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.”

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.

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.”

Governments urged to invest in healthcare systems despite global economic uncertainty

By Integrated Care Journal

There is an urgent need to invest in healthcare systems to build resilience against future crises and the growing burden of disease, according to new research presented at a Global Summit on 22nd November.

The research, commissioned by the Partnership for Health System Sustainability and Resilience (PHSSR), highlights the need for Governments around the world to address weaknesses in healthcare services which leave countries exposed to crises and increase the economic, social and environmental impact of disease.

The PHSSR, of which the London School of Economics and Political Science (LSE) is a founding member, is a collaboration between businesses, academic, non-governmental, life sciences and healthcare organisations. The Partnership aims to study and help build health systems that are resilient to crises and sustainable in the face of long-term stresses.

Commenting on the crisis facing healthcare systems globally, Dr. Shyam Bishen, Head of Health & Healthcare at the World Economic Forum, said: “Healthcare systems around the world are grappling with the same problems, delivering services amid resource constraints and increased demand. Amid aging and growing populations, rises in non-communicable diseases and the impacts of climate change, there is one thing that remains certain – the need to continue investing in our health systems.”

The research examined domestic healthcare systems in 13 countries* using a framework designed by LSE academics. The findings highlight the following weaknesses:

Healthcare systems are underfinanced and the financing mechanisms in place are often ineffective and do not incentivise better health outcomes.
Health services are grappling with staffing shortages and wellbeing issues. In addition, healthcare workforces are inequitably distributed, impacting their capacity to meet needs. In particular this affects people in rural areas, underprivileged and marginalised groups, and those with chronic conditions.
In many of the countries studied, providing coordinated and proactive care remains a challenge. Investments in primary care, prevention and health promotion also tend to be low.
Inequities are pervasive in healthcare and have deepened during COVID-19. Equally the social determinants of health remain under-emphasised in national policies.
Despite the fact human and climate health are inextricably linked, many healthcare systems are struggling to understand, monitor and take action to reduce their environmental impact, and adequately protect their populations from the health impacts of climate change.
Among the countries researched, there is a wide variation in the availability, completeness, and use of health data to drive evidence-informed decision making, policy evaluation and learning. Interoperability of disparate electronic health records systems is also a key challenge in many countries.

Commenting on the findings, Baroness Minouche Shafik, Director of the London School of Economics and Political Science said: “Health systems are there to protect us. They are one of the foundations of a healthy society and a prosperous economy. When a crisis hits, we need them to stand firm. We cannot repeat the same mistakes from the post-2008 financial crisis era which left health systems ill-prepared to deal with COVID-19 and the ever-rising burden of chronic diseases.

“Maximum efforts should therefore be taken to ensure that health systems are made more resilient to future crises, and in turn sustainable in the face of long-term pressures.”

The research also highlighted the importance of collaboration to build more resilient and sustainable health systems. Exchanging knowledge with other sectors and across borders can accelerate improvements and strengthen healthcare systems.

Through its work, the PHSSR and its partners collaborate to build knowledge and guide action through research reports that offer evidence-informed policy recommendations to improve the sustainability and resilience of healthcare systems.

The PHSSR was established in 2020 by the London School of Economics, the World Economic Forum, and AstraZeneca, who were later joined by global-level partners that include Philips, KPMG, the Center for Asia-Pacific Resilience and Innovation (CAPRI) and the WHO Foundation.

This new research builds on evidence gained through an earlier round of work in 2021 that studied health systems in an initial group of eight countries.** Findings from a specific regional cohort, CEEBA Health Policy Network, looking into the Central Eastern Europe and Baltics area will also be presented and discussed at the Global Summit. The new country reports and an overarching summary report will be published between now and March 2023. All research reports are available on the PHSSR website.

* Countries include: Belgium, Brazil, Canada, Egypt, Greece, India, Ireland, Japan, Portugal, the Netherlands, Saudi Arabia, Switzerland, and the United Arab Emirates.

** Countries include: England, France, Germany, Italy, Poland, Russia, Spain and Vietnam.

State of social care and support provision has not improved, new report suggests

By Integrated Care Journal

Care England, as a member of the Care Provider Alliance, which brings together the main national associations that represent independent and voluntary adult social care providers in England, published a report on the current state of social care in England this week.

The Care Provider Alliance (CPA) published a briefing this week, The State of the Social Care and Support Provision in England, that highlights the key issues currently afflicting the social care sector. These issues include, but are not limited to:

· The rising cost of living

· Lack of funding to Local Authorities to adequately raise fee rates for social care

· Impact of financial pressures and uncertainty

· Unmet need is unacceptably high and rising

The key message from the report is that immediate government investment into social care is needed now. Without substantial reform and investment to support that reform, achieving long-term sustainability is impossible in the current economic climate. The implication of continued governmental inaction is continued market instability. Provider failure will impact significantly on both the NHS and Local Authorities, who will be unable to commission care and support packages from providers. Lack of action now will also prevent care providers from enabling those who rely on care support to enjoy their rights to live purposeful lives, as active members of families and communities.

Professor Martin Green, Chief Executive of Care England, said: “We require a 1948 moment for adult social care to establish a long-term and sustainable future that will be to the benefit of all citizens and the economy. It is clear that the reforms introduced under the Johnson administration are a starting point but are by no means going to ‘fix social care’ and the current reform proposals may well be kicked into the long grass again.

“The sector stands ready and willing to support the delivery of a much-needed reform agenda that will deliver a clear funding strategy for social care, whilst also developing a range of careers and opportunities that will provide high-quality care and support local economic development. The health of the UK economy cannot be separated from the health of the social care sector, the two are fundamentally linked.”

The report comes after Care England accused Ofgem of predatory pricing by charging “horrendous and financially crippling rates” in an open letter. Care England, the country’s largest representative body for independent providers of adult social care in England, is calling on the government to launch an investigation into the matter.

Lack of self-care confidence putting pressure on frontline NHS services

By Integrated Care Journal

Study finds one in five do not feel confident treating a headache themselves, and a third would be uncertain about treating a minor burn.

A real-world research poll of more than 2,000 UK adults reveals an alarming lack of confidence and knowledge around self-care for everyday ailments and highlights the threat this poses to struggling frontline health services. The poll, conducted by consumer healthcare association, PAGB, finds that one in five people do not feel confident treating a headache themselves, almost a quarter would not be comfortable self-treating a sore throat and a third would be uncertain about how to treat a minor burn.

Yet, despite the difficulty many consumers face getting GP appointments, there has been a fall in the number of people seeking advice from pharmacists for common ailments. Fewer than half (44 per cent) now turn to these highly qualified health professionals for initial advice, compared to 47 per cent last year.

Deborah Evans, community pharmacist and an advisor to PAGB, said: “These shocking findings show we need to get people back into their community pharmacies and talking to their pharmacist. Pharmacists train to qualify for five years and can help provide expert advice on all self-treatable conditions including minor cuts and burns to aches and pains.

“Pharmacists are well placed to drive a holistic approach to self-care. They can help to advise people on the most suitable and effective over-the-counter treatments as well as self-care techniques.”

However, the PAGB research reveals a worrying lack of knowledge or self-belief among the public when it comes to treating common conditions themselves. Statistics showing how many lack the confidence to self-treat everyday ailments are alarming:

• Conjunctivitis: 73 per cent

• Warts or veruccas: 61 per cent

• Backache: 52 per cent

• Nose bleeds: 45 per cent

• Cold sores: 40 per cent

• Heartburn or indigestion: 38 per cent

• Minor burns: 34 per cent

• Diarrhoea: 33 per cent

• Sore throat: 25 per cent

• Headache: 23 per cent

• Coughs: 18 per cent

Deborah Evans added: “These are all instances where a pharmacist can help and seeking advice from these highly qualified and easily accessible experts ensures consumers get swift treatment and precious NHS resources can be focused on more serious conditions. The potential savings are enormous. In 2020, it was estimated that the average GP consultation cost the NHS £39.32, and the most basic A&E was at least £77.”

Michelle Riddalls, CEO of PAGB, who carried out the research warned: “Our real-world research study presents an urgent call to action for the Government. Even before the pandemic, there were an estimated 18 million GP appointments and 3.7 million A&E visits every year for conditions which people could have treated themselves or for which a pharmacist should have been the first port of call.

“With the increasing pressures over recent years it is clear that the NHS cannot afford to let this continue.

“During the pandemic, we saw a coordinated campaign by NHS England and the Department of Health and Social Care to encourage consumers to stay at home and self-treat. As a result, this had a positive effect on both people’s confidence and ability to self-treat. We need to replicate this for all self-treatable conditions, and this can only be achieved via a national policy on self-care.”

News November 16, 2022

NHS elective and cancer backlog plan “at serious risk”, warns NAO

By Integrated Care Journal and Gabriel Blaazer

National Audit Office warns plans to reduce long waits for NHS elective and cancer care services by 2025 at risk, citing the failure of funding to keep pace with inflation and deeply-rooted workforce and productivity issues.

In December 2021, the NAO reported that at the start of the COVID-19 pandemic, the NHS had not met its standard for elective care for four years, nor its full set of eight standards for cancer services for six years. Over the course of the pandemic, the waiting list for elective care grew from 4.4 million in February 2020 to 5.8 million by September 2021, and currently stands at more than 7 million.

In February 2022, NHS England (NHSE) published a plan to recover elective and cancer care (the recovery plan) over the three years up to March 2025, with the Department for Health and Social Care (DHSC) funding the recovery plan and responsible for holding NHSE to account.

NHSE’s intention is that the number of patients waiting more than 62 days for treatment from an urgent referral for cancer care should return to pre-pandemic levels by March 2023. They also hope to eliminate all elective care waits of more than one year by March 2025.

However, even if the objectives of the recovery plan are met, many patients will still be waiting longer than the NHS Constitution’s standards allow – elective care patients should start their treatment within 18 weeks, and cancer patients within 62 days of an urgent referral by their GP.

Elective care failing to bounce back

NHSE is aiming to increase elective care activity sharply to reach 129 per cent of 2019-20 levels in 2024-25. This would be an historic achievement – it previously took 5 years (2013-14 to 2018-19) to increase elective activity by 18 per cent. Even if NHSE meets this aim, it is unclear whether increasing elective activity to 129 per cent would be sufficient to meet the other commitments in the recovery plan.

During 2022-23 so far, overall elective care activity has remained below the planned trajectory for reaching 129 per cent of 2019-20 levels by 2024-25. By July 2022, the NHS came close to ending elective care waits of more than two years, but the waiting list has continued to increase – reaching 7.0 million patients in August 2022.

This includes 387,000 patients who have already waited longer than a year for treatment, compared with just 1,600 in February 2020. 26 of the 42 NHS integrated care systems have signalled in their plans that they will not reach their 2022-23 target of delivering 104 per cent of 2019-20 levels of elective care activity.

Increasing diagnostic capacity

NHSE’s programme to recover elective care partly relies on initiatives which have potential but for which there is so far limited evidence of effectiveness. It wants GPs to handle many elective cases usually referred to hospital doctors. This might add to GPs’ workload in the context of a 4 per cent decrease in the fully-qualified permanent GP workforce between 2017 and 2022.

Surgical hubs and community diagnostic centres can contribute to recovery, but their impact will need to be closely monitored – capacity could be reduced if their host hospital or other NHS and social care services in their local area come under pressure.

Urgent referrals for suspected cancer have increased compared with 2019-20, but the NHS is not treating all cancer patients in a timely way. Between April and August 2022, GPs urgently referred 15 per cent more people with suspected cancer than in the same period in 2019.

The welcome increase in patients coming forward has, however, highlighted the inadequacy of current diagnostic and treatment capacity. In 2022-23 up to the end of August, only 62 per cent of patients started cancer treatment within 62 days, compared with 78 per cent of patients in the equivalent period in 2019-20.

Funding and productivity

Inflation has eroded the value of both the £14 billion specifically allocated to the recovery plan and the wider planned increases in NHSE’s budget. In the October 2021 Budget, NHSE was allocated an additional £8 billion of resource and £5.9 billion of capital funding for the recovery plan for the period 2022-23 to 2024-25.

At that time, the total NHSE funding settlement provided for average annual real terms growth of 3.8 per cent in resource funding up to 2024-25. But the NAO estimates that, as at September 2022, this settlement represented an average annual growth in funding of just 3.3 per cent in real terms because of higher forecast inflation.

NHSE estimates that in 2021, productivity in the NHS was 16 per cent lower than before the COVID-19 pandemic and has continued to decline in 2022-23. Some of this stems directly from the pandemic, such as increased sickness absence and infection prevention and control measures. An internal NHSE review identified a range of other causes including reduced willingness to work paid or unpaid overtime.

However, organisations that represent NHS workers, including NHS Providers, point out that increasing workloads, burnout among staff and cost-of-living concerns are impacting the ability of healthcare staff to carry out their duties effectively.

There are many challenges threatening to push the recovery plan further off track, including high numbers of unfilled posts and low morale among the NHS workforce. The NAO recommends that DHSC and NHSE review the progress of the recovery plan in early 2023-24, and decide whether targets and funding allocations need to be adjusted.

They add that before April 2023, DHSC and NHSE should clearly and fully define metrics for increasing activity and reducing long waits. In 2024-25, they should publish a strategy for returning elective and cancer care services to a state where legal standards are met, the NAO recommends.

Gareth Davies, the head of the NAO, said: “There are significant risks to the delivery of the plan to reduce long waits for elective and cancer care services by 2025. The NHS faces workforce shortages and inflationary pressures, and it will need to be agile in responding as the results of different initiatives in the recovery programme emerge.

“DHSC has an essential role to play, holding the NHS to account for its delivery of the recovery plan and providing more challenge and support when it is needed.”

In response to the NAO’s warnings, the Interim Chief Executive of NHS Providers, Saffron Cordery, said: ““The NAO’s warning follows our own findings that fewer than half of NHS trusts expect to meet key end-of-year elective recovery and cancer targets.

“The NAO rightly highlights ‘significant workforce and productivity issues’ facing the NHS and that government funding to help clear backlogs hasn’t kept pace with double-digit inflation.

“NHS trust leaders and their staff continue to pull out all the stops to bear down on backlogs in the face of demand for services even higher than before COVID-19. They have slashed the longest waits for treatment and are exceeding pre-pandemic activity in many areas. Mental health services are in contact with record numbers of people and community services are doing their utmost to reduce a waiting list estimated at more than one million.

“But making further headway is hard due to long-standing, fundamental pressures which persist right across the NHS, especially chronic staff shortages and severely stretched budgets.

“With more than 130,000 vacancies across NHS trusts the government must produce urgently a fully costed and funded workforce plan so that the NHS can recruit and retain the people it so desperately needs to give patients first-class care.

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