Harnessing local assets – the NHS and Care Volunteer Responders programme: people powered healthcare

By Dr Allison Smith

By Dr Allison Smith, Head of Research and Insight at Royal Voluntary Service.

The NHS and Care Volunteer Responders (NHSCVR) programme was first launched in March 2020 by NHS England to support and protect those individuals who were ‘shielding’ because of clinical vulnerabilities to Covid-19. The programme proved to be a critical auxiliary service adding vital capacity for staff and patients. Today the programme aims to support integrated care systems (ICSs) alongside other voluntary sector provision to improve efficiency, patient care and add capacity. It is free of charge, making it an accessible resource for healthcare teams and patients seeking additional support.

In today’s healthcare landscape, collaboration across sector partnerships is essential to delivering high quality care. NHSCVR exemplifies partnership working between a public service, a charity with a social enterprise (GoodSAM digital app) and citizens. To date over 40,000+ vetted volunteers across England have made themselves available to be deployed in real-time – via the GoodSAM app – to support the needs of local healthcare systems.

Volunteers provide emotional (e.g. welfare calls) and practical support (e.g. grocery/prescription deliveries) to help people stay well and independent. In addition, volunteers play a crucial role in supporting healthcare teams with, for example, quicker discharges and virtual ward assistance through the Pick Up and Deliver service.

Since the programme was relaunched last year, Royal Voluntary Service, with GoodSAM, has been working in partnership with several Trusts, ICSs, and local volunteers to embed and pilot various volunteer activities.

We showcase two below.

Barnsley Hospital – Pick Up and Deliver

The service supports Barnsley Hospital’s Discharge Unit, Virtual Wards, and Haematology Departments. This supports individuals being discharged from the hospital by transporting medication to their homes and enables patients to return home earlier, rather than them waiting for their prescriptions to be ready.

*Delivering medication to a patient through Pick Up and Deliver*

Barnsley Hospital staff load Pick Up and Deliver shifts into the referrer online portal. With real-time support the system ensures fast volunteer deployment. Volunteer Responders across the North-East sign up for shifts via the GoodSAM app, enjoying the flexibility to choose when they volunteer. Discharge staff feel that it both improves patient flow by getting patients off the wards and home quicker but also saves bed days by reducing the number of patients still waiting on-ward past 5pm.

Kerry Evans, the Regional Relationship Manager for North East, North Cumbria and Yorkshire has been working in partnership with Barnsley Hospital and their Discharge Unit and Virtual Ward teams:

“Members of their Discharge/Virtual Ward Teams approached me to see how Volunteer Responders could assist with the delivery of medications. It was a real collaborative effort from the start, involving hospital departments and the Royal Voluntary Service.

“Initially, we implemented an alert-based notification system for volunteers to respond to individual requests. After one month, we gathered feedback and assessed the process. It became clear that the volume of deliveries warranted a shift-based model. This provided hospital staff with greater certainty about volunteer attendance and allowed for contingency plans if shifts were unfilled.

“Volunteers have appreciated knowing their scheduled times, resulting in consistent participation. This has fostered trust and rapport between hospital staff and volunteers. The immediate impact of their actions within their communities has further motivated volunteers.

“The hospital staff have embraced the service and have been happy to explain to other Trusts about the benefits they have experienced and the collaborative nature of working with the voluntary sector. So much so, other Trusts are coming on board.

“It really is a case of listening to what the hospital needs, engaging with the volunteers to fully explain the service and then supporting all parties to make sure the process runs smoothly.”

Jacqueline Howarth, Operational Manager of RightCare Barnsley said:

“We are exploring the possibility of expanding the service to other patient groups and are in the early stages of developing these new pathways. Additionally, we are looking into other services provided by NHS and Care Volunteer Responders that would be useful to our Virtual Wards.

“We have found the Pick Up and Deliver service to be incredibly helpful and necessary. We have already recommended it to other colleagues and department heads in the hospital. The service is available seven days a week and is highly responsive, which is fantastic”.

Yorkshire Ambulance Service – Welfare Vans

The programme also worked in partnership with Yorkshire Ambulance Service NHS Trust and local volunteers to pilot ‘welfare vans’ in October and November 2023 (at York Hospital) to improve the wellbeing and working environment of ambulance crews as they waited outside A&E.

The volunteers were asked to make themselves available to support crews who were waiting to hand over patients at Accident & Emergency departments. They were required to provide ambulance staff with refreshments and the opportunity for a friendly chat. Volunteers undertook shifts of two to four hours – either solo or in pairs; the welfare vans were available from 12:00 to 20:00 and had a range of hot/cold drinks and snacks.

Overwhelmingly, both ambulance crews and volunteers benefited from this role. Crews reported high satisfaction with the welfare vans (n=89): 88 per cent reported that they were ‘very satisfied’ and 9 per cent ‘satisfied’.

“Always a friendly face at the welfare van. Happy to help and chat … A very welcome sight during a busy shift. Very much appreciated.”

“It’s an excellent service, with all the queuing we do to have a friendly face to give you a warm cuppa is great. All the volunteers at York are friendly and helpful so please keep it going. A big thank you to them.”

Volunteers also reported high levels of appreciation and value in doing this activity:

“I just got a really nice feeling about it, and they did appreciate it. They were keen to say thank you very much for being here … ‘We didn’t know you were going to be here.’

“I thought it was a really good idea to do. And so I was quite keen to sign up to it. So I did! They (crews) appreciated it, and it was nice to have an opportunity to chat to them.”

These examples demonstrate what can be achieved with true partnership working. Being able to welcome in local citizens, via volunteering, not only has benefits for the healthcare system, staff, and patients but we also know from an existing breadth of medical evidence it improves health and wellbeing of the volunteers, and can drive future workforce recruitment. In a recent survey (March 2024, n=2817) 21 per cent of Volunteer Responders stated that the programme has inspired them to ‘think’ or ‘actively look’ for a job/career in the NHS/care; 4 per cent stated because of NHSCVR they are now working in the NHS/care.

Royal Voluntary Service will be attending the Integrated Care Delivery Forum event in Birmingham on the 9th May.

If you would like further information or a conversation with one of our team – please contact your Regional Relationship Manager; details can be found at nhscarevolunteerresponders.org.

News, Upcoming Events March 21, 2024

Rising costs, hidden risks: the unseen epidemic of wound care

By Bhawna Kanwal

On Monday 26th February 2024, Public Policy Projects (PPP) held a webinar to reflect on the PPP 2023 wound care programme, ‘Going Further For Wound Healing’ and to discuss the priorities for wound care in 2024.

Wound care represents the third highest expense for the NHS, after cancer and diabetes, and cost the NHS £8.3 billion in 2017/18. PPP’s webinar provided a platform for stakeholders to address critical aspects of wound care, emphasising collaboration, the challenges with engaging primary care and the urgent need to improve commissioning practices.

Chaired by PPP Chair, the Rt. Hon Stephen Dorrell, the panel included Kirsi Isoherranen, who serves as the Head of Helsinki Wound Healing Centre at Helsinki University Hospital and President of the European Wound Management Association (EWMA), Christine O’Conner, the National Commercial Strategy Lead at Coloplast, Naseer (Nas) Ahmad, a Consultant Vascular Surgeon at Manchester University Foundation Trust, and David Lawson, the Director of Strategy at the Medical Technology Directorate within the Department of Health and Social Care.

Experts stressed the need for integrated care boards (ICBs) to address the escalating costs of wound care and the importance of upskilling staff to prioritise healing over mere wound maintenance. One of the delegates stated: “We must change the conversation from management to healing; we can heal wounds!” Kirsi Isoherranen emphasised during the discussion that the “cheapest wound is the healed wound”.

Addressing “the delusion” that dressing spend constitutes the bulk of wound care costs, Christine O’Connor clarified that the majority of primary expense lies in the resources allocated to healthcare professionals, particularly community and practice nurses. O’Connor emphasised the need for commissioners to recognise the financial and capacity benefits of prioritising wound care.

David Lawson higlighted challenges of innovation adoption within the NHS, emphasising the need to move beyond pilot phases to scale adoption. He advocated for prioritising value-based procurement principles to understand the true value of products. He highlighted initiatives such as developing a draft methodology for applying these principles and actively managing the listing of products to prioritise value. The goal, Lawson argued, is to bring about a culture change in the procurement community and ensure that changes do not burden industry unnecessarily.

Effecting system level change

Speakers also highlighted successful initiatives undertaken in Greater Manchester ICB to include wound care as a strategic objective for the ICB. Nas Ahmad argued that, by re-evaluating traditional practices and leveraging a multidisciplinary approach, significant improvements can be made without additional resources. Results from the five-year initiative demonstrated a reduction in amputations, with a 42 per cent decrease observed in Salford alone. The strategy involved shifting the language from wound care to amputations, emphasising equality and reducing inequality in outcomes.

This approach facilitated engagement with commissioners and enabled wound care integration into Greater Manchester’s five-year strategy. The success factors included fostering a unified vision among stakeholders, optimising resource allocation by eliminating non-essential practices, and enhancing skillsets through training. This prompted a delegate to add: “A blue print for ICBs for joined-up, cross-organisational wound care would be good; [one] that describes the opportunity and the building blocks to implementing change.”

PPP advocacy as a vehicle for change

Another key aspect highlighted in the webinar was the collaboration between the European Wound Management Association (EWMA) and PPP, and EWMA, through PPP’s advocacy, research, expert panels, and cooperation can enhance wound care. Kirsi Isoherranen, President of EWMA, emphasised the importance of implementing wound care guidelines, particularly in primary care where early diagnostics play a crucial role.

O’Connor emphasised: “The PPP conference and roundtables were absolutely a major breakthrough in terms of moving the agenda forward. I think this has been a great opportunity to build on what’s been done previously. Commitment of industry is 100 per cent there to support the direction of travel. We need to go in and bring more”. In conclusion, the recent PPP webinar on wound care highlighted the critical need for collaboration, innovation, and improved commissioning practices to enhance patient outcomes and optimise healthcare resources

Nas Ahmad higlighted: “I’ve been to quite a few conferences, and this was one of the first conferences where we had such a multidisciplinary approach. We had people not only from nursing, but also from commissioners, finance and various other people there. So for the first time we had everybody in the same room for a detailed discussion about how we can actually move things forward. I think this is one of the strengths of PPP. So congratulations on all you have done.”

Turning knowledge into action

Echoing points made throughout the webinar, the Rt. Hon Stephen Dorrell emphasised the significant impact of effective wound care on healthcare delivery and patient well-being, highlighting the need to address the financial and human costs associated with inadequate wound care. He stressed the importance of professional and economic incentives for delivering high-quality services. He also highlighted the challenge of transforming “knowledge into action”, and the importance of “identifying and implementing best practices to improve patient outcomes and optimise healthcare resources”.

Similarly, a Chief Executive of a community service emphasised: “You need to commission early intervention in primary care. Currently, many GP practices do not believe they are commissioned to provide lower limb wound management.” This was supported by Kirsi Isoherranen, who added: “I totally agree with this point; the secret lies in primary care. EWMA now has a GP network that we aim to grow and similar teams exist for nurses. Education and implementation of guidelines, including prevention guidelines. Pharmacists and physiotherapists also play a role with dressings and compression.”

Additionally, Emma Deakin from compression solutions manufacturer Sigvaris emphasised the importance of prevention through early compression intervention and application and the need to improve clinician confidence and knowlegde to avoid delay in treatment. She added that here is a long way to go still (and that patient empowerment and education will also be needed), until patients can self-manage and take responsibility for their health.

Contributors shared their perspectives on the need for specialisation in wound care education; the role of GPs; the importance of multidisciplinary care, data collection and analysis; patient advocacy; and the need for a whole-system approach to wound care.

One participant, Tracy Vernon, Clinical Nurse Manager at Coloplast Wound Care, said: “ The challenge we have is the data quality we have to date varies significantly. Without time and investment to our HCPs, their confidence and competency is sub optimal in parts – hence the huge variation and health inequalities we see nationally.”

Contibutors also addressed challenges such as insufficient education for medical students, lack of data, and the need for better adoption of known effective practices. The discussion underscored the urgency of addressing these challenges to improve wound care outcomes and reduce harm to patients.

Health.IO’s Thariea Whisker, Director of Minuteful for Wound Services U.K. commented: “Yes we have seen commissioning gaps for wound care in our discussions with our NHS partners. We need to remember that wound care is not in a GP contract in real time and that it needs to possibly be adopted as a PCN initiative and significant upskilling and educational support is needed.”

What is next:

PPP’s second public webinar on wound care will build on this discussion. Held on 25th March, 5pm, it will be chaired by the Rt. Hon Lord Hunt of Kings Heath, OBE, and Former President of the Royal Society for Public Health, and will focus on the unmet needs in wound care, highlighting the key takeaways from PPP’s 2023 programme. These included fostering collaboration by breaking down professional silos, enhancing better commissioning of wound care and raising the patient voice.

Lord Hunt will be joined by a panel of speakers including Pioneer Wound Clinics Medical Director, Steven Jeffrey, who will give his perspective on what PPP’s programme achieved in 2023 and what he considers priorities for 2024, including driving improvements in services and the importance of research.

Andrea Keady, Health Economics Lead at 3M, will discuss how the PPP programme has helped to bring a community of thought leaders together, both from within and outside the wound care community and how this is helping to break down silos and grow the involvement of the National Pharmacy Association, commissioners, and NHSE leads.

Alison Hopkins, Chief Executive of Accelerate CIC will explore how the programme helped support change locally in Northeast London ICB and the challenges faced by wound care leaders like her trying to raise wound care as a priority at ICB level. She will discuss inequalities data and how it can help us understand the challenges facing patients and systems.

Victoria Townsend, Programme Director – Population Health Manager at Lincolnshire ICS, will reflect on what she learnt from PPP’s 2023 programme and what she considers priorities for wound care in 2024, including using population health data can help highlight inequalities in wound care and how wound care links to ICB priorities.

PPP’s 2024 Wound Care Programme

The valuable discussions from these webinars will be continued in the PPP Wound Care Programme. This programme will include four, virtual invitation-only roundtables, with an insights report produced for each roundtable featuring ICS case studies and capturing findings and recommendations. The programme will culminate in a large scale, in-person conference towards the end of 2024 which will include panel discussions, debates, networking and more. We will end the programme with the launch of the PPP 2024 Wound Care report.

Key themes of our 2024 Programme will address:

Innovation, prevention and inequalities
Wound care case studies delivered by ICS senior leaders
Commissioning wound care effectively and leadership in wound care
Pharmacy and the role of medicines professionals in wound care
Integrating wound care and breaking down silos
Workforce and harm

To be involved as a sponsor or speaker in the PPP Wound Care Programme 2024, please contact Ameneh Saatchi on ameneh.saatchi@publicpolicyprojects.com.

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Why clarity and consistency are essential to realise the benefits of integrated urgent and community care

By Lisa Harrigan

For the NHS to truly address pressures on emergency care, the integration and standardisation of urgent community response services is essential, writes Lisa Harrigan, Senior Consultant at NHS Arden & GEM CSU.

All integrated care systems (ICSs) are required to provide an urgent community response (UCR) service which delivers urgent crisis support to people in their own homes. Alongside the development of urgent treatment centres (UTCs), these services are a core part of national efforts to alleviate pressure on accident and emergency (A&E), ambulance services and primary care. Well-intentioned national guidance has helped to shape more community-based urgent care services, but the nature and maturity of these services, and the way they are delivered, varies considerably, limiting the potential for systems to realise much needed benefits.

Identifying inconsistencies

UCR is designed to deliver clinical support to patients who might otherwise face a long wait for an ambulance and for whom there is no immediate threat to life. UCR provides a response within two hours, to assess the patient, make them comfortable, administer pain relief and fluids, and, where appropriate, stand the ambulance down. Integrated care boards (ICBs) are finding, however, that the efficacy of this service can vary considerably across their system, with multiple providers operating in different areas, all delivering a slightly different service. While they may all meet the minimum national standards, lack of consistency means use of the service is inconsistent.

UCR should be set up to take referrals from 999, 111, ambulance crews, GPs, pendant alarm companies, care homes and, in specific cases, directly from patients. In our experience, however, this is rarely the case. Some providers take regular referrals from out of hours GPs but have no relationship with their local ambulance service. Others work closely with the ambulance service but have limited contact with GPs or care homes, limiting the community-level support they are able to provide.

Clinical support varies too. Some providers are GP or senior nurse-led, while others are staffed by more junior nurses. Simple elements such as opening hours can also be inconsistent, all of which impacts the level of care the UCR is able to provide. Collectively, these inconsistencies make it challenging, both for ICBs to understand the quality and consistency of provision across their system, and for individual services to make best use of UCR support.

Similar challenges exist when it comes to UTCs. Some centres are nurse-led, some GP-led, some offer a wide range of diagnostics while some provide much more limited services. Yet they are generally grouped under one definition, making it more complex for broader services such as 111 and alarm companies to provide confident signposting to patients. If these and other referrers are not confident in their knowledge of what is available, where and when, they will be less inclined to refer patients to these community-based services and opt to rely on more familiar services such as A&E and the ambulance service.

Addressing the challenge

In developing more consistent solutions, systems require a clear understanding of their local needs, existing provision and what will be required to make meaningful impact. The first step is to understand your starting point. For example, we worked with NHS Humber and North Yorkshire ICB to conduct a detailed review across the seven providers operating within their system to give a detailed picture of their overall UCR service, with recommendations on how the service could be strengthened. This has enabled the ICB to identify gaps and variation and consider a way forward which will provide a more consistent service for patients.

Engaging directly with providers and referrers can help identify and resolve hidden barriers. For example, we discovered that direct patient referrals were limited due to a lack of understanding of the ask. Once providers understood this would only be for previously known users, such as those with long-term conditions that may require frequent urgent support, those limits were addressed.

But this is also about identifying where the ICB can play a role in supporting providers to deliver a more consistent service. In Humber and North Yorkshire, our recommendations included developing a workforce plan to support providers with recruitment challenges, access to professionals, skill mix variation, competency updates and training with the aim of providing a more resilient, consistent service.

Providing clear, up to date information to all referrers about the services available in their area, including clinical and diagnostic variations and available referral routes, can also help to address barriers and enable better take-up of community-based urgent care services.

A holistic approach

There is much to be gained by taking a more holistic approach in integrating urgent and emergency care with community care, looking beyond the necessary to consider what achievable enhancements could significantly improve outcomes. For example, while national guidance suggests that UCR is delivered using a multidisciplinary team approach with staff ranging from a Band three to a Band seven nurse, data shows that more senior clinical expertise, especially where there is medical input, is likely to result in a greater reduction in conveyances to A&E, which can improve patient experience, alleviate system pressures and save money.

Furthermore, understanding what similar services are already available that can support the wider demand on urgent and emergency care can further enhance impact and reduce duplication. UCR and UTCs, for example, often prioritise physical health needs but the huge growth in mental ill health and subsequent pressure on community services contributes to patients attending GP practices and A&E where access and/or specialist support is often limited. Charities such as Age Concern and Samaritans offer experienced preventative care and crisis response services which systems could look to tap into as part of an integrated approach to urgent and community care, making best use of existing resources and reducing duplication. In taking a broad view of urgent care needs, commissioners have an opportunity to draw together expertise across all system partners to provide more joined-up services.

The NHS is constantly looking at different ways to address some of its most pressing challenges, and opportunities to alleviate pressure on the ambulance service and A&E are high on the priority list. However, there is a danger that this results in a series of siloed solutions, rather than a more cohesive, consistent approach. As systems mature, taking time to fully assess, adjust and integrate existing services will help reduce unnecessary duplication and create the headroom needed to enhance care quality and consistency for patients and staff in the face of growing demand.

*Lisa Harrigan, Senior Consultant at NHS Arden & GEM*

Will the disposable vape ban save the NHS from another health epidemic?

By Sienne Amer

As the government confirms its plans to ban the sale of disposable vapes, Sienne Amer examines the impact of vaping on the NHS so far, and to what extent the ban will help avert another health epidemic.

The UK government recently announced its plan to ban disposable vapes to protect children’s health and tackle the significant rise of vaping among young people. While we have not yet seen the full health impact of the younger generation using vapes, this ban may be a welcome first step in limiting the impact of what could have become the next health crisis.

The devices have appeared on the market recently and rapidly risen in popularity, which is why there is still little research available on the extent to which vaping harms our health. Introducing this ban has the potential to limit the impact vaping has on the NHS, which is already stretched responding to other health crises caused by tobacco smoking, alcohol abuse, obesity, and an ageing population.

There are 4.7 million people in Great Britain who use e-cigarettes, 31 per cent of whom are disposable vape users. Disposable vape brands are targeting children, using bright colours for packaging and a variety of interesting flavours, with the fruit flavours making them far more likely to appeal to children. A shocking 21 per cent of secondary school children have tried vaping and 57 per cent of disposable vape users are aged between 18 and 24. The most popular brand of disposable vapes, Elf Bars, were removed from supermarket shelves last year after the nicotine levels were found to be at least 50 per cent higher than the legal limit. The lack of regulation of these products is an issue, regardless of the effects of use.

Disposable vapes contain nicotine, and inflict similar impacts to any other nicotine product, including heart disease and other cardiovascular disorders, along with respiratory and gastrointestinal disorders. Children are especially susceptible to the toxicity of nicotine, which can impact brain development, leading to shorter attention spans, anxiety, depression and reduced cognitive function.

It has also been shown that when the coils in the e-cigarette are heated, toxic metals, including aluminium, chromium, iron, lead, manganese, nickel and tin leak into the e-liquid, which are then aerosolised, inhaled and absorbed by the lungs. E-liquids have been shown to contain ingredients that generate pulmonary irritants and carcinogenic carbonyl compounds, all of which can lead to respiratory, gastrointestinal, and constitutional symptoms, in addition to an increased risk of early onset strokes.

Although vaping is still recognised as a safer alternative to smoking by the NHS, there has not been sufficient investigation into the long-term impacts on health. Other countries, such as the United States, have recognised the impacts of vaping; in 2019, the US Center for Disease Control and Prevention announced an outbreak of e-cigarette/vaping product use-associated lung injury (EVALI) after it caused the deaths of several young people.

While there have not been any recorded e-cigarette related deaths reported in the UK, in 2023, the NHS recorded 420 vaping related hospital admissions, 15 of which were for children aged under 9, demonstrating the severe risk to health young children are exposed to.

When compared to just under half a million hospital admissions caused by cigarette smoking-related illnesses, the health impacts of disposable vapes appear to be minor. However, conventional cigarettes were only recognised as a significant health hazard in 1964, more than 40 years after the introduction of cigarette manufacture, showing the time it can take to fully understand the long-term effects a product can have on human health.

The NHS is already dealing with several other health epidemics, with smoking costing the NHS in England £2.6 billion per year, approximately 2 per cent of the NHS budget. Obesity costs around £6.5 billion a year and is the second biggest cause of preventable cancer. Alcohol abuse costs £3.2 billion a year in England. This is a total of £12.3 billion of the yearly NHS budget going towards preventable illnesses, and the cost of vaping would be an additional burden on NHS.

To what extent is vaping impacting the NHS?

At present, there is no record of the health-related costs associated with vaping. But modelling the cost to the NHS using smoking data could provide an estimation of the impacts vaping will have. The UK smoking population is equal to 6.4 million people, causing 474,000 hospital admissions a year at a cost of £2.6 billion. The model assumes that 7 per cent of the population requires hospital admissions, with each admission costing approximately £400.

The 420 admissions related to vape use last year would have cost the NHS approximately £168,000. However, vape-related hospital admissions only started to be recorded in 2019 and since then, there has been a 237 per cent increase in admissions. An annual growth of 10 per cent in the vaping population is also expected to cause an increase in admissions. This means that, if only 7 per cent of the vaping population is admitted, the cost to the NHS would be £132 million per year, excluding any impact of an uptake in the number of young people seeking mental health services as a result of the toxic effects of vaping.

The ban on disposable vapes is estimated to affect 2.6 million people in Great Britain – including 316,000 18-to-24-year-olds, who other than vaping, have never regularly used tobacco products – saving a large proportion of young people from the risks caused by nicotine dependence and vaping. As disposable vapes were initially introduced to the market as an alternative to cigarettes, there is a high risk that 75 per cent of people will revert to traditional tobacco products.

Since the focus of the ban is solely on disposable vapes, alternative e-cigarette products will continue to be available for people trying to quit smoking. It is crucial that information should continue to be collected and published, through platforms such as NHS Digital, to monitor and understand the health impacts of the current vaping generation, even post-ban. Hospitals should be advised to continue to use the ICD-10 code to improve data on vaping-related admissions, along with adjusting advisory information to support the disposable vape ban.

Sienne Amer is a Net Zero Graduate at Lexica.

Study developing AI to spot lung cancer risk from patient data

By Integrated Care Journal

Researchers are developing artificial intelligence which they hope will help to identify patients most at risk of lung cancer before symptoms have even appeared.

A team from Nottingham Trent University and Nottingham University Hospitals NHS Trust aims to create an AI-driven model which can autonomously piece together subtle clues and signs in patients’ data to identify those at risk so that they can be investigated further.

There are about 48,500 new cases of lung cancer in the UK alone each year with almost 35,000 people dying from the disease.

The team wants to address the current challenge of European health systems manually identifying people at risk of certain diseases and also help to reduce the financial burden by ensuring services are used by those who need them the most.

It will involve developing a system to recognise factors which might make an individual high risk and then creating ‘synthetic’ data in order to train it to pick up even the weakest signals that there could be an issue.

The aim is to help save lives by identifying people before the disease becomes symptomatic because that can be too late for patients with lung cancer.

The Nottingham team are the UK partners in PHASE-IV-AI, a much larger €7.6m project funded by the European Union’s Horizon Europe research and innovation program.

The project involves 20 partners from ten European countries and aims to unlock the full potential of AI and data analytics in health care in a secure and privacy-compliant way.

As well as lung cancer, the developments of PHASE-IV-AI project will also be validated by other partners in prostate cancer and ischemic stroke. Lung cancer and prostate cancer are among the top three priorities in tackling cancer in Europe, while neurodegenerative diseases are one of the most relevant issues with the EU’s ageing population.

If successful, it is hoped that the Nottingham team’s model could be trained to identify risk for other serious diseases and rolled out to hospitals and organisations across Europe willing to utilise AI-driven diagnostics.

It is thought that AI can enable real innovations in health care, and that AI systems which can process vast amounts of data quickly and in detail can be harnessed as a tool for preventative health care and clinical decision-making.

Despite this, the way in which information is currently stored across European countries and the limited access to health data can form a barrier to innovation, as developing trustworthy and responsible AI systems often requires large datasets for training and validation.

“The hope is that we could develop an AI-driven model for hospitals which they can then utilise and run to help find those most at risk,” said Dr Mufti Mahmud, an Associate Professor of Cognitive Computing in Nottingham Trent University’s School of Science and Technology.

He said: “Countries have huge amounts of clinical practice data, and we want to understand how we might harness this to identify the right people, so they can be invited for more focused diagnostics. We need the system to be able to find people before they start showing symptoms, and ultimately to help save lives.”

“Health care data storing is very sensitive, very private, so by developing synthetic data we can train the model to function responsibly and to provide the reasons why it selected an individual.”

Nottingham University Hospitals NHS Trust lung cancer consultant Professor David Baldwin said: “Identifying the right people for cancer screening is vital to ensure that the most people benefit whilst not harming people who have a low risk of developing lung cancer.

“AI offers the opportunity to improve the way we target screening programmes to make them more clinically and cost effective. AI is also changing practice in many other areas of lung cancer care. AI tools can help reduce the workload of specialists like radiographers and radiologists, as well as treatment costs, and improve outcomes for patients.”

Women spending 1.5 times more than men on personal health, report finds

By Gabriel Blaazer

Survey commissioned by Deloitte reveals that women in the UK are spending £1.5bn more each year across all categories of out-of-pocket spending, and recommends more specific action to support women’s health in the workplace.

Women in the UK are spending over £1.5bn more than men on medical-related expenses each year, according to a survey of working adults commissioned by the Deloitte Health Equity Institute Europe. YouGov conducted the survey of 3156 men and women aged over 18 for Deloitte, to gain a clearer picture of “out-of-pocket” health spend – how much money they spend on personal health and care each year.

The Women’s Health Cost Gap in the UK survey finds that 52 per cent of employed women spend out-of-pocket on health each year, versus only 39 per cent of men, suggesting that women experience more pressure to spend their own money on personal healthcare. In total, the women surveyed spent 1.5 times more than men, averaging £305 a year, compared to £210 for men. The figure of £1.5bn was reached by multiplying this £95 surplus by the number of working women in the UK – 16.06 million.

Women also spend more on all categories of out-of-pocket spending, according to the survey. These include fertility, menopause and menstrual health, but also medical diagnostics and wearables, private counselling or other mental health support and general healthcare (e.g. dentistry or physiotherapy). At least some of this differential may be explained by the ‘pink tax’, whereby products aimed at women are priced more expensively than those aimed at men. Women may also be more likely to seek specialist (and therefore more expensive) treatment for female-specific concerns.

In general, the survey finds that women are more aware of the women’s healthcare benefits being offered by employers than men. 40 per cent of men responding to the survey did not know if any women’s health benefits were being offered, versus just 17 per cent of women.

However, many employees lack awareness of measures that could be implemented to support women’s health; 42 per cent of men said they didn’t know how workplaces could support women’s health, versus 17 per cent of women.

The survey finds that 60 per cent women are more attracted to companies which invest in women’s health benefits, rising to 67 per cent among younger women. Only 31 per cent of men felt this way. Despite these figures, only 28 per cent of women consider the provision of women’s health benefits a key factor when choosing a job (compared with 14 per cent of men), suggesting that it is not a deal-breaker.

The report makes several recommendations to address gender-based health disparities in the workplace. Among these, it recommends employers work actively to create women-friendly working environments which understand and account for the specific health needs of women, and to promote a culture where women can take leave for conditions without it negatively impacting their career prospects. This recommendation supports recent guidance issued by the Equality and Human Right Commission guidance, which says that employers could be sued for disability discrimination if they fail to make “reasonable adjustments” for employees going through menopause.

To policy makers, it recommends action to ensure that women can access treatment and care regardless of their age, sexuality, ethnicity, disability or postcode, as well as provision of adequate funding for women’s healthcare services and the financial incentivisation of research into women’s health.

Liz Hampson, partner and head of Deloitte’s European Health Equity Institute, commented: “Women spend significantly more treating ongoing poor health, or seeking out specialist treatment at their own cost, contributing to a higher overall out-of-pocket spend. This ‘health cost gap’ which exists can be attributed to a variety of reasons, including being misdiagnosed more and incidents of pain ‘taken less seriously’ in the healthcare system, underinvestment in women’s health services and underrepresentation of women in medical research.

“Addressing gender-based disparities in health requires a collaborative approach – something that requires investors, healthcare providers, policy makers, life sciences companies and employers to take action on.

“Supporting women’s health is not only important for society, but a sound investment in the future of the workforce and overall economy.”

The full report, including the questions, responses and recommendations, can be accessed here.

West Midlands rolls out pharmacy-based bowel cancer screening

By Integrated Care Journal

Region becomes country’s first to speed up bowel cancer screening using technology as part of Levelling Up Smart City Region programme.

The West Midlands has become the first English region to screen people for bowel cancer in their local pharmacy, at home or at other local settings, using new colon capsule endoscopy services (CCE) – also known as ‘pill cam’.

Screening people in their own community rather than in hospital will help to significantly cut waiting times and speed up lifesaving diagnosis. It is expected that 2,000 people will use the new technology across the West Midlands in its first year, with waiting times cut from 30 weeks to just two.

The rollout of ‘pill cam’ is the first time this innovative, clinically proven screening technology will be available to residents in Birmingham and Solihull. It will also significantly increase bowel cancer screening capacity in Coventry and Warwickshire and follows successful trials led by University Hospital Coventry and Warwickshire NHS Trust and WM5G.

This is the first part of the pioneering £10 million Levelling Up Smart City Region programme led by the West Midlands Combined Authority (WMCA). It is a key part of the £1.5 billion deeper devolution deal agreed between the government and the WMCA last year.

The programme sets out to use cutting-edge wireless technology to help revolutionise the way healthcare is delivered within local communities and aligns closely with plans to increase NHS productivity set out in last week’s Budget.

The NHS Productivity Plan focuses on three key areas: transforming access and services for patients, using data to reduce time spent on unproductive administrative tasks, and updating fragmented and outdated IT systems.

Through the Smart City Region programme, the West Midlands is already leading the way in all three areas, rolling out CCE, developing an exemplar hospital that addresses issues around capacity and flow, and trialling the use of AI and data to improve primary care tasks and measure intervention outcomes for conditions such as diabetes.

WM5G, which is part of the WMCA, leading health-tech innovation, has partnered with Corporate Health International (CHI) to provide the ‘pill cam’ service and will work in close partnership with the NHS Birmingham & Solihull and Coventry & Warwickshire Integrated Care Boards to deliver the screening.

In addition to colon capsule endoscopy, the WMCA will also be expanding prevention, remote monitoring, and smart hospital services. This will help more people stay healthy and in-work, avoid being admitted to hospital or get discharged faster and be supported to live at home for longer.

Andy Street, Mayor of the West Midlands and WMCA chair, said: “The roll out of this life saving technology is a direct result of the West Midlands winning the competition in 2018 to become the UK’s 5G testbed.

“That has left a lasting legacy for the West Midlands which is now the UK’s best connected 5G region and a national leader in the real-world use of innovative 5G products and services like the ‘pill cam’.

“Bowel cancer is the second biggest cancer killer in the UK but the disease is treatable and curable if diagnosed early. The ‘pill cam’, as part of the Smart City Region programme, has the potential to provide thousands of local people with an earlier and easier diagnosis and the treatment they need to survive this disease.”

Dr Adil Butt, Consultant Gastroenterologist and Clinical Service Lead for Endoscopy at Queen Elizabeth Hospital Birmingham, said: “Adopting clinically proven and remotely available technologies, such as CCE, enables both quicker diagnosis by streamlining existing referral pathways and releases valuable extra capacity within existing systems.

“This makes the diagnostic process more convenient for all, bringing previously hospital-based specialist care closer to patients by delivering screening services in their local community. This vital extra capacity comes at a critical time when the UK is facing a significant diagnostic backlog.”

Dr Mark Andrew, Consultant Gastroenterologist and Clinical Service Lead for Endoscopy at Good Hope Hospital said: “CCE is an established diagnostic examination that helps provide access to patients whilst protecting their dignity. I am pleased to see with the support of WM5G and CHI we can hope to offer this bowel test on a larger scale, whilst also reducing our carbon footprint.”

Dr Cornelius Glismann, Managing Director at Corporate Health International, said: “This contract is clearly a game-changer for the region and we are looking forward to working in partnership with WM5G and the health care providers to rapidly roll out Colon Capsule Endoscopy across the region.

“Our Colon Capsule Endoscopy technology was developed in direct response to a team-member’s personal experience of bowel cancer screening and was therefore designed with a firm focus on reducing waiting times while improving patient experience.”

Genevieve Edwards, Chief Executive at Bowel Cancer UK, said: “Around 43,000 people are diagnosed with bowel cancer in the UK each year, but a lack of capacity to meet demand in endoscopy services means there are often long waits between referral and testing, leaving thousands of people awaiting tests that could either confirm a diagnosis or put their minds at rest.

“The use of new technologies such as Colon Capsule Endoscopy helps identify those who require urgent colonoscopies so they can be tested and begin treatment more quickly.”

Case study: Improving diabetes care in Norfolk and Waveney

By Integrated Care Journal

How collaboration between DUET diabetes and Norfolk and Waveney ICB is helping to upskill healthcare professionals involved in conducting primary care diabetes reviews.

DUET diabetes was founded to improve the understanding and knowledge of those looking after adults with diabetes. The service offered is designed to improve the skills and confidence of professionals working in health and social care roles and the standards of diabetes care they provide; ultimately benefiting the people (adults) they look after.

DUET has been working with Norfolk and Waveney integrated care board (ICB) to develop a face-to-face workshop programme as part of their creation of a Diabetes Training Academy. Through the creation of a central diabetes training hub, the ICB aimed to:

Drive excellence in diabetes care, ensuring healthcare professionals (HCPs) had the competencies they require to improve the management of diabetes.
Reduce potential complications that arise from more uncontrolled diabetes.

The workshop programme was designed for HCPs involved with conducting diabetes reviews within primary care practices. The content focussed on laying the foundations of understanding diabetes and its management and then built upon these to include the ‘eight key care processes’ and the importance of a ‘holistic diabetes review’. A key aspect was to ensure that learners could confidently and competently undertake a diabetic foot screening examination and be aware of the local footcare pathways.

Representatives of the ICB involved with driving this initiative also attended the workshops to further understand the challenges taking place in primary care (looking specifically at local issues) as well as better understand the inconsistencies.

The workshops have been attended by 55 HCPs (additional funding is being sought to roll out further training), with overwhelmingly positive results:

100 per cent of learners recommended the workshops.
100 per cent also felt their knowledge and skills had improved because of the training.
More than 80 per cent of learners indicated a preference for learning in small groups that are interactive and led by a professional.
Fewer than 2 per cent indicated a preference for E-learning.

*HCP knowledge satisfaction scores pre-training*

*HCP knowledge satisfaction scores post-training*

The training has helped HCPs to understand how to be more person-centred by understanding the impact diabetes can have; such as the importance of pre-conceptual care and availability of additional local services. Being better educated, knowing when and where to refer concerns, providing a person-centred, safe and responsive service enables HCPs to provide appropriate support (and education) to people living with diabetes in a caring and effective manner. The ultimate beneficiaries are the people living with diabetes.

“Very happy with this course! One of the best courses in healthcare I have done. I have learnt so much, and gained lots of confidence in diabetic reviews and foot checks.” Tiffany Ellis Healthcare Assistant, Primary Care

“It was a lovely small group and we all engaged in the activities, as well as ask and answer questions.” Sam Chapman Healthcare Assistant, Primary Care

For more information about DUET diabetes, click here.

Unpacking cancer disparities in England

By Rachel Millar

Despite major gains in diagnosis and treatment, England continues to experience high disparities in cancer outcomes, with social and financial deprivation major drivers.

In December 2023, The Lancet Oncology published a landmark paper highlighting the “astounding inequality” in the risk of dying from cancer in England. Researchers from Imperial College London looked at the 10 most deadly cancer types in England and analysed the risk of dying from these across England’s 314 districts from 2002 to 2019.

Although the overall risk of dying from cancer before the age of 80 had declined over that time period, their analysis shows huge inequalities in risk depending on where in the country someone lives. For women, the risk of dying from cancer was one in 10 in Westminster, while for women in Manchester the risk was one in six. Meanwhile, the picture for men ranged from one in eight in London’s Harrow to one in five in Manchester. The study found that lung cancer had one of the highest inequalities in risk across areas with those at greatest risk areas having triple the risk of dying from lung cancer compared with those in lowest risk regions.

The concept of health inequalities is now well established in the UK and beyond. The publication of the DHSC Black Report in 1980 demonstrated that, although there had been a general improvement in public health since the introduction of the welfare state, there were widespread health inequalities across the country. It found that the primary cause for these inequalities was deprivation. Over four decades later, there is now a vast body of evidence examining health inequalities and the evidence suggests that despite new treatments and technologies, overall health is deteriorating, and the inequalities are widening.

Social determinants still a major influence

Research has shown that for cancer, the social determinants of health impact both prevalence and prognosis. The Health Foundation describes the social determinants of health as the “social, cultural, political, economic, commercial and environmental factors that shape the conditions in which people are born, grow, live, work and age”.

A 2020 report demonstrated that more than 30,000 extra cases of cancer in the UK each year can be attributed to social and financial deprivation, while survival was found to be worse among the most deprived groups. Many of the risk factors for cancer are influenced by the social determinants of health. For example, individuals residing in areas with higher levels of deprivation are 2.5 times as likely to smoke compared to those in the least deprived areas, and they find it harder to quit.

Diet inequality is also an issue that affects the most deprived in society. Research has shown that people in deprivation have poorer diets, and consumer higher levels of poor quality, ultra processed, high calorie food than those in the least deprived areas. This population also suffers from much higher rates of obesity. As a result of such social determinants of health, those that grow up and live in deprivation are more likely to get cancer, but the story doesn’t stop there.

Variations in diagnosis

There is huge variation across the UK in cancer diagnosis. There are currently three UK screening programmes: for bowel, breast and cervical cancers. In theory these screenings are open to everyone eligible, however, in reality there are various barriers to screening that disproportionately affect certain populations, and this leads to inequalities in diagnosis.

Barriers to screening are an active area of research but there are several factors that have been identified to contribute. Stigma is one factor, with research showing that cancer stigma is linked to lower screening uptake, and this tends to be more prevalent among people from ethnic minority backgrounds.

Another barrier recognised is the practicality of attending a screening. For example, other responsibilities such as work or caring may make it difficult to get to an appointment. There are ways to overcome these barriers and increasingly NHS services are implementing changes to make screening more accessible to everyone. For instance, research suggests language barriers hamper screening uptake and therefore translation services can help overcome this. Also, offering greater flexibility on appointment times and re-invitations for those that haven’t responded have been found to positively impact uptake in underserved populations.

Overall, there are clearly gross inequalities across both the risk of developing cancer and the prognosis once it has developed. However, as researchers gain deeper insights into these inequalities and the mechanisms that contribute to them, NHS and public health services can implement best practices in order to try and level the playing field for cancer care. In April, Public Policy Projects will be hosting a round table event looking at regional inequalities in prostate cancer, so look out for the report later this year.

Improving the lives of people in our places through place-based procurement

By Stuart Watkins

Place-based procurement is a strategic approach that provides benefits for healthcare systems, value for the taxpayer and serves as a catalyst for economic development. Stuart Watkins, Health Business Manager at Crown Commercial Service explains the importance of place-based procurement and offers key considerations for developing successful policies.

Providing a good quality and healthy life for people that live in the communities that make up our places is at the centre of public service provision.

Place-based procurement is about understanding the issues, interconnections and relationships in a place and coordinating commercial action and investment to improve the quality of life for people.

Beyond health outcomes, place-based procurement has the power to shape the broader landscape by encompassing social value, carbon neutrality, interoperability and sustainable economic benefits.

All the places that make up our diverse communities across the United Kingdom will have different health and social care models to meet their specific local needs. This gives rise to both Integrated Care System (ICS) place-based procurement challenges and opportunities.

The benefits of place-based procurement

There are several benefits that can be achieved through strategic place-based procurement, including:

Efficiency and cost savings: standardisation and place-based Cost Improvement Programmes (CIPs) of clinical pathways ensure the best possible outcomes for patients, place-based partnerships and the taxpayer.
Patient and community centred care: investing in place-based digital health services ensures the provision of accessible, patient-centred care at home or in other community settings.
Tackling health inequalities head-on: place-based procurement strategies directly address disparities by aggregating social value and sustainability requirements and helping ICSs improve access, outcomes and experiences.
Economic development through pricurement: the intentional support of local businesses and the aggregation of sustainability requirements not only support economic growth but also contribute to the overall well-being of the community.

Five considerations for your integrated care boards’s place-based procurement policy

While each region will have different strategies based on its unique goals and circumstances, the following place-based procurement strategies are helpful approaches for all ICSs to consider.

Choosing national procurement aggregation initiatives: A simple way for ICSs to save costs and improve procurement efficiency is through collective buying. When ICSs combine their own buying needs with those of other organisations across the public sector, they can tap into savings not possible when buying individually. CCS runs ongoing aggregation programmes for goods and services including IT hardware, mobile services, software licences and utilities. Joining an aggregation enables ICSs and place committees to combine local requirements with other ICSs nationally, ensuring economic value and favourable terms.

Regional collaboration through purchasing and innovation: Working together with regional NHS trusts, schools, science networks and universities helps develop and procure innovation. These contracts allow a lead group, or authority, to source goods and services for everyone within the ICS. This means that economies of scale can be achieved. 

Engaging communities / co-designing strategic projects: Place committees and integrated care boards regularly connect with local communities and interest groups. This makes it straightforward to turn these localised stakeholder engagements into strategic procurement projects that have a positive influence on places, like establishing a new acute hospital.

Harnessing data-led procurement: ICSs are investing in data analytics to inform procurement decisions and enable them to secure sustainable procurement value. 

We understand that this is a critical area for the NHS. It is the foundation of developing an efficient, effective and economic commercial strategy, both nationally and locally. In this context, CCS has provided £12.8 million of funding over three financial years to support the rollout of the Atamis e-commerce system. 69 per cent of NHS organisations are already signed up, with a target of 90 per cent by 2025. 

Empowering local small and medium enterprises: Prioritising local SMEs aligns with ICS goals, supporting community growth. This creates business opportunities and supports local development, as well as reducing environmental effects from distant supply chains.

How CCS can help

At CCS, we’re committed to collaborating with our colleagues across the public sector to revolutionise health and social care, and improve the lives of UK citizens.

As the largest public procurement organisation in the UK, our scale allows us to access multiple savings and provide real benefits for customers.

Think of CCS as a collaborative partner. Our experts can help you successfully navigate the complexities of place-based procurement and achieve transformative healthcare outcomes.

Download our full white paper

Our latest white paper, ‘Place-based procurement strategies for Integrated Care Systems’, aims to enable ICSs to optimise every pound spent, address their communities’ unique needs and maximise the health and wealth of the regions they serve. You can download the guide from the CCS website.