News, Oracle Health July 12, 2023

Creating a data-driven health organisation across Milton Keynes

By Oracle Health

Between 2018 and 2023, Milton Keynes University Hospital NHS Trust gained a large set of clinical data. On its journey with Oracle Health, the trust has transformed into a data-driven organisation, improving patient experience, lowering the cost of care, enhancing the staff experience, improving population health, and addressing health equity.

What’s the background and context?

Over the past few years, Milton Keynes University Hospital NHS Foundation Trust (MKUH) has been on a clinical digital systems journey. Due to the recent advances in the organisation’s Oracle Health (formerly Cerner) electronic patient record (EPR) system between 2018 and 2023, they have gained a large set of clinical data. This has enabled MKUH to make strides in visualising and using information to support the Quintuple Aim, which includes improving patient experience, lowering the cost of care, enhancing the staff experience, improving population health, and addressing health equity. MKUH continues to advance in this field, with its goal being to evolve from a data-driven organisation today to analytic excellence in the future.

Using data to drive EPR adoption and help improve patient outcomes

MKUH had historically hoarded data and used information for outputs including statutory and ad hoc reports. However, with limited resources, the Trust struggled to find the right information for the right end users. Their data workforce and skill set were designed based on needs of traditional NHS statutory reporting, so using data more directly as an enabler for improving staff experience and patient health outcomes was an alien concept.

There was a gap between teams that needed to manage the data and format it in a way that made it meaningful and useful to those making clinical or operational decisions. The way MKUH accessed the data was down to the end users using the system and understanding the workflows. In the initial stages, once data had been clinically validated, the team could create dashboards for a small subset of users.

A dawn happened when Cerner Millennium was connected directly to the Trust’s PowerBI instance, a Microsoft product that allows users to pull in data and information to produce dashboards and visualise data in a way that’s meaningful and insightful to the end users. As PowerBI is used across the Trust for a multitude of purposes, including this data within the same platform enabled a more seamless user experience. Creating dashboards of rich data is academic if they are unusable.

Ways data is being used to drive the organisation

The very first project to use data differently analysed the way MKUH was receiving pathology and imaging results in Cerner Millennium, and the process of endorsing those results. This was a real technological response to an organisational need. Electronic endorsing of results was, at the time, a new concept that MKUH clinicians had variably adopted. There was often discussion about how electronic endorsing could be improved. How do we improve adoption, and how can we measure it? How do we know who is and isn’t endorsing results? How do we know we’re improving it? This became a sticking point, and the hospital didn’t know how to move forward.

Presenting the data through PowerBI enabled the team to split the data by department or lead clinicians responsible for results, allowing them to share the report with clinicians. Through PowerBI, it’s also possible to give access to the full report – with snapshots once a month – so each lead clinician or department could see how they’re doing, with a league table. After examining the data, the team decided to set a target: 80 per cent of results would be endorsed within two weeks. They then discovered the data included encounters for consultants who had previously left the organisation, which prompted MKUH to look at their leavers processes. For example, what steps must be taken when a clinician leaves?

Many results were attributed to senior nurses and midwives, which prompted the team to bring them into the fold in conversations and, if appropriate, have them endorse their own results. Occasionally, clinicians were ordering in the wrong encounter, which would then associate the wrong lead clinician with it. Having the data has shed fresh light on the process, and MKUH has discovered much more than it anticipated. It took time to organise this dataset, with completion only coming about in 2020 following the 2018 go-live. The team did several things wrong and made mistakes before they were able to share the correct data on endorsing results.

The next big phase was development work in response to the challenges presented by the COVID-19 pandemic. At its onset, MKUH was still an organisation driving the need for data, as opposed to being a data-driven organisation. The Trust was eager to see the data, which enabled it to prioritise the work. By compiling the data, the team had a new technical skill set across the department, but the real challenge was understanding the dataset – bridging the gap between understanding workflows and managing data.

The team experimented with the COVID-19 data, which provided several different visualisations. Two years into the pandemic, they were using the fifth version of the dashboard, which allowed them to view patient cohorts by postcode, interrogate cases of nosocomial infection (hospital-acquired COVID-19 infections) in patients, and look at those patients’ location histories – including their previous wards and beds, and which other patients they may have been in contact with.

Specific views of this report were also provided to Milton Keynes and Buckingham local health teams, with shared data sorted by relevant postcodes. These reports were updated daily, and team feedback showed that the information shared was very helpful. In December 2020, MKUH was part of the first wave of COVID-19 vaccination centres and utilised the Cerner mass vaccination workflow, Microsoft booking application, and PowerBI to create twice-daily site reports. These reports flagged data quality issues, monitored progress through the vaccination centre, and provided metrics – regarding the number of patients vaccinated, how many patients were waiting, and so on.

COVID-19 was the first time the team focused on building a system that was conducive for reporting and sharing data, and the first time data drove the way the system was built.

Designing the system with data in mind

An example of designing the system with data in mind is the revaluation of free-text fields where users can add unstructured text. MKUH knew it would require time investment to make changes. For example, MKUH reviewed a midwife form used to record patient birthing preferences. Assuming the form was completed, no action was taken, nor did the data go anywhere. MKUH redesigned the form entirely, with data in mind. Answers to questions now populate the antenatal document, meaning anyone who treats patients can view, and take into consideration, their birthing preferences. The nature of the form was then changed so it was rendered into textual narrative document and easier to consume.

Currently, reporting is available to the midwives – refreshed daily to show the number of forms completed and by which midwife. The Trust then uses this data to target extra training. For instance, it’s important for the rendered note to be completed, as this document is shared with the patient through the MyCare patient portal. When reviewing the reporting, if the Trust sees more forms than completed notes it follows up with the midwives, reiterates the process, and ensures they complete the two-step process so they can create the note again.

MKUH can then report on the number of booked patients who are more than 34 weeks pregnant and have no birthing preferences noted. This highlights gaps in the process and enables the Trust to follow up with patients to ensure their information is complete at the time of delivery. Capturing this level of data also enables the Trust to gain a better understanding of the birthing preferences of the Milton Keynes population. All of this is possible because workflows were designed with these data aims in mind, rather than being an afterthought. In simple terms, the report was designed before the data-capture forms.

MKUH has started a journey with the Oracle Health Command Centre, including real-time, predictive analytics using AI. This takes a dataset from historical EPR statistics and allows the organisation to review real-time statistics with added predictions on the hospital bed state in four-, eight-, or 12-hour intervals. This was only recently implemented, so as MKUH continues to progress, the Trust will assess the predictions accuracy and then work to update the algorithms to better align with actual events.

There are also other pilots exploring how to better use data within buildings and the hospital environment. MKUH didn’t know how its wards and spaces were being used, and with upcoming building projects, there were opportunities to take a data-driven approach to hospital design and ergonomics. As there was no existing way to accurately manage this, MKUH worked with partners Haltian and their Empathic Building solution to track staff movements – with permission – and equipment around a particular ward. By starting with the question, the organisation wanted to answer, MKUH could then build a solution that captures required data and presents it in a manner that allows management to make more informed decisions about the future hospital design with patients and staff in mind.

How does the NHS culture need to change?

National datasets feed into decision-making at a regional and national scale more generally, and into commissioning more specifically. There will always be a place for this mechanism, even if it could benefit from a little pragmatic consolidation.

When a hospital is reactive to local, regional, or national targets, the effort invested in reporting against those targets is increased and improvements are generally seen in that area. There’s a clear cost versus benefit case for the invested time and effort that brings in roles from all parts of the management structure; financial incentives are a big driver for this activity.

Finding alternative ways to commission hospitals so incentives are different but just as attractive has been a more recent approach and represents a move away from pay-as-you-go. If this were done in parallel with reducing how prescriptive that commissioning activity is, providers are afforded the space and incentive to be more innovative in the ways they deliver services. Were there support on how to introduce those innovative models into hospitals – whether exemplar sites, services, or cases that used information to respond to this challenge successfully, access to models or approaches that can be applied locally, or short-term training offered by NHS centres of excellence to develop the skills to lead on such work – then there could be a culture shift. This would be contingent on local efforts bearing fruit, so end-to-end support would be needed.

The world of information governance has come so far since COVID-19 and the introduction of the EU General Data Protection Regulation (GDPR). It is important that an information governance program considers events that can impact the organisation and legal requirements, while also considering operational efficiency. The work done across OneLondon, the Wirral, the Great North Care Record, and many more demonstrates information governance is possible and doesn’t need to be restrictive.

It’s not just NHS culture that must change. Hosting data and information management functions no longer needs to be an extortionately expensive offering. However, the commercial, well-known products available to the NHS for this purpose remain at inflated costs – leaving many to keep what they have, make difficult decisions to spend money on these platforms instead of direct care, or try to use local in-house solutions or open-source options that require significant in-house expertise.

MKUH is developing a growth culture as it responds to having data available to drive organisational change. This culture change is in progress and this case study highlights some of the benefits being realised and the ideas being explored.

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Major agreement to deliver new cancer vaccine trials

By Integrated Care Journal

Government signs agreement with BioNTech SE to provide up to 10,000 patients with precision cancer immunotherapies by 2030.

The Government has announced the signing of a major agreement with pharmaceutical company BioNTech, to deliver precision cancer medicine to 10,000 patients by 2030, supported by NHSE’s Cancer Vaccine Launch Pad and new laboratories to be set up by BioNTech around England. The agreement brings the NHS a step closer to transforming cancer treatment for patients, using the technology first used during the pandemic against COVID to create personalised cancer immunotherapy options.

Groundbreaking progress towards trials has been far quicker than expected, as although the initial partnership saw the first trials rolled out in Autumn of 2023, trials for MRNA cancer vaccines for colorectal cancer already underway at University Hospitals Birmingham NHS Foundation Trust (UHB). Further trials are to be set up around England, with the majority of trials involving patients expected to commence from 2026.

Dr Lennard Lee, Associate Professor at the University of Oxford, said:

“The United Kingdom has delivered a stunner. We are off the starting block for another vaccine advance, but this time against cancer. What is most surprising is that our country’s outlook has changed. There is global acknowledgement of the UK opportunity, and capacity for vaccine research. There is also high level of confidence in our hospitals, clinical researchers and the cancer research infrastructure. If the aforementioned issues were addressed using the path forged by our coronavirus vaccine response, this is the perfect recipe to deliver transformative benefits to those affected by cancer and realise the potential of vaccines for cancer”.

In March of this year, after a partnership between Government and BioNTech was first announced in January, PPP ran a roundtable entitled Implementing precision medicine in the UK: The case of cancer vaccines, chaired by Dr Lennard Lee, Associate Professor at University of Oxford and National Clinical Advisor at DSIT and Joanne Hackett, Head of Genomic and Precision Medicine at IQVIA. The roundtable was attended by clinical oncologists, oncology researchers, pharmaceutical companies and policy experts, and discussed the opportunities and challenges posed by the undertaking of cancer vaccine trials in the UK.

A key insights report has been produced from this roundtable. In order for cancer vaccine trials to be a success and for benefits to be felt equitably, the report makes a number of policy recommendations, including:

NHS England and DHSC should review the progress of their funded plan to tackle backlogs due to the pandemic and talking waiting lists for elective care, given that targets for oncology services, and other elective care services, are continually unmet. The success of cancer vaccine trials will be dependent on investment that factors in the costs incurred in the clinical settings in which they are taking place.
Multidisciplinary teams should be formed during cancer vaccine trials so that pressures on frontline medical staff and overloaded clinical settings are reduced, lightening the burden of clinical trials overall.
As part of the overhaul of regulatory processes, the MHRA should consider ethical fast-tracking as part of their review.
New incentives should be developed to encourage trial participation from underserved groups with lower socioeconomic status, this would serve to overcome historical barriers to trial participation that often limit the diversity of trial participants. Hospital trusts should mobilise trusted community leaders to encourage those who may be vaccine hesitant to engage with clinical trials, if appropriate.
The UK government should engage in positive communication and advertising campaigns, including informative documentaries, to inform the public about the potential personal and social benefits of cancer vaccines.

Rethinking cancer care: a system strategy for improved outcomes

By Lucia De Santis and George Batchelor

Boosting early detection and reducing backlogs through data-backed, collaborative initiatives will be crucial to addressing the deteriorating state of cancer care in the UK, write Edge Health’s Lucia De Santis and George Batchelor.

In the battle against cancer, the UK is grappling with alarming statistics, with outcomes for colon, lung and pancreatic cancers being particularly sobering. According to the Comparator report on cancer in Europe 2019, the UK was last out of all Western European nations for 5-year survival of colon cancer, as well as among International Cancer Benchmarking Partnership (ICBP) jurisdiction countries (Figure 1).

Figure 1: Age-standardised incidence, mortality rates and 5-year net survival for Colon cancer. Arnold M, Rutherford M, Lam F, Bray F, Ervik M, Soerjomataram I (2019). ICBP SURVMARK-2 online tool: International Cancer Survival Benchmarking. Lyon, France: International Agency for Research on Cancer. Available from: http://gco.iarc.fr/survival/survmark, accessed [08/06/2023]. (Click to enlarge)

The complex factors behind the UK’s cancer outcomes

Understanding the root of this crisis is not straightforward, as many intertwined factors play roles, from cultural attitudes affecting help-seeking behaviours to underinvestment in critical medical resources. As a doctor in a busy acute trust, I could not grasp why one of my patients only presented to hospital long after his skin tone had turned an unmistakable dark shade of yellow, a tale-telling sign of his late-stage lymphoma. On the other hand, as of 2021, the NHS operated with around 63 decade-old LINACs (essential cancer treatment machines), and the UK has the lowest number of PET-CT scanners per 100,000 people among International Cancer Benchmarking Partnership countries.

The UK’s uphill struggle is deep-seated, with it having the worst cancer survival rates in the EU as far back as 1995. NHS’s low spending on cancer treatments and restricted access to cancer medicines for patients have been contributing factors.

Turning the tide: a dual-pronged strategy

Despite the complexity, there are attainable starting points for improvements: boosting early detection through the two-week-wait (2WW) referral pathway and ensuring prompt diagnosis and treatment through collaborative approaches that have proven successful in other countries.

Front one: boosting early detection

Data shows that cancers identified via a 2WW referral are often diagnosed earlier, and result in fewer diagnoses during emergency admissions, with implications for survival.

Analysis on stage at diagnosis performed by Cancer Research UK (Figure 2) demonstrates this clearly, with 30 per cent of cancers detected via 2WW referral being at Stage 1, versus just 8 per cent of cancers detected through an emergency presentation to hospital.

Figure 2: Proportion of cancers by stage at diagnosis by route of detection. Source: Cancer Research UK Early Diagnosis data, accessed June 2023. (Click to enlarge)

However, across England, there is a glaring disparity in cancer detection rates – that is, the number of confirmed cancers that are detected via an urgent suspected cancer referral (2WW). This is intimately related to the overall volume of 2WW referrals (Figure 3), where higher figures are associated with a higher detection rate.

Patients whose practices have a lower threshold to refer under the 2WW programme fare much higher chances to have cancer detected via this route and as shown above, at an earlier stage. This, again, has implications for treatment and survival.

The national disparity between these practices not only means that average figures for cancer outcomes are affected by differing primary care strategies, but also that there are wide inequalities of care across the nation.

Cancer alliances and primary care networks can play an essential role in encouraging practices to revisit their referral behaviours. This effort can help reduce healthcare inequalities and potentially save lives by identifying and treating cancer earlier. Understanding what drives referral rates and promoting effective referral practices can make the difference between a life saved and one lost, and in the end spare the much higher healthcare and societal costs associated with late-stage cancer.

Front two: tackling backlogs through collaboration

Our second strategy is to reduce backlogs through collaboration. The NHS’s diagnostic capacity is currently strained, as the steady decline in patients diagnosed within the 28-Day target since its 2021 introduction suggests.

Figure 4: Proportion of patients referred for suspected cancer who meet the 28-Day faster diagnosis standard that was introduced in 2021. (Click to enlarge)

Taking cues from countries like Denmark, which successfully improved cancer survival rates by centralising specialised care and launching data-focused initiatives, the NHS can rethink its approach. By making comprehensive cancer patient data centrally available, we can make more informed decisions, improve workflow, and direct finances more effectively.

The NHS collects extensive data on cancer patients, encompassing their entire journey from referral to treatment. The key to better cancer care is ensuring the data is available centrally to key organisations and decision-makers, such as integrated care systems and Cancer Alliance leaders, to make evidence-backed financial, workflow and population health decisions and foster collaboration.

Sharing cancer data can help speed up diagnosis and treatment for patients. For instance, by sharing a cancer patient tracking list (PTL) across multiple trusts, patients who are at risk of breaching targets can be identified early and receive timely care. This strategy can also address the shortage of diagnostic appliances or services and specialised treatment.

Figure 5: Example of how cancer alliance PTL data could be pooled to estimate breach risk scores and inform waiting lists to either allow local prioritisation or highlight mutual aid opportunities. (Click to enlarge)

The road ahead: data-driven initiatives and collaboration

The current state of cancer care in the UK calls for an urgent, systemic response. By prioritising early detection and fostering data-driven collaboration, we can significantly enhance the prognosis for the UK’s cancer patients.

Expediting early detection efforts, particularly through increased 2WW referrals, is crucial to change the narrative. These efforts, when paired with the power of collaborative and data-driven care models, can revolutionise the cancer care landscape. It’s a potent combination that can help us ensure that no matter where patients live, they can access timely and high-quality cancer care. This system-wide approach presents an opportunity not just to catch up with our European neighbours, but to potentially lead the world in effective cancer care.

Sector responds to long-awaited workforce plan

By Gabriel Blaazer

Long-awaited workforce plan aims to deliver thousands more doctors, nurses and midwives through expansions in training places and degree apprenticeships.

The NHS has today published its much-anticipated Long Term Workforce Plan, promising a “once in a generation opportunity” to address the staffing shortages that have beset all parts of the health service in recent years. The government has pledged £2.4 billion over the next five years to fund the additional training and education measures included in the plan.

The number of medical school training places will increase from 7,500 to 10,000 by 2028 and to 15,000 by 2031, with areas with the greatest shortages being prioritised. The number of GP training places will increase by 50 per cent to 6,000 by 2031, and the number of adult nurse training places will almost double, with 24,000 extra nurse and midwife training places being promised, also by 2031.

The plan will also give greater prominence to apprenticeships, offering “earn while they learn” degree apprenticeships to trainee doctors for the first time. One in six (16 per cent) of all training places for clinical staff will be offered through apprenticeship by 2028, while the increase in nursing degrees will be accompanied by a 40 per cent rise in nursing associate training places over five years, with increases in other associate roles also promised.

A “huge step forward”

The plan has been broadly welcomed by medical organisations and those representing NHS staff, with NHS Confederation Chief Executive, Matthew Taylor, saying: “The government should be commended for backing NHS England to produce a thorough, bold and ambitious plan – one that has taken on board much of what the wider NHS has been asking for. There is much to welcome, not least the planned doubling of medical school places, the ambitions around apprenticeships and degree apprenticeships and the commitment to recruit more staff into mental health, community care and primary care roles.”

Andrea Sutcliffe, Chief Executive and Registrar at the Nursing and Midwifery Council, said: “Nursing and midwifery are rightly at the heart of this plan. Investing the time, money and effort needed to ensure we have a growing, capable and confident nursing and midwifery workforce is the right thing to do.”

While welcoming the “huge step forward” in terms of the commitment to train more clinical staff, the Chief Executive of The Health Foundation, Dr Jennifer Dixon has called for the measures to be backed by legislation, citing previous “good intentions [for reform] that have fallen by the wayside”. Dr Dixon also warned that “the plan relies on optimistic assumptions about improving NHS productivity”.

The Long Term Workforce plan alludes to “a renewed focus on retention”, which “could mean the health service has at least an extra 60,000 doctors, 170,000 more nurses and 71,000 more allied health professionals in place by 2036/37”. Measures to address retention include more opportunities for career development within the NHS, “improved flexible working options”, and reforms to NHS pensions.

Will the plan be enough?

However, a number of organisations have noted that the plan makes no mention of pay and conditions, which are widely held as key barriers to the health service’s ability to attract and retain sufficient numbers of staff. Dr Jennifer Dixon added that “leaver rates among NHS staff are close to record levels, and years of below inflation pay settlements mean the wages of many NHS staff have fallen behind comparable occupations. Training more staff is essential, but this will be little good if the NHS is unable to retain the staff it’s already got.”

Dr Billy Palmer, Senior Fellow at the Nuffield Trust, added that the plan “will fail unless it is followed up by efficient, effective ways we can fix the holes in the workforce by making the NHS a place where people really want to work. This must include taking a look at our broken pay review system, which has aggravated dissatisfaction.”

The plan also makes no mention of social care, described by Matthew Taylor as a crucial next step for the NHS to “revive and thrive… alongside extra investment in capital and technology.” The sector currently has an estimated 165,000 posts vacant – close to 10 per cent of all roles. Nadra Ahmed CBE, Chair of the Care Provider Alliance, added: “Social care providers share the same staffing shortages, funding challenges and cost of living pressures as our NHS colleagues” and called for “an equally necessary plan for social care”.

Other measures included in the plan aim to increase the speed at which new staff can reach the front lines. These include a consultation with the GMC and medical schools to shorten the length of medical degrees to four years, and allow student nurses to join the workforce as soon as they qualify in May, rather than waiting until September.

An additional 150 paramedics will also be trained annually, and training places for clinical psychology and child and adolescent psychotherapy will be increased, “on a path to increasing by more than a quarter to over 1,300 by 2031”.

Cost of living driving worsening health, finds Nuffield Health

By Gabriel Blaazer

Efforts to improve health outcomes being stifled by cost-of-living crisis, with many unable to afford simple measures to improve their physical and mental health

A new report from Nuffield Health has reaffirmed the damaging link between the high cost of living and worsening health outcomes in England. Nuffield Health’s The State of the Nation’s Health and Wellbeing in 2023 summarises the findings of Nuffield Health’s third annual Healthier Nation Index, a survey of 8,000 UK adults that asks detailed questions of all aspects of respondents’ physical and mental wellbeing.

It found that slightly more than one-third of people have experienced declining physical and mental health over the last twelve months (35.1 per cent and 33.7 per cent, respectively), and that nearly 50 per cent of people have experienced declining financial health over the same period. 63.2 per cent of respondents believed that the cost of living crisis is having a ‘negative impact’ on the nation’s health – a fact supported by an ever-growing body of research.

A central role for ICSs

On 13 June, Nuffield Health convened a roundtable discussion at the House of Commons, supported by MPs Kim Leadbeater and Dr Lisa Cameron, to explore the findings of the report. The roundtable highlighted the vital role that integrated care systems (ICSs) will have in ensuring that local population health strategies are responsive to the many factors influencing health, not least cost-of-living challenges.

The attendees of the Nuffield Health roundtable at the House of Commons (click to enlarge)

It was also noted that collaboration is crucial to effectively addressing the health impacts of the cost-of-living crisis “across multiple sectors – not just the NHS”, according to Nuffield Health’s post-event briefing. Contributors agreed that ICSs should seek to use “their convening ability… to collaborate with local anchor institutions, voluntary and community sector partners and local residents” to produce holistic solutions that address the multitude of factors driving poor physical and mental health.

An example of local solutions that can promote good health is the local prioritisation of building healthy environments. The need for these spaces can be best understood at neighbourhood and place level, and this insight can be turned into action through integrated care partnership strategies and collaboration with local partners, including local authorities. Participants in the roundtable identified that individual behavioural changes will only go so far, and that policies that ignore the contextual environment in which people live and work are bound to be limited in their effectiveness.

Leadership on prevention

While the key role of ICSs was discussed, it was also acknowledged that leadership around the prevention of ill health must come at the national level, with accountability shared across all government departments. It was emphasised that the most impactful preventative measures are best driven at the local level, so the role of national government should be that of an enabler for localised action, “empowering and supporting residents to be engaged in solutions, from inception to delivery”.

At the same time, greater clarity around terminology and the ultimate objectives of prevention are required, which can be instigated at a national level. Helping the population to understand how vital prevention is, and will be, for the sustainability of the healthcare system, will help to increase buy-in for measures that require the active participation of citizens.

There is also a role for employers to play in supporting the health and wellbeing of their workforce. As working practices have shifted so much in recent years, so too should employers’ strategies for supporting workers, particularly those working in remote or hybrid working environments. This is especially important for women, who tend to be disproportionately affected by poor mental health in the workplace.

Many of the themes to come out of the roundtable discussion understandably align with Nuffield Health’s recommendations made in the report, which argues that the health and wellbeing of the population is our most important national asset, and should be a national priority.

More than 1 in 10 NHS mental health jobs currently vacant despite sharp rise in demand

By Integrated Care Journal

An additional 450,000 people a month are contacting mental health services in 2023 compared to 2020, while antidepressant prescriptions rise by millions in just a few years.

New analysis of the latest NHS statistics by Clerkenwell Health show that more than 1 in 10 mental health professional jobs in the NHS are currently unfilled. The analysis also reveals significant regional disparity with the North West and Midlands faring worse than average, with 17.5 per cent and 14.9 per cent respectively of mental health jobs vacant. This compares to an overall NHS medical vacancy rate of 5.8 per cent.

The figures come alongside a sharp increase in the number of people seeking contact with NHS mental health services every month – rising consistently from 1.3 million people a month in June 2020 to 1.75 million people a month by March 2023. Meanwhile an extra 3,000 people every month are also occupying a bed in a mental health hospital, when compared to January 2021.

The latest NHS data also shows a sharp rise in the number of antidepressants prescribed. Between October to December 2022 (the latest figures available), 22 million antidepressants were prescribed to an estimated 6.6 million identified patients. This compares to 15 million prescriptions in Q1 of 2015 and 19.6 million in October to December 2020.

The new analysis comes from Clerkenwell Health, the first commercial organisation in Europe to design and deliver clinical trials for a range of drug developers to find novel treatments for complex mental health conditions. They are working with drug manufacturers to explore innovative treatments for conditions with which the NHS is struggling to cope including treatment-resistant depression, anxiety, PTSD and alcohol use disorder, as well as conditions affecting the central nervous system.

Clerkenwell Health is developing trials to test the use of psychedelics such as psilocybin to treat a range of mental health conditions and are actively recruiting participants.

Tom McDonald, Chief Executive Officer at Clerkenwell Health, said: “With a sharp rise in people contacting mental health services and antidepressant prescriptions rocketing in just a few short years – all amidst a major mental staff shortage – it’s clear the need for innovative mental health treatments has never been more acute.

“There is no silver bullet, but a growing body of research suggests that psychedelic drugs could be ground-breaking for the treatment of complex mental health conditions. The Government must help accelerate the number of clinical trials being delivered in the UK to help new treatments reach patients more quickly and stem this growing problem.”

Time to reprioritise rehabilitation

By Sara Hazzard

This historically under-funded service could be key to reducing pressure on acute NHS services, and pave the way for a healthier, happier workforce, writes Sara Hazzard, Assistant Director Strategic Communications and Co-Chair Community Rehabilitation Alliance at The Chartered Society of Physiotherapy (CSP).

Transformation doesn’t always need to be complicated, expensive or even that radical. Sometimes, it can be achieved by simply prioritising an existing, under-utilised asset. Rehabilitation services are a case in point and if the NHS is to have any hope of tackling some of its biggest challenges, it is exactly that kind of transformation that will be required.

At its best, rehab makes lives worth living. It adds life to years and years to life, enabling people to recover from major trauma or serious events like stroke and cancer, while supporting others to live with long-term conditions, such as COPD or arthritis. Rehab gives people the mobility and function to maintain independence and reduce the need for other NHS and social care services.

At its best, rehab keeps the NHS moving. It reduces the number of people being admitted to hospital by helping people to manage their conditions in the community.

This means greater system capacity for anyone who needs to arrive at the front door of a hospital, while inpatient rehab ensures they recover promptly and are ready for discharge, often to those much-needed community services, in a timely manner.

All of this allows for greater flow throughout the system, unblocking some of the most pressurised parts of the NHS.

Finally, at its best, rehab also yields benefits for wider society, reducing health inequities and sustaining a healthy, productive workforce by reducing sickness absence. Unfortunately, too many people do not find rehab at its best.

It has been under-funded for decades and shown a chronic lack of prioritisation, sometimes derided as a Cinderella service of lower importance than surgical treatment and medication. Historically, the problems were most significant in the community, with patients often discharged and then waiting weeks, if not months, to be picked up by outpatient services.

During the pandemic, however, hospital gyms and other spaces were lost to make way for overspill wards and to allow social distancing, making high-quality rehab harder to access for inpatients too. This has been further exacerbated by the most recent winter crisis when further rehab space was lost to create room for extra beds.

The irony of investing in beds rather than the rehab that could prevent so many needing one has not been lost on the profession. The impact of this loss of space is taking a toll on patients, staff and the system alike.

Six in ten physiotherapy staff in a recent survey said they are seeing increased levels of disability and 50 per cent report depression and anxiety among patients as they struggle to cope with long-term pain and immobility.

The survey also reveals that the issue is having a further impact on the NHS workforce crisis, with 32 per cent saying it means they struggled to recruit staff and four in ten citing retention problems. What is more, 60 per cent of respondents say they are considering quitting the profession altogether because of the issue.

The lack of rehab is also increasing the need for readmission to hospital and more intensive treatment, the survey shows. Clearly that situation cannot continue. Services need to be given the appropriate space, staff and resources to provide high-quality rehab.

That’s just the minimum required, however, to meet the enormous patient demand that has built up in recent years and continues to grow every month, according to NHS figures. To truly transform how we deliver healthcare in this country, we must break free of the outdated mode of thinking and place a far higher priority on the value of rehab.

That shift appears to be happening – and not a moment too soon. In a letter to the Community Rehabilitation Alliance, which the CSP co-chairs and convenes, Health Minister Will Quince said he agreed that “rehabilitation is as essential to good health outcomes as medicines and surgery”. With millions on waiting lists and large parts of the system falling down, rehab’s time has come.

Now’s the time to invest in rehabilitation and the workforce to deliver it, recognising the ripple effect these vital services have through the system. But this requires leadership, and it is vital that there are accountable leaders whose focus is on the effective commissioning and delivery of personalised rehab.There is much work to do, but this shift of emphasis could unleash the enormous potential of rehab and have a transformative impact on the NHS at a time when it’s needed most.

The Chartered Society of Physiotherapy will be joining ICJ and Public Policy Projects at the Integrated Care Delivery Forum in Leeds, on Wednesday 28 June. The event is free to attend for relevant healthcare professionals, so come and say hello!

West Midlands Academic Health Science Network annual report reveals transformative impact

By Integrated Care Journal

10 years after being formed by NHS England, the organisation has helped improve standards of care and facilitated millions in inward investment into the West Midlands.

The West Midlands Academic Health Science Network (WMAHSN) has released its 2022/23 Impact Report, highlighting its work and innovations contributing to improved health and generate income growth across the West Midlands.

Key achievements outlined in the report include a reduction of 745 emergency 999 calls – just over two per day – as a result of West Midlands care homes adopting deterioration management tools. This resulted in a reduction of 11,633 hospital bed stays, in cases where patients could receive alternative treatment.

As well as reducing pressures on the NHS and encouraging young people to get involved with healthcare innovations, the WMAHSN has also created 16 new jobs, supported 448 businesses and achieved over £9million of inward investment into the region.

April 2023 marked 10 years since the AHSN Network was established by NHS England and, in this time, the WMAHSN has undergone significant growth and transformation. In the past year alone, the organisation has grown to support the delivery of its programmes, which focus on improving Implementation and Adoption, Patient Safety and Improvement, and Innovation and Commercial.

Key highlights from the WMAHSN Impact Report include:

The launch of the Junior Innovation and Skills Incubator, which aims to address the UK skills shortage by unlocking untapped potential and accelerating training among young professionals. Three workshops were held to introduce innovators to a range of real-life health and social care challenges, helping to shape the minds of the future.
The introduction of Thopaz+ to the MedTech Funding Mandate. Thopaz+ is a portable digital chest drainage and monitoring system used for patients who have air or fluid around the lung, due to chest trauma or lung disease. Thopaz+ supports clinical decision-making and assists patients’ recovery and, in 2022/23, national reporting metrics demonstrated an increase from 28 per cent to 46 per cent of trusts implementing or adopting this innovation.
The West Midlands Managing Deterioration Programme worked with 1,679 care homes across the region to support the training, adoption and sustainability of deterioration management tools, helping professionals to better spot and respond to deteriorating patients. As a result, between January 2021 and September 2022, there were 3,232 fewer emergency admissions, resulting in a saving of £13,590 per care home.
The West Midlands region was chosen as one of the pilot areas to trial the Child-Parent-Screening programme a method of identifying children and their parents who have familial hypercholesterolemia (FH). FH is an inherited condition passed through families caused by a faulty gene making the liver less able to remove ‘bad’ (LDL) cholesterol. A total of 99 children have been screened to date, across three West Midlands sites, with a further three sites due to go live in 2023 which will have a combined potential of 247 annual immunisations.

Professor Michael Sheppard, Chair of the WMAHSN, said: “Our purpose is to lead, catalyse and drive cooperation, collaboration and productivity to accelerate the adoption of healthcare innovation across the region. With this in mind, it is inspiring to see the positive impact our work has had over the past year, generating continuous improvement in the region’s health and wealth and making a real difference to patients.

“The healthcare sector continues to be a highly dynamic and evolving environment, and we’ve seen several changes across the landscape during 2022/23. Despite this, we intend to keep strengthening our ability to work nationally, regionally and locally, maintaining the environment we have helped create.”

To read the full Impact Report, visit the WMAHSN website.

Pharmacies could free up more than 30m GP appointments, Company Chemists’ Association says

By Gabriel Blaazer

Report calls on government to “go further and faster” in giving more capability to pharmacy to prescribe prescription-only medicines and reduce pressure on general practice.

A new report from the Company Chemists’ Association (CCA), whose members include Asda, Boots, LloydsPharmacy, Morrisons, Rowlands Pharmacy and Superdrug, has urged the government to be bolder in its plans to expand pharmacy services, announced in May as part of its Delivery plan for recovering access to primary care.

Included within the Department of Health and Social Care’s (DHSC) plans is £645m to enable the expansion of pharmacy services in England over two years, intended to help relieve pressure on GPs – including an approach it dubs Pharmacy First.

This includes ambitions for community pharmacies to be able to supply prescription-only medicines for seven minor health conditions (Pharmacy First), increase their provision of the oral contraception and blood pressure testing services, and the delivery of improved IT system connectivity between general practice and community pharmacy in England.

The measures are expected to free up an additional 10 million GP appointments per year once scaled – equivalent to around 3 per cent of all appointments – but the CCA have urged the government to move faster and be “bolder” in their plans and accelerate plans to train pharmacists in England to act as ‘independent prescribers.

By their own estimates, the CCA expect the plans for Pharmacy First will free up around 6m appointments annually. They estimate that a more ambitious Pharmacy First service could free up 30m+ GP appointments per year, five times as many as in the government’s current plans.

In their new report, Pharmacy first and independent prescribing, the CCA argue that giving community pharmacy additional capability to supply non-prescription medicines and additional prescription-only medicines is a necessary and urgent step.

“There are an estimated 23,000 pharmacists currently in England without independent prescriber qualifications. A simple extrapolation of the plans currently in place indicate that it will take until 2040 to train the entire workforce. We need 95 per cent of community pharmacists to be trained as independent prescribers by 2030,” said Malcolm Harrison, Chief Executive of the CCA.

The CCA argue that their recommendations would effectively create 11,000 urgent care centres in England. With an estimated 90 per cent of the population located within a 20-minute walk of a local pharmacy, they believe that a “Pharmacy First” approach could transform access to care and help address under-provision of clinical services in certain areas. They say, for example, that “ambitious commissioning could position pharmacies as the ‘go-to’ place for urgent and emergency care”.

Alongside the expansion of prescribing capabilities and certain clinical services, the CCA are also calling for:

A fairer funding framework for community pharmacies. Community pharmacy is chronically underfunded. The current annual funding shortfall equates to more than £67,000 per pharmacy in England. The funding announced in the recent Delivery Plan is new money for new activity and does not address the historic underfunding of the sector.
A bold approach to harnessing Pharmacist Independent Prescribing. All pharmacists registering after 2026 will be independent prescribers (IP). There are an estimated 23,000 pharmacists currently in England without IP qualifications. Under current plans, it will take until 2040 to train the entire workforce.
A flexible and future-looking legal and regulatory framework that enables pharmacists and pharmacies to deliver and safe and effectively of medicines and to provide appropriate clinical care directly to patients.

Malcolm Harrison added: “Government plans to rollout Pharmacy First are welcome, but are only a drop in the ocean. Under current plans, pharmacies are expected to free up 6m GP appointments annually – but our analysis shows pharmacies could do five times this number.

“Action to address the historic underfunding of pharmacies and a roadmap to utilise the clinical skills of pharmacists are essential to achieving this. The Covid-19 vaccination programme showed what pharmacies can do when the Government places its faith and investment in pharmacies. An investment in community pharmacy is an investment in greater capacity for the NHS, enhanced resilience in primary care and better patient outcomes.”

A spokesperson for DHSC said: “Community pharmacies play a vital role in the NHS and we are providing them with an additional £645m investment that could free up as many as 10m GP appointments a year. This is on top of the agreed annual £2.6bn of funding set out in the pharmacy framework.

“We are also taking a range of actions to modernise and enable better use of resources and automation, allowing pharmacists to provide more care for patients.

“We are working closely with NHSE and Community Pharmacy England to launch Pharmacy First by the end of 2023 and will share an update on timings shortly.”

“Time for health and care to face the right way” – Stephen Dorrell

By Stephen Dorrell

In his foreword to Public Policy Projects’ (PPP) latest ICS Delivery Forum report, Chair, Stephen Dorrell, argues that now is the moment to reorientate the health and care system and seize upon cross-party support for integrated care systems.

It is an old truth that our system of health and care services faces the wrong way. Success obviously requires the ability to respond in a timely way to demand for high quality care and treatment, but the objective should be to support people to enjoy healthy, happy years of life rather than simply to treat disease. Delivery of this objective is the focus of our work at Public Policy Projects.

To borrow a word chosen by Coventry and Warwickshire ICS Chair Danielle Oum, integrated care has the potential to ‘subvert’ our system of health and care. Resources and effort can finally be rebalanced to better target health prevention, early intervention and reducing health inequality.

This thought process underpins the development of ICSs; furthermore, it is a thought process which, crucially, is the subject of bipartisan support between the Labour and the Conservative Party.

“National government has created the structures and can coordinate their development, but it cannot micro-manage delivery.”

This is vital. As we go into the pre-election period, the framework of health policy for the next decade is not the subject of party-political debate. There will of course be intense arguments about the health service in the run-up to the election, focused in particular on funding levels which do represent a political choice, but the principle of integrated care is now a shared ambition across the political divide.

But, although the aspiration has been articulated many times, the ICS programme is still in its very early stages. Despite the predictable journalistic desire to declare the system “broken” and call for headline-grabbing “reforms”, it is important to remind ourselves that the current structure is only 12 months old.

The policy challenge centres on the development of properly integrated care systems at local level. National government has created the structures and can coordinate their development, but it cannot micro-manage delivery. Any attempt to do so is not only certain to fail; worse than that, attempts to over-centralise will ensure that valuable local initiatives will fail too.

This is not a prediction; it is a history lesson. The NHS has always struggled to create a healthy balance between local initiative and central accountability; the requirement to create more integrated local systems makes that balance more urgent and more difficult.

The ICS Delivery Forum is a series of events designed to address these challenges. Our focus is on developing ICSs and helping them to deliver integrated care for citizens and populations.

Our inaugural Delivery Forum convened leaders from across the West Midlands at the City Library of Birmingham. This centre for local excellence epitomises the ambition of integrated care – an anchor institution that creates space for creativity, employment and learning while bringing communities together and fostering close ties between public services and the public themselves.

We believe these events help create the space to allow ICSs to deliver on their promise. We also believe that the successful delivery of that promise is what will ensure that the NHS maintains the position it established 75 years ago as a global role model for universal healthcare.

The full version of the West Midlands ICS Delivery Forum Key Insights report can be found here.

Stephen Dorrell is Executive Chair of Public Policy Projects, and was a Member of Parliament from 1979 to 2015. He served as Secretary of State for Health from 1995 to 1997, and was Chair of the NHS Confederation from November 2015 until 2019.