Driving change in 2023: The Cleaning Show unites industry experts to discuss latest trends

By Integrated Care Journal

Recruitment, training and sustainability are among the notable trends set to be discussed at The Cleaning Show 2023, which returns to the ExCeL, London, from 14-16 March 2023.

Recruitment, training and sustainability are among the notable trends set to be discussed at The Cleaning Show 2023, which returns to the ExCeL, London, from 14-16 March 2023.

Under the banner ‘The Cleaning Sector in 2023 – Driving Change’, the full line-up of this year’s conference programme is now available online, highlighting the topics and speakers set to encourage learning, discussion and debate around the key topics facing a modern cleaning and hygiene sector, buoyed by greater public and political recognition earned during the Covid-19 crisis.

Expert speakers from across the sector – including members of leading trade associations and industry organisations – will take a deep dive into a range of topics including recruitment pressures post-Brexit, training and education, sustainability and climate change, employee wellbeing, technology and more. Attendees can also join keynote sessions presented by representatives from Dettol Pro Solutions and highlights from the CSSA’s ‘Innovation Showcase’ programme.

Looking to the future

To kick start the conference programme, Jim Melvin, Chairman of the British Cleaning Council (BCC), will review the BCC’s stated aims in his session The Cleaning Sector Post-Pandemic – Progress, Obstacles and the Future (14 March, 11:00). Here, Jim will review the successes and failures of the past 12 months, the key priorities moving forward.

Also discussing the future of the industry, Paul Ashton, Chairman of the CSSA, will be joined by representatives from Infogrid, Softbank and ICE to discuss The future of cleaning – The role of data in driving positive change (14 March, 12:00). This session will help attendees understand the significance of data, the key benefits and how to overcome related challenges.

Paul Ashton will return on day two with representatives from Birkin, Bunzl and OCS to delve into The future of cleaning – How technology is creating career opportunities (15 March, 12:00). Here, the panel will answer questions such as, ‘why did they choose to work in the industry?’, ‘How do they see the industry changing because of technology?’, ‘What technology do they feel will have the biggest impact?’ and more.

Meanwhile, a new panel discussion for this year’s event will honour Hygiene innovation for the future (15 March, 14:00). It will be moderated by Louisa Moore, communications and sustainability leader, Kimberly-Clark Professional EMEA who will guide panellists through the trends – good and bad – that have emerged, along with the biggest challenges now facing the industry.

Closing the Conference Theatre on day one, three CSSA Innovation Showcase finalists will take to the stage for the CSSA Innovation Showcase Presentations – The future of cleaning (14 March, 15:00), to provide an overview of their innovation and explain how it is relevant to the future of the industry, including the key benefits.

Addressing emerging trends

Sustainability and climate change in the cleaning sector remains top of the agenda for many businesses and brands, as well as rising in consumer expectations. Other trends making an impact on the industry up for discussion during this year’s programme include recruitment pressures post-Brexit, obstacles within training and education and employee wellbeing.

Nina Wyers, marketing and brand director, The Floorbrite Group will address the issue of climate change and the role of the cleaning sector in reducing its impact during her session, Cleaning for climate change (15 March, 10:30). Elsewhere, Delia Cannings, Director at Environmental Excellence Training Development Ltd., and deputy chair of the British Cleaning Council (BCC), will stress the importance of training for cleaning and hygiene operatives to reduce risk factors whilst creating safer spaces. During her presentation. Education opportunities for the cleaning industry (15 March, 11:00), she will provide visitors with an understanding of the value of training, designed to assist with succession planning for the future.

Also urging the value of employees and the significance of front line workers in the cleaning sector, Kelsey Hargreaves, BICSc youth ambassador, will address the difficulties in recruiting and retaining staff in her session, Youth employment: Less talking, more action (14 March, 14:00). Kelsey will explore how and why the industry fails to attract a new generation of cleaning professionals, exploring the ways in which the sector can combat issues with youth employment.

Facing the truth

Other highlights of the programme will see a technical presentation led by Peter Thistlethwaite, technical projects manager at MSL Solution Providers, who will inform attendees on two of the most popular techniques of decontaminating cleanrooms: ultraviolet light systems and automated chemical misting (airborne automated disinfection systems). With recent changes to regulations concerning both of these decontamination systems, visitors are invited to join Peter in his session, Whole-room disinfection – the impact of changes to regulations, on 16 March, 10:30 to learn more.

Meanwhile, Elise Craig, programme manager of the Living Wage Foundation and Dominic Ponniah, CEO at Cleanology will discuss the living wage in Paying a wage based on the cost of living – why it’s the right thing to do for your staff and for your business (16 March, 11:00), while Fiona Bowman, Managing Director for Dysart 57 Ltd. will return to the stage following her 2022 session, Hidden in plain sight (16 March, 11:00). She will offer advice on how to support staff experiencing domestic abuse.

Neil Nixon, conference director for the Cleaning Show 2023, said: “Knowledge and learning are at the heart of the modern cleaning and hygiene sectors – learning from experience gained during the pandemic, learning from each other, and learning from mistakes made. The cleaning sector has been re-energised by its role during the pandemic, and the agenda continues to be driven by a strong and determined British Cleaning Council.

“This conference will promote discussion and debate on what has been achieved, what needs to be done, and what resources are available in meeting the objectives of a critical sector providing an essential service at a time of limited budgets and recruitment challenges. This year more than ever engagement is key to ensuring that the cleaning sector continues its current upwards trajectory.”

Paul Sweeney, Event Director, The Cleaning Show, added: “The cleaning industry is at a crucial turning point, with many suppliers and manufacturers tackling the ongoing issues of the cost-of-living crisis amongst other global problems. We are thrilled to welcome the industry’s experts to the Conference Theatre in March to hear about the latest trends and challenges.

“I am confident visitors will leave with a greater understanding of the efforts being made to adapt to the new challenges faced, embracing the tools and strategies to overcome them with a fresh outlook on what is achievable. The cleaning and hygiene sectors are filled with so many new and exciting opportunities. We’re excited to see people reconnect at the show and immerse themselves in the future of this highly valuable and exciting industry.”

Registration for The Cleaning Show 2023 is now open. To register for your free pass to attend and to find out more about this year’s event, visit https://cleaningshow.co.uk/london/.

Ward nurses overwhelmingly lack suitable incident reporting technology, Radar Healthcare report finds

By Integrated Care Journal

Whitepaper finds that while 92 per cent of secondary care nurses report incidents immediately, an overwhelming majority feel that they lack the technology required to report incidents effectively.

A new whitepaper from Radar Healthcare, Incident Reporting in Secondary Care, has sought to examine the state of incident reporting in secondary care, amid a major NHS drive to improve patient safety and reduce missed opportunities to provide high-quality care.

The report, Incident Reporting in Secondary Care, was produced using the insights of a panel of 100 nurses working in wards across the UK, all of whom work with hospital in-patients daily and are responsible for reporting safety and regulatory incidents involving patients to senior colleagues.

The report estimates that 1000 extra lives and £100 million pounds in care costs could be saved through better incident reporting, and finds that overall, 92 per cent of secondary care nursing staff say they log or report incidents immediately. Of these, however, more than a quarter (26 per cent) said that they only reported incidents verbally to senior staff, who then log the incidents themselves. While these reporting delays can potentially lead to serious outcomes in certain cases, 91 per cent of nurses surveyed agreed that overall, incident reports do lead to improved outcomes for patients.

However, the report finds that barriers to timely reporting remain in some instances, with 9 per cent of nurses using handwritten notes to report incidents, and 26 per cent reporting incidents verbally to senior colleagues, creating further delays between incidents occurring and them being formally logged.

Nurses were almost unanimous on their need for suitable technology to aid incident reporting; 97 per cent stated that they needed access to “the right technology” to effect better incident reporting, while 83 per cent said that they needed more time (something that can technology can provide by eradicating slower reporting methods, such as hand written notes). 60 per cent of nurses surveyed described “reporting via a mobile or a tablet” as a “desirable improvement” to current methods.

While there was overall agreement that incident reports do improve patient outcomes, the report finds the older and more experienced a nurse is, the less likely they are to agree. This may stem from the fact that much of their experience predates the stricter reporting standards in practice today, when incident reports were less likely to make a meaningful difference to patient outcomes.

Accordingly, many nurses agreed that sharing learnings from incidents was the most important organisational or cultural change that could be made to improve patient outcomes, and indeed, this was found to be most important change by nurses regardless of years of service, age or gender.

Commenting on the report was Paul Johnson, CEO of Radar Healthcare, who said: “Staff engagement involves much more than merely giving people the means to be able to report something, good or bad. If they get feedback on what they report and understand the lessons learned, they truly get a sense that you are taking it seriously and are taking action, and that will drive positive change.”

To download the report, please visit Radar Healthcare’s website.

Millions waiting to access mental health services, says NAO report

By Integrated Care Journal and Gabriel Blaazer

Despite increases in funding and staffing levels, millions of people are waiting to access mental health services in England, according to a new report from the National Audit Office (NAO).

The NHS saw a 44 per cent increase in referrals to mental health services between 2016-17 and 2021-22 and although capacity has increased, services are failing to keep pace with demand, according to a new report from the National Audit Office (NAO). The report, Progress in improving mental health services in England, has found that the number of people accessing NHS mental health services rose from 3.6 million in 2016-17 to 4.5 million in 2021-22, and while the mental health service capacity expanded during this time, it has failed to keep pace with demand.

Published on 9 February 2023, the report focuses on the implementation and progress of NHS commitments around mental health service provision, as set out in the Five Year Forward View for Mental Health (2016), Stepping forward to 2020/21: The mental health workforce plan for England (2017) and the NHS Long Term Plan (2019).

It finds that trusts are increasingly seeking alternative means of managing surging demand for mental health services and in many cases, are reducing the levels of support they offer. According to the report, from 2021-22, six out of 33 mental health trusts reduced provision of some services in order to cope with demand, while nearly half (15) raised treatment thresholds and 32 of 33 increased their use of temporary and bank staff, implying the presence of significant and system-wide pressures.

Workforce constraints “a major challenge”

The report also notes that the NHS mental health workforce increased by 22 per cent between 2021-22 (to 133,000 full-time equivalent staff) but describes the ability to retain staff as “a major constraint [and an] increasing challenge”. According to the report, 17,000 of the mental health workforce (13 per cent of the total) left the NHS during 2021-22 alone.

The NAO’s own survey of NHS mental health trusts has previously highlighted concerns over shortages of medical and nursing staff and psychologists, with the reasons behind these shortages including “difficulties recruiting and retaining staff, high turnover between service areas, and competition from health and non-health sectors”.

The NAO finds that NHS mental health services achieved new waiting time standards for talking therapy services as well as early intervention in psychosis services, whereas waiting times for eating disorder services for children and young people rose. Waiting times for eating disorder services for children and young people were falling until 2019-20, until surges in demand during the pandemic disrupted performance. Just 68 per cent of young people who were urgently referred to these services were seen within a week from April-June 2022, significantly below the target of 95 per cent.

While lauding the “important first steps” taken by the NHS to improve mental health service provision, the report describes services as “under pressure”, and NAO interviews with stakeholders have highlighted poor experiences accessing and using these services. This is particularly true for children and young people, people from minority ethnic groups, LGBTQ+ people, and those with complex needs.

Among the lingering effects of the Covid pandemic is a sharp rise in mental health conditions among young people. The report estimates that between 2017 and 2022, the proportion of young people with probable mental disorders increased by 50 per cent for 7-to-16-year-olds and more than doubled for 17-to-19-year-olds, higher than was estimated in the NHS Long Term Plan. This will likely increase the length of time it takes to reduce the gap between mental health service provision and demand.

The share of the total NHS budget dedicated to mental health services rose slightly, reflecting the government’s 2014 commitment to ‘parity of esteem’ for mental health provision. The report notes, however, that neither DHSC nor NHS England have defined exactly what achieving ‘parity of esteem’ in service access and provision will entail. As such, the NAO is unable to quantify the degree of progress to date and what else is needed to achieve ‘parity of esteem’.

“It is vital that DHSC and NHSE define what is required.”

Gareth Davies, Comptroller & Auditor General of the NAO, said: “The Department for Health and Social Care and NHS England have made a series of clear commitments and plans to improve mental health services, but they have not defined what achieving full parity of esteem for mental health services will entail. It is therefore unclear how far the current commitments take the NHS towards its end goal, and what else is needed to achieve it and match the increasing public awareness and need.

“While funding and the workforce for mental health services have increased and more people have been treated, many people still cannot access services or have lengthy waits for treatment. With demand for mental health services having increased since the pandemic and being expected to increase further in the coming years, it is vital that DHSC and NHSE define what is required to meet the growing demand.”

Meg Hillier MP, Chair of the Committee of Public Accounts, said: “The many individuals affected by mental health problems rely on the right treatment at the right time, so they can lead fulfilling lives.

“Today’s NAO report shows that DHSC and NHSE have made some progress on expanding vital mental health services. However, their plans fall short of demand and the quality of provision is uneven. I am concerned that children and other vulnerable groups are more likely to have a poor experience of treatment, if they manage to receive treatment at all.

“My committee has previously highlighted the immense challenges across the health and social care landscape; addressing fundamental workforce issues are central to fixing the crises. The challenge facing the nation’s mental health has grown enormously since Covid-19. DHSC and NHSE must ensure that mental health provision is given due attention as they firefight on all fronts. The cost to individuals and wider society will be significant if they fail to do so.”

The full report can be accessed here.

News, Thought Leadership February 15, 2023

How climate resilience can future-proof healthcare

By Rusheen Bansal

ICJ spoke to Kavitha Hariharan, Director of Healthy Societies at Marsh McLennan Advantage, to explore the urgency of climate resilience in the healthcare sector.

The climate crisis is a health crisis. Increasing greenhouse gas emissions, rising temperatures, pollution levels and natural disasters are among the leading causes of serious, but preventable, medical issues such as asthma and antibiotic resistance. This growing disease burden will coincide with operational and financial disruption directly caused by increasingly frequent weather events and natural disasters, which will fracture supply chains and damage healthcare facilities.

Given this dynamic, and the fact that the healthcare sector is a major contributor to climate change, the sector should perhaps be taking a more central role in reducing its impact. The global healthcare sector is responsible for 4.4 per cent of annual global greenhouse gas emissions (two gigatons), the equivalent of 514 coal-fired power plants. Were the sector a country, it would be the world’s fifth-largest greenhouse gas emitter.

Articulating this dual challenge for health providers, global risk management firm, Marsh McLennan, last year published Feeling the heat: How Healthcare Providers Can Meet the Climate Challenge in 2022. The report outlines how the health sector can make use of standardised frameworks and tools to identify risks and opportunities and assess their impacts. It also discusses strategies for mitigating and adapting to evolving climate risks. Among the report’s core recommendations are focuses on investment, planning and collaboration.

Kavitha Hariharan, one of the key authors of this report, leads Marsh Mclennan’s societal ageing and health agenda, exploring long-term trends, risks, and opportunities in public healthcare as demographics change and health expenditures rise around the world.

“It can make the difference between life and death for patients and for people in the community.”

A major barrier to climate action within healthcare, Hariharan notes, it is the lack of prioritisation. “There are several other competing pressures on healthcare systems at the moment. There are backlogs, low staff retention rates, etc.,” Hariharan explains. “There are plenty of other things that are clamouring for their attention. Adding an assessment of climate risks and subsequent actions required to that list can pose a significant challenge for the leadership of healthcare organisations.”

However, according to the report, climate change is an “Environment, Society and Governance (ESG) risk multiplier” that is directly and indirectly aggravating the multitude of social issues healthcare leaders are already dealing with, such as increased disease incidence, workforce burnout and unequal access to public healthcare. Thus, building climate resilience through community and stakeholder collaboration can collectively ease the pressures on the healthcare sector.

Hariharan notes that “every healthcare system, regardless of their structure or the model that they’re currently part of, is going to have to become climate resilient at some point, and they’re going to have to start the journey somewhere. The nature of climate impacts is such that continued delivery of essential services is vital today. Not only would they make communities less vulnerable to environmental shocks,” she says, “but the same types of measures could also help improve social issues such as disparities in terms of access to healthcare.”

According to Hariharan, the framework of integrated care systems (ICSs) provides a good model for collaborating on climate resilience strategies because “they are founded on collaboration that involves community engagement as well as big healthcare facilities and local stakeholders.”

The second, perhaps more crucial obstacle, is the lack of related knowledge or expertise in climate issues within the sector itself. She explains, “the technical analysis that may be required to understand the type of climate-related risks and opportunities that they face, the range of tools that are required and the funding that may be necessary, alongside the skill sets required to make the changes translate into effective mitigation, may go beyond the core skill sets of many healthcare organisations.”

However, Marsh McLennan’s report can act as a beginner’s guide for those assessing where to start and it suggests three steps upon which healthcare systems can focus. First is selecting a reporting framework – it recommends using the Task Force on Climate-Related Financial Disclosures (TCFD) framework, a tool widely used by governments and public companies alike. Second is to “understand, assess and disclose” climate-related risks and opportunities specific to the local organisation and community. Third is assessing the negative and positive impacts of the risks and opportunities identified.

According to Hariharan, the context of the healthcare facility dictates its next steps; “it’s probably going to depend on which risks are material and transitional to which organisation, depending on which location they’re in, what type of services they provide, the underlying needs and vulnerabilities of the communities they serve and so on.”

“Climate change isn’t only a source of risk. It’s also a source of opportunity.”

Discussions of climate-related solutions can often involve spending large sums of money, which deters many small organisations from climate-related actions.

“Different organisations are going to be at different points on their journey towards climate resilience [and] the kind of investments that they will need to make are going to differ,” explains Hariharan, when asked how relevant the recommendations are to smaller facilities with limited budgets. “Obviously, very little funding is going to limit what you can do”, she states. “But there are still ways that these organisations can identify the risks and opportunities of climate action and start to address them.”

“For instance, they could identify hotspots, or particular locations if they are a hospital group or a group of clinics, where there might be more or less at climate-related risk and prioritise actions based on those risk drivers. This could be just one or two issues. Starting small that way and then scaling up these initiatives might be one way to proceed.

“Another could be making changes in infrastructure with a climate lens”, Hariharan suggests. According to the report, such adaptions often produce positive returns in the longer-term. For example, the Cleveland Clinic in Ohio saved $2.5 million a year after switching from fluorescent lights to LEDs, and another $2.5 million by adjusting air exchanges in operation theatres without increasing infection risk. “These savings can then be channelled into other climate resilience initiatives,” says Hariharan.

For those struggling with financing, the rapid rise in sustainability-linked bonds and green subsidies can help healthcare providers secure funding for climate-related initiatives. Ramsay Health Care, for instance, was able to meet its climate resilience targets by taking a sustainability-linked loan of $1.5 billion. Moreover, healthcare firms taking climate-related actions are able to negotiate more affordable insurance premiums and access additional capacity from insurers such as Beazley.

The business case for action

In terms of who should be involved in implementing climate resilience strategies, Hariharan asserts, “this is such a large challenge that an effort must be made by the whole [of] society. There’s a role for every stakeholder to play.”

Embedding climate risk mitigation and resilience into enterprise management, strategy and reporting can serve to facilitate collaboration among leaders. It can also help direct strategic investments across business functions, instead of sporadic expenditure during times of crisis that can cost exorbitant amounts. For example, due to a lack of telemedicine, the travel costs for NHS Cumbria’s community health teams amounted to £7 million after 2009 UK floods closed roads and bridges – this exceeded the trust’s total spending on health facilities in the preceding year, according to the report.

A good place to start can be aligning strategic and financial goals with climate priorities. In particular, reaching large-scale targets such as emissions reductions can only be achieved through major investments into new facilities or by financing incremental improvements by refurbishing existing facilities, both of which require long-term financial planning and board input. Another approach can be creating an internal “green team” involving clinicians who can identify and formulate policies that would have both environmental and clinical impacts.

Moreover, communicating climate strategies and goals to internal and external stakeholders can help attract talent, boost workforce morale, and improve confidence in a company and its reputation. “During our research, a hospital revealed to us that, in the recruitment section of their website, the most visited page was the page describing sustainability and climate initiatives”, Hariharan recounts. “Employees seem to be increasingly screening for ESG compliance in their employers.” A recent survey also revealed a trend in consumer choice favouring healthcare providers that pursue climate and sustainability initiatives.

A climate-resilient financial strategy will need to be built around new relationships with climate friendly suppliers. Nearly 70 per cent of the healthcare sector’s emissions are attributed to the supply chain. Healthcare providers can minimise supply chain emissions by raising environmental and ethical standards for purchasing and increasing screening measures for suppliers.

The NHS is currently dealing with some of the worst crises in its history. Climate-related action is a cross-cutting solution that is bound to improve workforce retention and employee wellbeing, care provision, equitable access, and rising work burdens, all of which will make the system more resilient to future crises. When asked where healthcare providers should begin on their journey, “simply get started,” says Hariharan – the case for not acting shrinks by the day.

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NHS waiting lists unlikely to fall in 2023: IFS

By Gabriel Blaazer

One year on from the publication of the NHS elective recovery plan, the IFS has warned that waiting lists are unlikely to fall this year.

New analysis from the Institute for Fiscal Studies (IFS) has found that NHS waiting times targets are unable to be met this year, and that overall waiting lists are likely to flatline in 2023 before finally falling in 2024.

The NHS Elective Recovery Plan was published in February 2022 as the health service began to recover from Covid-19. Its headline ambition was the aim to increase NHS elective activity to 30 per cent above pre-pandemic levels by 2024-25. Also covered in the plan were targets to eliminate waits of more than two years for treatment by July 2022, one-and-a-half-year waits by April 2023, and to reduce waiting times for diagnostic tests, cancer referrals and outpatient appointments.

Although the IFS notes good progress on certain metrics, such as the two-year wait target, the overall elective waiting list grew to 7.2 million incomplete pathways by November 2022. The IFS is now warning that the backlog may not begin to recede until 2024, “due to the lingering effects of Covid-19 and other pressures on the system.”

Although the NHS did treat more patients in November 2022 (1.55 million) than it did in December 2019 (1.48 million) – a result of “steady, if modest, increases in treatment volumes since July” 2022, according to the report – the IFS analysis shows that between January and November 2022, “the NHS treated 6.6 per cent fewer patients from the waiting list” than in the same period in 2019.

To achieve its target of achieving a 30 per cent increase in elective activity by 2024-25, the NHS is seeking to make use of more non-hospital treatment pathways, such as increasing the usage of advice and guidance services. This allows GPs to liaise with consultants before, or instead of, a hospital referral, with the aim of reducing overall referrals to secondary care. These requests have increased from 42,700 in January 2019 to 114,000 in December 2022, a 167 per cent increase.

As such, after accounting for the increase in guidance and advice services, the IFS has calculated that in order to reach its targets by 2024-25, overall elective activity levels will need to increase by 20.9 per cent.

Taking average treatment volumes from September-November 2022 (97 per cent of 2019 levels) as a starting point, the NHS would need to increase treatment volumes by 10.3 per cent annually between now and March 2025. The IFS describe this as “an incredibly high growth rate”, especially considering that between February 2015 and February 2020, treatment volumes grew by an average of 2.9 per cent annually.

Tackling long waits

As set out by the NHS Constitution for England, 92 per cent of patients should wait no longer than 18 weeks from referral to treatment, but NHS figures show that this target was met in just 58 per cent of cases in December 2022, falling from 60.1 per cent the previous month.

The Recovery Plan also included the ambition of eliminating waits of more than two years for NHS treatment by July 2022, something that has largely been achieved, if slightly behind schedule; the number of people waiting for more than two years for treatment fell from 23,300 in February 2022 to 1,400 in November 2022, a 93.9 per cent reduction.

NHS Providers Chief Executive, Sir Julian Hartley, commented: “Trust leaders and their staff have made significant progress in reducing long waits for patients, which is remarkable given the challenging circumstances in which they’re operating. Their success in virtually eliminating two-year waits for elective care and being on track to bring down 18-month waits by April is testament to the hard work of frontline teams.

“Despite progress around two-year waits, however, overall numbers for other target groups have continued to grow. The ambition to eliminate 1.5-2 year waits by April 2023 looks unlikely to be met, with this group growing by 7.4 between January and September 2022 (45,200 to 48,500, respectively.

The total number of people waiting for more than a year to receive treatment also grew during 2022, rising from 300,000 people in February to 410,000 by November. This figure stood at a mere 1,845 in February 2020, and according to the IFS, “illustrates the broader challenge: while waiting lists are continuing to grow overall, it is not mathematically possible for the NHS to reduce the number of people waiting for all time periods. Instead, it can only prioritise reducing some groups, such as those waiting more than two years, while other parts of the waiting list continue to grow.”

Responding to the IFS’ findings, Saffron Cordery, the Deputy Chief Executive of NHS Providers, said: “This has been one of the toughest winters for the NHS, but the hard work of trust leaders and their staff is leading to promising results. Despite demand for urgent and emergency care services remaining very high, ambulance response times have improved considerably.

“However, we’re still not in the clear: waits of 18 months or more have gone up, and trust leaders are deeply concerned that other pressures – including staff shortages and escalating strikes – could not only obstruct future gains but derail ones already made.”

Tim Gardner, Senior Policy Fellow at the Health Foundation, said: “There were 7.2 million people waiting for routine hospital treatment at last count, up from 6 million a year ago. Behind these numbers are patients left in pain, and people enduring unnecessary suffering. The public and government must be under no illusion: there is still a significant mountain to climb before waiting lists are back to a more acceptable level.”

Short-term issues hampering ICS progress, says PAC report

By Gabriel Blaazer

Major new reforms of the NHS will not work until government addresses multiple chronic issues in the service, the Public Accounts Committee (PAC) has said in a report released today.

PAC’s report cites a “decrepit NHS estate, record treatment backlogs [and] workforce and financial issues” as posing risks to the health of the nation, patient safety and the success of integrated care systems (ICSs).

The report has been produced following the Committee’s Introducing Integrated Care Systems inquiry, which was commissioned in 2022. It sought to establish whether ICSs have been set up in a way that will allow them to achieve their objectives of improving population health and healthcare outcomes; tackling inequalities in outcomes, experience, and access to healthcare; enhancing productivity and value for money; and helping the NHS support broader social and economic development.

“While the ambition is right, the tool kit simply isn’t there to deliver on it.”

It states that while ICSs hold the potential to improve population health by joining up services and focusing on preventing the causes of ill-health, the new systems will not be able to achieve their objectives if longstanding challenges facing the NHS and social care remain unresolved. Lead PAC member, Anne Marie Morris MP, said of this tension that “while the ambition [of ICSs] is right, the tool kit simply isn’t there to deliver on it.”

While short-term challenges such as the elective care backlog and A&E waiting times are taking up much of the day-to-day focus of the NHS, PAC’s report argues that ICSs will struggle to progress on their longer-term objectives around population health, reducing health inequalities and preventing avoidable ill-health in the future.

At a national level, it says, “not enough is being done to focus on preventing ill health [and] there do not appear to be effective arrangements for joint working between government departments to tackle the causes of ill-health.” The report also singles out “NHS England’s failure to ensure adequate NHS funded dental care”, as risking an increase in acute dental health problems.

Furthermore, the report expresses concern that “accountability arrangements [for ICSs] appear under-developed [and that] there is a concerning lack of oversight of ICSs.” On concerns over the extent to which ICSs have created an ‘integrated’ system, it states that “it is not clear who will intervene if joint working between the NHS, local government and other partners break down.”

The report does praise the government’s consultative approach during the development of ICSs and attributes the largely positive reception ICSs have received to the fact that different models were trialled before legislation was implemented.

“There is no clear responsibility for ensuring that social care is properly integrated with health care.”

Public Accounts Committee Chair, Dame Meg Hillier MP, said: “Far from improving the health of the nation, staff shortages and the dire condition of the NHS estate pose a constant risk to patient safety. But government seems paralysed, repeatedly rethinking and delaying crucial interventions and instead coming up with plans that do nothing to address the fundamental problems of funding and accountability.

“The ICS reforms have potential but there is no clear responsibility for ensuring that social care is properly integrated with health care or that patients will see the difference on the ground. Changes will not succeed if they are imposed on the NHS in its current state. Government needs to get a grip on the wider, full-blown health and social care crisis it allowed to develop from long before the pandemic.”

Sarah Walter, Director of the ICS Network at the NHS Confederation, commented: “The introduction of ICSs was overwhelmingly supported by the sector. With limited resources and ever-increasing demand for health and care, it makes sense for greater collaboration between the NHS, local government and other partners to improve population health, reduce inequalities, improve efficiency and provide a more joined-up experience for local communities.

“ICSs were never intended as a silver bullet that will solve all the entrenched challenges facing the NHS and social care. Judging their success on this, and after only seven months since entering the statute books, would be unfair as we know these macro issues require additional investment and support at a national level.

The government has two months to respond to the report’s recommendations.

The Public Accounts Committee’s full report can be viewed here.

Research shows patients want more control over how their health data are shared

By Integrated Care Journal

Patients mostly happy to share their data but want to know who and how the information will be used, finds new report from University of Manchester and the Patients Association

Patients support the use of patient data in health research but do not like the idea of companies making money from the use of their health data, finds a new report based on the views of 24 people who took part in two focus groups.

Members of the focus groups were selected to give a diverse representation of age, ethnicity and region.

Forming part of a wider GP Data Trust pilot project, the work by researchers at the Centre for Social Ethics and Policy (CSEP) at the University of Manchester also found high levels of mistrust in organisations, including the NHS, to keep their data secure, record their data accurately, and only use the data for ethical purposes among the patients taking part in the research.

Rachel Power, Chief Executive of the Patients Association, said: “It’s clear that the attempted introduction of schemes to share patients’ health information has damaged patients’ trust in organisations, including the NHS. This is not helpful to anyone, including patients who do understand the value of sharing data for research, healthcare planning and their own well-being.

“CSEP’s research is extremely important, as it suggests a way forward to rebuild trust and, eventually, share healthcare data.”

Sarah Devaney, lead researcher on the project at the University of Manchester, said: “Patients are calling for greater information and transparency about how it is proposed to use their GP data in health research and planning. It’s very important that their views are taken on board in developing health data sharing programmes which give them more control over their data. This can help regain their trust and make them more likely to share their data in vital health research.”

The GP Data Trusts pilot project was prompted by the mass opt-out by patients from health data sharing in response to the announcement of the GP Data for Planning and Research (GPDPR) programme in 2021. The programme has yet to launch. CSEP researchers wanted to understand what had prompted 1 million people to opt-out and what would need to be in place to make people comfortable about sharing their health data.

What the research found

Many participants in the study felt they had not been given enough information about the GPDPR programme. Some participants would have been happy to share their data if they had known more about the programme, but because they had not been given enough information to decide for themselves, they opted out.

Participants were unhappy that NHS Digital, which had launched the programme, had, in their view, simply decided what it would do with their data, rather than asking people to help by sharing their data.

What could be done better

Most participants wanted more information about what their health data would be used for if they shared it and how it would be kept secure. Some wanted to be informed about every use of their data and the benefits achieved.

Participants overwhelmingly wanted more ongoing control over the use of their health data rather than a one-off choice whether or not to share them.

A legal Trust

Holding patient data in a legal Trust was generally supported because participants believed it may help patients to ensure their choices about how their health data are shared, are respected. Participants were keen to see patients involved as Trustees, along with people who had medical knowledge and those who have expertise in the technical aspects of data sharing and security.

Conclusions of the study

Lack of trust in the system was the main reason patients opted out of sharing their GP data in the GPDPR programme. They did not trust that their GP data would be handled securely and only used for purposes they consider ethically acceptable.

The report suggests that to be trusted, any process of data sharing must provide patients with information about who their data is being shared with and why. It must also give patients more opportunity to control the use of their data, for example by being represented as and by Trustees in a legal trust.

Without these features, patients’ concerns over sharing their health data will remain and these could lead to a lack of trust in future health data sharing initiatives.

Shared Services in the age of integrated care systems – friend or foe?

By Jordon Beevers

The introduction of integrated care systems (ICSs) gives the NHS a once-in-a-generation opportunity to streamline, standardise and level up care across an area – coordinating services and planning in a way that improves population health and reduces inequalities, writes Jordon Beevers, Director of ICS Solutions, NHS Shared Business Services.

While much has been made of the importance of provider collaboratives and the need to reach beyond the NHS, relatively little attention has been paid to the opportunities presented by back-office integration, with a lack of actionable insight causing some ICSs to put it on the ‘too difficult’ pile.

NHS England 2023/24 Priorities and Operational Planning Guidance stipulates that Integrated Care Boards (ICBs) and providers should work together to:

Develop robust plans that deliver specific efficiency savings and raise productivity consistent with the goals set out in this guidance to increase activity and improve outcomes within allocated resources.
Put in place strong oversight and governance arrangements to drive delivery, supported by clear financial control and monitoring processes.

Plans, it says, should also set out measures to:

Reduce corporate running costs with a focus on consolidation, standardisation and automation to deliver services at scale across ICS footprints.
Reduce procurement and supply chain costs by realising the opportunities for specific products and services.
Improve staff experience and retention.
Use forthcoming digital maturity assessments to measure progress towards the core capabilities set out in What Good Looks Like – the framework that sets out to enable healthcare leaders to digitise, connect and transform services safely – and identify the areas that need to be prioritised in the development of plans.

When it comes to corporate services, however, the problem for the diverse range of organisations coming together to work as one system is in knowing what’s already working well, and what needs improvement.

Using insight diagnostics to provide system-wide data and intelligence can aid decision-making across corporate services

By taking an agnostic and independent view, it’s possible to co-create a holistic, joined-up roadmap for organisations to drive collaboration and best value across ICSs.

Data and benchmarking can help ICSs to transform the back office. Detailed analysis can help identify what’s working well, areas of inconsistency within and across an ICS, where the greatest improvements opportunities lie – and how investments can be best targeted – to support better and more informed decision-making across multiple organisations and identify potential savings.

In this vein, an insight diagnostic exercise we ran with a leading pathfinder ICS highlighted not only the potential for system-wide service improvements, but also significant savings of £7.3 million (26 per cent) on operational expenditure over the next ten years, including cash releasing savings of almost £4 million.

Shared Corporate Services for the digital age – the shared service ecosystem

It is now more than 20 years since the concept of shared services for NHS business support functions came into existence.

Philip Hewitson was acting Chief Executive at Northwick Park & St Marks Hospitals in North London when he was asked to lead the Department of Health’s national programme to develop shared service arrangements for NHS business support functions.

In Hewitson’s view, shared services provide the best of both worlds. They enable the operational and strategic levels of an NHS organisation to concentrate on what they need to without having to worry about managing back-office systems as well.

This frees up NHS Trusts, commissioners – and now ICSs – to concentrate on and develop the job they must do in delivering healthcare, planning, and commissioning health services. There’s less duplication and access to high levels of automation from sophisticated systems that talk to each other. This, in his view, can only improve management and therefore, patient care.

As he puts it, “there’s a whole suite of benefits. Shared services are applicable in so many areas. When skills are so scarce and when money is so tight, why wouldn’t you look to things that already exist?”

John Yarnold, another original proponent of shared services was Finance Director at Plymouth Hospitals NHS Trust when he took up the post of Project Director of the programme.

He points out that to successfully manage the health component of the ICS, the ICB will need transparent financial activity information consolidated at system level, but able to be interrogated at transactional level.

“If I were directing this nationally, I’d make it mandatory for all NHS organisations within an ICS to go with shared corporate services. From a finance and accounting perspective, have one common chart of accounts, one set of common processes, and then introduce enhanced systems to enable consolidation of the accounts at a national or regional level. Then, the ability to extract data from different sources and combine it with financial information. Data that’s available to all partners within an ICS to inform and improve decision-making. That’s what we need.”

Creating a shared services ecosystem of Finance, HR and Procurement services can empower healthcare leaders, giving them control to improve outcomes for their patients, staff and suppliers by reimagining shared corporate services for the digital age.

At NHS Shared Business Services, we’ve crunched the numbers and estimate shared services have the potential to deliver £400 million in operating savings across ICSs, can enable them to realise £726m+ of Procurement savings opportunities and attain 25 per cent in operational savings.

With numbers like these at stake, and ICSs reportedly likely to post a combined deficit of £600 million for the current financial year, we simply cannot afford to let a lack of insight relegate these savings to the ‘too difficult’ pile.

Negotiations at an impasse as further industrial action looms

By Gabriel Blaazer

Almost 9,000 ambulance workers were on strike yesterday (Monday 6th February), with the GMB and Unite also striking across 9 regions in England – the most NHS settings ever affected by a single day of industrial action.

Following Monday’s unprecedented strike action, nurses with the RCN are striking today (7th February), with the Chartered Society of Physiotherapy striking on 9th February and the ambulance union, Unison, striking on 10th February. This means that Wednesday (8th February) will be the only day this week on which no strike action is taking place.

Official figures show that more than 88,000 appointments have been postponed already this winter due to industrial action, yet unions have accused the government of intransigence over the disputes, which centre largely around pay and conditions and a perceived lack of investment in recruitment and retention.

Despite claims that comparatively low pay and high levels of in-work stress are contributing to the difficulty in recruiting and retaining health and care professionals, unions say that the government is in effect refusing to discuss improvements to pay and conditions. There are more than 130,000 vacancies across the NHS in England alone, and a worrying number of health and care professionals plan to leave their jobs in the coming years, citing burnout, anxiety and working in a system that has reached its breaking point.

Further, a recent analysis of official figures has shown that burnout and stress among health staff has led to more NHS staff absence than the Covid-19 pandemic. NHS sickness figures show that more than 15 million working days have been lost since March 2020, more than double were list to Covid infections and self-isolation.

A government spokesperson has claimed that Health Secretary, Steve Barclay, is ready to resume talks with unions, and said that “the Health and Social Care Secretary has held constructive talks with unions on pay and affordability.” This was disputed by the General Secretary of Unite, Sharon Graham, who said that no such discussions were taking place. On the negotiations, she added: “In 30 years of negotiating, I’ve never seen such an abdication of responsibility. Categorically…there have been no conversations on pay whatsoever with Rishi Sunak or Steven Barclay about this dispute in any way, shape, or form.”

Pat Cullen, General Secretary of the RCN, today accused the government of ‘punishing’ nurses for their stance, after Maria Caulfield, (the minister for mental health and women’s health strategy, herself a nurse and RCN member), said that nurses’ pay would be discussed, “but only [for] next year’s deal.” However, all 14 health unions have declined to continue talks on this basis, saying that they would only negotiate a settlement that covers the 2022-23 pay deal.

Hope remains for a breakthrough, however, with the new Chief Executive of NHS Providers, Sir Julian Hartley pointing out that industrial action in Wales and Scotland have been suspended following fresh pay offers.

Saffron Cordery, who until 1st February was interim Chief Executive of NHS Providers, said: “For many trusts, Monday [6 February] will be the toughest challenge they’ve ever had as nurses and ambulance staff strike together for the first time, and in more places than before. Leaders are doing everything they can to prepare by putting plans in place to minimise effects on patients and making sure they can provide high-quality, timely care where possible. But without a resolution, disruption is inevitable.

“We need to do everything we can to ensure industrial action doesn’t become the new normal. The government has the power to end this disruption right now by talking to the unions about working conditions and, crucially, pay for this financial year. Their reluctance to do so is getting in the way of efforts to tackle elective recovery for patients.”

Rachel Harrison, National Secretary of the GMB said: “It’s been almost a month since the Government engaged in any meaningful dialogue – instead, they’ve wasted time attempting to smear ambulance workers. The NHS is crumbling; people are dying and this Government is dithering.”

Empowering young people with digital mental health tools

By Beth Gibbons

Beth Gibbons explains how her team created a digital tool that acts as a single source of truth for the mental health resources available to young people in the area, and how it’s given them more control in their care.

Earlier this year, NHS Gloucestershire’s children and young people’s mental health services launched its digital support finder. On Your Mind Glos aimed to get young people to the right support at the right time and improve their experience of accessing mental health support.

We know that young people can find asking for help with their mental health difficult. We also know that Covid-19 disruption caused waiting lists for mental health support to grow significantly and the barriers to support became difficult. Gloucestershire has a wide range of mental health services for children and young people but following the pandemic, there was a clear need to digitalise access to these services so that people are put in touch with the support they need as quickly and easily as possible.

And so, at the start of 2022, the Trust wanted to explore ways to use digital tools to increase awareness of the range of support available.

One collaborative team

With the support of tech specialists, Made Tech and Mace & Menter, NHS Gloucestershire created a team of designers and technologists along with our NHS staff to research and build this new tool. The work was commissioned rather than built in-house because of the specialist skills and capabilities needed around service design and agile service delivery.

The team worked with clinicians, frontline workers, children, young people and the local community to research user needs. We found that interaction with these specific groups was crucial to help us create a tool that truly worked for those that needed it. Mental health support practitioners, GPs, school nurses and mental health leads in schools were also included in the research to help to understand the specific problems that needed fixing.

These conversations highlighted specific challenges – knowing where and how to access support, the length of waiting times once referred and the lack of support whilst waiting. There were already many services (including outside the NHS) where individuals could get support but it became clear that people simply weren’t aware of them.

The discovery and first version of the tool was completed in 8 weeks. We looked for feedback from our users throughout the whole process, meaning that the final tool truly delivers on the needs of children and young people in Gloucestershire.

A single source for local mental health support information

An online support finder on the dedicated website guides users through a series of questions to understand how they’re feeling and what support they might need. They’re then signposted to the most relevant service for their needs and given useful information about mental health.

The results are available to young people, their parents and carers via the website and SMS. Providing SMS access was an important element of the service as it needed to be accessible and secure for any child or young person to use, regardless of their access to a computer. Just three months after the initial launch, a round of user research revealed that young people like using the service, with more than 2,500 visiting the site to date.

Today, the support finder is an easier solution for young people to understand, find and access over 100 mental health support services while giving them more choice and control of their care. For health practitioners it provides accurate advice and helps them signpost to services.

The Trust is delighted this tool helps children, young people and their families get the right support for them. This means that young people are not being passed around multiple services having to repeat their story. It also means that services are less likely to duplicate triage efforts for the same young person. With the introduction of self-referral young people are empowered to access support earlier, removing potential barriers.

It has since been launched in schools alongside a programme of mental health awareness and has reached around 10,000 young people. While it was developed for young people, it’s expected that professionals, parents and carers will use it too.

A wider impact across the health service

The support finder has been designed with security at its core, making sure user data is protected. The baseline architecture and codebase was developed under open standards principles, making it available to other NHS organisations with similar patient needs to use and adapt for free.

Thorough and rapid discovery, alpha and beta testing phases with one fully collaborative team meant we were able to make the best possible version of this technology. We designed the service based on feedback from users, helping us meet their needs. As a result thousands more young people can now access mental health support quickly.

Beth Gibbons is the Programme Manager for Children’s Mental Health & Maternity at NHS Gloucestershire.