressing whistleblowing concerns in the NHS is crucial for promoting a culture of transparency and accountability. By taking proactive steps, such as reviewing policies, providing comprehensive training, and ensuring independent investigations, the NHS can create an environment where employees feel confident and protected when speaking up against wrongdoing.

Fostering a culture that values whistleblowers and their contributions will not only strengthen the NHS internally but also enhance its reputation and commitment to patient care.

*Chancelle Blakey, Business Development Manager, Safecall*

NHS Workforce Plan will need a change in mindset from clinicians, patients and systems

By Amanda Grantham

Enacting reforms through a clinically-led, multi-disciplinary lens will be critical to achieving the ambitions of the NHS Long Term Workforce Plan.

The NHS Long Term Workforce Plan centres on the need to train, reform and retain its employees to meet future demand, leading to an increase of up to 360,000 new staff across integrated care systems (ICSs). Increasing the number of formal training places available through more diverse points of entry and improving retention through rewarding career and development are at the heart of what needs to be done to deliver this plan.

The introduction of new roles, reforming the way care is delivered and by whom, will be critical to meeting anticipated demand in 2036/37. But these roles will need to be designed, clinically-led, and committed to driving productivity to create the capacity needed.

Determining which roles will be needed to meet demand

It is important to recognise that more staff will not increase capacity unless clinical pathways can be redesigned to be more efficient and effective. During COVID-19, there was about a 10 per cent increase in headcount within NHS acute trusts. However, at the beginning of 2023/24, providers were at 97 per cent of pre-pandemic productivity levels. Delivery of the NHS Workforce Plan means broadening the skill mix of multidisciplinary teams, creating new and diverse roles across systems. In designing the new workforce, the roles need to create new capacity to meet demand, either through new services to meet future need or by increasing provision in existing services.

Creating a new role requires the redesign of the way that multidisciplinary teams work together. The starting point for this workforce design should be the optimal clinical pathways, rather than what is being done today. That means setting out the clinical red lines (what can only be done by a registered healthcare professional), looking at the skills and roles needed, and the most efficient use of capacity.

The design of the COVID-19 vaccination workforce demonstrated how new roles could be created to meet increased demand. The drive to create this workforce led over 145,000 people to join the NHS working as unregistered vaccinators who came from diverse backgrounds, including retired medical staff, airline workers, volunteers and students.

Systems will also need to be more focused on the competency of the workforce, training employees in the skills needed to deliver their role safely and efficiently. The aim from the offset should be designing broad and rewarding recruitment, training and career pathways that will attract and retain the right talent. This could include consideration of how these roles can be steppingstones into future training or careers, as well as how apprenticeships could open doors for eligible people to take on these new roles.

To meet growing demand in the national breast screening programme, two unregistered roles have been created in collaboration with the College of Radiographers, along with redefined roles and clinical career frameworks. Approximately 30 percent of the breast screening workforce is now in these new roles. – mammography associates and assistant practitioners – with defined scopes of practice and accreditation to undertake mammography.

Clinical leadership is required

Creating new roles in healthcare is about shifting care, or elements of decision making, to another trained and competent healthcare professional. This requires a change in approach from the provision of clinically delivered care to a position where healthcare is clinically-led but can be provided by a diverse multidisciplinary team. Clinicians should be at the centre of the redesign of the workforce, but their input will need to be coupled with that from those with the skills and expertise in increasing capacity.

The NHS has had mixed success in integrating new roles into healthcare teams. The COVID-19 vaccination programme was a nationally designed workforce model which used simulation to provide an evidence base and was clinically-led.

Another approach, the Additional Roles Reimbursement Scheme (ARRS), was established in 2019 and produced more variable results. The scheme provided an automatic funding stream to Primary Care Networks to recruit 26,000 alternative roles to expand service provision and reduce patient waits.

This was part of the government commitment to improve access to general practice and included roles such as clinical pharmacists and technicians. Not all practices have seen the anticipated benefits of these roles, with the Kings Fund highlighting that the roles were not being implemented or integrated into primary care teams effectively.

It will also be important to manage the expectations of patients, in particular that they will always see a medical professional. The government and NHS leaders need to consider how to secure public acceptance of self-management for those with long term conditions, more care being provided in the home and community rather than hospital, and from trained staff who are not medically qualified. However, there will need to be a visible improvement in access to healthcare services if the public are to support these changes.

The NHS is aiming to have 10,000 virtual ward beds in place to support growing demand this winter. A clinically-led redesign of the workforce means that care will continue to be overseen by a medical team, but the delivery of healthcare will predominantly be through a multidisciplinary team of healthcare support workers and allied healthcare professionals.

New capacity will be needed to meet training demands

The Workforce Plan contains a commitment to grow the number of training places across all professions. Capacity to provide this training will need to be created from existing workforces and services. This creates a risk that waiting times may increase.

The plan commits to growing the number of medical school training places from 10,000 in 2028/29 to 15,000 by 2031/32. Each of these training place will require support from existing clinicians. The British Medical Association (BMA) recommends additional non-patient facing time to support trainees, of only an hour a week, per trainee, for each consultant.

To meet this standard will require more than 125 full time consultants/GPs to be released each year from NHS services. By 2036/37 this will see more than 625 full time consultants/GPs supporting additional trainees, rather than delivering care. That makes it critical that productivity and efficiency are at the heart of service redesign to minimise the impact on waiting times.

This underlines that the plan’s ambitions on training and retaining staff will not be achieved without fundamental reform. That will require a careful analysis of the right size and shape of the workforce that will be needed to meet future demand for local populations. Now more than ever, diverse, multidisciplinary, efficient, and clinically-led approaches will be the key principles that systems should be adopting when driving the reform of their workforce.

Written by Amanda Grantham, healthcare expert and Partner at PA Consulting.

Protecting the dignity of vulnerable people through technology

By Gavin Bashar

Gavin Bashar, Managing Director at Tunstall Healthcare, discusses why it’s important to protect the dignity of vulnerable people and how technology can be used to achieve this while improving health and care outcomes.

As the health and care needs of our population change, it’s important to uphold the dignity and rights of those who use health, housing and social care services. There are a number of strategies and innovations that providers can implement to help them deliver high quality services that support the dignity of vulnerable people.

Protecting the dignity of vulnerable people

As the health and care needs of our population change and the number of older people increases, it is important that service providers understand why and how care provision can play a crucial role in protecting the dignity of vulnerable people.

Dignity can be defined as the state of being worthy of honour and respect. When it comes to health, housing and social care services, this particularly focuses on being able to provide care that is tailored to meet the needs of each individual, their circumstances and wishes.

Robust and integrated systems can be well placed to deliver improved outcomes for citizens, reducing their need for emergency and more extensive care, such as hospital admission. The longer that people are able to remain independent without the need for acute services, the more their dignity and quality of life will be protected.

The role of technology

One of the prime objectives for technology-based solutions is to put people at the heart of their own health and care needs, protect their independence and dignity, and achieve citizen-focused outcomes. With the right digital frameworks in place, services can become focused on engaging each individual with their own health and care support.

When technology is embedded seamlessly into care and support services, it can be transformative, helping people to live happy, fulfilled lives in their homes and communities. Digital tools can also be used to ensure timely and appropriate responses to emergency events, encourage greater engagement from citizens, and provide more person-centred care.

Developments in the provision, scale and quality of digital technology can support improvements in how care providers are able to collaborate and provide person centred care. The UK’s transition to a digital communications network brings a once-in-a-generation opportunity to modernise, improve and shift the sector and its thinking from a reactive, to a proactive delivery model. This in turn can improve health outcomes for citizens, deliver efficiencies, and enable people to live independently for as long as possible.

Investment in digital solutions will support health and social care providers in reconfiguring services to make them more agile and integrated, leading to better outcomes. Utilising data and technology to create a connected approach can also provide actionable insights to deliver more informed, and more effective care.

Importance of collaboration

Last year saw the introduction of integrated care systems (ICSs) across the UK. ICSs should help us to integrate services effectively and drive collaboration between service providers, such as care homes, GPs and hospitals. Collaboration across sectors is essential to keep people healthy, reduce inequalities, enhance productivity and value, and support economic and social development. ICSs will play a key role in enabling us to remove silos between health and social care providers, while increased collaboration will reduce duplication and fragmentation, disseminate best practice and progress in technology.

Through collaboration we can create a truly joined up approach where we listen to citizens, understand their everyday needs and work together to bridge gaps in our services. Building on ongoing collaborations will see a system begin to emerge that is better connected and user focused. The latest generation of digital solutions broaden the circle of care to engage families, friends and communities, and promote services that are connected and data-driven.

Strong relationships between health and care providers and end users is vital to ensure users feel both respected and protected. This in turn can lead to clearer communication, giving care providers the opportunity to deliver care that is targeted to the requirements of individuals.

The workplace and a cultural shift

The digital transition is an opportunity to create a clearer and consistent approach to care delivery. Collaboration is essential but to encourage this, a cultural shift must take place. While technology has sometimes previously been viewed as an additional aspect of service delivery, embedding digital solutions into services will contribute to the successful transformation of existing care models, and provide more intelligent insight to improve health outcomes and protect the dignity of vulnerable people.

Increasing system capacity and capability, as well as providing a foundation for future technological advancement, will see health and care services more able to effectively meet the changing demands of the population. There are compelling benefits for all stakeholders when it comes to technology, particularly from an economic and operational perspective. By driving education within the health and care landscape and building on an already shifting culture, we’ll see more professionals become open to the idea of using technology and transfer their skills, knowledge and experience to the people they care for, to create a digitised world.

A dignified future for care users

As people live longer, increased pressure is put on our care services. Technology has the ability to aid the management of this and potentially reduce pressure points. If successful and integrated digital services for citizens can be realised, the benefits flow will through the health and care system. If we get our approach right, citizens can live independently for longer and have more choice and control.

As we look to a more digital future, we must consider how we can best harness the power of the connected world and the value that can come from technology solutions. By committing to investment in more technological solutions, we will reform our services, improve outcomes and place users at the centre of care to protect their dignity.

For more information, please visit www.tunstall.co.uk.

Digital Implementation, News August 21, 2023

BEAMS banishes alarm fatigue at Sheffield Children’s

By Integrated Care Journal and Gabriel Blaazer

On a recent visit to Sheffield Children’s Hospital, ICJ found out about the benefits that BEAMS – the world’s first acoustic bedside equipment alarm monitoring system – has had on patient safety and staff workload.

Hospital staff are rightly keen to have all the tools at their disposal to be able to respond to urgent situations on wards and prioritise patient care effectively.

Bedside alarms are a case in point. They improve patient care, reduce stress for staff, and produce better outcomes for the wider health system. When Sheffield Children’s NHS Foundation Trust approached TBG Solutions in 2018, the trust was soon to be opening a new hospital wing, housing wards up to two times bigger than previously existed. The wing would also feature a higher percentage of single bedrooms than there were in the past.

While a boon to patient privacy and dignity, and better for infection control, the shift presented Sheffield Children’s then Medical Director, Professor Derek Burke, with a conundrum; how to preserve patient safety and ensure that alarms were heard and responded to when patients were behind closed doors?

Founded in 1876, Sheffield Children’s is one of only three stand-alone specialist children’s hospitals in the UK, primarily covering Sheffield and South Yorkshire but also offering specialist services to children from across the UK and internationally.

ICJ recently visited Sheffield Children’s to speak to the Matron for Medicine Care Group, Joanne Reid-Roberts, about the impact that BEAMS has had on nursing practice and patient safety in the new wing. We also asked Paul Rawlinson, Managing Director of TBG Solutions and sister company Tutum Medical, to speak to ICJ about the inception, design and roll-out of BEAMS, and about his vision for the future of BEAMS.

Why BEAMS?

Although not a medical device company, TBG Solutions is no stranger to highly complex technology, operating as a provider of testing, measurement, and control solutions to the aerospace, automotive, defence, medical and energy sectors. As such, they were well placed to take up Sheffield Children’s challenge, which Paul Rawlinson explains: “Most monitoring systems require central monitoring, and every piece of equipment needs to be plugged in to power and ethernet. If you’ve got eight or nine different pieces from different manufacturers, your only option is to have eight or nine central monitoring systems.

“Alternatively, you can go to a third party who will give you one interface, but you need to have the software library to mimic the instrument or touchscreen. If you need to add a new piece of equipment and there’s no software library from these third parties, then there is no interface. These solutions are also expensive,” adds Paul.

After a period of close consultation between Sheffield Children’s and TBG Solutions, the latter “concluded that for the best possible benefit to patient safety, you need a nurse in each room – which of course, you’re not going to get – but putting the ear of a nurse in the room is the next best thing.”

BEAMS utilises its own Wi-Fi mesh network, removing the need to interface with existing hospital infrastructure.

From this brief, BEAMS – and Tutum Medical – were born. BEAMS works by picking up and identifying tonal noises emitted by alarms, routing alerts to a central monitoring system through its own Wi-Fi mesh network – removing the need to interface with existing hospital infrastructure.

“Not only can it do this in an environment that might have a radio or TV on,” maintains Paul, “it can also identify what the equipment is doing. It could be a ventilator’s high priority alarm, and BEAMS can provide this detailed data. And so, if a nurse has four or five alarms going off, such as a ventilator alarm and an end-of-infusion alarm for an IV drip, they are able to prioritise which one to address first.”

Fewer alarms, safer patients

Following a clinical trial, designed to make it possible to compare alarm response times before and after the installation of BEAMS, the system was found to produce an 84 per cent reduction in the maximum alarm response time, and a 74 per cent average alarm response time. The system was subsequently installed into 70 single-occupancy rooms, and it has fast become a vital fixture for the Matron, Joanne Reid-Roberts.

Joanne tells Hospital Times that she “couldn’t imagine being on the wards without it”. She credits BEAMS with inducing a “calmer, and more relaxed atmosphere” on the wing, and helping to address the harmful consequences of alarm fatigue.

Studies have shown that in paediatric wards, up to 99 per cent of clinical alarms are either false or clinically insignificant (such as a battery needing to be changed) and do not warrant clinical intervention. Research also shows the consequences of this dynamic – alarm fatigue – which arises when alarms are so numerous (and often inconsequential) that they blend into the background and are missed.

BEAMS addresses alarm fatigue by helping to reduce the number of alarms sounding at any one time, relaying alarm information in a details spoken notification and making it more likely that any one will be picked up. The statistics appear to back this up; alarm response times at Sheffield Children’s have been cut by an average of 90 per cent, down to just 40 seconds.

“We wouldn’t be able to function without it.”

These efficiency savings add up, bringing benefits to patient safety. “If a patient is on intravenous antibiotics,” Joanne illustrates, “BEAMS alerts us to say that the infusion has ended. If we missed that alert even for 30 minutes previously, what should have taken an hour would end up taking an hour and a half. It may sound small, but this can have a big impact on recovery.”

The second generation of BEAMS, currently in use at Sheffield Children’s and at Leeds Children’s Hospital, communicates the precise nature and severity of alarms, enabling the efficient delegation of tasks and saving precious clinical resource. It can now be instantly established whether an alarm requires the intervention of clinical staff or a support worker, “which has really improved the utilisation of our time,” Joanne adds.

Another important aspect of BEAMS is its reporting mechanism, which allows ward managers to see week-to-week reports detailing the number, location and nature of alarms, and response times, allowing them to pinpoint exactly where improvements are needed. Joanne is under no illusions that such comprehensive data reporting strengthened the impact of the BEAMS pilot, allowing them to demonstrate proof of concept and gain buy-in from the trust’s procurement and finance managers.

Importantly, and key for the workforce, Joanne is certain that BEAMS “has taken away many aspects of stress for staff. We no longer have to walk corridors just in case there is an alarm going off. It’s simple when you think about it, but we wouldn’t be able to function without it.”

Peace of mind for patients and carers

Having a loved one in hospital can be a troubling and anxious experience for anybody, not least when the patient is a child. In paediatrics, mere seconds can prove the difference between life and death – under certain conditions, children can reach an emergency condition faster than adults. This is often the case with respiratory conditions, where the smaller relative size of children’s airways can lead to greater difficulty with breathing than in adults.

Joanne Reid-Roberts, Matron for Medicine Care Group, Sheffield Children’s Hospital (L) and Paul Rawlinson, Managing Director, TBG Solutions and Tutum Medical (R)

While BEAMS has been successful in reducing average alarm response times, feedback from patients, parents and carers at Sheffield Children’s shows the reassuring effect it can also have. “It gives parents peace of mind,” Joanne relates. “It used to be normal that parents complained that alarms weren’t being addressed in a timely manner but that almost never happens anymore.”

She finds that most parents do not like to press the nurse call alarm for fear of wasting their time, yet are also fearful of what might happen if they are not at their child’s bedside. But, “BEAMS gives parents the confidence to know that the nurses will respond to their child’s needs if they are not there, and patients feel reassured because they know that somebody is coming,” a factor that can be important for recovery, explains Joanne.

Just the beginning for BEAMS

Joanne was full of praise for the manner in which Tutum Medical supported Sheffield Children’s throughout the trialling of BEAMS, recalling how easy it was to contact the company, and the fact that “they listened to our feedback and changed the product” according to need.

Why has BEAMS mostly been taken up in paediatric settings thus far? “It just so happened to be Sheffield Children’s who first wanted to trial BEAMS,” Paul says, “and Leeds like to look at what other children’s hospitals are doing.” Looking to the future, however, Paul hopes to see BEAMS deployed in other, non-paediatric settings (citing its particular utility for respiratory wards), and trials are indeed underway at a number of hospitals in England. According to Joanne, “there is no reason why BEAMS couldn’t go into adult services, as they will experience the same issues as us and will probably have less staff than we do.”

At Sheffield Children’s at least, the results are in; BEAMS is one of the tools that helps healthcare staff to provide the best possible care for their patients.

To find out more about BEAMS, visit www.tutummedical.com.

All news

Improving the cancer patient experience, with David Chuter

By Mary Brown

Public Policy Projects spoke to patient advocate David Chuter about the experience of cancer patients within the NHS, and how improved co-production and communication can lead to improved patient outcomes and boost participation in trials.

David Chuter was diagnosed with Oesophageal cancer in 2006, has been a carer for his brother who also suffered with Oesophageal cancer, and has been actively involved in patient advocacy since his diagnosis. He is currently Chair of the Surrey OG Cancer Support Group, Chair of Digestive Cancers Europe Patient Group and Chair of EORTC Patient Panel, among other roles.

Communication and informed decisions about care

For meaningful improvement in the delivery of cancer care, patients must be at the heart of all policy decisions. Patients must be able to make more informed decisions about their treatment and care. For this to happen, available treatment and care options must be clearly communicated to patients, or a trusted person if the patient is unable to make the decision, so that they can make informed decisions about their treatment pathway.

Recommendation: A standardized PROMS strategy for cancer treatment should be implemented across the NHS, with outputs that are accessible for patients receiving treatment. This will mean that current patients can learn from the experiences of others, and make informed decisions about their own care, with the knowledge about how treatment options will impact their quality of life.

Trials and research

During our discussion, it emerged that a lack of transparency and communication between services in the NHS is a hinderance to patient participation in trials. Clinicians are not always aware of trials taking place for particular cancers which may be relevant to patients. However, some patients would be willing to travel to take part in relevant trials which have the potential to treat their cancer.

As David highlighted, “every consultant wants to do the best for their patients and provide better care”. If clinicians were better informed about the trials taking place in and around their patch, research would be made more accessible to patients and increase participation.

Recommendation: NHS England should create a central trial/research directory, so that clinicians understand which trials are taking place where, in order that they can direct patients to the appropriate trials for which they are eligible.

Patient trust in trials and data

The safe and appropriate use of patient data is essential for understanding patient outcomes and contributing to research. Often, there are concerns from the public around the safety and security of data collection, storage and use in the NHS.

However, this distrust of data handling appears to be dispelled once a person becomes a patient, and experiences first-hand the value of data sharing and involvement with trials. Consenting to the sharing of patient data and involvement in clinical trials are beneficial for patients in a number of ways. Data sharing generates regional and national insights which can inform clinicians and improve the standard of care. Additionally, involvement in clinical trials can mean early access to innovative and life-saving treatment and care.

Recommendation: Efforts should be made to amplify the voices of patients who can share testimonials of how the correct use of data, and involvement in trials, can contribute to improved care and outcomes.

Recommendation: NHS England should create an openly available directory of national cancer datasets, alongside outcomes of trials and the benefit trials bring. If actively communicated, this will educate the public about the benefits of data sharing and trial involvement and help boost participation.

Patient support groups

Support systems are essential for anyone coping with a cancer diagnosis and the experience of treatment. For those without a strong social network, or who need support from those having similar experiences, support groups are essential to provide comfort, reassurance and companionship for those diagnosed with cancer.

Patients report that patient-to-patient support is important, not only for patients themselves, but also for friends, family and carers who are involved in the care of a loved one. While lots of patient support groups exist across the country, they do not always receive support from the NHS, and patients are not always informed about the support available in their area.

Recommendation: Clinicians should be made aware of local patient support groups, and patients should be signposted to support groups, where appropriate, by their healthcare providers.

Patient apps and digital access

Patients often use apps to manage their appointments and care. However, these apps are not always user-friendly, and patients can find that they are using multiple apps, all with different layouts and functions. For many patients, this can be complex and make managing care via apps difficult. This difficulty is amplified for patients with less digital capability – which often includes older or disabled people.

Recommendation: The NHS app should be used as a central portal for other services currently offered by medical management apps. This should be co-designed with end users to ensure good user experience, and should prioritise ease of use for those who are less digitally confident or able.

This interview took place as part of PPP’s Cancer Care Delivery Plan programme, which culminates in the Cancer Care Conference . To get involved, please contact:

Willy Morris – Partnerships Manager at willy.morris@pppinsight.com

Mary Brown – Policy Analyst at mary.brown@publicpolicyprojects.com

Alongside his roles listed above, David Chuter holds the following positions:

Lead and Rest of England Governor, Royal Surrey County Hospital NHS FT
Lay member, NHS Leadership Academy
Patient Advocate and PPI Panel Interviewer, NIHR Academy
PPI Representative to the Partnership Board, NIHR Kent, Surrey and Sussex Clinical Research Network
Trustee, ICPV (Independent Cancer Patient Voice)
Executive Group Member, use MY data
Board member and Chair of the Patient Panel, DiCE (Digestive Cancers Europe)
Chair of the Patient Panel, EORTC (European Organisation for Research and Treatment of Cancer)

Creating a consistent and transparent approach to NHS procurement

By Andy Smallwood

By Andy Smallwood, Assistant Director of Procurement, NHS Wales Shared Services Partnership.

NHS procurement teams face a wide range of challenges, which have been amplified in recent years due to the far-reaching impacts of the COVID-19 pandemic, rising levels of inflation, and ongoing workforce pressures.

From identifying cost-saving opportunities to reducing the NHS’ environmental impact through better purchasing decisions, the only way to can enhance the NHS’ procurement processes is by using data effectively and implementing innovative technology solutions to support us.

Identifying challenges in procurement

Having worked in NHS procurement for over 25 years, one of the biggest challenges I’ve repeatedly faced is the lack of access to consistent and transparent data within complicated procurement systems. Data visibility hinders our ability to identify cost-saving opportunities – an essential part of procurement in all walks of life. The challenge is even greater when data is spread across multiple systems and teams, which many procurement teams in England will be aware of, given the ongoing transition to integrated care.

The move to integrated care has left some regional procurement leads with less visibility and control over procurement spend data and analytics, with more data to manage across multiple sites within a region. In Wales, the NHS has been operating in an integrated way for a while through the NHS Wales Shared Services Partnership, which ensures that the right products, provisions and services are sourced and supplied efficiently and at the right price across the country.

This has only been made possible through the emergence of advanced analytics and solutions which have improved the quality and visibility of data considerably.

Enabling better decision making

To help our procurement team deal with the vast amounts of data being collected and managed across each care setting in Wales, we implemented AdviseInc’s Procurement Dashboard, now known as the AdviseInc Platform. The platform provides us with complete oversight of catalogues and procurement data across the country, while also enabling us to add more detailed classification to spend, including all the major clinical categories.

By working with AdviseInc, who act as an extension of our team, we now have the ability to cleanse our data, compare this data with areas outside of Wales, and have visibility of greater savings and richer information as a result.

AdviseInc also provides us with valuable analytical support, meaning that instead of analysing rafts of procurement data and manually searching for cost-saving opportunities, our team has more time to focus on other key areas of procurement.

For example, we can now dedicate more time to consider how our procurement decisions align with objectives set out in the Future Generations Act. This was introduced in 2015 to make sure public bodies in Wales think about the long-term impact of their decisions and work collaboratively to prevent persistent problems such as poverty, health inequalities and climate change.

Using data analytics to improve safety and accuracy

For NHS procurement teams, environmental considerations should be made with every purchasing decision. Along with buying fewer overseas products and reducing the number of single-use plastics across the NHS, procurement teams need to spend more time innovating and contributing towards green initiatives, which is where companies like AdviseInc can make a tremendous impact. The solution is helping us meet national and local targets and gives us the ability to clearly target actions and deliver against carbon reduction targets.

It goes without saying that safety is a top priority for all NHS staff, from clinical staff to administration to procurement. In 2016, the Scan4Safety programme was introduced across England and Wales, with the aim of ensuring all products are labelled according to GS1 standards with a Global Trade Item Number (GTIN). This safety system is being implemented across the country, contributing to improved patient safety, product traceability, operational productivity and supply chain efficiency.

Across Wales, we’re now identifying hundreds of thousands of product barcodes and collecting as much information on these products as possible. So far, we’ve identified more than 170,000 products with barcode information and shared these with AdviseInc who can validate these barcodes, resulting in richer data. The AdviseInc team can then give a confidence rating for these codes to indicate if the data is reliable, as sometimes suppliers provide inaccurate product codes.

Additionally, AdviseInc has helped to identify more than 230,000 barcodes. The added benefit of being able to check these codes against existing data adds another level of safety for patients as stock can be recalled through the GTIN number which is also linked to patient records.

As always in procurement, our goal is to ensure products are coming from the correct supplier. Through the AdviseInc Platform we can check GTIN numbers, further adding another layer of accuracy. Looking to the future, our teams are working with AdviseInc on an inventory model which will act as a ‘one-stop shop’ for data analytics. This model will give users the ability to see what stock is available, who bought it and when.

The use of data to make informed decisions

Thanks to these new capabilities, we now have more time to collaborate with our clinical staff, using our data to inform and guide procurement decisions. By bringing our procurement team and clinicians together, we can find solutions that work for everyone.

Procurement teams face many challenges, but then use of technology can make workflows easier and more efficient. Better use of technology allows us to identify cost-savings, support green initiatives, and generate genuine value through procurement decision-making for both patients and staff. The future of procurement is transparent, and data-driven.

How industry can help deliver the ambitions of the NHS Workforce Plan

By Stephen Jowett

The long-awaited NHS Long Term Workforce Plan (NHS LTWP) was published at the end of June and has been broadly welcomed across the healthcare system.

The NHS in England is under increasing pressure. By 2037, the number of people aged over-85 is estimated to grow by 55 per cent, which means there will be an ageing population who will require more healthcare interventions and more care for long-term conditions and co-morbidities. The NHS currently has the longest waiting times and lowest satisfaction rates ever recorded which has been demotivating for employees and frustrating for patients.

The current NHS workforce challenges have impacted the whole of the healthcare system and can delay people receiving the best treatments available. Once a treatment is approved by the National Institute for Health and Care Excellence (NICE) there needs to be the capacity for it to be rolled out, including any additional training requirements and this will have an impact on industry partners if new treatments are not utilised.

There are examples of fast-paced innovation within cancer treatments, but the adoption is slowed by a stretched and understaffed system – following the long-term impacts of the pandemic – that does not have protected time to embed new approaches. Collaboration between sectors is also crucial to support adoption at scale. If these workforce challenges are not addressed, patients will not be able to access the right healthcare when they need it.

There are three big ambitions laid out in the NHS LTWP:

Recruitment – there is a focus on a big recruitment drive into roles in the NHS and into training places. As there are currently shortfalls in almost every area of the NHS, particularly in frontline care, this needs to be a priority.
Retention – a large number of professionals leave the NHS every year, so focusing on how the NHS keeps the people who are already employed is essential if they are going to meet the increasing demand on the system.
Retraining – there is more to training than getting new people into the workforce – it is also recognising that to make the NHS future proof, more needs to be done to support the current and future workforce to embrace new technology. This needs to address how the whole health system embraces new ways of working and developments in technology. There can’t be fast adoption of new technologies if the training and skills aren’t quickly put into place for the workforce and patients.

Although the NHS LTWP has been broadly welcomed by the healthcare system, there are some very clear omissions that will make it hard to deliver. There is no mention of infrastructure, meaning that capital investment isn’t aligned to the planned workforce investment. Many of the current hospital buildings in use are not fit for purpose and it was recently announced that the target to build 40 new hospitals by 2030 is likely to be missed.

“There is an opportunity for industry to think about how new technologies can address some of these pressures in the system.”

This NHS LTWP does not include social care and is not aligned to a similar reform of our social care system, which is currently suffering from many of the same challenges as the NHS in terms of increased demand on services with a reduced workforce. If the healthcare and social care systems do not receive investment simultaneously, then one will take on the burden of the other, as they are intrinsically linked.

The NHS LTWP talks about innovation in robotics which has dramatically reduced how long patients need to stay in hospital; for example, heart surgery often now requires a shorter stay in hospital due to technological advances. However, these technologies often need to be accommodated in modern facilities, which means new capital investment. Furthermore, without appropriately resourcing the social care system, many patients are not able to move out of hospital when they are ready to.

Many of the ambitions laid out in the NHS LTWP will take time to deliver, so there is an opportunity for industry to think about how new technologies can address some of these pressures in the system. Those in industry can position themselves to make relevant value propositions and be part of the discussions over the coming years.

The education piece in the NHS LTWP is also interesting for industry, as there are plans to accelerate how people are trained, meaning that there could potentially be a role for life sciences to support with this. IQVIA’s work in population health management and service redesign will also continue to help address workforce challenges, especially when aligned and augmented with IQVIA’s clinical services.

This NHS LTWP is highly innovative, but there is no mention about how it is going to be funded, which raises questions around whether it will actually deliver what is needed for the NHS. This is especially true given the current issues within social care, but by working collaboratively with industry, there is an opportunity to bring in experts to look into niche, innovative solutions.

Stephen Jowett is Senior Director and Head of Healthcare Consulting at IQVIA.

Specialist app use sees unnecessary skin cancer referrals drop by 80 per cent

By Gabriel Blaazer

Norfolk and Waveney GPs’ use of app that directly connects them with hospital dertmatology consultants prompts drastic fall in number of unnecessary referrals.

A specialist app being used by GPs in Norfolk and Waveney has helped the integrated care system (ICS) reduce unnecessary hospital referrals for suspected skin cancer by 79.6 per cent, analysis of patient pathways has found.

The app, Cinapsis, was designed by an NHS surgeon and enables GPs to contact local hospital consultants directly to request a second opinion and decide whether or not a referral to urgent care is needed. Its use has been credited with enabling the ICSs to manage more cases within primary care settings, reducing the burden on secondary care and enabling urgent cases to receive more timely treatment.

There are currently 7,800 patients waiting to start specialist treatment in Norfolk and Waveney, and routine referrals for specialist dermatology treatment in Norfolk take up to 57 weeks. Using the app, however, GPs can receive specialist advice from a consultant dermatologist within 48 hours, allowing them to determine the severity of the presenting case.

Using a specialist camera attachment – a dermatoscope – which fits to the GP’s own phone, clinical-grade photos of the worrying skin lesion can be captured and sent securely to the consultant via the app. The specialist can then review the lesion remotely, and decide whether they need to see the patient in clinic, or if they can instead be treated outside of hospital.

The project has been rolled out across 86 GP surgeries in the region so far, with plans to implement it across all 105 practices in Norfolk and Waveney over the coming months.

Discussing the app’s impact in Norfolk and Waveney, Dr Paul Everden, GP at North Norfolk Primary Care, commented:“The roll-out of the teledermatology project in Norfolk and Waveney has been transformative in supporting our clinicians across primary and secondary care to collaborate and streamline referrals for urgent skin care. This partnership with Cinapsis is allowing us to tackle growing wait lists while maintaining optimal outcomes for our patients and clinicians.

The technology has opened up more collaborative communication channels, enabling more joint, holistic decision making. It is helping us to meet the increasing demand for dermatology in Norfolk and Waveney effectively and sustainably. The project marks a turning point in reducing wait times and consequently, the burden placed on urgent care services.”

Dr Owain Rhys Hughes, CEO and Founder of Cinapsis, said: “Supporting NHS staff to reduce unnecessary referrals, tackle wait lists and speed up patient access to urgent care is something that our team is so proud to be helping achieve. It’s been a pleasure working with North Norfolk Primary Care to help deliver this through the teledermatology project, and to see the significant impact that digital advice and guidance has had on the number of cases being kept within primary care.

“It’s great to be assisting primary and secondary care clinicians across Norfolk to help implement this initiative and roll it out across an increasing number of practices. We’re looking forward to continuing this support and ensuring the best outcomes are maintained for clinicians and patients alike.”