Registration for Health Plus Care has now gone live

By Integrated Care Journal

CloserStill Media, organisers of Health Plus Care, taking place at ExCeL London on 26-27 April, are thrilled to announce that registration is now live. As part of Health Plus Care, there are three co-branded shows: The Healthcare Show, Digital Healthcare Show and The Residential & Home Care Show.

The Health Plus Care show is the most significant and innovative UK event for healthcare professionals looking to revolutionise the healthcare and social care sectors. The Health Plus Care show is the ideal platform for you to talk about your successes, promote best practice and be a part of key discussions with the UK’s most senior healthcare leaders.

Your team will be meeting senior policy makers from NHS providers, integrated care systems, local authorities and primary care. The event offers the opportunity to generate new leads and have a unique opportunity to meet top decision makers face to face across two days at the show.

With only the most up to date content exploring the latest developments across healthcare and social care, the three shows will educate across various different streams, with a carefully curated and thought-provoking agenda.

The whole of Health Plus Care is free to attend and fully CPD certified to meet your educational needs. This is a topical and timely event, where you’re able to meet your peers in person and come away refreshed with ideas and examples you can implement in your organisation.

FREE tickets for all healthcare and care professionals are available to book here.

The organisers, CloserStill Media, specialise in global professional events within the healthcare and technology markets. The healthcare portfolio includes some of the UK’s fastest growing and award-winning events, such as The Clinical Pharmacy Congress, The Dentistry Show, The Pharmacy Show, Best Practice and Acute & General Medicine.

It is a market leading innovator. With its teams and international events, it has won multiple awards, including Best Marketer – five times in succession – Best Trade Exhibition, Best Launch Exhibition, and Sunday Times Top 100 Companies to Work For – four years in series – among others.

CloserStill Media delivers unparalleled quality and relevant audiences for all its exhibitions, delivering NHS and private sector healthcare professionals from across occupational therapy, pharmacy, dentistry, primary and secondary care with more than £16m worth of free training.

For more information please contact –

Exhibition and speaker enquiries:

Michael Corbett – m.corbett@closerstillmedia.com

Marketing enquiries:

Sabrina Travers – s.travers@closerstillmedia.com

Health inequality high on the agenda at Rewired 2023

By Gabriel Blaazer

ICJ attended Digital Health Rewired 2023 this week, where combatting health inequalities received much of the focus.

“1.5 million homes do not have internet access and approximately 10 million people lack basic digital skills,” announced Richard Stubbs, Vice Chair of the Academic Health Science Network, in his keynote address at Digital Health Rewired 2023. The panel, Using Digital to Address Health Inequalities, saw Stubbs join Christopher El Badaoui, CEO of LVNDR Health and Catherine McClennan, Programme Director for Women’s Health and Maternity Services at Cheshire and Merseyside Health and Care Partnership, to discuss the use of digital as a means of addressing health inequalities.

“85 per cent of primary care practices use online triage,” Stubbs continued, “while more than 99 per cent of primary care practices use digital consulting platforms.” These facts, he argued, create an intrinsic problem; how can patients be expected to use these services if they remain out of reach, hidden behind a digital barrier?

“The pandemic digital transition was too quick to allow for real co-production.”

Layla McCay, Director of Policy, NHS Confederation

Stubbs pointed to a report from PPP, The Digital Divide: Reducing inequalities for better health, authored by Mary Brown, and stressed that government should consider digital access and skills as key measures to assess deprivation. He reiterated the importance of the report’s recommendation that “digital-by-default must operate in the context of the digital divide”, and that healthcare systems must be responsible for providing support for those who wish to access digital pathways.

L-R: Christopher El Badaoui, CEO, LVNDR Health; Catherine McClennan, Programme Director for Women’s Health and Maternity Services, Cheshire and Merseyside Health and Care Partnership; Richard Stubbs, Vice Chair, Academic Health Science Network

This view was shared by, Layla McCay, Director of Policy at the NHS Confederation. In her address to the National Policy on the Table session, McCay explained that “the pandemic digital transition was too quick to allow for real co-production.” As such, digital services that have since been deployed do not mirror the digital competence of many of their intended users, particularly those without ready access to the internet, or those with complex and long-term health conditions, minority communities and the elderly.

“Digital does not just mean ‘apps’.”

Tony Browne, Head of Innovation Digital Care Models, NHSE

Elsewhere, at Rewired’s Integrated Care Stage, Head of Innovation Digital Care Models at NHSE, Tony Browne, discussed the value of interdisciplinary teams when designing new models of care. Himself a former product designer, Browne argued that “product design is needed for digital pathways to be accessible and viable,” and that the current solutions on offer tend to be limited in their value by poor usability and a lack of co-production in their initial design.

“Digital does not just mean ‘apps’,” Brown contended. Rather, it should be closely aligned with Public Digital’s definition of the term; “applying the culture, processes, business models and technologies of the internet era to respond to people’s raised expectations.” Browne detailed the process behind NHSE’s digital cardiac pathway,” which included hundreds of hours of interviews with patients, carers, and NHS staff, as well as undertaking surveys and frontline observations. This “user-centred, data-informed approach” should be the basis for future digital pathways, Browne concluded, and will be key to reducing disparities in access to healthcare.

The Deputy Chief Executive of NHS Providers, Saffron Cordery, used her address at the Integrated Care Stage to discuss the organisation’s work to “build understanding of the potential and implications” of digital solutions at board level to “to increase the confidence and capability of boards to harness digital opportunities”. Building this digital knowledge at the top tier will be essential if health systems are to maximise the benefits of technology, Cordery argued, while ensuring that new solutions do not widen existing inequalities. Cordery referenced the Board Development Sessions run by NHS Providers, which have been delivered to more than 100 healthcare boards to date.

“These tools are built for patients and clinicians and it is so important that they are included throughout the process.”

Christopher El Badaoui, CEO, LVNDR Health

Discussing how healthcare systems can become more inclusive of LGBTQ+ individuals was LAVNDR Health CEO, Christopher El Badaoui. He argued that industry can play a vital role in improving access to underserved groups by creating parallel digital corridors into the health system. Describing how LGBTQ+ individuals often feel marginalised by traditional models of healthcare, El Badaoui emphasised the importance of co-creation and co-development of services.

He detailed the six-month period of consultation and interviews LVNDR Health undertook with members of the LGBTQ+ community, local authorities and health systems when designing their service. “These tools are built for patients and clinicians,” he explained, “and it is so important that they are included throughout the process”. El Badaoui added that during this process, “service users said it was the first time their voices were heard and respected – this is especially important to bridge trust.”

Across the stages ICJ visited, the topic of health inequalities was a recurring theme, and it became clear that most, if not all, attendees agreed that current and future reforms of the health system will have limited impact if they do not address disparities in access and outcomes. It was also clear that while digital solutions will have a substantial role to play in this area, they are not inherently a panacea to health inequalities; new ways of thinking are needed to ensure that digital solutions do not further widen the digital divide.

If health systems and policymakers can get this balance right, it could transform healthcare delivery for good.

The Hewitt Review is a unique chance to commit to the ICS agenda

By David Duffy

Barely six months in and ICSs are already subject to their first independent review – but Patricia Hewitt’s re-evaluation of integration represents a genuine attempt to finally empower ICSs, not another deck chair reorganisation.

Unless you were plugged into the health and care sector, you could be forgiven for not even realising that the NHS had only just undergone its biggest reorganisation in a decade. As we emerge from the toughest winter health and care services have ever faced, images of patients waiting on trolleys for emergency care and of people waiting years for life-altering elective treatment are now etched into the public psyche. The situation has, unsurprisingly, led to calls for fundamental reform in our system of health and care.

But while honest conversations about the state of UK health and care are essential, so too are accurate depictions of the current state of reform – as well as clear and realistic expectations of what these reforms can be expected to achieve.

“It is welcome, therefore, that rather than announce more ‘deckchair reorganisation’, the government has this time opted for a more considered re-evaluation as to the role of ICSs.”

Integrated care systems (ICSs) took up statutory footing in July 2022 with a mandate to deliver joined-up services along a place-based approach, using population health management techniques to bring down health inequalities across the country. Achieving improved health outcomes through these means cannot be accurately assessed in six months’ time, but that hasn’t stopped many commentators from calling for further wholesale reform of the NHS. No major corporation would expect instantaneous results following a merger or acquisition, so why are such patently unrealistic achievements persistently expected from the largest employer in Europe?

The answer, of course, is that our health matters to all of us, and that the government has consistently mismanaged the health service over the course of 13 years. However, the ‘holy grail’ of any health system in the world is a locally responsive integrated care system (or whatever name is used for it) and ICSs do represent a step in the right direction. What they require is time and support to harness their still new statutory position and achieve their goals.

It is welcome, therefore, that rather than announce more ‘deckchair reorganisation’, the government has this time opted for a more considered re-evaluation as to the role of ICSs. The ongoing review of ICS autonomy and accountability, led by former Health Secretary Patricia Hewitt and commissioned by former Health and Care Secretary Jeremy Hunt, amounts to a recognition of two key points: 1) that ICSs are here to stay 2) that if they are to work at a truly local level, central NHS and Whitehall must finally learn to let go.

Hewitt’s combined experience as a former Health Secretary and current ICB chair of Norfolk and Waveney ICS makes her more than well suited to conducting such a timely review. That a Tory Chancellor has asked a former Labour cabinet minister to review the government’s flagship health reform could be seen as something of an olive branch to a Labour Party that will likely inherit England’s nascent 42 ICSs. Any government would be loath to commit to another reform agenda and more legislative upheaval would neglect the significant impact ICSs have already had.

“ICSs have finallly started to build bridges between NHS providers, who are finally taking system-wide views to finance and care strategy based on joint working.”

What ICSs have been able to do so far is address tensions between commissioners (CCGs) and NHS trusts – a dynamic deliberately designed to spark competition and innovation across health and care. Many NHS regions were plagued by tense relationships as NHS trusts competed with each other for funding and CCGs sought to avoid giving said funding. This collaborative, joined-up approach has already promted system-wide approaches to financial decision-making and better adoption of digital innovation.

Hewitt will look to build on this momentum – and first among her six priorities for the review is collaboration.

The issue of collaboration versus competition in the NHS has long been debated, with proponents of the latter arguing that it promotes innovation, while those favouring the former stress that collaboration can reduce risk, expedite information sharing and facilitate scaled innovation. Evidence suggests that, given the choice, most NHS leaders prefer collaborating over competing.

Despite moving towards a collaborative model, it is the age-old shortcomings of centralisation, and an ‘NHS first’ approach to health and care, that continue to hamper the progress of integrated care in England.

Fundamentally, Hewitt is examining the overly centralised, target-driven environment in which health and care operate. Central support and direction for ICSs cannot be overly proscriptive, as the delivery of a truly integrated system is reliant on developing collaborative frameworks that respond to the differences in size, stakeholders and priorities that characterise each ICS region.

“The Hewitt Review must help empower ICSs to cut through these tensions and develop locally responsive and locally reflective service delivery.”

Despite ICSs’ remit for locally managed healthcare with a new brief to connect with local authorities and wider community services, the 2022 Health and Care Act saw Whitehall assume more central power to outline targets, creating fundamental contradictions within the current reforms. At times, ICSs across the country feel squeezed by NHS England and DHSC at a national level, and by individual providers locally.

This tension has come into sharp focus as ICSs have sought to merge the NHS with local government. If ICSs have shown us anything so far, it is that the NHS is not yet ready to marry its own accountability frameworks to those from local government. The NHS is not democratically accountable to its citizens like local authorities are, but is subject to scrutiny from central NHS, DHSC and the Care Quality Commission (CQC) – the latter of which does of course regulate social care, but this is only one part of the community service offering from local government. The Hewitt Review must help empower ICSs to cut through these tensions and develop locally responsive and locally reflective service delivery.

“The absence of an all encompassing metric is not an admission of failure, but rather an acceptance that collaborative models for health delivery are inherently complex and unique to individual localities.”

It will be fascinating to see how Hewitt will seek to reimagine the role of the CQC, which has made repeated efforts to shift its inspection regime to evaluate the progress of integration and wider system working. However, without a comprehensive remit and authority to evaluate whole systems, their impact has been limited.

Assessing the impact of such a model is extremely complicated. Globally, few have been able to produce measurement frameworks or metrics to accurately assess the impact of integrated care. Even the government’s own impact assessment of the 2022 Health and Care Act stated that “there is mixed evidence on whether collaboration can provide cost savings in the delivery of services”.

The absence of an all encompassing metric is not an admission of failure, but rather an acceptance that collaborative models for health delivery are inherently complex and unique to individual localities. Ultimately, the introduction of the Hewitt review is a recognition that successful collaboration is as dependent on culture, management, and resources as it is on rules and structures.

So, before ICSs are consigned to the scrap heap of failed health reforms, Whitehall must finally let go and provide these still young organisations with the autonomy, accountability and cultural freedom to demonstrate what they can do.

David Duffy is Head of Content for Public Policy Projects.

The Cleaning Show launches 2023 Trends Report

By Integrated Care Journal

New report looks into the trends and innovations driving change and influencing the facilities management and cleaning industries.

On 22nd February, organisers of The Cleaning Show, which took place at ExCeL, London on 14-16 March, revealed its 2023 Trends Report, exploring where the cleaning and hygiene industries are heading, the latest innovations and trends, as well as the challenges affecting the cleaning and FM industries.

With insights from leading experts representing industry bodies, suppliers and operators, the report identifies five trends that will drive and disrupt the industry in 2023. The report offers a deep dive into how challenges in recruitment and resources, as well as technology and sustainability, will influence the industry, and what businesses need to do to respond to existing and new challenges.

Unpacking the recruitment challenge, Delia Cannings, Director, Environmental Excellence Training & Development Ltd, highlights two notable shifts in the workforce during the pandemic. The first saw an influx of new, untrained entrants looking for work, while simultaneously seeing a mass exodus of trained, experienced staff. The impact of this, as confirmed by Jim Melvin, Chairman of the British Cleaning Council (BCC), is that business owners are faced with the challenge of having more jobs vacant than there are people looking for them.

Lorcan Mekitarian, Chairman of the Cleaning & Hygiene Suppliers Association (CHSA), suggests that the lack of cleaning and hygiene operators has been one of the biggest challenges to emerge in 2022 and was a clear “carryover from Brexit and COVID”. Meanwhile, one of the ramifications of the labour shortage has been a bigger focus on automated cleaning systems and robotics.

The collaborative role of technology was put under the spotlight by Kim Phillips MBE, Head of Catering & Facilities Services at Rotherham Metropolitan Borough Council, who explains that the pandemic had resulted in a “growing recognition of cleaning activities as professional services”, resulting in “an emerging sector assisted by technology”. Meanwhile, Paul Ashton, Chairman of the Cleaning & Support Services Association, agrees that technology was having a profound impact on the industry, and if the industry could embrace there would be an “immense opportunity to support front-line teams with effective automation”.

With additional input from Hamid Ghadry, Facilities Services Manager, Estates & Campus Services, University of Northampton; Dominic Ponniah, CEO of Cleanology; and Yvonne Taylor, Global Head of Cleaning at OCS Group UK; the report offers a diversity in perspectives helping to create a rounded look at current and future trends.

Paul Sweeney, Event Director, The Cleaning Show, said: “Over the past three years, the cleaning sector has experienced meaningful change. It was thrown into the spotlight, which served to demonstrate the industry’s frontline role in safeguarding and protecting the public. Today, while the pandemic has taken a backseat, new challenges are emerging.

“The Cleaning Show 2023 Trends Report recognises this transition and the emerging challenges that business owners and operators will face in the coming months. It acts as a important sneak preview of some of the trends we can’t expect to see and hear more about at this year’s show. We’re excited to return to ExCeL, London to explore how these challenges are driving innovation and chance within what is an exciting and highly valuable industry.”

The Cleaning Show 2023 Trends Report is now available to download here: https://cleaningshow.co.uk/london/trends-report.

The NHS must break the cycle on heart failure

By David Duffy

Integrated Care Journal recently spoke to Dr Ashton Harper, Head of Medical Affairs (UK & Ireland) at Roche Diagnostics, to examine the heart failure diagnostic pathway and identify where the biggest opportunities in NHS diagnostics exist.

In the midst of its most challenging period of pressure, diagnostics have a significant role to play in helping to alleviate patient backlogs and free up vital resources across the sector – and nowhere is this more critical than with heart failure.

The health challenge that heart failure, a serious and chronic disease that prevents the heart from pumping blood through the body, poses to the NHS is both immense and relentless. An estimated one million people live with heart failure in the UK, with approximately 200,000 developing the condition every year, creating a profound and multifaceted set of health challenges for the NHS.

Writing in a recently published report by PPP for Roche Diagnostics UK & Ireland, Professor Sir Mike Richards described diagnostics as a “Cinderella” service within the NHS. Yet the UK’s capacity to diagnose heart failure has been consistently hampered by broader capacity challenges in NHS diagnostic service provision, as well as the lack of uptake of, and access to, innovation. A combination of workforce shortages and outdated facilities have historically contributed to late diagnosis and poorer health outcomes. This realisation directly informed Professor Richard’s 2019 report, which led to the introduction of community diagnostic centres (CDCs).

A ‘silent epidemic’

Heart failure is notoriously difficult to diagnose, in part because its key symptoms – breathlessness, exhaustion and ankle swelling – can be caused by a number of other conditions. As a result, late diagnosis of heart failure is unfortunately common, often only occurring once a patient has presented in secondary care following the onset of severe symptoms.

“If heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better”

“Current estimates are that 80 per cent of patients are diagnosed [with heart failure] after a hospital admission,” explains Dr Harper, “and a significant proportion of those will be emergency cases, and so these patients are at the late stage, requiring more intense and complex treatment.” This matters because heart failure patients who require hospitalisation account for “somewhere in the region of a million inpatient days every year, which is about 2 per cent of total NHS annual bed days”. It is also estimated that between 2-4 per cent of the total annual NHS budget is spent managing patients with heart failure (up to £6 billion in 2022/23) and according to Dr Harper, “the majority of this burden is due to hospitalisation – and hospital admissions for heart failure have increased by 50 per cent in the last decade alone”.

“Somewhere in the region of 70 per cent of the total annual cost [of managing heart failure] is actually utilised by the management of stage four patients alone,” says Dr Harper, “but if heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better; they have a better quality of life; and significantly reduced requirements of both primary and secondary care services ongoing.”

Diagnostic reform

“The NHS must look to adopt innovative diagnostic tools at a faster rate”

As was made clear in Professor Richards’ report, the NHS must conduct a wholesale rethink of diagnostic service provision. “Early diagnosis is key to effective management and better outcomes for these patients”, explains Dr Harper, “but while the use of medicines which are deemed to be beneficial and cost effective is mandated in the UK, diagnostics aren’t. It can often take 10 or more years for a diagnostic test to be widely adopted across the NHS.” As such, the NHS must look to adopt innovative diagnostic tools at a faster rate.

NT-proBNP tests are fast, cost-effective, non-invasive and recommended by NICE for the diagnosis of heart failure. Recently updated NICE Quality Standards, recommend that this test be conducted on all patients presenting to primary care with a possible heart failure diagnosis, but this guidance is not universally followed with recent data showing that only 18.3 per cent of heart failure patients had an NT-proBNP test recorded.

“Following the NICE guidance for NT-proBNP testing can reduce unnecessary referrals and allow GPs to better identify patients that do need more urgent referrals for echocardiograms”, Dr Harper notes, which is important because “we’ve got massive echocardiogram backlogs, with patients waiting months”, many of whom may not need one at all. The ability to preclude a heart failure diagnosis early would reduce the echocardiogram bottleneck, meaning those who really need one can access one sooner. “I think mandated funding for NT-proBNP would go a long way,” says Dr Harper. “This approach could help to potentially flip the site of primary diagnosis from 80 per cent in hospital to 80 per cent in the community, and therefore reduce pressure on the NHS.”

Reprioritising and reframing the issue of heart failure

Dr Harper believes that “there’s a strong case for heart failure to be prioritised by NHS England in the upcoming NHS Long Term plan refresh with clearly defined targets, such as exist for stroke and cardiac arrest.” Accordingly, “there needs to be increased collaboration between the NHS, industry and patient organisations to tackle inequalities in the diagnosis and management of patients.”

Much of this comes down to a need to educate and raise awareness of heart failure and its symptoms. “It has been described as a ‘silent epidemic’ because it hasn’t received as much attention as other pressing healthcare issues,” Dr Harper remarks. This lack of awareness has produced some alarming disparities, particularly around gender and misdiagnosis.

“Clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list”

“There is an historical presumption that heart failure is a more male-dominated disease rather than female,” he explains, “when actually it’s about a 50/50 split.” Despite this, women are more likely to be misdiagnosed than men or to wait for much longer than men for their diagnosis. Dr Harper continued, “clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list.”

Echoing recommendation three of Breaking the cycle, Dr Harper also encourages widespread adoption of the Pumping Marvellous Foundation’s BEAT symptom tracker. If shared with the wider public, this checklist – Breathlessness, Exhaustion, Ankle Swelling, Time for a simple blood test – could increase heart failure symptom awareness and ensure that more cases are identified sooner and treated more effectively.

Conclusion

“Ensuring primary and secondary care professionals share a common goal is key”

A coherent and system-wide approach will be needed if capacity is to be increased across all diagnostic modalities, but especially in heart failure. “Ensuring primary and secondary care professionals share a common goal is key,” Dr Harper says, “[and] the introduction of integrated care systems is a great opportunity to foster this collaboration.”

“By increasing diagnostic capacity in the community, we might be able to reduce the pressure on hospital admissions and NHS bed days,” and the use of NT-proBNP tests to confirm or rule out suspected cases of heart failure will be crucial. Taking the present opportunity to radically overhaul the heart failure diagnosis pathway will help to decrease the societal burden of the disease, create extra capacity for the NHS and, most importantly, help heart failure patients lead longer, healthier lives.

Breaking the cycle: Tackling late heart failure diagnosis in the UK, finds that late diagnosis of heart failure is a significant hindrance to the effective management of heart failure. It makes a series of recommendations to NHS England, Health Education England, and integrated care systems, as well as patient groups and industry to come together to improve heart failure diagnosis across the entire healthcare system.

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.”