Devolution & health outcomes: Getting a seat at the table

By Gavin Bashar

Gavin Bashar, UK&I Managing Director at Tunstall Healthcare, discusses the importance of ensuring all key stakeholders, including citizens, get a seat at the table to link up care and ensure access to technology.

As a nation we are living longer and we have the information we need to make healthier and better-informed choices. However, having the right information is only the beginning. The next stage, which integrated care systems (ICSs) and their empowered integrated care boards (ICBs), will provide significant direction on, is using this information in the right way to meet the aims and objectives of our health and social care services.

As ICBs establish themselves, we will begin to see citizens and service providers become more engaged across the board and the beginning of the distribution of the £150m of additional funding to drive greater adoption of technology and digitisation across the health and care landscape. This in turn will create a more connected and intelligent world that enables a collaborative approach to the delivery of efficient, proactive and integrated health and social care services.

Engaging with citizens

If citizens are to have a seat at the table, with health and social care services centred around them, we must engage effectively and actively listen to their concerns and needs. Relationships should be based on partnership, flexibility and a commitment to citizen success, rather than one-off transactional interactions. A sustainable future for the long-term funding of essential services must be a priority if we are to realise a positive vision which puts people at the heart of delivery.

Before ICBs, many public commissioning and procurement processes were hampered by fragmented funding, a shortage of high-quality evidence-based services and a lack of involvement of the appropriate citizens’ voices in decision making. These challenges of course made it extremely difficult for professionals and care providers to fully engage with citizens and deliver effective care that would effectively prevent more complex requirements.

Engaging with citizens can help to ensure that valuable solutions involving technology are appropriate, accessible, practically useful and as such, less likely to be abandoned.

As services become more efficient and citizen outcomes are improved, it will become easier to deliver cost efficiencies. Improved condition management and medication compliance through greater engagement for example has a clear impact on decreasing GP visits, clinicians are able to target patients that need support, and early intervention can prevent future, often high cost, care requirements.

By engaging closely with citizens and their communities with the help of ICSs, it is possible to create an environment in which they have the freedom to live life to the full in a place of their choice, with the people and things that they love, doing the things that matter most, through care and support that is inclusive, accessible and innovative.

Collaboration to drive links

To drive links between social care, primary care and wider community services it’s important to consider the crucial role of collaboration. ICSs will help with the integration of services and drive collaboration between service providers. A large majority of the population have both health and social care needs, and it makes sense for a collaborative approach to become the norm as this will contribute to an improvement in health outcomes and cost savings.

Collaborative services will be the first step to start reducing the silos that currently exist between health, housing and social care and encourage care provision that is tailored to the individual who needs it. Through collaboration we’ll be able to deliver joined up care so that people accessing health and social care services can experience them as seamlessly as possible.

However, local authorities and health and social care providers continue to grapple with workforce shortages, case backlogs and an increase in the complexity and level of need of the population. This hampers the ability to drive forward with collaborative working as we are too focused on meeting these short-term challenges to have the time to consider longer term approaches.

ICBs have a number of aims, with one being to deliver transformation in order to improve how our systems operate. By focusing on this, they’ll be able to encourage collaboration between partners and professionals, with a strong focus and determination on delivering person-centred care and support.

Providing universal access to technology and software support

The integration of technology and its increased use have long been seen as a key part of transforming health and social care. However, the system has been slow to adopt innovations and tends to view technology as a way of managing people’s care. This is partly due to the growing number of solutions that are available, which make selecting, commissioning and implementing a complex task.

With the ICBs now holding statutory powers, we are at a pivotal time that will shape our services and the use and deployment of technology for decades to come. The ability to transition to a system that can provide universal access to new technologies that manage, analyse and harvest actionable intelligence will be crucial to the success of the health and care industry in the future.

Using technology to support people is relatively low cost, meaning citizens can stay at home for longer with an increased quality of life. Digital solutions can also empower staff to work more efficiently, reduce bureaucracy and enable them to spot changes in people’s behaviour.

Integration and investment in technology will enable the reconfiguration and integration of services. It’s essential that service providers and the service users are involved in the digital transformation if they are to innovate, embrace technology successfully, and deliver new approaches which create benefits for citizens.

By working closely with ICBs, technology providers will be able to citizens, their communities and the workforce to invest in value-generating digital solutions that improve lives and drive the prospects of businesses.

Moving forward

Through collaboration and investment in the right services and solutions, such as digital technology enabled care solutions, it will be possible to improve citizen experience and support improved quality and reliability of services, which are tailored to meet the specific needs of individuals. With the engagement of ICBs, there is the potential to move towards a system where it is standard practice to use technology to manage long-term health conditions and deliver efficient and personalised care.

A digital transformation will create a predictive environment that highlights behaviour changes and forecasts the need for extra support. It will join up stakeholders and provide a better opportunity for planning, giving a clearer picture of those with vulnerable needs.

I hope that ICBs will provide a new kind of leadership that can deliver change and tighten up governance, while at the same time improving the working lives and motivation of employees and the health and wellbeing of our population. The healthier the population becomes, and the more they learn about the benefits of technology within health and social care provision, the more able we’ll be to engage with citizens, give them a seat at the table and link up care.

This is a sponsored article.

For more information, please visit www.tunstall.co.uk.

Billions needed to plug growing NHS maintenance backlog

By Integrated Care Journal

New figures from NHS Digital show sharp rise in funding needed to undertake upkeep and repair on NHS buildings, as trust leaders say delays hurting patients.

The NHS maintenance backlog – the measure of how much would need to be invested to restore facilities through work that should have already taken place – has risen to an estimated £10.2 billion according to new figures from NHS Digital – an 11 per cent rise since 2020-21.

More than half of the total backlog (52 per cent) represents a “high and significant risk” to staff and the public according to NHS Providers, as 62 per cent of trust leaders responding to a recent survey said that delays to the new hospitals programme were affecting their ability to deliver safe and effective patient care.

Saffron Cordery, Interim Chief Executive of NHS Providers, said: “Far too many NHS buildings and facilities are in very poor condition and the latest figures show the situation is getting worse. The costs of trying to patch up creaking infrastructure and out-of-date facilities are piling up.

“We need a step change in capital investment by the government as well as urgent clarity and commitment about its delayed new hospitals programme.”

According to NHS Digital’s figures, the total cost of running the NHS estate rose 8.8 per cent from 2020-21 and now stands at £11.1 billion. Also increasing was total energy usage across the estate, rising 2.6 per cent during the same period to reach 11.7 billion kWh. The total cost for cleaning services has also risen to £1.2 billion – a 7.5 per cent increase since 2020-21.

From 2020-21 to 2021-22, the value of investments made to cut the maintenance backlog increased to £1.4 billion, a rise of 57 per cent. Despite this, trusts are currently shouldering £5.3 billion of the total backlog risk, £700 million more than in 2020-21.

Saffron Cordery added: “The maintenance backlog across the NHS continues to grow at an alarming rate. It’s not just about old boilers and bricks and mortar. Safety of patients and staff is at the heart of everything the NHS does.”

The figures from NHS Digital come as concern mounts among trust leaders regarding the ability of the current capital budget to meet cost pressures; half (50 per cent) of all trusts surveyed by NHS Providers were ‘not confident’ or ‘not at all confident’ that their funding allocations are enough to deliver projects currently included under the new hospital programme – one of the headline manifesto pledges of the Conservatives under Boris Johnson.

In signs that trust leaders have concerns over funding allocations, almost 96 per cent of trusts surveyed agreed that the government should ‘confirm the funding envelope for the new hospital programme beyond the current spending review period (2022-23 – 2024-25)’. Less than half of trusts (46 per cent) in the new hospitals programme are running on time, and of these, 100 per cent reported that costs would increase because of delays.

How any budgetary shortfalls are to be met remains unclear, but with 62 per cent of respondents saying that delays would ‘somewhat effect their trust’s ability to deliver safe and effective patient care’, the latest figures will add more fuel to concerns over the NHS’s ability to cope this winter.

‘Partners in Protection’: How Mölnlycke works with clinicians to prevent infections and support elective recovery

By Lucy Catlin

Lucy Catlin, UK OR Solutions Marketing Manager for Mölnlycke, tells ICJ how Mölnlycke works with clinicians to prevent infections and support elective recovery.

Research from the Healthcare Safety Investigation Branch demonstrates that the COVID-19 pandemic has made people increasingly concerned about contracting infections in hospital settings.¹ Ensuring that patients have confidence that their treatment is safe, especially in the operating theatre, will be important to the uptake of planned and elective surgery to help tackle the backlog in care.²

It is evident that breaking the chain of preventable infections in hospitals should continue to be prioritised in the wake of the crisis. Mölnlycke aims to support healthcare professionals (HCPs) to face these challenges by offering solutions to significantly decrease the risk of surgical site infections (SSIs) in patients.

Effects of COVID-19 on infection control in elective care

During the beginning of the pandemic, increased infection prevention and control protocols in operating theatres were introduced, which HCPs adapted to brilliantly. These additional measures required more preparation time, reducing the amount of time in the day available to complete operating procedures, and therefore resulting in fewer non-urgent patients being treated.³

However, as the pandemic has progressed over the last two years, COVID-19 related infection prevention protocols have been adapted to help return the volume of elective care procedures to pre-pandemic capacity.^3,4 With the focus now on elective care recovery, we must ensure that infection prevention remains a top priority to support patient safety which does not fall off the agenda, and clinicians are adequately supported to deliver this in the operating theatre.

How can Mölnlycke’s solutions help ‘break the chain of infection’?

Most SSIs are caused by contamination of an incision with microorganisms from the patient’s own body during surgery.⁵ While they can cause considerable harm to patients, up to 60 per cent of SSIs are preventable, demonstrating the need for the health system and its partners to actively work together to tackle the problem.⁶

Ashford and St Peter’s Hospitals NHS Foundation Trust is a notable example of how SSI rates can be reduced by assessing risk across the whole patient pathway. The Trust were able to put in place multiple changes simultaneously, from pre-operative chlorhexidine washing and patient pre-warming, through to an oozing wound protocol. Ashford and St Peter’s were successful in reducing their early infection rate from 5 per cent to 0.24 per cent, which GIRFT estimates saved the Trust £2m. This proved adopting a multidisciplinary approach, in collaboration with industry partners, can have a positive impact on infection rates.⁷

Additionally, creating an environment within clinical teams where there is open dialogue with patients, including providing education on SSIs, could be part of wider solutions. When patients are empowered with the information they need to prepare for surgery and to improve their chances of recovery, they can work collaboratively with clinical teams to make decisions about their own care. Ultimately, patient-centred approaches and patient safety should be at the heart of breaking the chain of infections.

This multidisciplinary approach with the patients’ perspective at its centre is critical in assessing both risks and opportunities along the pathway. Mölnlycke have a range of solutions across the patient pathway, from pre-operative to post-operative surgical care to help minimise the risks of SSIs. For example, the Mölnlycke BARRIER® EasyWarm® blanket can be used in line with NICE guidelines which recommend active warming should start at least thirty minutes prior to induction of anaesthesia, with an earlier start to active warming required if the patient has a temperature under 36 degrees to reduce the risk of perioperative hypothermia, which is associated with poor outcomes for patients.^8,9

Where are we heading next?

Beyond equipment to improve SSI prevention, there needs to be wider changes to the healthcare system to tackle the structural barriers to further reducing SSIs in the operating theatre. This includes the need for consistent, mandatory SSI reporting across all surgical categories.¹⁰ Acknowledging the clear challenge around SSIs, Mölnlycke developed a first-of-its-kind report, Time to Act, to explore the current landscape and recommend system-wide changes and partnership opportunities.

The report sets out a range of recommendations for stakeholders across the healthcare system, including policymakers and hospital teams. These include supporting investment in training and education of HCPs, as well creating infection prevention strategies across the UK, for example through a Preventable Infections Taskforce.

Hospitals should also support HCPs where possible to ensure they have the skills and equipment they need to perform surgery in a way that is safest for patients. It is vital that HCPs are engaged in a dialogue about safety, efficiency, and use of infection prevention solutions. This ensures procurement teams have all the right information about the safety and quality of products for them to make informed, value-based choices.

Conclusion

While we address the elective care backlog, we must ensure that patient safety is not compromised in the process. Healthcare professionals can be supported directly to put in place best practice solutions and processes, but there also needs to be wider system support to ensure that reducing the risk of SSIs is prioritised. Mölnlycke is committed to supporting healthcare professionals, hospitals, and policymakers to improve outcomes for patients.

¹ HSIB (2020) COVID-19 transmission in hospitals: management of the risk – a prospective safety investigation, https://hsib-kqcco125-media.s3.amazonaws.com/assets/documents/hsib-report-covid-19-transmission-hospitals.pdf

² Lee, G., Clough, O.T., Walker, J.A. et al. The perception of patient safety in an alternate site of care for elective surgery during the first wave of the novel coronavirus pandemic in the United Kingdom: a survey of 158 patients. Patient Saf Surg 15, 11 (2021). https://doi.org/10.1186/s13037-021-00284-8

³ NHS (2022), Delivery plan for tackling the COVID-19 backlog of elective care. p20. Available online: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2022/02/C1466-delivery-plan-for-tackling-the-covid-19-backlog-of-elective-care.pdf

⁴ GOV.UK (2021) UKHSA publishes new recommendations for COVID-19 infection prevention and control https://www.gov.uk/government/news/ukhsa-publishes-new-recommendations-for-covid-19-infection-prevention-and-control

⁵ NICE guideline NG125, Surgical site infections: prevention and treatment https://www.nice.org.uk/guidance/ng125/chapter/Context

⁶ Diaz et al (2015) Surgical Site Infection and Prevention Guidelines: A Primer for Certified Registered Nurse Anesthetists, AANA Journal, 83;1 https://www.aana.com/docs/default-source/aana-journal-web-documents-1/jcourse6-0215-pp63-68.pdf?sfvrsn=1ad448b1_6

⁷ GIRFT SSI National Survey 2019 https://gettingitrightfirsttime.co.uk/wp-content/uploads/2017/08/SSI-Report-GIRFT-APRIL19e-FINAL.pdf

⁸ Clinical study to assess the safety and efficacy of BARRIER® EasyWarm®, an active self-warming blanket used to prevent hypothermia. Data on file. 2012.

⁹ NICE guideline CG65 Hypothermia: prevention and management in adults having surgery https://www.nice.org.uk/guidance/cg65/chapter/Context

¹⁰ Mölnlycke (2020), Time to Act: A State of the Nation report on Surgical Site Infection in the UK. Available on request.

This is a sponsored article.

NAO urges DHSC and NHSE to act on systemic pressures hindering ICS priorities

By Gabriel Blaazer

New report calls for action on workforce, social care and wider financial sustainability, as new figures show worsening picture for NHS waiting lists and staff vacancies.

The National Audit Office (NAO) has called on NHSE and DHSC to deliver national-level strategies addressing workforce and social care issues to allow integrated care systems (ICSs) to fulfil local priorities on prevention and health inequalities, in a new report, Introducing Integrated Care Systems: joining up local services to improve health outcomes, published today.

The report states that “inherent tensions between meeting national targets and addressing local needs… mean that there is a high risk that ICSs will find it challenging to fulfil the high hopes many stakeholders have for them.”

It comes as the NHS continues to hit unwelcome milestones. NHSE figures released today show the number of people waiting for hospital treatment topped 7 million for the first time in August, while just 56.9 per cent of A&E patients in September were seen within four hours, which is a record low.

The NAO’s report urges DHSC and NHSE to clarify a realistic set of medium-term objectives for ICSs, “to ensure ICSs can make progress on prevention and local priorities”, and states the need for government support in addressing the current workforce crisis engulfing large sections of the wider healthcare system, including social care.

The NAO fears for ICSs’ ability to fulfil their primary objectives – joining up local services and addressing health inequalities – if there is no national-level action to tackle the long-standing pressures on the NHS.

NHS bosses are growing increasingly concerned about the system’s ability to cope with demand this winter, with NHS England’s National Medical Director, Professor Sir Stephen Powis, saying the service was anticipating “a difficult winter ahead.”

“You can’t have a healthy economy without a healthy society.”

Tim Gardner, Senior Policy Fellow at The Health Foundation, described the latest waiting list figures as “a grim milestone for the NHS”, adding that “the data should be a warning to government that NHS and social care services are already under severe strain, even before winter starts to bite.”

The Shadow Health Secretary, Wes Streeting, said: “It is totally unacceptable for millions of people to be left waiting months or even years for treatment, often for painful and debilitating conditions.

“Twelve years of Conservative understaffing of the health service is holding our economy back, with patients unable to work while they wait. You can’t have a healthy economy without a healthy society.”

Saffron Cordery, the Interim Chief Executive of NHS Providers, said: “The NAO’s report highlights how tough it will be for systems to deliver stretching efficiency savings. Systems face significant operational challenges including workforce shortages, increased activity to tackle backlogs and ongoing Covid-19 pressures, all of which are creating major cost pressures.”

Sarah Walter, Director of the NHS Confederation’s ICS network, said: “Many of the barriers highlighted by the NAO still ring true to what our members are experiencing. Recently, ICS leaders have been growing increasingly concerned by the government’s lack of attention and coherence across its departments… [including] the pausing of its planned obesity and mental health strategies, in addition to the apparent disappearance of the white paper on health disparities.

“ICS leaders are clear that they cannot be subjected to further national targets at the expense of tackling specific local issues, especially when central funding is not given to deliver them.”

Meanwhile, against the backdrop of the first potential nationwide nursing strike, Health Secretary Thérèse Coffey told The Evening Standard that “nurses can leave if they want to”, apparently rejecting the idea of any pay increase for nurses. “I feel we have acted, and NHS staff have already been offered an annual pay rise of £1,400. We have accepted the recommendation of the pay review body,” she explained.

When challenged on the fact that many qualified nurses are leaving the NHS to seek work abroad, Dr Coffey replied saying “it is their choice of course if they want to do that, but then we also have an open route for people to come into this country who are professional staff.”

The Health Secretary has previously been accused by the Royal College of Nursing of “having her head firmly in the sand.”

Cost of living hits social care staff as vacancies soar

By Gabriel Blaazer

As a Health Foundation report finds care home staff are more likely to be living in poverty than other health workers, figures from Skills for Care show the social care vacancy rate has risen to a record-high.

Skills for Care’s annual social care workforce report has shown a drop in the number of care workers in England for the first time in 10 years. It follows a new report from the Health Foundation which finds that care home staff are far more likely to be living in poverty than other health workers, with one in five living in poverty before the latest cost-of-living crisis, compared to one in eight of all workers.

The findings have raised fresh concerns over the viability of a career in care. Despite a stream of pleas for the government to raise the status and pay of care workers, Skills for Care’s report also shows that 80 per cent of jobs in the economy pay more than the average job in social care.

Estimates within Skills for Care’s report show a three per cent fall in the number of posts filled in 2021-22 (amounting to 50,000 posts), the first time a drop has been recorded in 10 years. As such, the vacancy rate in adult social care has risen to 10.7 per cent, the highest rate since figures began in 2012-13. However, the number of vacancies in adult social care also increased by 52 per cent over the last year, up 55,000, and now stands at 165,000 vacant posts.

Furthermore, the starter rate for carers fell from 37.3 per cent in 2018-19 to 30.8 per cent in 2021-22, while staff turnover rates remained at a similar level (29 per cent in 2021/22), meaning that a similar proportion left their roles with fewer staff to replace them.

Taken together, the figures suggest that longstanding difficulties in recruiting and retraining staff are behind the fall in overall workforce numbers, rather than a decrease in demand.

Speaking about Skills for Care’s report, Professor Martin Green, Chief Executive of Care England, said: “This report illustrates the impossible challenge currently facing independent care sector providers. A growing number of people are living with increasingly complex conditions but are being supported through an insufficient government funding pot.

“A lack of government action has had a significant consequence on providers’ ability to recruit and retain staff, with staff being lost faster than they can be replaced. The writing is on the wall and immediate help is urgently required to secure the future sustainability of the sector.”

In-work poverty increasing among social care workforce

Using national survey data from April 2017 to April 2020, the Health Foundation found that around one in 10 residential care workers experienced food insecurity during this time, with 13 per cent of residential care workers’ children living in material deprivation – unable to afford essentials like fresh fruit and vegetables or a warm winter coat. Among the children of all working families, this figure stood at 5 per cent.

Care home staff were also found to be twice as likely to be in receipt of in-work benefits compared to all workers, with around 20 per cent of residential care home workforce drawing on universal credit and other legacy benefits from 2017 to 2020, compared with 10 per cent of all workers.

Given that these figures account for the period before the latest cost of living crisis and Covid-19, the Health Foundation suggests that the picture has likely worsened since 2020; food costs rose by 13 per cent in August 2022 and the annual rate for clothing and footwear was 7.6 per cent in the year to August 2022, up from 6.6 per cent the previous month.

Commenting on the Health Foundation’s report, Hugh Alderwick, Director of Policy at the Health Foundation, said: “Social care workers – who are mostly women – play a vital role in society but are among the lowest paid workers in the UK, and experience shocking levels of poverty and deprivation. Many cannot afford enough food, shelter, clothing and other essentials, putting their health at risk.”

With inflation topping 10 per cent following the Chancellor’s disastrous September ‘mini-budget’, and showing no signs of dropping, there are real fears for the ability of the social care workforce to function under the current circumstances.

Many criticised the absence of a workforce plan in Health and Social Care Secretary Thérèse Coffey’s announcement to the House of Commons in September. The latest reports have prompted renewed calls for the government to issue a comprehensive and fully-funded workforce plan for social care in England, as well as broader measures that tackle the root causes of poverty.

The Health Foundation accuses the government of prioritising the needs of the wealthy over the needs of average workers, although considerable funding has recently been made available to provide support with energy bills. However, they argue that “despite [the government’s] 45p tax rate U-turn, its plan for growth will mostly benefit the richest households.”

“£15 an hour – it’s the least they deserve”

Hugh Alderwick added: “Sustained underfunding of social care has contributed to unacceptable pay and conditions for staff and major workforce shortages, with vacancies in England rising by 52 per cent last year. This reflects political choices. If government values people using and providing social care, it must act to tackle low pay and insecure employment conditions in the sector.

“People on low incomes are most likely to struggle through the current cost-of-living crisis, and poverty in the UK is set to increase. Yet government’s plan for growth prioritises tax cuts over investment in public services – with a further squeeze on public spending likely to follow.”

GMB, the general workers’ union, is citing the report in it calls for social care workers to receive £15 per hour. Rachel Harrison, GMB Nation Officer, said: “Care workers are an immensely skilled, compassionate workforce who do an incredible difficult job. Instead of being properly rewarded, they are expected to survive on a whisker above the minimum wage.

“Essential care is delivered by underpaid and mostly women workers. And without the dedication of our care workers the whole house of cards will come tumbling down. GMB is campaigning for care workers to be paid no less than £15 an hour – it’s the least they deserve.”

News, Tunstall Healthcare October 11, 2022

Redefining place-based care: facilitating system change

By Graham Brown

Graham Brown, UK&I Marketing Director at Tunstall Healthcare, discusses what the future holds in regards to service transformation and place-based care, and how technology can facilitate access to care and reduce health inequalities.

In order to redefine care and achieve preventative services that reduce health inequalities, it’s important to approach healthcare services both holistically and through targeted resolutions to specific areas of care provision.

By starting with place-based care and the role of technology, it is possible to approach issues around prevention and proactivity and the tailoring of care to individual people and communities. This in turn will help care providers to combat health inequalities and improve access to health, social care and housing.

Defining place-based care

Place-based care presents multiple opportunities, as well as some intrinsic challenges. In order to capitalise on the opportunities that are presented, we must first define ‘the place’ and what this means to the people both providing and receiving health and social care services.

When defining place-based care it’s important to consider the different demographic regions across the UK. There are disparities in the health and wellness of communities with different population characteristics, with affluent areas tending to be more well and living longer than those in poorer areas. Any attempts to tackle these inequalities must therefore be able to target different demographics, by taking into account disparities in access to technology, health and wellbeing, and life expectancy.

The local nature of ICSs will mean that the professionals involved are better placed to understand the needs of different populations and the communities in which they are based. This will then enable better collaborations so that place-based care can be defined, which will in turn support more tailored care that plays a key role in reducing health disparities between communities.

The majority of the population moves between different places, such as the workplace and home, on a daily basis, and this impacts our ability to deliver place-based services across a range of sectors. However, this presents significant challenges when it comes to health and care delivery. Consideration of how to adapt where and when care is provided to each individual that needs it is very important if services are to become proactive and preventative.

A key question is how to ensure that the right objectives, targets and outcomes to manage this are in place. For place-based care to integrate technology and be truly effective, it has to be mobile.

Person-centred and community care

Achieving personalised care will support the transition beyond a holistic approach to one where it is possible to deliver place-based care that targets specific areas, particularly those that require transformation.

Only by making person-centred care a reality can healthcare services be transformed to become flexible and have a place-based approach at their core. To look after a population as a whole in the right places, we need to look after individuals first, particularly through individualised health and care records.

Timings and the evolution of service provision will need to flex for different areas, and the skillset of the workforce will have to change accordingly. By bringing equilibrium to the living standards and available opportunities of our population, we will see an immediate and sustained benefit on health and wellbeing and a reduction in the need for severe elective activities.

Funding streams and ICSs

Changes in funding streams could precipitate a real system change that removes the silos that are currently placing barriers on delivering the most effective services with their own outcomes. However, it is first necessary to take a step back and define these outcomes, to keep the population healthy and deliver real change.

Considering single accountability and each step of an individual’s care journey will empower Tunstall to support ICSs in their role. For example, providing winter funding to social care services first, rather than straight to the acute trust, could have the potential to cut the numerous problems and pressures that the colder weather places on healthcare services and reduce the number of people requiring hospitalisation and other complex care services.

This will be further supported by real collaboration and integration across the system, with a particular focus on enabling data sharing. If issues and demand are addressed earlier, budgets and funding streams can be allocated to the specific areas that need them, and professionals will have peace of mind that there will be fewer significant hospitalisations of vulnerable people.

Falls protection is a particular point that places significant pressures on the health and care spectrum. For example, unaddressed fall hazards in the home are estimated to cost the NHS in England £435 million.1 If the right funding streams, people and technology are put in place, we can build on preventative and proactive approaches to reduce the number of people experiencing falls and the complex and often severe elective activities that can occur. This will in turn lead to a significant pressure being removed from the system.

The impact of technology

Technology’s role as an enabler can move the prevention agenda forward, however it is only valuable if it drives sustainable system change. In order to integrate technology effectively, we must bring the right skill sets into our services to ensure they can deploy digital solutions successfully.

Technology can have a significant impact on the citizen, particularly with the advancement of wearable technology. The ongoing progress that’s been made around data privacy is likely to continue, particularly as the next generation grows up in a digital-first landscape. This will lead to citizens being more comfortable with health and care technology and their data being fed directly into their health and care records.

Technology can provide a longitudinal profile of an individual instantaneously, which is particularly important for personalised care provision, and for making citizens feel more in control and responsible for their own health, wellbeing and care. The more that technology is integrated into care provision, the more empowered the population will become.

However, technology can also initially make people feel less empowered which has contributed to the uptake challenge. Providing education to citizens and care providers can help them to understand how and why they should use technology, which is ultimately to help people live freely and independently in a place of their choice.

Facilitating system change

Tunstall can facilitate system change by integrating technology into our services and considering big data, trends analysis and early indicators. Preventative services will develop effectively when individuals are willing and open to engage with technology and allow the right people to have access to their data. If this engagement is not driven forward, it’ll be more challenging to generate system change and the generational improvement that is needed.

The need to address short term pressures is one of the fundamental challenges within our services. Immediate pressures can become overwhelming and all-=encompassing, which then make it challenging to get to the root causes and tackle them in a systemic way. This is where technology can help, by increasing the bandwidth of the people who can make these changes happen. By giving them access to the right information in the right way they will have the ability to make the right changes at a place based and population level.

As a leading provider of technology, Tunstall is working closely with ICSs to understand the challenges that are faced by our health and care services and how these can be solved collectively. Technology leaders should be focused on breaking down barriers between organisations to help ICSs have the desired impact. Communication through the system, partnerships and problem solving will drive a central vision that ensures shared outcomes.

For more information, please visit www.tunstall.co.uk.

This article was kindly sponsored by Tunstall Healthcare.

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Ethicon showcases product portfolio in UK & Ireland hospital tour

By Ethicon

Ethicon, the Surgical Technologies Company of Johnson & Johnson MedTech, has launched its first-ever roadshow across the UK & Ireland, including a showcase that demonstrates the role of digital innovation in supporting the NHS to tackle the backlog of patients waiting for treatment.

Ethicon is committed in its mission to support healthcare systems to treat more patients and provide better experiences and outcomes, especially as recent announcements from the Department for Health and Social Care show how important digital transformation of the healthcare system is, with £2 billion earmarked from the spending review to help digitise the NHS and social care sector.

The Ethicon roadshow began in September and runs until early December. It is a unique opportunity for clinical and non-clinical healthcare professionals to speak to representatives and industry experts about how driving digital transformation is pivotal in this mission, outlining the importance of Ethicon’s Surgical Simulation Strategy and Services & Solutions offering which gives surgeons additional information to support their clinical decision-making.

The products being showcased on the tour bus cover specialties including Colorectal, Gynaecology, Thoracic, and Bariatric. Ethicon’s digital offering has the potential to drive the next surgical revolution, bringing together the value of Next Generation Robotics and Instrumentation, Advanced Imaging, and AI-powered Digital Solutions.

Learn more about Ethicon and its product portfolio here.

“We’re focused on creating a differentiated digital ecosystem including working in partnership with our dedicated account management team to support a successful implementation, data insights, and best practice sharing,” said Jenny Nagy, Ethicon’s General Manager in Great Britain. She continued to highlight the value the company sees in this collaboration:

“Our Ethicon roadshow will give customers the opportunity to discuss innovation in healthcare and witness our innovations first-hand with our product demos hosted on the bus. Our mission may have been accelerated by the pandemic, but we’re keen to connect with our customers in-person to demonstrate the value we place on working together to advance the use of technology in tackling the biggest healthcare challenges.”

The Ethicon tour bus is also hosting:

Science of Energy Training
Surgical Simulation Suite
Product Training Innovation Workshops
New Product Innovations

Clinical and non-clinical healthcare professionals can register their interest in attending and booking a slot at their chosen hospital location here.

This is a sponsored article.

An opportunity to secure sustainability

By Rusheen Bansal

Care England, the largest and most diverse representative body for independent providers of adult social care in England, has welcomed a new Care Provider Alliance publication as an opportunity for Local Authorities to recognise the pressures facing independent providers now and in the future.

The report, Provider Market Sustainability – Planning Support to Councils, produced by Care Provider Alliance (CPA), reflects a number of care providers’ thoughts on the Fair Cost of Care process and lays out their key concerns to assist local authorities in creating realistic Market Sustainability Plans ahead of the 14 October deadline.

The Fair Cost of Care (FCoC) exercise is a process of engagement between local authorities, commissioners, and providers, data collection, and analysis by means of which local authorities and care providers can arrive at a shared understanding of the local cost of providing care.

The FCoC exercise is aimed at helping local authorities identify the lower quartile, median, and upper quartile costs in the local area for a series of care categories. It is the purpose of the FCoC exercise to identify accurately the gap between what is currently paid, and what rate is sustainable for the future.

CPA was tasked by provider members to produce this report for councils to consider ahead of finalising their Market Sustainability Plans.

Professor Martin Green OBE, Chief Executive of Care England, commented: “This report evidences the significant pressures care providers are currently operating under. It is now incumbent upon Local Authorities to recognise these pressures in their Market Sustainability Plans due to be submitted to the Department of Health and Social Care on 14 October, to reflect the current and future reality of the sector to sustain the workforce and financial viability, whilst also to address the impact of rising energy and agency costs, as well as rising inflation.”

“The Fair Cost of Care exercise was engaged with by around 32 per cent of care homes, equating to 41 per cent of care homes places in England. With such a significant representation of data, Local Authorities now have the evidence they require to secure the future sustainability of the sector. There is no room for further excuses.”

Alongside Cost of Care exercises, local authorities are required to develop and submit a provisional Market Sustainability Plan, which will be followed by a final Market Sustainability Plan when local government budgets for 2023 to 2024 have been confirmed.

The key concerns for providers detailed within the CPA publication were workforce, energy, inflation, and return of operations and capital. Some key costs that local authorities should account for are:

Vacancies are up 52 per cent in the last 12 months against a 48-year low in unemployment
60 per cent of providers will need to uplift carer pay in addition to their annual pay uplift, due to the cost-of-living crisis
88 per cent of providers struggle to secure agency staff
Recruitment costs are up 127 per cent in the last 2 years
Overseas recruitment costs £3-5k per annum and in some locations, accommodation is unable to be sought
Even after the introduction of the Energy Bill Relief Scheme and the introduction of a cap, energy prices for providers are 3-4 times what it was 12 months ago
Food inflation is over 15 per cent of total costs currently for care home providers
Insurance premiums can be 400 per cent higher than pre-pandemic levels
Councils do not apply sufficient Return on Operations or Capital levels to sustain providers who need to maintain a profit/ surplus to invest in their organisations and to stay in business

According to the findings of the House of Commons Levelling Up, Housing and Communities Committee report titled Long-terms funding of adult social care, a gap of £7 billion was identified to respond to the growing problem of unmet needs and access to care. So far, £1.36 billion has been pledged as a part of the FCoC exercise to improve care systems bottom-up through strategic spending by local councils according to its local circumstances.

NHS community pharmacies sound alarm as inflation bites

By Gabriel Blaazer

The National Pharmacy Association (NPA) has raised concerns about the future of the community pharmacy sector, with a new report highlighting the impacts of inflationary pressures

The NPA commissioned the investigation into the implications of inflation on community pharmacy commissioned in June 2022 following large spikes in inflationary pressures this year. Professors David Taylor of University College London and Panos Kanavos from the London School of Economics and Political Science were asked to investigate the capability of community pharmacy across the UK to purchase and dispense NHS and other medicines and to become more focused on the provision of clinical services.

The report, Protecting the UK Public Interests in NHS Community Pharmacy, was published in September 2022 and warns of several thousand community pharmacies in the UK having to close thanks to rising costs and ‘flat’ NHS pharmacy funding.

The overall number of community pharmacies in England has fallen by 600 since 2018, about 5 per cent of the total. This number was likely kept artificially low thanks to temporary additional payments that were made to pharmacies during the Covid-19 pandemic, while many pharmacies that remain open have only done so by accepting reduced incomes and incurring more debt.

Many have also reduced the services they offer, cutting loss-making discretionary services and reducing opening hours. A FOI request has revealed that between December 2020 and July 2022, 1600 pharmacies in England reduced their opening times by an average of six hours per week in a bid to cut costs.

Many of the pharmacies that remain under threat are located in more deprived areas, where further closures of pharmacies risks widening existing health inequalities. The report warns that serious damage could be done to the NHS’ medicine supply without urgent government action to help community pharmacies remain as viable going concerns.

However, the picture looks less grim outside of England, with initiatives in Scotland and Wales producing a more stable outlook for community pharmacies there. In Wales, shifts in the balance of NHS pharmacy fees towards providing clinical services, as opposed to dispensing medicines, are being introduced, while in Scotland, prescribing pharmacists are now able to diagnose and treat a variety of conditions that previously would have required GP intervention thanks to the Pharmacy First Plus scheme.

Inflation, inflation, inflation

The report comes after Ernst & Young (EY) were commissioned by the NPA to conduct a study of the funding, policy and economic environment for independent community pharmacies in England. This study was concluded in September 2020 and predicted a deficit of £500 million in community pharmacy funding by 2024. It also asserted that the current financial framework for the NHS pharmacy network was unsustainable.

According to figures from the NPA, the inflation adjusted value of NHS community pharmacy ‘global renumeration sum’ fell by 10 per cent between 2015 and 2017 (see Figure 1 below). It has remained at £2,592 million since then, with no annual allowance for inflation. As things stand, the proportion of English NHS funding allocated to pharmacies will have fallen in real terms by over one third in the period 2015-2024, falling from 2.4 per cent to 1.6 per cent. However, higher inflation rates and increased NHS outlays mean that the drop is likely to be larger.

Figure 1 (click to enlarge): The Community Pharmacy Global Sum in England to (projected) 2024 in current prices and at 2015 prices, CPI adjusted. Source: Professor David Taylor, Professor Panos Kanavos. Authors’ estimates based on ONS and NHS data.

The current Community Pharmacy Contract Framework for England was agreed upon for the period 2019-2024, before the pandemic and the recent inflation crisis. It would have been appropriate to expect a 2 per cent annual inflation rate when the ‘flat NHS funding’ contract sum was agreed upon. However, with inflation sitting at over 10 per cent, and expected to remain there for potentially one or two years, community pharmacies in England are now facing up to net funding shortfalls of 15 per cent in 2023 and 20-25 per cent in 2024, against what could have reasonably been expected in 2019.

Following the steep rise in inflationary pressures in 2022, the new report, Protecting the UK Public Interests in NHS Community Pharmacy, was commissioned by the NPA. It urges the new government to intervene to prevent further pharmacy closures and ensure the viability of the sector throughout the current period of economic turbulence.

The report does, however, point to some signs for long-term optimism, notably the fact that all new pharmacy graduates will qualify as prescribers by 2026. The government has recently announced its ambition for community pharmacy to assume some of the clinical services burden, thus relieving pressures on GP practices and A&E departments.

Such measures were also recommended by a recent Public Policy Projects report, ICS Futures, and the NPA say that that under the new integrated care systems, a transformation of community pharmacy’s role can be achieved, “given sufficient political, managerial and professional will to pursue the public’s best interests.”

Intelligent Healthcare: the tech transforming the NHS

By Gavin Wheeldon

Manchester-based technology company, Purple, is playing a vital role in the digitalisation of the NHS with its innovative ‘Intelligent Healthcare’ solution. Gavin Wheeldon, Chief Executive Officer, discusses the future of the healthcare sector and the vital tech required to drive this digital transformation.

This is a sponsored article.

As the world continues to recover from the crisis that is the Coronavirus pandemic, the healthcare industry is under immense pressure to catch up and keep up. With patient numbers reaching an all-time peak and 6.5m people on the waiting list for hospital treatment, healthcare providers are searching for solutions to stop the backlog growing even further.

Many are understandably resorting to people power to help solve the problem. As a result, a number of hospitals and facilities are continually inundated with waves of new, temporary and student staff. Staggering statistics show that hospitals in England spent more than £1.7billion on agency staff in the first three quarters of 2020-21 alone.

But what the healthcare sector needs are viable ways in which it can innovate, speed up and revolutionise its service to make things much more efficient – to ease the pressure on this growing employee base and to support the overall patient experience. The NHS 2022-23 business plan highlights an absolute dedication to “transforming care through harnessing information and technology”, with the overall strategy focussed on a “care […] to digitalise services, connect them to support greater integration and, with these foundations, enable service transformation.”

Driving the change

Purple are at the forefront of this digital transformation. Thanks to their ‘Intelligent Healthcare’ platform, Purple are able to help hospitals revolutionise for the long term. Their vital technology offers healthcare facilities large and small a range of different tech-led solutions; from real-time location of employees and wayfinding for patients to the launch of Purple’s innovative asset tracking technology.

Purple’s ‘Intelligent Healthcare’ platform

The latter was recently launched by the Purple team in order to provide staff with the ability to keep track of hospital assets such as drugs and apparatus in real time, through their phones. As an interactive ‘indoor Google map’, the platform’s integrated wayfinding hardware then enables them to navigate towards those assets in the hospital as required.

Speedy solutions and wayfinding tech

It is estimated that nurses spend at least one hour of every shift searching for critical pieces of equipment and medication, with only 31 per cent of their total time being spent with patients due to this admin.

As an asset tracking and navigation tool, Purple’s new digital capability will help increase efficiency, reduce costs and improve patient experience for healthcare organisations up and down the country, as well as in the US.

Not only will staff be able to closely monitor and reach their materials more quickly and efficiently, but hospital visitors and patients will also be able to find their way around the hospital much more swiftly, alleviating unnecessary stress and allowing them to focus on the priority of health.

Creating efficiencies

Using Purple’s technology, pharmacies and healthcare providers also have the option to track their medicines on site using mini tags which can help better manage their prescription services. By attaching a mini tag to either a medication bag or an individual vial, applying a BLE tag to a medication cart or by using individual badge tags on delivery personnel, medical providers can better understand where the medication, cart or personnel is located using a mobile device or portal. Upon arrival on site, pharmacies will be notified that medication has arrived by using Purple’s Geo Fences, which initiate notifications.

Purple’s asset tracking solution, combined with the wider intelligent healthcare package, has the potential to help the NHS address the £300m in lost medicine reported every year – money that could pay for more than 11,000 community nurses or almost 20,000 more drug treatment courses for breast cancer.

A trusted provider

With 60 per cent of British employees now using apps on their mobile phones to perform their duties to a higher standard, this shift to tech-first will be a key driver in the digitalisation and future of the healthcare sector.

Purple already provide Wi-Fi to a number of healthcare providers in the UK, including Croydon University Hospital and Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust. As well as providing connectivity for patients, staff and visitors, Purple’s service it goes beyond the limits of everyday Wi-Fi, allowing for real time alerts and information sharing.

In partnership with VCU Health, their team were able to harness its wayfinding solution to create a personalised navigation app for all eight buildings and the VCU Medical Centre as well as its corresponding parking decks. Vitally, Purple’s resource here offers patients a downloadable route which can take them from their front door right to their appointment.

Their app gives a turn-by-turn direction to the exact unit or clinic location allowing patients to arrive on time and anxiety-free. Patients are also equipped with the ability to manually search for facilities such as food and dining and shops on site – and even return to their car or other saved locations.

The future of the sector

Without doubt, the increasing support required by the NHS and wider healthcare community is staggering. Fortunately there is a straightforward solution at hand. These technological advances will serve to alleviate nurses’ valuable time, reducing unnecessary admin and relieving some of the additional stress encountered in the workplace.

If Purple’s Intelligent Healthcare platform can go even part-way to bridging the gap in staff shortages and waiting times, it will have succeeded in its aim. Equipping healthcare professionals with the tools they need, will allow them to focus on delivering vital care, transforming the patient experience for the better.