Finding the right support to provide the NHS with the capacity needed

By David Duffy

Dr Jean Challiner, Medical Director for Medinet, outlines how the NHS must harness spare capacity from all corners of the health and care sector to meet this period of unprecedented service demand.

As has been made abundantly clear by the Prime Minister earlier this month, the NHS is suffering from a severe capacity crisis. In addition to emergency departments tackling the toughest winter on record, 7.21 million people are currently on an elective care waiting list and staff shortages are crippling service delivery.

The Prime Minister himself acknowledged that these trends existed prior to Covid-19 but the pandemic has escalated the problem beyond what the NHS is able to tackle without added support. “With so many people waiting longer and longer for elective care, patients’ conditions are worsening and becoming urgent for some,” reflects Dr Jean Challiner, Medical Director for independent healthcare provider, Medinet.

Dr Challiner stresses that for Medinet, who have a two decade history of providing dedicated ‘insourcing’ for NHS trusts to boost capacity, the time patients are spending waiting for treatment is having a drastic impact on their work. “We used to almost exclusively offer capacity in the NHS for low complexity day cases, but now the priorities within the NHS are very different, and there is a growing need for us to address more urgent and more complex cases.”

Medinet holds the country’s largest pool of expert clinicians across 20 different specialties, and supplies teams to provide additional clinical capacity to enable hospitals to meet waiting times targets and then work with them to ensure these are not breached. In the last 12 months, 170,000 patients have been seen and treated by Medinet’s clinical teams.

The fact that Medinet teams work in close conjunction with NHS clinical teams and within existing estates means that they can adapt their service offering to include more complex surgery when needed. This includes cancer surgery and other procedures that fall under the realm of specialised commissioning. Medinet’s large pool of consultants, often made up of part-time NHS doctors or recent retirees, can perform most procedures, although they rarely tackle acute emergency procedures.

Reforming the referral process

Beyond directly boosting capacity with additional staff, Medinet have looked to enhance NHS efficiency and bring down backlog figures by reducing time to referral for patients. With cataract surgery, (accounting for one of the largest elements of the elective waiting list with 600,000 patients waiting for a procedure) patients are now having to wait up to two years to have their cataracts assessed.

“We are seeing some trusts getting twice as many referrals in certain areas as before and you can’t instantly train the necessary staff to meet this demand in the short term,” says Dr Challiner. “Part of our process is to not only bring in additional direct expert capacity where required but also help enhance overall efficiency or perhaps deploy existing resource differently.”

Based on a study conducted with a customer in Scotland, Medinet consultants have recently put forward recommendations to bring down cataract wait times across England, particularly for low risk patients. The study set out to determine the suitability of community cataract referrals for a one-stop cataract surgery service and the target areas for referral refinement. The results of the study showed that waiting time was significantly reduced – an average of 30 weeks for one-stop patients. Approximately one quarter of referrals were considered suitable for the one-stop service and many more may have been suitable if there had been more information in their referrals.

Capitalising on system reform

While Medinet services are still primarily commissioned by individual NHS trusts, the development of integrated care and closer collaboration between individual providers could potentially create opportunities for Medinet to expand its service offering elsewhere. “There is a huge opportunity within ICSs to change the model of harnessing spare capacity and applying [it] to other parts of the system. ICSs must provide the framework for providers to break out of regional, professional and organisational silos and boundaries to alleviate the capacity crisis currently being faced by the NHS.

“As providers evolve their service offerings to meet new challenges, they must be able to highlight where new capacity where is required without fear of reprimand.”

Encouraging active dialogue

Under no illusions, Dr Challiner acknowledges that the Medinet model is not a magic bullet to NHS capacity pressures as there are fundamental obstacles that can restrict impact. “Operating within existing NHS estate allows us to work much closer with NHS teams,” she says, “but we face regular challenges with bed availability, as we cannot conduct day case surgery unless there are beds available for recovery if needed. We also often have difficulty in simply finding the space within a trust for Medinet to operate in work or having a trust staff lead on hand to provide trouble shooting assistance or can locate replacement equipment if required.

“We encourage trusts to highlight new ways in which we can boost capacity. We are seeing an NHS that is working tremendously hard, and we want to help them. Nothing is off bounds for us, to help tackle what is most important, so we need the NHS to talk to us, and engage in discussions to look for possible solutions that are risk assessed and will work.”

Medinet’s position as a capacity booster has placed it in a unique position to reflect on the various challenges that lie within the NHS backlog. Last year, the organisation released its Manifesto for Better, outlining how they plan on supporting hospitals across the country to support commitments to improve access to treatment, empower patient choice, and provide the capacity required in response to the growing backlog of elective services.

Radar Healthcare report ranks UK second on overall healthcare equalities

By Integrated Care Journal

Report from Radar Healthcare shows Canada leading the way on overall healthcare equality, with the UK and other northern European Countries making up the rest of the top six.

A new Healthcare Inequalities Report, released by Radar Healthcare, has ranked 35 of the most developed countries around the world, offering a comprehensive insight into which of these countries offers the best healthcare rights to its citizens through their laws and regulations.

The report places Canada, the UK and Norway in the top three for global healthcare equality, with each generally offering fair and equitable access to healthcare for its citizens.

Radar Healthcare’s report also makes reference to a recent Public Policy Projects report, A Women’s Health Agenda: Redressing the Balance, which produced a series of recommendations aimed at improving the design, delivery and outcomes of women’s healthcare.

While the UK places well overall, the report ranks it number 1 for factors relating specifically to women, with Canada coming in second place.

Below is a snapshot of the report’s findings on maternity and paternity leave.

Maternity and paternity leave

The UK lags behind Denmark and Norway on the ‘paid maternity leave’ metric, offering 39 weeks of paid leave and 13 weeks of unpaid leave, compared with 52 weeks of paid leave in Denmark, while Norway offers 49 weeks of paid leave and 59 weeks of unpaid leave.

The report draws key distinction between paid and unpaid maternity leave; a high number of overall weeks of maternity leave may appear impressive but the degree to which this includes paid leave is highly consequential. For example, Italy offers 4 months of paid maternity leave and 17 weeks of unpaid leave, however, leaving a new mother without a salary for 17 weeks places them in a potentially vulnerable situation, perhaps leaving them more reliant on a partner or family for support.

On paternity leave, the UK scores poorly, scoring offering just 14 days of paid leave to new fathers, while Sweden offers 240 days, the Netherlands 182 days and Denmark 168 days. Germany, meanwhile, has no laws mandating employers to offer new fathers paternity leave, either paid or unpaid.

The lower provision of paid paternity leave is a key metric of gender-based healthcare inequality, since less leave for fathers places more of the burden for childcare on mothers, as well as limiting the valuable bonding time between a newborn and their father.

Further to maternity and paternity leave, the report assesses each country’s standing in regard to the following categories:

The legal age of consent – the age at which a person is considered to be legally competent to consent to sexual acts
Doctor / patient confidentiality ages – the age a resident can speak confidentially to a healthcare professional without parents/guardians being informed
Cervical cancer screening – what age they are recommended for women around the world
Mammogram screening tests – what age they are recommended for women
Flu vaccines – at what age is this offered to elderly residents around the globe
IVF treatment age range – how age impacts the chances of becoming a parent via in-vitro fertilisation in different countries around the world
Cosmetic surgery – at what ages someone can have a cosmetic surgery procedure
Transgender hormone treatment – at what age do healthcare practitioners in different countries allow transgender patients to start hormone treatment
Access to birth control around the world – (age requirements/costs/the countries offering free birth control)
Abortion laws – how they differ across the world

Commenting on the report, Hayley Levene, Head of Marketing at Radar Healthcare, said: “Radar Healthcare partners with organisations such as Public Policy Projects who are learning from experience (both their own and others) to make contributions to the policy debate which address real-world choices on the basis of real-world evidence.

“As a healthcare supplier, Radar Healthcare is passionate about helping to make a difference and delivering improved outcomes. Working with PPP to produce reports such as ‘The Social Care Workforce: averting a crisis’, ‘The Digital Divide: reducing inequalities for better health’ and ‘Integrating Health and Social Care: a national care service’ is vital in helping to drive change and improve some of these health inequalities.

“For example, technology could offer oversight that 80 per cent of patients or healthcare workers themselves are having suicidal thoughts – and this could prompt a process to be followed to tackle it, which will encourage decisions of change.”

To find out more, please visit www.radarhealthcare.com.

First ICS rolls out award-winning healthcare communications app

By Integrated Care Journal

Mid and South Essex Integrated Care System (ICS) has become the first UK care system to make an award-winning communication app available to all its care providers to help tackle health inequalities.

The CardMedic app, designed to improve care for patients who face a communication barrier, is now available to all health and care services in the mid and south Essex area.

The ICS states that more than 35 per cent of people have additional communication needs, which can be due to language, visual or hearing impairment, cognitive impairment, literacy, or other reasons. Communication barriers can contribute to healthcare inequalities, which the newly formed ICS aims to tackle.

“Communication is the first key barrier to health equity and, until you solve that, you can’t move forwards,” said Sarah Haines, Head of Patient Experience and Engagement for Mid and South Essex NHS Foundation Trust.

“Our medical colleagues in the Intensive Care Unit and elsewhere have been excited about using CardMedic, especially the British Sign Language and easy-read options. I’ve been blown away by the potential that CardMedic holds to improve patient experience and safety. It provides people who have struggled to fully participate in their care to be involved in shared decision making with clinicians. Working at ICS level means we can improve communication across multiple settings, enabling more and more people to access the standards of care that they deserve.”

“It helps us to get the simple but important things right.”

Rhona Hayden, a lead out-of-hours nurse at the Trust, and her team, have used the app since May to reduce communication barriers between patients and healthcare professionals, such as language or hearing impairments.

She said: “We have the app downloaded on our tablets and phones and it’s very helpful, especially out-of-hours where we often have to wait for a translator,” she says, explaining that she previously had to rely on picture boards or Google Translate, which are slow and unreliable.

“It helps us to get the simple but important things right, such as not being comfortable in bed,” she adds. “We also use it to make explanations clearer to patients’ families.”

As important stakeholders within the ICS, charity groups have been instrumental in defining how the app can be used to improve patient care. According to Sophie Ede, Chief Executive Officer of Hearing Help Essex, the CardMedic app could be a real “game changer” for improving the accessibility and equity of care across the region.

“One in six of the adult population have hearing loss and acquired hearing loss is most commonly age-related, arriving at a time when people can start to experience many other health conditions” she says.

“All healthcare services have patients with hearing loss, even if the patient themself doesn’t know it,” she explained. “It can be very difficult for people with hearing loss to keep up with what’s being said, especially in an emergency situation.”

Attending A&E can be more challenging for people with hearing loss, as they may not understand what the receptionist, healthcare or allied healthcare professionals are asking. Procedures, such as an emergency c-section, can be even more stressful for people with hearing loss or a language barrier, as they can’t understand what’s being said.

The CardMedic app supports instant translation during consultations and treatment, using a mobile device or tablet. After beginning the roll-out at the Mid and South Essex NHS Foundation Trust hospitals, the ICS will move software deployment into primary care and community-based health settings.

The digital platform hosts a rapidly growing A-Z library of nearly 800 pre-written scripts, replicating conversations between healthcare staff and patients on healthcare topics ranging from obstetrics and maternity to end-of-life care and emergency situations.

The content can be flexed at the point-of-care to different languages, sign language videos, easy read with pictures, or read-aloud. An integrated translation tool supports conversations beyond the content of the scripts.

Dr Sophia Morris, System Clinical Lead for Inequalities, Mid and South Essex Integrated Care System, said, “Being able to ensure all our residents can experience equity of access to healthcare is at the heart of narrowing the gap in health and care inequalities in mid and south Essex. This app will ensure that those who need help communicating and accessing essential services can feel more confident of getting the help and care they need.”

Purple AI: Creating Efficiencies with ‘Intelligent Healthcare’

By Gavin Wheeldon

Manchester-based technology company, Purple, is playing a vital role in the digitalisation of the NHS and wider healthcare system with its innovative ‘Intelligent Healthcare’ solution. Gavin Wheeldon, Chief Executive Officer, discusses the smart technology so desperately needed to create efficiencies.

2022 was undoubtedly another year of weathering the storm, as political instability, the cost-of-living crisis and Russia’s invasion of Ukraine delayed the UK’s post-pandemic recovery.

But for the nation’s NHS and healthcare systems, the storm has been raging for some time, and will continue until drastic action is taken. Spending on healthcare has increased, with core sums expected to reach £176.4 billion for 2023/25 and many are calling for extra funding to be released.

A big injection of cash, however, looks unlikely. Budgets across the UK came under scrutiny as 2022 drew to a close, with tax hikes for all and significant cutbacks due. The government has promised to protect the NHS from such cuts and this is welcome news to many within the healthcare sector, but this alone won’t save it.

The tech making a difference

What the healthcare sector so desperately needs is to free up budget without cutting crucial corners – and at Purple we do just that by using intelligent technology to create significant efficiencies for healthcare institutions.

While it might sound complex, Purple’s smart solutions are actually incredibly simple and deliver ROI and real, meaningful value by increasing day-to-day productivity, reducing loss or misplacement of product, and improving patient experience.

Purple’s new service app, ‘Intelligent Healthcare’, is proudly at the forefront of digital innovations in the healthcare industry. With vital services ranging from real-time location for healthcare employees, digital wayfinding for patients and asset tracking on medicine and products, Intelligent Healthcare provides the most comprehensive, flexible and proven solutions. Our vital tech allows healthcare providers of all sizes to easily adapt their existing tech to meet the growing needs of their patients and speed up processes in the meantime.

Creating efficiencies in healthcare

According to the UK government, increasing employee productivity by just five minutes could save the NHS £280 million a year, yet each nurse spends the equivalent of 40 hours per month searching for equipment. Bridging this gap is our digital wayfinding tech. Combined with the wider Intelligent Healthcare solution, this asset tracking and navigation tool not only allows health experts to monitor and track exact locations of vital equipment, but also provides direct navigation routes to ensure swift and efficient access to these items at all times.

Alleviating unnecessary stress for employees will be crucial for the sector to recruit and retain staff, whilst enabling employees to offer the very best service, achieve job satisfaction and meet rising demands.

A smooth transition for nurses

In September 2022, NHS nurse vacancies reached an all-time high of almost 47,000. In the same breath, NHS agency spend also increased by 20 per cent, according to Nursing Times. With this comes a real influx in temporary (and new) workers flooding into hospitals and healthcare environments. To relieve the mounting pressure on these individuals – and the teams they’re supporting – it’s vital that they have the tools they need to hit the ground running and truly fill the skills gap that is widening every day in the healthcare sector.

A smooth transition is made much easier with Intelligent Healthcare. Hospital buildings and healthcare facilities can, for example, be situated in extremely large buildings which are easy to get lost in – and more recently, emergency facilities have been popping up in new and unfamiliar locations to tackle Covid-19. With the Intelligent Healthcare app, however, healthcare bodies can provide staff and visitors with access to a map of a building and it even allows the user to plot routes to specific locations.

Purple’s LogicFlow alerts also ensure alternative routes are always available in periods of high emergency and it allows immediate and real time communication direct to a users’ phone, for example, ‘if x happens, do y’.

For patients, the technology could save lives. If a monitored patient leaves a specific area – or geozone – an SMS message will be sent to the senior nurse. Six in ten Alzheimer’s and dementia patients tend to wander, and here is just one of many invaluable applications of this technology.

The future of healthcare is digitalisation

Giving the NHS the best possible chance means embracing digital innovation. Taking the small but necessary steps will enable vital transformations and help the NHS overcome the growing number of hurdles.

With a record high of 7.1 million people currently waiting for hospital treatment in the UK, it’s with no doubt that the NHS and wider healthcare systems need end of the line help – and digital transformation is the first step in this journey. Purple are wholly dedicated to making our smart tech solutions work hard for the healthcare sector, to help fill the gaps in the system. If we can go even some of the way in supporting the sector on its road to recovery, we will have been successful.

By making simple changes to improve digital processes, healthcare organisations boost output, increase efficiencies and speed up operations – and completely overhaul the sector in the process.

This article was kindly sponsored by Purple.

To find out more, please visit www.purple.ai/solutions/intelligent-healthcare/

Dementia UK bolsters support for families ahead of anticipated rise in helpline contacts

By Integrated Care Journal

Specialist dementia nursing charity launches the ‘I live with dementia’ campaign to support people affected by the condition in one of the charity’s busiest months of the year.

Dementia UK’s Helpline, staffed by dementia specialists from Admiral Nurses, saw a 17 per cent spike in calls, emails and appointments between December 2021 and January 2022 as families reached out for advice and support following the Christmas period.

With data also showing that January was the Helpline’s second busiest month of 2022, Dementia UK is calling on the public to download its free ‘Living with dementia’ guide which contains vital practical and emotional advice, life hacks, information and top tips.

The charity’s specialist dementia nurses, people living with dementia and their families and friends have shared their expertise on a number of topics including diagnosis, coping with behavioural change, family dynamics and finding care options.

Data from Dementia UK’s Helpline in 2022 revealed that almost two fifths (38 per cent) of calls, emails and other contacts were from individuals seeking advice on accessing support for dementia. A further 36 per cent of contacts were from people seeking advice on understanding dementia or getting a diagnosis for the condition.

Dementia is a huge and growing health crisis. There are an estimated 944,000 people living with dementia, set to rise to more than 1 million people by 2025, and the condition is currently the leading cause of death in the UK.

Dementia UK will also be raising awareness of its free Helpline and virtual clinics through a nationwide advertising campaign between January and March 2023. The campaign has been designed to focus on parts of the country where there is a demand for more support for people with dementia, and encourages people to reach out to Dementia UK’s Helpline, virtual clinics and its team of over 400 specialist dementia nurses.

Dr Hilda Hayo, Chief Admiral Nurse and CEO at Dementia UK, said: “If you love someone living with dementia, you’re living with it too, and we understand the challenges that individuals and families face every day. We’re launching this campaign as we know people often reach out to the dementia specialist nurses on our Helpline and clinics after Christmas. In January 2022, we saw a 17 per cent increase in contacts on the previous month.

“We want to let families living with dementia know that they are not alone. The ‘Living with dementia’ guide contains practical and emotional support, and is an extension of the fantastic work carried out by Admiral Nurses on our Helpline, clinics and online resources.”

The Dementia UK Helpline is staffed by experienced Admiral Nurses, who give vital support by telephone or email. Alternatively, you can book a free video or phone appointment at a time that suits you to get expert dementia support from an Admiral Nurse. Find out more at dementiauk.org/book-an-appointment.

For advice or support on living with dementia, contact Dementia UK’s Admiral Nurse Dementia Helpline on 0800 888 6678 or email helpline@dementiauk.org.

Delays in cancer diagnosis leading to catastrophic outcomes

By Integrated Care Journal

The Less Survivable Cancers Taskforce (LSCT) has released new data to highlight the critical importance of symptom awareness for early diagnosis of these cancers.

The taskforce represents six less survivable cancers (lung, liver, brain, oesophageal, pancreatic and stomach), with an average five-year survival rate of just 16 per cent. Together, these less survivable cancers make up nearly half of all common cancer deaths in the UK. The data were released on 11th January, Less Survivable Cancers Awareness Day.

A UK-wide survey carried out by the LSCT has found that awareness of the symptoms of these deadliest cancers is dangerously low across the country. Only 1 per cent of respondents were able to correctly identify all symptoms of liver cancer from a list presented to them. Symptom awareness for oesophogeal and stomach cancers fared slightly better at 2 per cent and 3 per cent respectively while only 7 per cent of respondents knew all the symptoms of pancreatic cancer. 9 per cent of people could spot the signs of lung cancer while knowledge of brain tumour symptoms was higher but still only 20 per cent.

Concerningly, when asked whether they had a friend or loved one who had delayed seeking medical advice when experiencing symptoms which were later shown to be caused by a less survivable cancer, a massive 31 per cent of respondents said yes. Of these cases, 67 per cent were told by medical professionals that this delay had an impact on their treatment options.

In 2022, the LSCT reported that many patients with a less survivable cancer will only be diagnosed after an emergency admission to hospital or an emergency GP referral after symptoms have become severe. These late diagnoses account, in part, for the catastrophic prognoses for thousands of people each year as patients with cancers that are diagnosed in an emergency suffer significantly worse outcomes.

Anna Jewel, Chair of the Less Survivable Cancers Taskforce, said: “It is deeply concerning that most of the general public are unaware of common symptoms of less survivable cancers. It’s one of the many challenges that we’re facing in the fight against these deadly diseases. All of the less survivable cancers are difficult to diagnose. Screening programmes are limited or non-existent and treatment options are falling far behind those for more-survivable but equally common cancers.

“The Less Survivable Cancers Taskforce is urging everyone to be aware of the symptoms of cancer and to seek medical help at the earliest opportunity if they recognise any of the signs.

“We’re also calling on all UK governments to commit to increasing survival rates for less survivable cancers to 28 per cent by 2029 by delivering on their commitments to speed up diagnosis and proactively investing in research and treatment options.”

Dr Marnix Jansen, Cancer Specialist at UCL Cancer Institute and GUTS UK-funded researcher, said: “The symptoms of less survivable cancers such as stomach cancer can be difficult to spot or even non-existent until the later stages of the disease. Despite this, public awareness of the common signs is crucial if we’re going to tackle the problem of late diagnosis. As well as this, we need more emphasis and investment in research for treatment and prevention of these cancers if we’re going to increase survival chances.”

ONS data highlights ‘worrying’ UK excess mortality trends in under 65’s – LCP

By Integrated Care Journal

ONS data released this week shows that while the pandemic impacted over-65s in the UK in a similar way to other European countries, the UK is among the countries analysed with the highest excess mortality for under 65s in Europe.

This may be because under 65s have been hit harder by the indirect impacts of the pandemic. While the vaccines mean that far fewer people are dying directly from Covid itself, the additional deaths in this bracket may be the result of extended NHS waiting lists and missed and delayed treatments in the wake of the pandemic.

Over the period from January 2020 to July 2022, the UK experienced mortality rates which were 3 per cent higher than the average of the previous five years. Absent the pandemic, consultancy firm LCP would have expected mortality rates in 2020-2022 to be significantly lower than in 2015-2019. Mortality rates have historically fallen in response to improving public health and healthcare and this was expected to continue.

The new ONS data is based on relative age standardised mortality rates, which compare mortality each week to the five-year average mortality rate. The data also uses relative cumulative age standardised mortality rates, which compare mortality rates over a longer period to the five year-average.

Key points from the ONS data were:

The UK had the fifth highest cumulative mortality for under-65s in Europe. Mortality rates were 8 per cent higher than the average of the previous five years.
UK death rates were above the five-year average in 80 per cent of weeks from June 2021 to July 2022 for under-65s. Among the European countries analysed, only Greece exceeded this for this age bracket.
Within the UK, England and Scotland were hit hardest with 80 per cent and 78 per cent of weeks having death rates were above the five-year average. This compares to 56 per cent for Wales and 48 per cent for Northern Ireland.
For over-65s, the UK has not been hit as badly. Cumulative mortality rates were 2 per cent higher than the average of the previous five years. 18 out of 33 countries saw worse relative excess mortality among this age group.

About 7 million people are on waiting lists for treatment, and LCP estimates that there are a similar number with ‘hidden health needs’, i.e., people who have health issues but have not yet come forward for treatment. LCP predicts that the total level of health need will peak next year and still stand at over 13 million in 2024, even with planned government interventions.

LCP are urging government to provide targeted help through a better understanding of where the pressure points are and funnelling investment to the NHS trusts that need the most help.

Stuart McDonald, Partner at LCP, commented: “The increase in NHS pressures are well known. But these new figures provide worrying proof that the indirect impacts of the pandemic are filtering through into the death rates and the impact on the working age population is among the worst in Europe. This trend could have a real long-term impact on life expectancy, which we know is already stalling, and this will have repercussions for our society and economy.”

Ben Bray, Principal at LCP, added: “There are huge regional and demographic disparities when it comes to health and access to healthcare. More worrying still, the inequalities across geographies continues to persist at vast levels and the true size of the waiting list when including the estimating ‘hidden need’ remains unknown.

Really drilling down into data like this will help the government more effectively target resources where they are needed and to stem this worrying trend among the under-65s.”

Acute Care, Community Care, Thought Leadership January 4, 2023

Non-emergency transport is crucial for winter resilience

By Andrew Pooley and Simon Smith

Seasonal pressures and existing backlogs look set to increase demand for non-emergency transport this winter. Writing for ICJ, ERS Medical’s Chief Executive Andrew Pooley, and Quality and Governance Director Simon Smith, outline why they are pushing hard for winter transport resilience.

The NHS was already experiencing significant pressures, even before this winter’s challenges. Although a smaller component of the NHS, non-emergency transport services (NEPTS), which provide transportation for patients with non-urgent conditions but who would struggle to travel independently, play a pivotal role in maintaining smooth patient flow.

Last year, ERS Medical launched a campaign to raise awareness of non-emergency transport. The aim of this, in part, is to emphasise the importance of non-emergency transport and more importantly, to encourage the earlier booking of contingency winter patient transport shifts to support hospitals with patient discharge and alleviate some of the anticipated winter challenges.

Easing system pressure

Delays to patient discharge cause significant patient flow issues, and these are well documented. News headlines often focus on bottlenecks and delays via front door admissions, such as A&E, and the significant pressures being faced by emergency departments.

However, if beds are not available in hospital wards where patients can be treated after assessment in A&E, there is less capacity for newer patients to be admitted. The traffic jam at the exit route now becomes a problem at the entry points for patients, as well as preventing ambulances from returning to the community, increasing already dangerously long ambulance response times.

One of the main reasons for the patient flow crisis is the availability of social care. There is a direct correlation between the absence of an ongoing care package and higher rates of readmission. Further, discharging patients too early without any ongoing care and proper safeguards in place will often mean the patient is readmitted sooner or later. Poor discharge protocols can also lead to an increase in complaints and reputational damage for hospitals. It is no surprise then that discharge coordinators and healthcare staff have such a tough balancing act to manage, in addition to their workload challenges.

The role of transport

Transport can play a huge role in addressing the discharge backlog, and booking transport early is vital. This may sound simple enough, but transport is an often-overlooked aspect of the discharge process. When patients are ‘made ready’ for discharge, this is often the first point at which transport is considered. However, booking transport in advance, preferably the day or so before the patient will be ready to leave, is usually more efficient. While it is difficult to be a hundred per cent certain that a patient will be ready for discharge on a particular day, clinicians often have a good indication of when discharge might be feasible and appropriate.

To this end, planning and communication are essential. Planning the transport in advance, booking it and then communicating with the provider if the plans change for any reason are crucial elements in the efficient discharge of patients. This ensures there are enough resources available in the system for trusts and integrated care systems to keep the patient flow running smoothly.

One solution that is showing promise is to appoint specialist patient transport liaison officers (PTLOs) in hospitals. This “human” point of contact is a specially trained individual who can assess transport needs and then recommend the best approach on a case-by-case basis, often communicating with patients, hospital staff and families to keep everyone informed.

Lessons from previous spikes in demand

Contrary to conventional wisdom, one of the key insights from looking at our data (as illustrated below) is that spikes in winter demand often arise, not because of increased activity levels, but because of changes in booking behaviour, patient mobility, an increase in aborted journeys, and the subsequent need for more resources to accommodate these changes.

Let’s take a hypothetical fleet of 10 vehicles servicing a local acute hospital. With the “normal” commissioned pre-planned booking behaviour and mobility mix, the activity matches resource and there are no service issues. Add in just one complex journey – for example, an obese patient that requires an additional crew to assess the property and support the journey – very quickly, that can reduce 10 per cent of available resource for more than half a day.

Add in multiple issues – for example, bookings made at the last minute, or with incorrect mobility requirements, or patients’ drugs not being ready at the pickup time – and it is possible to see how demand outstrips built-in spare capacity and pressures build in the system. Integrated care boards (ICBs) should act with caution when being presented with supposedly easy fixes. The Uber model does not work with a regulated service that relies on trained staff and specialist equipment, and simply drawing on resources from outside the contract often fails because other services will also be under pressure, as they rarely hold spare capacity. The simple answer is to plan well in advance – it takes time to mobilise a fully compliant NEPTS ambulance crew, communicate with all stakeholders and educate healthcare staff about the correct use and limitations of the NEPTS service.

Providers should also re-examine the point at which mobility assessments are carried out. When hospitals carry out patient mobility assessments, this is often done at a fixed, predetermined point. If a patient is independently mobile, but has been sitting and waiting for a doctor’s assessment, the patient’s mobility levels could deteriorate. When crews arrive to pick up a patient that has been booked on a seated vehicle to accommodate four patients, the crews undertake what is called a dynamic mobility assessment of the patient. They then establish whether or not the patient can walk independently, and whether they might now require a wheelchair or stretcher. This means that the vehicle originally booked to transport the patient is no longer suitable, and more, or different, resources are required.

The reality is often different to the perceived activity levels within NEPTS, where the ideal scenario is multiple patients in the same mobility category travelling in one vehicle. If transport is planned at the last minute for patients with the lowest mobility (patients who need stretchers), this blocks out a significant number of vehicles in one go, thereby increasing delays and placing a greater strain on existing resources.

Of course, effectively balancing these factors comes down to proper planning, communication and funding contracts on actual resources needed, not just activity levels. This does not mean simply communicating with transport providers, but also between hospital departments.

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The role of operational platforms in creating system-wide awareness

By Carl Davies

Carl Davies, Solutions Director (Europe), TeleTracking, explains the role that operational platforms must play in the new NHS: enabling more capacity and more effective management of that capacity by providing the foundation for better visibility, coordination, and control across care settings.

NHS pressures and safety risks

There are two types of risk associated with healthcare, clinical risks (associated with direct patient care) and operational risks (risks to the organisation), which both increase the likelihood of adverse events.¹ Interestingly, decreasing operational performance, particularly in the Emergency Departments increases the likelihood of both the operational and clinical risks and has been shown to result in significant increases in excess, and therefore preventable, deaths.²

In the NHS Winter Plan, Amanda Pritchard asked all systems to operationalise 24/7 command centres, to ensure the safety and resilience of the operational function across their local health and social care geographies. Operational systems can be the supportive technologies that provide the missing piece of the puzzle alongside the clinically focused Electronic Patient Records.

The changes being asked for in the Winter Plan require both new structures and processes and, most importantly, ‘people’ to work in different ways. However, these people need to be supported and given the time to engage. Now, more than ever, we need technologies that not only improve the healthcare system, but that help create the type of change that makes the lives of our workforce easier and simultaneously more effective at delivering the outcomes expected from them by NHSEI and the DoH.

ICSs, EPRs and operational platforms

With integrated care systems (ICSs) taking centre stage as the core delivery mechanism for the radical changes to health and care services that are needed, the spotlight is on the processes and systems that will help them achieve this joined-up, patient-centric care – particularly the adoption of electronic patient records (EPRs) or electronic medical records (EMRs).

As a technology for – mostly clinical – data capture, which can support decision-making across the system in relation to an individual patient, EPRs are undoubtedly an essential component of the digital transformation journey that the NHS is on. However, there is a vital function that runs alongside them, that has an arguably greater impact on performance and outcomes: the ability to capture and view in real-time the range of operational processes and where pressures are building or being exerted on the system; to recognise how they can be improved or changed, and support decision-making with regards to relieving those pressures.

Consider the information that is required to ensure effective management of beds across both the Acute Trusts and the wider system, and the coordination of the many workflows that must seamlessly work in unison, but are often linear due to outdated mechanisms for capturing and communicating data. This is where operational platforms can help increase the visibility of that information (providing one single truth), the speed of its transmission and enable flows to run concurrently rather than step-wise – and further support by building in controls, automation and tools for coordination of workflows.

These systems ideally run alongside an EPR as a specialist, operationally-focused suite of technologies that can provide all the necessary tools for releasing time back into the organisation. That is, additional time for people: time for healthcare professionals to spend with patients; time for staff to support the management of their own wellbeing; time for management to create changes in structure to support new ways of working; time to support the delivery of the performance improvement targets as described in the planning guidance; and time for patients to be moved through the hospital as needed, in accordance with their personal needs, providing assurances to the Executive that the system remains safe.

Reform

Effective outcomes are the emergent product of excellent technology combining with excellent people. Maidstone and Tunbridge Wells NHS Foundation Trust (MTW) is one example of an Acute Trust that has deployed an operational platform alongside its EPR to support and enable excellence in its internal management practices.

Great leadership combined with this operational system focuses on how all of the operational components of the Trust work together, supporting the coordination of complex information flows to drive more effective organisational decision-making. It gives full visibility of Trust-level bed capacity and imminent discharges, a system-level control centre dashboard and most recently, with an extension into Kent Community Health NHS Foundation Trust’s community hospitals and virtual wards for management at home, provides everything that is needed for visualising, managing and improving bed capacity and resilience across the integrated care setting.

The result? Organisational change, improved patient flow management and more effective matrix working. They have zero 52-week waits and the best urgent care performance in the region, all achieved alongside clearly identifiable financial savings. Despite increasing pressure at the front door, with extremely high attendances and admissions, it also has one of its lowest occupancy rates in years leading to being the 2nd highest performing Accident & Emergency Departments in the country, and overall 6th best Trust in the country.

Unlocking capacity

Operational platforms are key to identifying known bottlenecks in the system, mainly due to linear, archaic practices and unnecessary administrative activity, providing visibility and improvement of them in real-time. They are instrumental in improving coordination and control across the system and seek to support clinicians and managers by relieving them of unnecessary and duplicative administrative work. They are therefore fundamental to giving clinical staff time back to care; to unlock and allow more effective management of the capacity that is going to be key to, ultimately, improving outcomes and saving lives.

This article was kindly sponsored by TeleTracking.

¹ Cornalba, C (2009) Clinical and Operational Risk: A Bayesian Approach. Methodology and Computing in Applied Probability volume 11, pg 47-63

² Jones et al (2022) Association between delays to patient admission from the emergency department and all-cause 30- day mortality. Emerg Med J 2022;0:1–6

**Carl Davies, Solutions Director (Europe), TeleTracking**

Local authorities call for ICBs to increase council representation and outline success measures

By David Duffy

Councils are working starting to work closer with health partners within integrated care systems (ICSs) but require more representation at system level to drive improvements, this is according to the County Council Network (CCN).

The report, The Evolving Role of County Authorities in ICSs, analyses the progress of ICSs from the perspective of councils. The study, which was commissioned by the CCN and conducted by IMPOWER, is based on a detailed survey and interviews with local authorities in county areas and senior health officials.

County leaders say councils and health partners are forging closer relationships in many ICSs across England, and evidence in the study shows that council leaders are investing significant amounts of time with health colleagues within these arrangements. However, the CCN say there are significant challenges to overcome before councils can consider ICSs a true “partnership” endeavour.

Local authorities feel there is a lack of processes in place to measure the impact of ICSs. In the report’s survey, less than one in five (18 per cent) of councils were confident that their ICS had a clear process for monitoring success against its primary objectives and national data on “integrated” issues was found to be very limited.

The report has also found that across England, just nine of 777 Integrated Care Board (ICB) members are elected councillors. It highlights that both councils and the NHS recognise that local politicians will need to be key allies if ICSs are to deliver transformative change, but that their role in systems is still unclear.

CCN’s report also suggests that council leaders feel that ICS are held back by a continued focus on mandated, top-down targets from the NHS and central government. It argues that this centralised control may hinder the success of local solutions rooted in long-term preventative measures developed within communities.

The report recommends that the government and NHS review the level of centrally imposed targets on ICSs, particularly in shared policy areas with local government, which could help induce a culture shift that gives greater prominence to prevention. ICSs themselves should ensure that funding and decision-making are devolved to the most appropriate level in order to best facilitate local joint-working.

It also calls on council and local NHS leaders to agree on a small number of specific and achievable inclusive ambitions this winter, to build partner confidence in ICSs’ ability to deliver real change.

CCN’s report comes ahead of Patricia Hewitt’s upcoming independent review of ICB oversight, which will be the first major stocktake on the role of councils in ICSs since their introduction in July of this year.

Other key findings of the report:

80 per cent of councils say they have increased their time working with health partners since the inception of ICSs, but that this is in part due to too much of focus being given to immediate NHS pressures.
Local authorities are ‘very cautious’ about pooling further resources with the NHS at a time when finances are stretched, particularly as the NHS is felt to have less focus on living within budgets than councils. Nationally, county authorities have pooled £13.43 per-head from their budgets into the Better Care Fund (BCF) this year; down from £15.56 per capita in 2017-18.
Councils recognise the need for decision-makers in ICBs to tackle immediate issues in the NHS and acknowledge they are also facing real pressures on their own services. However, there is concern that in the medium-term, it will be difficult to shift focus onto overarching, long-term system issues such as investing in preventative measures and out-of-hospital care, as envisioned in the NHS Long Term Plan.

Cllr Tim Oliver, Chairman of the County Councils Network, said: “Councils support the introduction of ICS and their aim to closer integrate health and care services and ultimately drive down costs for both the NHS and local government through preventative measures. Since their inception, evidence shows that councils have been enthusiastic about these arrangements and are spending more time with health colleagues.

“But today’s report acts as a useful barometer to find out what is happening on the ground in ICSs across England. Partly as a result of the funding challenges facing the NHS, and top-down central targets, there is a feeling from councils that there is too much focus on immediate and acute NHS pressures, such as hospital discharge and ambulance waiting times, rather than the preventative agenda.”

Sean Hanson, Chief Executive of IMPOWER said: “This report is the first to consider ICSs from the perspective of councils whose role is central to the integration agenda. It will be essential reading ahead of the Government’s upcoming review of Integrated Care Boards.

“These systems are complex and their implementation varies widely across councils but our report is clear that the desire exists across local authorities and the NHS to reduce health inequalities, boost preventative services and improve outcomes for citizens. However, there is concern that a lack of local autonomy and squeezed budgets will make it difficult to convert that desire into action.”