Workplace discrimination and equality concerns driving NHS acute staff exodus

By Integrated Care Journal and Gabriel Blaazer

Almost a quarter of surveyed staff working for NHS England acute trusts stated in their 2022 Staff Survey that they intend to leave their role in the next 12 months.

Workplace discrimination and equality concerns are the most significant factors driving acute staff to leave the NHS, according to analysis of the 2022 NHS Staff Survey conducted by consultancy firm Lane Clark & Peacock (LCP).

In a workforce already plagued by burnout, stalling pay and low morale, the findings will come as concern for policymakers seeking to staunch and reverse the flow of acute staff leaving the NHS. The acute sector employs more than 850,000 full-time equivalent staff, 25 per cent of whom are Asian, black or another minority ethnicity, compared to 13 per cent of all working-age adults in the UK.

Among the diversity and equality issues highlighted in the NHS Staff Survey were: a lack of fairness in career progression and promotion (reported by one in eight respondents); discrimination from managers or other colleagues (nearly one in ten); discrimination from patients, their relatives, or members of the public (more than one in twelve); and a lack of respect for individual differences (almost one in twelve).

There was variation in staff responses based on their ethnic background. In particular, 17.2 per cent of staff from ethnic minority backgrounds reported experiencing discrimination from their manager or colleagues, compared to 6.8 per cent of white staff members. These findings are notable in light of recent reports documenting a pattern of racism and discrimination in the NHS.

LCP also looked at all the acute trusts across England to identify which areas most struggle with the diversity and equality issues named above. London and the East of England are the worst-performing regions, but the problem is widespread.

Source: LCP. Data source: 2022 NHS Staff Survey. Diversity and equality score is reported on a 0-10 point scale and is based on responses to four contributing questions. Acute trust catchment boundaries adopted from the Office for Health Improvement & Disparities. (Click to enlarge.)

Hotspots for staff dissatisfaction

There is a stark geographical contrast across England when it comes to staff planning to leave the NHS. Trusts with the highest percentages of staff intending to leave are overwhelmingly located in London and the East of England, while trusts with the lowest percentages of staff intending to leave are concentrated in the North West and North East and Yorkshire.

Source: LCP. Data source: 2022 NHS Staff Survey. Acute trust catchment boundaries adapted from the Office for Health Improvement & Disparities. (Click to enlarge.)

Natalie Tikhonovsky, Analyst in LCP’s Health Analytics team, said: “Our analysis reveals a grim picture of low satisfaction levels and higher staff turnover rates currently facing the NHS acute sector. Understanding what is driving this will be key to the success of the government’s new workforce plan and to the overall aim of reducing steadily increasing wait lists.”

Catrin Treharne, Principal in LCP’s Health Analytics team, also commented: “The next steps for improving the NHS’s organisational health could include addressing disparities in staff satisfaction levels between trusts and investing in diversity and equality efforts to foster inclusive workplace environments. By understanding the root cause of NHS workforce challenges and designing solutions to properly address these, we can improve not only workforce satisfaction in the NHS but also patient satisfaction and outcomes.”

Leaders call for ICSs to “subvert” health and care system

By Integrated Care Journal

Public Policy Projects’ ICS Delivery Forum event in Birmingham on Tuesday, 18 April, saw integrated care leaders from across the West Midlands convene for localised debate on the future of integrated care for the region.

“Ambition and partnership” are the central ingredients to successful integrated care, according to Danielle Oum, Chair of Coventry and Warwickshire ICB (pictured above). Oum was speaking at the Public Policy Projects (PPP) ICS Delivery Forum at the Library of Birmingham on Tuesday, 18 April, where hundreds of key health and care stakeholders, including ICS leaders, clinicians, local authority leadership and community representatives gathered for a day of localised debate and networking.

The ICS Delivery Forum is a series of localised events designed to monitor the progress, and help realise the aspirations, of integrated care. Throughout 2023, PPP is hosting Forums in: Birmingham, Manchester, Leeds, Bristol and London.

The setting for this Forum was the Library of Birmingham, a place described by Oum as a “centre of excellence for research, for learning, for creative expression, for health information.” In many ways, Oum said, this visible anchor institution epitomises the ambition and partnership a that should define an ICS.

“If integrated care is successful, it can totally subvert our model for health and care”

Oum used her keynote address to call for the NHS to be more “mindful” of the impact it has on local economies, emphasising the role of the NHS as key local employer to regions.

“If integrated care is successful, it can totally subvert our model for health and care,” said Oum, who stressed that resources must be “refocused and rebalanced” in order to target energies onto health prevention, early intervention and reducing levels of ill health and inequality.

ICS Delivery Forum — Hundreds of health and care leaders from across the midlands attended the Delivery Forum.

Following Oum’s keynote address, a series of panel discussions and case study presentations were provided to an audience of more than 150 local ICS, NHS and local authority leaders and community representatives. Key topics of the day included:

Developing partnerships to deliver services
Collaborating to optimise the patient pathway
Effectively addressing health inequality in the West Midlands
Developing a truly integrated workforce strategy

While topics may be familiar to many who will have attended health and care conferences, this Delivery Forum was unique in that it was entirely focused on the West Midlands region. “If integrated care is to be developed locally, then it must be discussed and debated locally,” said PPP Head of Content, David Duffy, who also stressed that, in the shadow of the Hewitt Review, it is vital that, now more than ever, that local leaders are given the necessary platforms to identify the challenges and opportunities in integrated care most relevant to them.

Also speaking was Tapiwa Mtemachani, Director of Strategy and Partnership for Black Country ICB. Emphasising the importance of partnership and of assets to transform care presented by the local community, Tapiwa Mtemachani, Director of Strategy and Partnership for Black Country ICB. Mtemachani emphasised the importance of partnership and prevention in bringing down stubborn levels of deprivation and health inequalities seen across the Black Country, which has the second most deprived population of any of the 42 ICSs in the country.

“There is a narrative that prevention is too costly, but prevention is how the system should be managing demand, how it can reduce costs and expenditure while improving outcomes,” said Mtemachani. Black Country ICB has been doing this through extensive partnership working with local housing providers, using their local reach to promote prevention and overall health promotion. “At fairly low cost, we have developed a health coaching model for citizens, in close partnership with Walsall Housing Group, with impact already visible for our citizens,” Mtemachani explained.

Other notable local ICS representation included Dr Ananta Dave, Chief Medical Officer for Black Country ICB, who outlined how ICSs can help optimise patient pathways across the West Midlands. Also in attendance was Former MP, Salma Yaqoob, who is now Programme Director for Health Inequalities for Birmingham and Solihull ICB and Shajeda Ahmed, Chief People Officer for Black Country ICB.

The next ICS Delivery Forum takes place in Manchester on 25 May . PPP will be publishing a full report of the key insights uncovered at the Birmingham ICS Delivery Forum. For more information on the Delivery Forum, please visit the PPP website.

Prevention, early access and health inequalities: Redefining place-based care

By Gavin Bashar

Gavin Bashar, UK & I Managing Director at Tunstall Healthcare, discusses the focus on prevention, early access and health inequalities and the need to use technology to redefine place-based care.

If the healthcare system is to are to re-define care and achieve preventative services that reduce health inequalities, it’s important to approach services both holistically and through targeted resolutions to specific areas of care provision.

Redefining place-based care

Place-based care has the potential to deliver multiple opportunities. In order to capitalise on those that are presented, it is important to first define ‘the place’ and what this means to people both providing and accessing care services.

When defining place-based care it’s important to consider the different demographic regions across the UK. There are disparities in the health and wellness of communities with different population characteristics, and differences in access to technology, health and wellbeing, and life expectancy should be accounted for.

By starting with place-based care, it is possible to approach issues around prevention and proactivity and the tailoring of care. This in turn will help care providers to combat health inequalities and improve access to health, social care and housing.

The implementation of ICSs

It is hoped that integrated care systems (ICSs) will drive real system change that removes silos that are currently placing barriers on delivering the most effective services.

Considering single accountability and each step of an individual’s care journey will empower us to support ICSs in their role. This will be further supported by real collaboration and integration across the system. If we address issues and demand earlier, budgets and funding streams can be allocated to the specific areas that need them.

The role of tech

Technology’s role as an enabler can move the prevention agenda forward, however it is only valuable if it drives sustainable system change. In order to integrate technology effectively, we must bring the right skill sets into our services to ensure they can deploy digital solutions successfully.

Technology can have significant benefits for citizens, particularly in terms of using data to provide intelligent insight to inform more personalised and preventative care. We should see the ongoing progress that’s been made around data privacy continue, particularly as future generations are now growing up in a digital landscape. This will lead to citizens being more comfortable with health and care technology, and having a better understanding of how they can be empowered to play a more active role in their own wellbeing.

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

News April 20, 2023

Working together at scale: FAQs on provider collaboratives

By Charlotte Lewis

Provider collaboratives represent an opportunity to transform health and care delivery while driving improvements in patient outcomes and lived experience. This supports the ambitions set out in the policy paper: Integrating care: next steps to building strong and effective integrated care systems across England.

Provider collaboratives are one of the cornerstones of the English health and care landscape.

As of July 2022, provider collaboratives are mandatory for all NHS trusts providing acute and mental health services. Many NHS community and ambulance trusts have also been offered the opportunity to take part and non-NHS providers may also be included where this will benefit patients and makes sense for the providers.

NHS England defines a provider collaborative as partnership arrangements involving at least two trusts working at scale across multiple places. Provider collaboratives represent a move away from competition to one of cooperation and collaboration – underpinned by the duty to collaborate in the Health and Care Act 2022 (the Act).

In summer 2021, NHS England published guidance to formalise the move to collaborative working, which sets out some minimum expectations for how providers should work together at scale in provider collaboratives. A supplementary toolkit provides further support on setting up collaboratives, including potential governance models.

Mills & Reeve share insights from their learning and experience of working with provider collaboratives up and down the country on what makes a successful collaborative – the honeymoon period can fade fairly quickly as you get down to the difficult issues.

Mills & Reeve have prepared 10 FAQs as a guide to the process of forming a collaborative.

1. Choose your partners carefully: who should you partner with?

The first step for providers is to work out who will form the collaborative. This will often depend on the purpose of the collaborative.

For example, ‘horizontal’ collaboratives usually bring together providers that offer similar services (e.g., acute hospitals or mental health services) whereas ‘vertical’ collaboratives tend to involve organisations that provide different services (eg, collaboratives bringing together primary care, community, local acute, mental health and social care providers).

Often existing relationships will make for a good partnership as you will have a shared history of other joint working or partnering.

There is no ‘one size fits all’ and providers should come together in provider collaboratives in ways which make sense to achieve benefits of scale, provide resilience and deliver system priorities.

Providers will also need to bear in mind how different types of provider organisation operate and take this into account when deciding how they will be treated within the collaborative and how this might affect the contractual structure.

For example, independent sector (IS) organisations might be restricted by their banking covenants from underwriting another organisation’s risk. Providers should therefore be mindful of these differences and work together to develop equity within the collaborative. This means giving each provider what it needs in order to reach a place of equality within the collaborative, as each provider is not necessarily starting from the same position.

2. Objectives: Do we need to define our priorities early?

Providers will need to consider the overall aims and objectives of the collaborative. This means thinking about the reasons and incentives that organisations have to enter into the collaborative in the first place, their ultimate goals and what they are actually seeking to achieve together. Be clear about your objectives.

For example, is the collaborative a vehicle for contracting, or are the providers looking to create real change and improvements to the service for patients?

Providers will also need to work out how place and provider collaborative arrangements interface, especially given that ICBs will be able to delegate functions and budgets to both types of partnership arrangement. Provider collaboratives will need to both agree objectives with ICBs and align priorities with place-based partnerships, as well as develop a shared understanding of their respective roles.

3. Capacity and complexity: How will the various collaboratives work together?

Providers are likely to be part of multiple collaborative arrangements and/or alliances which will perform different functions and operate over a range of geographic footprints including neighbourhood, place, ICS and multi-ICS levels. The complexity and variety of different partnership models within any single system is likely to put pressure on already overloaded leadership teams, clinical services and operational teams.

We have supported providers to develop cross-organisational support functions to pool resources and expertise in order to overcome some of these issues.

4. Governance: Be clear and transparent on your governance model. What do you need to think about when deciding on your governance structure?

Providers need to be clear and transparent on their chosen governance model. So, providers will need to agree on the voting and decision-making structure of the collaborative, and consider questions like:

Do all the providers have equal voting rights, or does the lead provider get more of a say?
Must the majority vote also include the lead provider, or can the lead provider be bound by a decision it has not agreed to?
In the event of deadlock, does the lead provider get the casting vote?
What are the processes for existing providers to leave or new providers to join the collaborative, and how should this be agreed?

Where a lead provider model is adopted (see below) careful consideration must be given to the interaction between, and separation of, the lead provider’s dual role as both provider and commissioner.

For example, rather than reserving all commissioning decisions to the lead provider, it might be better if these are dealt with by the collaborative as a whole, or even by a separate team instructed by the collaborative. This is where a hybrid model might be useful (see below).

5. Model: Form follows function but which model suits best?

No one size fits all and NHS England’s guidance is clear that it is up the providers to decide which model will work best for them in the context of their ‘shared purpose and objectives’.

The following guiding principles should however underpin the chosen model:

a shared vision and commitment to collaborate
strong accountability mechanisms for members
building on existing successful governance arrangements
efficient decision-making
embedding clinical and community voices
streamlining ways of working

Popular governance models:

Lead provider:

Where a single provider holding a contract with a commissioner, sub-contracts with other providers in the collaborative to coordinate service delivery and improvement. This model was common with the mental health NHS-led provider collaboratives.

Shared leadership:

Where multiple providers appoint a single person (or group of people) to fulfil key leadership roles across the collaborative – particularly the chief executive role – while maintaining specific leadership capabilities for each provider within the group.

Provider leadership board:

Where senior leaders from participating providers establish a joint forum to shape a collaborative agenda. The joint forum may operate with delegated authority to take decisions for the providers.

These models are not mutually exclusive, and Mills & Reeve have worked with a number of collaboratives on hybrid models.

For example, a lead provider model could still involve shared decision making and include a leadership board, enabling the lead provider to be aligned equally with the other providers by use of a partnership agreement. In our experience, this can help to create a more open and collaborative environment where all providers feel they can contribute and participate on an equal footing.

Increased powers detailed in the Act have opened up the potential to:

Enable collaboratives to take on functions and budgets from ICBs via delegation, where appropriate;
Allow trusts to come together via a joint committee to make legally binding decisions;
Facilitate provider collaboratives to take on more formal responsibilities from ICBs, including budgets and functions, via delegation agreements.

6. Financial risk and opportunity: How do you manage the risk and/or gain of a collaborative?

Providers will also need to plan and agree on how to deal with the financial risk and/or “gain” of the provider collaborative. In many collaboratives, any financial surplus is reinvested into the system in order to improve the service and ultimately, benefit patients. This means that individual organisations will not take a portion of any “profits”. Instead, the surplus is a saving that can be used as an opportunity to make improvements, buy equipment, or hire more staff.

Such risk and gain share agreements can support the idea of mutual accountability by ensuring fair impact and benefit of collaborative activities for all members.

7. Clinical mode: Do I need to scope out a model identifying how care will be delivered?

Clinical leadership should be at the heart of provider collaboration, with improving services and outcomes for local populations as the driving force behind the collaborative’s programmes. It is essential for the collaborative to prepare a clinical model in order to work out how care will be delivered in a better and more cost-effective way, in order to improve the experience of patients and staff. A detailed clinical model should set out exactly how the service will be delivered differently and will also help providers to see how the collaborative will work in practice.

8. Sharing information: Do we need to set up a data sharing agreement?

The success of integrated care relies on sharing information, so providers will need to be aware of the issues associated with competition and sharing information.

There are potential difficulties where the collaborative includes independent sector (IS) organisations because they must comply with various competition rules, such as not sharing commercial sensitive information or fixing prices. For multi-site IS providers, this presents a risk in terms of having to share patient and staff data or information with other organisations.

It will be important to agree what information needs to be shared with which organisations and to document this accordingly. For example, we have supported organisations to set up information flows and barriers in order to ensure that the right (and only the necessary) information is shared between the various organisations in a safe, legal and appropriate way.

9. Intellectual property: Do we need to include IP clauses in a collaborative agreement?

Potentially yes. Providers will need to think about the IP position, such as what will happen where a provider leaves the collaborative after developing or contributing to new ideas or concepts that have created useful IP. Will the provider be able to take this IP with them or does it remain with the collaborative? Can it be licensed?

10. Risk management: Balancing the organisational and collaborative’s needs

Accountability between providers is a key feature of a collaborative, and an important means of ensuring progress on shared objectives. Providers will be expected to support and contribute to transparency and mutual accountability.

Providers and provider collaboratives will need mechanisms to identify and monitor risk, and to ensure the governance arrangements they work through are strengthened – and not eroded or confused – as statutory system working develops. However, there is a balance to be struck between proactively managing the questions and risks which arise through emerging collaborative arrangements whilst also realising the opportunities stemming from provider collaboration.

Get in touch with Mills & Reeve for advice or support with your provider collaborative.

Join Mills & Reeve at the I ntegrated Care Delivery Forum in Leeds, on Wednesday 28 June.

All news

The Hewitt Review: key takeaways so far

By David Duffy

The eagerly anticipated Review into integrated care systems (ICSs), led by former Health Secretary Patricia Hewitt was published today, setting prevention decentralisation and cross government co-production as key priorities. What have we learned so far?

Former Health Secretary and current Chair of Norfolk and Waveny ICS Patricia Hewitt, was commissioned by Chancellor Jeremy Hunt last year to undertake a substantial review into the accountability, governance and oversight of ICSs. The 89-page Review, published on Tuesday, covers England’s 42 ICSs and makes a series of recommendations to enhance the autonomy of ICSs.

In the forward to her report, Ms Hewitt says: “Unless we transform our model of health and care, as a nation we will not achieve the health and wellbeing we want for all our communities – or have the right care and treatment available when it is needed.”

The Hewitt Review calls for ICSs to be given the time and support to succeed. The establishment of ICSs must not simply be another superficial reorganisation – and the Review acknowledges a growing policy alignment ICSs that will “last well beyond one parliament, government or minister,” giving ICSs the time and space to embed the new model.

Shifting power from the centre

The Review also outlines how growing acceptance of the ICS model from DHSC and NHS England should come with a drive towards decentralisation wherever possible. To realise the promise of these systems, the Review states that “national and regional organisations should support ICSs in becoming ‘self improving systems’ given the time and space to lead – with national government and NHS England significantly reducing the number of national targets to no more than 10 key national priorities.”

Central to providing ICSs with greater autonomy is to reset approaches to health and care finance. Accordingly, the Review calls for greater funding flexibility for 10 of the most mature and best performing ICSs, as well as for broader funding reforms to be “multi-year and recurrent”.

Commenting on this, Sir Julian Hartley, Chief Executive of NHS Providers, said: “The emphasis on improvement over top-down performance management is essential and we hope the NHS at all levels will commit to the cultural shift necessary to bring this about.”

However, Hartley went on to call for greater clarity on the responsibilities and accountabilities of the different system players.

“We worry that trusts and integrated care boards (ICBs) will struggle to work as equal partners while ICBs have day-to-day oversight of providers.

“We’re also concerned that some recommendations could add complexity and bureaucracy – for example, with auditing prevention spending and reframing the role of local government oversight.”

Cross-government co-production

Hewitt insists that, for ICSs to be successful, substantial reform is also required at the heart of government. Article 1.25 of the Review states that:

“Critically, all of us need to change. Local partners within every ICS need to put collaboration and cooperation at the heart of their organisations. NHS England, DHSC and CQC need to support and reflect this new model in the crucial work they do; and central government needs to change, mirroring integration within local systems with much closer collaboration between central government departments and other national bodies.”

Hewitt also calls upon the government to lead a “national mission for health improvement” to shift the national conversation around health promotion – this forms a central part of Hewitt’s drive to promote better health and wellbeing, rather than simply treating sickness. “To underline its importance, this could be led personally by the prime minister,” the Review states.

The Review also calls for the establishment of a central Health and Wellbeing Assembly with a membership that “mirrors the full range of partners within ICSs, including local government, social care providers and the VCFSE sector as well as the NHS itself.”

Shifting the dial on prevention

Hewitt makes a number of recommendations to embed prevention as an overarching principle for ICSs. This includes increasing the share of NHS budgets at the ICS level going towards prevention by 1 per cent over the next five years. While acknowledging that many systems will struggle with this adjustment, the Review insists that:

“An ambition of this kind is essential if we are to avoid simply another round of rhetorical commitment to prevention.”

The Hewitt Review also calls for a consistent national framework to monitor prevention investment by Autumn 2023, and suggests that ICSs should establish and publish their baseline investment in prevention by April 2024. Further, the Hewitt Review includes a recommendation to increase the public health grant allocation, which is central to enabling systems to drive forward their ambitions for the health of their local populations

Commenting on the Review’s focus on prevention, Mathew Taylor, Chief Executive of the NHS Confederation, said: “The focus on prevention is crucial for long term sustainability of both the NHS and more broadly to increase health and wellbeing of the population, and something for which we have long been advocating.“

Health inequalities as the primary objective

Recent research from Public Policy Projects revealed widespread acceptance among ICS leaders that reducing health inequality is the biggest priority for integrated care. However, with ongoing immediate pressures and a seemingly endless cycle of year-on-year winter crises, many systems have been unable to develop the long term population health strategies needed to bring down health inequality.

In arguing that action on health inequalities is far more than a ‘nice to have’, the Hewitt Review echoes PPP’s position that action on health inequality is itself the primary objective of ICSs and essential for the long-term viability of the health and care system.

Hewitt said in her review that: “I heard real concern that the transformational work of ICSs and specifically the opportunity to focus on prevention, population health and health inequalities might be treated as a ‘nice to have’ that must wait until the immediate pressures upon the NHS had been addressed and NHS performance recovers. That is what has always happened before, and must not happen this time.

“Prevention, population health management and tackling health inequalities are not a distraction from the immediate priorities: indeed, they are the key to sustainable solutions to those immediate performance challenges.”

Empowering ICPs

The Hewitt Review also suggests a number of measures to give greater significance to the role of integrated care partnerships (ICPs), including the establishment of a national ICP Forum to create direct communication between ICPs and DHSC and to make the ICP the primary mechanism through which preventative health policy can be delivered.

The Review also gives due consideration to the need for cultural change within NHS, local government and provider bodies. As stated in PPP’s report, Ensuring ICSs represent a partnership of equals, it will take time for the constituent parts of ICSs to become familiar both with each other and with collaborating across organisational boundaries.

Digital skillsets

There is also welcome recognition in the Hewitt Review that the lack of digital skills at all levels of the health and care workforce is a significant barrier to the success of digital and data-driven transformation. This formed a core recommendation of PPP’s ICS Futures, which calls for mandatory digital expertise at board level and efforts to increase the digital competency of the workforce more broadly.

Expanding the role of CQC

With greater autonomy for ICSs will come a greater need for flexible accountability and as such, the role of CQC, and how it can be enhanced to provide greater system oversight, is one of the key focuses of the Hewitt Review. In accord with PPP’s Ensuring ICSs represent a partnership of equals, the Hewitt Review calls for increasing expectations of CQC to assess the level of mutual accountability between partners within a system. This will include assessments on cultural change and system integration.

Section 3.87 of the Review states that: “CQC should take into account the extent of collaboration around organisational development and quality improvement.” This, the Review states, should be led by a “Chief Inspector of Systems” who should draw upon the multiple sources of quantitative and qualitative data available to CQC.

Tackling rehabilitation provision must be a priority for ICBs

By Natasha Owusu and Rachel Newton

By Natasha Owusu, Policy Lead (England) and Rachel Newton, Head of Policy at the Chartered Society of Physiotherapy (CSP).

Rehabilitation, long-term conditions and health inequity

It is not fair that a person’s ethnicity, socioeconomic situation, sex, age, religion, sexuality and disability can determine the level of access they have to rehabilitation services which can lead to worse health outcomes.

People in deprived communities and groups marginalised by discrimination live shorter lives and spend a greater proportion of their lives affected by long-term conditions and disabilities. The evidence of treatment outcomes for people with frailty, musculoskeletal, cardiovascular, respiratory, and neurological conditions, cancer, spinal injury, brain injury, and many more conditions, shows irrefutably that rehabilitation is as essential as medicines and surgery.

But rehab services are either unavailable, have long waiting times, or are poorly equipped to meet the needs of their communities, having been desperately under-resourced and under-staffed for decades. The impact of this is felt by those communities most in need, entrenching health inequity. Whether or not an individual accesses rehab affects not only their health but also their life chances, earning potential, likelihood of being in work, how active they are in their community, how likely they are to become socially isolated, and how happy they are.

Without rehab, people can be stuck in a downward spiral of worsening health, loss of mobility and poor mental health and multiple medication regimes. Ensuring everyone who needs rehab can access it can reverse this downward spiral, so that people cannot only survive but live healthy and active lives.

For decades rehabilitation services have been fragmented and developed in a piecemeal way. This has created a confusing system, which is hard for service users to navigate, or to know what to ask for or expect. GPs and hospital doctors are often unfamiliar with what rehabilitation is, what it can achieve, and the evidence supporting this. This means referral rates are low and when they do refer there is often poor communication with patients about what rehabilitation is and why it is an essential part of their treatment.

Rehabilitation is siloed, located in hospital department out-patients when it doesn’t need to be and there is inconsistency in what a ‘good’ level of provision and quality looks like. People who are marginalised, and those experiencing higher levels of deprivation, are more likely to be diagnosed with one or multiple long-term conditions, and this will be earlier on in their lives, with more severe conditions.

The same parts of the population with the greatest need for rehab also face the biggest barriers to access it. The sad fact set out in the CSPs 2022 report, Easing the pain: Rehabilitation, recovery, reducing health inequity, is that patients from deprived communities and marginalised groups are failed at every stage of the rehabilitation pathway.

This much we know. But there is so much we don’t know because data collection on rehabilitation needs, and provision is poor. Legally, all NHS and social care services must collect data about patients’ protected characteristics but there is a huge variation in how consistently and accurately this is done. This inconsistency is part of a wider issue of a dearth of data in community rehabilitation services.

The CSP’s Making Community Rehabilitation Data Count report, highlights the need for centralised data collection to best meet the needs of populations and to track the development of integrated rehab services.

The drive for improvement and innovation that has produced medical breakthroughs now needs to be applied to recovery and rehabilitation.

The role of integrated care systems

Rehabilitation sits at the intersections of health and social care sectors, taking place in social care, community, intermediate and acute NHS settings, and provided by multiple sectors.

The modernisation of rehabilitation can only be done by working across the whole system, rather than sector-by-sector or condition-by-condition. Through this approach, rehabilitation should be seen as a litmus test for integrated care systems.

There are many pockets of excellent rehab services for people with any long-term condition, that have designed their service to be accessible to all their communities, and take a holistic, integrated approach.

Scaling up this approach requires strategic leadership, adoption of consistent standards, the workforce to deliver and data.

The CSP has joined forces with more than 50 other professional bodies and national charities in the Community Rehabilitation Alliance (CRA) to recommend the following for ICBs:

Appoint Single Accountable Leads for Rehabilitation operating at a strategic level to deliver expansion, integration and redesign of services and be accountable for key performance metrics.
Adopt the Community Rehabilitation Best Practice Standards co-developed by the Chartered Society of Physiotherapy with our partners.
Expand and develop the rehabilitation workforce. This includes making use of the growth in registered physio numbers, but also the non-registered workforce, exercise professionals and other AHPs, nurses and doctors involved in rehabilitation.
Develop ICB data plans to show who is and isn’t accessing rehabilitation services, the consequences of this, the level of provision against population need, and performance on improvements.

CSP Member and Chair of the Birmingham and Solihull ICS AHP Council, Seema Gudivada, will be talking more about this approach at the panel discussion, Effectively addressing health inequalities in West Midlands (at the Birmingham ICS Delivery Forum on 18 April). Seema hopes delegates will be inspired after the event to action these recommendations to make equitable access a reality and improve outcomes for all patients across the West Midlands.

For further information or advice, please visit the CSP stand at the Birmingham ICS Delivery Forum on 18 April 2023 or email cre@csp.org.uk.

Why interoperability is key to transforming the healthcare service and patient safety

By Ed Platt

Ed Platt, UK Sales Director for Omnicell UK & Ireland, discusses digital systems and why interoperability is key to transforming the healthcare service and driving patient safety.

Within healthcare, interoperability is the integration of technology and healthcare systems to simplify the communication, delivery and digitalisation of clinical information across an organisation or system. Effective interoperability allows for improved collaboration and clinical workflows to inform crucial decision making, creating time and financial savings – all with the aim of driving better patient outcomes.

Omnicell, as a leading medication management solution provider, is paving the way for interoperable technology to become widespread in the healthcare landscape, as it is in other sectors. Omnicell’s Automated Platforms have been integrated with several leading providers of Electronic Prescribing and Medicines Administration (ePMA) and electronic patient record systems (EPR, more commonly known as EMR outside of the UK) which have led to a reduction in medication errors and better workflows for staff.

These working interfaces are with Better, Cerner, EPIC, AllScript, SystemOne, WellSky and MedChart, to name but a few. However, it is also possible for platforms to link and integrate with medication wholesalers, finance systems and many more stakeholders, with a view of delivering a patient-centric supply chain.

The global challenge

The World Health Organisation recognised the severity of medication errors and more than 5 years ago, introduced a Global Patient Safety Challenge, Medication without Harm, with the ambition of reducing avoidable medication-related harm by 50 per cent. The scale of the issue within the UK is worrying; in 2018 the EEPRU report, Prevalence and Economic Burden of Medication Errors in the NHS in England, further highlighted the sheer scale of medication errors taking place.

The shock of these findings led to a review, which set the healthcare system on the path to technological solutions with the impressive adoption of the ePMA systems. According to a National Institute for Health Research (NIHR) funded study, high-risk medication errors can be reduced by up to 50 per cent with the implementation of this technology.

The next step; interoperability

Linking and integrating ePMA and EPR systems with complementary systems such as inventory management tracking systems, electronic controlled drug solutions, robotic dispensing systems and automated medication dispensing cabinets is the next step in truly driving down medication errors. NHS Trusts are now taking digitalisation a step further by investing in integrated electronic health record (EHR) systems.

EHRs represent a step beyond the standard patient medical history found in paper-based patient medical records and include a broader view, including information from all the clinicians involved in a patient’s care. Importantly, they also share information with other healthcare providers, such as laboratories and specialists. This approach enables NHS Trusts to enhance their operational and financial efficiencies and improve the experience for staff working at multiple sites.

Interoperability with partners helps ‘close the loop’ in the medication management process; not only does it enable optimisation of medication administration, it also provide a full access to patient data records allowing for complete visibility and accountability. For patients, it means healthcare professionals have up-to-date access to all information, irrespective of the treatment venue, enabling the delivery of high-quality, coordinated and informed care. Integration also allows for additional features and shared data with Omnicell pharmacy technology automation and intelligence solutions to drive inventory optimisation, diversion management, medication usage analytics, compliance and population health services.

A collaborative partnership approach

Omnicell prides itself on being a long-term partner to hospitals as a quality, trusting relationship supports a smooth transition to new, technology-enabled ways of working – supporting full buy-in and adoption by staff. Technology solution providers should spend time on-site, understanding different workflows in various departments and proving expert guidance on how adoption can best be used to make significant time and cost savings quickly. For example, the medication needs on an intensive care unit are different to the needs of an orthopaedic ward.

But what is the optimum solution for each of those wards, and which model of interoperable technology is going to be the most effective when it comes to achieving zero errors, zero waste and zero time-consuming process for staff? The future must therefore be one of sharing, co-operation and transparency; between systems, between patients and healthcare providers, between healthcare providers and industry experts and between different healthcare disciplines – all driven by knowledge and supported by data.

Conclusion

Interoperability solutions are a great opportunity for the healthcare sector and could be a crucial factor in realising the future of our much-loved national health service by presenting the sector with cost, safety and efficiency opportunities. With the right partners, Omnicell’s solutions can transform medication management and create synergies across healthcare enterprises. Technology doesn’t stand still and, looking to the future, interoperable technology solutions, data and AI have the power to change the healthcare landscape beyond recognition.

Chesterfield Royal Hospital introduced ward based automation systems for medicines to further reduce the risk of error and increase efficiency, with the ultimate goal of improving the management of medicines in the ward environment and reducing the burden placed on nurses and pharmacy staff. Martin Shepherd, Head of Medicines Management at Chesterfield Royal Hospital NHS Foundation Trust, commented: “This is a significantly better and safer way of dealing with ward medicines. The risk to patient safety is lower as we have reduced our dependence on manual processes. It provides a safety net, reduces the risk of products being wrongly selected and near misses. Integrating the ward-based systems with PMA only strengthens that level of security. It helps us in our drive to ensure that patients receive the right medicines at the right time.”

St Mary’s hospital already had a ward level electronic prescribing system in operation for two years when they decided to take the next step in patient safety and automation by installing Omnicell automated medication dispensing cabinets in all care areas. Jackie Harry, NICU Ward, Isle of Wight NHS Trust, commented; “We have much better stock control and expiry date management, and it’s really easy to use even in an emergency. We have saved time hunting for keys and searching in cupboards – we know we have the stock and the cabinet takes us to it. Invaluable. Really time efficient and safe.”

**Ed Platt, UK Sales Director, Omnicell UK & Ireland**

This article was kindly sponsored by Omnicell.

To learn more about the importance of interoperability, visit Omnicell.co.uk or email:

UKMASales@Omnicell.com

Call: +44 (0)161 412 5333

Can ICSs unlock the value of private business to health equity?

By David Duffy

New insight from Public Policy Projects (PPP) outlines how businesses can support health equity through community engagement, why they should, and how integrated care systems (ICSs) can support them.

The findings go on to suggest that should these community engagement strategies be co-designed by ICS members involved in the setting of priorities for the public sector in a local area. Private businesses can align their strategies with public bodies and with one another, maximising the value of their role as community stakeholders.

The insight piece outlines how businesses can impact the health of a community – such as by implementing healthy workplace policies, implementing inclusive local recruitment practices, partnering with community organisations, investing in community development, implementing local procurement strategies, and advocating for health equity. The piece goes on to make the business case for community investment, outlining how investing in communities can increase community loyalty and trust, improve employee morale and retention, enhance brand visibility, and increase innovation.

The value of community engagement to businesses, the document suggests, can be further grown through collaboration with the public sector. This can support better knowledge sharing, as a number of NHS trusts already oversee effective community engagement strategies, and enable initiatives from both the public and private sector to better support oneanother and accelerate the improvement of health equity within a region.

Improving health outcomes in the community provides the following recommendations to business leaders and policymakers:

Businesses should be incentivised to invest in communities – through recruitment, procurement and outreach – and should be encouraged to partner with other businesses and public bodies to improve the quality of data and insight.

ICSs, local authorities, central government and businesses should explore opportunities to utilise ICPs as a forum for private, public and third sector stakeholders in a local area to communicate, establish shared priorities and create plans of action.

In order to develop stronger guidance for businesses to collaborate with ICPs, there should be a tailored section within the Maturity Matrix for ICSs discussing partnerships with private businesses.

Businesses should communicate regularly with other local stakeholders, including Health and Wellbeing Boards. These communications should ensure businesses are supporting local health equity ambitions by responding to Joint Strategic Needs Assessments.

Businesses and local authorities alike should seek to grow their investment into tools to understand the impact of community engagement and the health value of social investment.

Further guidance on partnerships within the ICS framework should be issued – with a specific focus on enabling effective public-private collaboration. The Department of Health and Social Care (DHSC) should collaborate with the Department of Work and Pensions to issue this guidance.

ICSs and DHSC should seek to develop guidance for businesses to support local health outcomes through recruitment, procurement and outreach. This guidance should not be overly proscriptive, but should provide a clear idea of the relationship between various social determinants of health and business practices.

Improving health outcomes in the community is the second instalment of the Population Health in Business series, which discusses the health creation value of business and suggest to business leaders and policymakers alike how they may re-envisage their roles, collaborate and deliver better outcomes.

The roundtable that served as the evidence-base for this report was conducted in February 2023 and chaired by Professor Donna Hall CBE, Chair of New Local, Integrated Health and Care Systems Advisor for NHS England, and a woman once described as a “public service pioneer” by Mayor of Greater Manchester, Andy Burnham.

Professor Donna Hall CBE said of the series: “The three workshops by PPP have explored the practical ways businesses can support health and wellness in their local communities. We have had engagement from a wide range of businesses, public health experts and academics which has been a rich and diverse discussion. The report provides helpful support and advice to local health and care system leaders, businesses and communities on making the most of private employers as a key part of the local infrastructure to support breed health and wellness for all.”

The PHIB roundtable series has concluded, however the final insight summary and final report are still being written and will be launched in June 2023.

Read the full insight piece here.

For further information about the report please contact eliot.gillings@publicpolicyprojects.com  

New survey finds public awareness of pharmacy services as low as 13%

By Integrated Care Journal

Findings from pharmacy tech startup Charac reveals more than half of patients do not use their local pharmacies for anything more than minor illnesses.

A new study from Charac, an NHS-integrated one-stop platform for independent community pharmacies, has provided a new insight into public perception and patient usage of pharmacies. Awareness of the full scale of services is as low as 13 per cent of those surveyed, and 53 per cent are not using pharmacies for anything further than very minor ailments.

With pressure on the NHS reaching unprecedented levels, Secretary of State for Health & Social Care Steve Barclay has acknowledged the importance of a ‘pharmacy first’ policy for England. This is designed to allow pharmacies to act as another entry point into the health service, and to relieve some of the pressure from general practice. However, this is yet to be realised in policy, and Charac’s research has found that patient knowledge of pharmacy services remains worryingly low.

Knowledge of services

More than 50 per cent of patients were not aware of the majority of services pharmacies provide. Most respondents were only aware of 4 out of 15 potential services, being minor illnesses, repeat prescriptions, emergency contraception, and flu vaccination. Knowledge of services was as low as 13 per cent for chlamydia screening and treatment, for example.

Usage of services

The only pharmacy services that more than a third of respondents reported using were for minor illnesses, such as colds, flu, and low-level digestive issues (58 per cent), and for repeat prescriptions (47 per cent). In fact, these were the only two services that the majority of respondents would go to a pharmacy for instead of their GP – 57 per cent for minor illnesses and 52.5 per cent for repeat prescriptions, respectively.

Furthermore, patients on the whole are still using pharmacies for traditional services, such as ordering prescriptions (96 per cent) and disposing of old medication (80 per cent). While satisfaction with pharmacy services remains high, with almost half of respondents giving their pharmacy the highest satisfaction rating, patients evidently remain hesitant to use pharmacies as the first port of call.

Santosh Sahu, founder and CEO of Charac, said: “Though it is great to see patients largely very happy with the services provided by their pharmacies, it’s clear that patient confidence in various services other than prescriptions is low. To push a ‘pharmacy first’ policy, more must be done to provide pharmacies with better resources and increase patient confidence.

“Both funding and improved digital access can make a tangible difference in equipping pharmacies for the future. Charac’s platform is helping pharmacies improve their online presence, as well as helping them generate a steady income by digitising processes such as consultations and prescriptions.”

Public satisfaction with NHS hits lowest level ever recorded

By Gabriel Blaazer

Public satisfaction with the NHS has slumped to the lowest level ever recorded by the British Social Attitudes Survey (BSA), the annual survey of public opinion covering conducted by the National Centre for Social Research (NatCen).

Overall satisfaction with the NHS now stands at 29 per cent according to the new BSA survey – the lowest level yet recorded. A fall of 7 per cent from the previous year, this year’s report shows the fourth largest year-on-year drop in NHS satisfaction recorded. First carried out in 1983, NatCen’s BSA is seen as the gold standard barometer of public attitudes to a wide variety of social issues. The 40th iteration of the survey was conducted in September and October 2022.

According to analysis published by the Nuffield Trust and The King’s Fund, dissatisfaction with the NHS has also reached an all-time high, with 51 per cent of respondents saying that they were dissatisfied with the NHS. 69 per cent of respondents cited long waiting times for GP and hospital appointments among the reasons for their dissatisfaction.

Dissatisfaction with A&E services has jumped by 11 per cent, the biggest year-on-year increase in dissatisfaction since the question on A&E services was introduced in 1999. A record 40 per cent of survey respondents said they were dissatisfied with A&E services, and only 30 per cent reported feeling satisfied.

Other NHS services reaching record-low levels of satisfaction include general practice, dentistry and hospital in-patient services.

As with last year’s survey, public support for the NHS and its core principles remains undimmed. Nine out of 10 respondents agreed with the principle that the NHS should ‘definitely’ or probably’ be free of charge at the point of need, while eight out of 10 agreed that the NHS should be available to all and primarily funded through taxation.

The Royal College of Physicians (RCP has warned that the survey’s findings make the need for a long-term workforce plan from the government all the more urgent. Dr Sarah Clarke, President of the RCP, said: “It’s sadly unsurprising to hear that one of the main reasons for the public’s dissatisfaction with the NHS is staff shortages. NHS staff are under more pressure than ever before – often stretched far beyond the limits of their contractual working hours and responsibilities as they try to keep up with demand and do their best for patients.

“The government needs to publish the promised long-term workforce plan in full, including numbers of staff needed to meet demand in 5-, 10- and 15-years’ time, and commit to deliver the funding needed to underpin it. The plan must include an expansion of medical school places to increase the number of doctors. Lives are depending on it.”

Jessica Morris, report author and Fellow at the Nuffield Trust, commented: “Behind the political upheaval and turmoil playing out at the time of this survey, the British public was sending a message about the worsening situation for the NHS. The fact we have now recorded the lowest level of satisfaction with the NHS in the 40-year history of this gold standard survey is a warning siren. The rate of decline has slowed from the previous year, but that is barely a silver lining given the challenges and impact of the pandemic.

“The Prime Minister has made recovering the NHS one of his central promises going into the next general election. But these results show what an enormous task this will be. It is clear that the level of unhappiness amongst the British public over the way the NHS is running is going to take many years to recover.”

Dan Wellings, report author and Senior Fellow at The King’s Fund said: “It is easy to become desensitised to the relentless flow of bad news about struggling health services, but we cannot underestimate the significance of today’s unprecedented results. These stark findings should act as a wake-up call to those in power.

“Even with satisfaction dropping to its lowest ever level, support for the founding principles of the NHS remains strong. The public do not want a different model of healthcare, they just want the current model to work.”