Health Inequality, Population Health, Primary Care, Thought Leadership September 30, 2022

Has the government given up on its health ambitions?

By David Duffy

David Duffy analyses Theresa's Coffey's start as health secretary.

Despite the already catastrophic impact of the government’s mini-budget, the first casualty of the government’s short-termist approach to governing was health and care.

Amid the ongoing response to the government’s remarkably misguided mini-budget, recent announcements from DHSC have flown somewhat under the radar of national media. But last Friday’s postponement of the health inequalities white paper is a reflection of a 12-year-old government who have become devoid of long-term strategic thinking in health and care.

Much like how Mr Kwarteng’s budget is being criticised for seeking a short-term growth boost while sacrificing economic stability, Ms Coffey’s health announcements so far seem to be aimed at garnering public support in the short term, and fail to into account the long-term causes of ill health and the enduring challenges facing the sector. Our Plan for Patients, Thérèse Coffey’s first stab at a plan for health and care, is receiving as much attention for what it misses as what it includes, with glaring omissions around workforce strategy and health inequality.

Last week it was reported that new Health and Care Secretary intends to postpone, and potentially scrap, the publication of the long-awaited government health inequalities white paper. It is estimated that health inequalities cost the UK £31 billion to £33 billion per annum before Covid-19 and the paper was a key part of Boris Johnson’s leveling up initiative. When first announced by then Health Secretary Sajid Javid back in February, the intention was to set out “bold action” to deal with disparities in health outcomes based on race, gender and income.

In response, over 155 members of the Inequalities in Health Alliance (IHA) last week wrote to Coffey urging her to maintain the commitment to publishing a Health Disparities White Paper (HDWP) by the end of this year.

The Alliance said: “The DHSC and NHS will be left in the ultimately unsustainable position of trying to treat illness created by the environments people live in”.

The IHA have urged for the government to restate its commitment to health inequalities, warning that “focusing on individual behaviors and access to services alone will not be enough to close the almost 20-year gap in healthy life expectancy that exists in England between those from the least and most deprived communities.”

“that the Secretary of State has so far chosen to ignore the issue almost entirely poses ominous signs for the future health of the nation”

Whether or not you agreed that Johnson’s levelling up initiative was ever truly going to become a reality, it did help kickstart hugely beneficial discourse around health inequality, further prompted by the uneven impact of Covid-19. It was clear from recent Public Policy Projects meetings between system leaders that there is a growing consensus that tackling health inequality is the central objective of integrated care systems (ICSs). With ICS leaders in agreement on the need for action, what has happened to the government’s desire for “bold action” on health inequality?

The obvious answer is that while the economy is rapidly deteriorating and every government department is being asked to find ‘efficiency savings’, long term social and economic rejuvenation is taking a back seat. But in the context of a deepening cost of living crisis, the fact that the new Secretary of State has so far chosen to ignore the issue almost entirely poses ominous signs for the future health of the nation.

Cost of living

Recent polling from the Roya College of Physicians has found that even by May 2022, 55 per cent of people felt their health had been negatively affected by the rising cost of living, with the increasing costs of heating (84 per cent), food (78 per cent) and transport (46 per cent) reported as the top three factors.

Rising costs are creating environments for preventable ill health to manifest in deprived areas across the nation, ultimately impacting health services – but of course, the crisis directly impacts health providers, as well as those delivering care.

NHS Providers have published a shocking new survey from its membership, revealing that some staff are electing to not eat during work hours in order to provide for their children, with some quitting altogether to find better paid work in pubs and bars. Other key findings from the survey include:

71 per cent of trust leaders reported that many staff are struggling to afford to travel to work;
69 per cent said the cost of living is having a ‘significant or severe’ impact on their ability to recruit lower-paid roles such as porters and healthcare assistants;
61 per cent reported a rise in mental health sickness absence;
81 per cent are ‘moderately or extremely’ concerned about staff’s physical health;
95 per cent said that cost of living increases had significantly or severely worsened local health inequalities;
72 per cent said they have seen more people coming to mental health services due to stress, debt and poverty;
51 per cent said they have seen an increase in safeguarding concerns as a result of people’s living conditions.

The health and care community is united in its concern for the wellbeing of its staff and for their capability to respond to the underlying causes of the nation’s health challenges. Unfortunately, the government is failing to match this concern with sound, long-term policy – this epitomised by Our Plan for Patients.

In some ways, it can hardly be a shock that the government is losing its desire to implement long-term health policy; Coffey is the country’s fifth Secretary of State for Health in as many years and must also balance this role with the position of Deputy Prime Minister. Even still, much of the sector has been taken back by some of Our Plan for Patients’ glaring omissions, as well as questioning some of the key commitments within it.

In setting out her key priorities as Health Secretary, the threadbare document published last week attempts to establish Coffey as a “champion” for patients. So far, the plan has achieved little more than alienating much of the health and care community, while simultaneously discrediting the last 12 years of government health policy.

Primary care

“Ministers are quick use the pandemic to excuse ominous backlogs in elective care, yet they do not offer the same leeway for the primary care sector”

One of the central aims of Our Plan for Patients is the expectation for all patients to receive a GP appointment within two weeks of request. In setting this wholly unrealistic, arbitrary national target, without providing additional support for GPs to achieve it, Coffey is seeking to create a doctors vs patients dynamic.

It’s a cheap tactic, designed to pick up votes, and the right wing press immediately came out in support of it. The Daily Mail blamed ‘soulless megapractices’ for ‘Glastonbury style 8am ticket rushes’ – the simple and highly flawed suggestion is that GPs must ‘do more’ and ‘care more’ to improve access to services.

“Targets don’t create doctors,” said Helen Buckingham from the Nuffield Trust, one of many organisations and figures who criticised the target. Former Health Secretary Jeremy Hunt insisted in the Commons that “adding a 73rd national” target for GPs would not address the challenges in the sector. Matthew Taylor Chief Executive of the NHS Confederation simply said the plans “do not go far enough”.

Fundamentally, the UK has a rapidly ageing population with increasingly complex conditions and comorbidities to manage – and it does not have the staff to deal with it. The Health Foundation recently revealed a shortage of full-time 4,200 GPs, with that number projected to rise to about 8,900 by 2030/31. Further, there are 132,000 vacant posts across the NHS. This number includes 47,000 nurses and more than 10,000 doctors.

In the face of these challenges, primary care teams continue to perform remarkably. The latest figures show that GPs carried out 26.6 million appointments in August, up from the previous month and over three million more than in August 2019 – before the pandemic. Nearly half of appointments in August took place on the same day that they were booked and over 80 per cent within two weeks of booking. Almost 70 per cent of these appointments were delivered face-to-face.

Ministers are quick use the pandemic to excuse ominous backlogs in elective care (despite the fact that there were already four million people on waiting lists before Covid-19 hit), and yet they do not offer the same leeway for the primary care sector and continuously fail to acknowledge its achievements.

Primary care was at the centre of the UK’s highly successful Covid vaccine rollout, one of the few genuine achievements of Boris Johnson’s government. All the while the sector maintained impressive rates of service delivery in other areas and managed to rapidly adapt to digital consultations, ensuring that as many patients as possible received care with little to no infection risk.

Rather than support and celebrate a sector that delivered when we most needed it, the government has decided to point the finger at primary care – demanding more from GPs without providing them with the means to deliver.

Unfortunately, initial noises from the current ‘government in waiting’ will have done little to reassure primary care professionals. Shadow Health Secretary Wes Streeting has not only reaffirmed the gas lighting of GPs but has gone a step further, promising same day face-to-face GP appointments to anyone who wants them if Labour were to win power – an announcement already dismissed by the British Medical Association as “not being grounded in reality”.

Even in a political sense, this seems a needless promise to make while the Tories continue to haemorrhage support in all policy areas. A recent YouGov poll suggests that Labour are four times more trusted by the public to manage healthcare – the party should use this political capital to outline long-term health policy that addresses fundamental workforce shortages.

We need our leaders to be realistic and honest with the public about what is possible, and not automatically assume “meeting public expectations” is best for primary care without seeking to manage those expectations.

In the absence of a bona fide, long-term workforce strategy from Westminster, perhaps it is time that we had a government that faced a hard truth: that not every patient should get to see their GP upon request. Patients and end-users should be better engaged with system reform so that they are more aware of the options available to them within health and care and not resort to using GPs for every request – there are simply not enough doctors to see everyone.

Where is the integration agenda?

“This is ‘sugar rush’ politics at its worst. A short-termist approach to governing that is designed to garner a quick dose of public support while the long-term needs of the sector go ignored.”

Political leaders must reaffirm the aims and objectives in the NHS Long Term Plan and indeed the recent Health and Care Bill. In integrated care, there is a principle for care delivery which is designed to segment patients to different parts of the system – delivering them the care that most appropriately addresses their needs while protecting the precious capacity of seriously understaffed and under-resourced parts of the sector.

It is concerning that supporting the development of ICSs, and their focus on addressing health inequality through population health strategies relevant to specific regions, received so little attention in last week’s announcements. If properly supported, ICSs can act as conveners of public services beyond health and care, and so have a huge role to play in revitalising communities and addressing broader inequalities.

The term ‘ICS’ does not appear once in Our Plan for Patients, and the only references to ‘integrated care’ are made in the context of describing integrated care boards as ‘local NHS services’. The whole point of integrated care, i.e., the heart of the government’s flagship health legislation only published two months ago, is to unite a disparate health and care system under a common purpose to improve health outcomes. This of course includes providers within the NHS, but it also includes social care, primary care and wider local government and community care.

As Richard Vize outlined recently in the British Medical Journal, the government has repeated the age-old trope of essentially treating social care as a discharge service for NHS hospitals. Yes, it is true that that a healthy social care sector would alleviate pressure on the NHS, but social care should be so much more than a pressure valve for hospitals.

For many with serious and lifelong conditions, social care is the lifeline that enables them to interact with the world and live with dignity and independence. Politicians who treat social care as a mere afterthought would do well to remember this.

As well as this, the care sector harbours unique insight and intelligence into local health challenges and could provide a hugely meaningful career option for thousands of new recruits. The government should be looking to professionalise the social care sector while helping ICSs to harness the expertise that already exists within it to improve population health outcomes.

There should always be a dual purpose to health reform: addressing immediate challenges while moving towards common, long-term objectives. Immediate problem solving is essential – patients deserve the best possible care that the system is able to give them and right now they are having to wait too long to get it or not receiving it at all. But in purely focusing on the immediate, more visible issues, such as GP waiting times, the government fails to address the root of the problems. The sector needs more staff, better equipment and more resource.

To make matters worse, there are already worrying rumours that the government plans to scrap its obesity targets. Alongside smoking, obesity is one the largest preventable causes of ill health and contributes significantly to cancer rates. Scrapping targets before they have barely had a chance to have an impact makes the promise in this plan to “support people to live healthier lives” ring rather hollow.

This is ‘sugar rush’ politics at its worst. A short-termist approach to governing that is designed to garner a quick dose of public support while the long-term needs of the sector (and ultimately the public) go ignored. It seems that finally the Conservatives have now stopped pretending they have any intention of fixing this very broken health and care system.

It will be of little reassurance that DHSC has already begun rolling back some of these expectations, with the two-week GP appointment target pushed back to the Spring of 2023. The damage has been done, Coffey has drawn her ‘battle lines’, and seeds for a crisis winter like no other for health and care have already been sown. Compounding this is the fact that the government seems incapable or unwilling to provide light at the end of the tunnel in the form of a long-term plan for health and care.

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35,000 patients diverted from primary care through social prescribing hubs

By Rusheen Bansal

NHS Property Services announces the successful delivery of more than 50 buildings and outdoor spaces converted into social prescribing hubs to ease burden on primary care ahead of a winter crisis.

NHS Property Services (NHSPS) has announced the successful delivery of more than 50 buildings and outdoor spaces being used as social prescribing hubs by members of local communities across the country.

The government-owned company has helped local communities up and down the UK over the last three years by identifying, converting, and handing over 54 tailor-made hubs where people can access non-clinical services such as outdoor gyms, sensory gardens, suicide prevention counselling, breastfeeding advisory sessions and ‘toy libraries’ for families to engage in social interaction.

Patients are encouraged to take greater control of their own health and improve their wellbeing in a bid to help reduce mounting pressures on clinical and acute services. Rhea Horlock, Head of Corporate and Social Responsibility for NHSPS comments: “Passing the 50-hub milestone is important progress in our efforts to support NHSE in meeting its targets for 900,000 people to be referred to social prescribing by 2023/24. We are committed to continue to grow our social prescribing programme to bring this valuable support to more local communities”.

It is estimated that about 35,000 people have been able to access services and spaces located at the converted sites since the project began in 2019. This includes patients experiencing a range of physical and mental health issues, including people with special educational needs/learning difficulties and disabilities, people with physical and mental health issues, young carers, asylum seekers and refugees, expectant parents, and adult offenders

This supports NHS England’s announcement earlier this summer to recruit 2,000 link workers to ease the demand on primary care this winter. Hubs like the ones successfully delivered by NHSPS will be a vital component in ensuring the NHS remains resilient as winter pressures are expected to be the worst to date.

One example of this kind of space delivered by NHSPS is The Listening Space in London, set up to provide ongoing face-to-face support available for many people with chronic suicidal feelings, given by well trained and professionally supervised volunteers.

CEO Sarah Anderson CBE shared: “Although The Listening Place was only established five and a half years ago, with a second full time premises opened in partnership with NHSP, and even more Volunteers trained, we are now receiving and responding to more than 500 referrals a month.”

With the NHS Long Term Plan expecting to be refreshed over the coming months, non-clinical interventions such as social prescribing are expected to feature as a core focus for innovation given their proven results to reduce the pressures on primary and acute care. NHS Property Services will continue to support the development of hubs across the NHS estate to support this growing ambition.

Labour’s 45p tax rate pledge welcomed as workforce crisis set to deepen

By Gabriel Blaazer

With nearly one in five NHS and social care workers planning to leave for better pay, the RCP welcomes Labour’s plans to double the number of doctors by restoring the 45p tax rate.

New research has revealed that 43 per cent of health and care workers are considering a job change due to the pressures of their current job, with nearly a fifth (16 per cent) planning to leave the industry completely.

The findings come after Labour pledged to reinstate the 45p tax rate, abolished by Chancellor of the Exchequer, Kwasi Kwarteng, to fund the doubling of medical training places for doctors and nurses.

The announcement from Labour’s Shadow Chancellor, Rachel Reeves, has been welcomed by groups representing the doctors and the NHS, with the RCP President, Dr Sarah Clarke, saying: “We have long called for a doubling of medical school places and were pleased that on Monday the Shadow Chancellor set out Labour’s pledge to do just that.”

Labour have also committed to adding an extra 10,000 nursing and midwifery clinical placements every year, as the NHS and social care battle unprecedented workforce crises which went largely unaddressed in Thérèse Coffey’s first major policy announcement as Health and Social Care Secretary last week.

Addressing a workforce in crisis

Labour have also pledged to recruit 8,500 mental health workers, a move which was welcomed by NHS Providers’ Director of Policy and Strategy, Miriam Deakin, who said: “It is good too to hear a focus on mental health, tackling health inequalities, investing in expanding the workforce and boosting prevention in the community.”

Summarising the effects that more than a decade of cuts and underinvestment have created, Shadow Health and Social Care Secretary, Wes Streeting, said: “Because people can’t see a GP they end up in A&E, which is worse for them and more expensive for the taxpayer.

“Because people can’t get the mental health support they need, they reach a crisis point, which is worse for them and more expensive for the taxpayer. Because people can’t get the social care they need, they’re left stuck in hospital, which is worse for them and more expensive for the taxpayer.”

Responding to Wes Streeting’s speech, Dr Clarke added: “Training more doctors is essential to addressing the challenges that we know the healthcare system will face in the future, such as the rising demand that will come with an ageing population.

“The Shadow Secretary of State’s speech also recognised that a lack of social care leads to people staying in hospital for longer than they need to. A long-term funding settlement for social care is vital to speeding up discharges from hospital and preventing admissions in the first place by enabling more people to live fulfilling, independent lives.”

Responses to Labour’s policy pledges differ sharply to those recently announced by the Conservative Government. Professor Martin Marshall, Chair of The Royal College of GPs, said of the latter’s plans that: “Lumbering a struggling service with more expectations, without a plan as to how to deliver them, will only serve to add to the intense workload and workforce pressures GPs and our teams are facing, whilst having minimal impact on the care our patients receive.”

Underlining the scale of the challenge, Miriam Deakin added that: “With a staggering 132,000 vacancies across trusts and many more in primary and social care, we need a long-term national workforce plan to help the NHS and social care recruit and retain the staff they need. Without this, efforts to improve patients’ access to care will be challenging.

However, Labour has received criticism from some quarters, after Wes Streeting announced at the Labour Party Conference that Labour would require all GPs to offer face-to-face appointments to anyone who wants one. The British Medical Association said the plan was “not grounded in reality”, and suggested that GPs are simply “not trying hard enough”.

“The lack of support on the ground is leading to mass burnout”

The survey of more than 1,000 health and care professionals in England was conducted by Florence, a technology platform providing health and social care workers access to available shifts, and paints a damning picture of how low morale and burnout are impacting an already stretched workforce.

It finds that almost a third of healthcare workers (28 per cent) admit to feeling overwhelmed at least once a week, with 17 per cent feeling burnt-out every day. Meanwhile, 97 per cent stated that the cost-of-living crisis has caused further stress or burnout among healthcare professionals.

It comes after more than half of healthcare workers (56 per cent) admit to working more than 2-3 times a week over their contracted hours, with 7 per cent working overtime every day. Not having enough staff is causing the most pressure in their role (50 per cent), followed by low pay (39 per cent) and high workload (35 per cent).

Fiona Millington, Chief Nurse at Florence, who has long argued that vacancy rates are a big problem within the sector, commented on the NHS’s current situation, saying: “The biggest challenge for the industry at the moment is, without a doubt, staffing. There are more nurses leaving the industry than joining, at a time when the demand for nurses is increasing. The number of vacancies still sits above 105,000 and remains much higher than the overall unemployment rate.

“The lack of support on the ground is leading to mass burnout across the workforce, leading many to question their futures in the profession. The NHS is plugging vacancies with resources from other countries and areas but it has become just a constant cycle of crisis management, without developing long term solutions to the problem.”

World Pharmacists Day: UK pharmacists join the celebration of modern pharmacy to create healthier futures

By Rusheen Bansal

Pharmacists from across the globe have shared their thoughts on the changing role of pharmacy as part of celebrations to mark International Federation of Pharmacists’ (FIP) World Pharmacists Day 2022.

27 pharmacists from across the globe and the AmerisourceBergen family, a pharmaceutical distributor, have contributed to a digital book of celebration, which aims to highlight the changing role of pharmacists and how they can create healthier futures.

Pharmacists are no longer just ‘chemists’ – some pharmacists are now able to diagnose, treat and prescribe for patients who traditionally may have needed to see a doctor or GP, and the government now plans to give more of a role to community pharmacy to alleviate the pressure on GPs. Others are guardians of their local community – keeping an eye on vulnerable patients who may not have regular contact with other healthcare professionals.

Raj Rohilla of Midhurst Pharmacy (West Sussex)/Goys Pharmacy (Battersea)/ Hamlins Pharmacy (Shepherds Bush) noted: “We need doors to open and mindsets to change so that all healthcare professionals can work collaboratively to improve the health and wellbeing of people.”

During the COVID-19 pandemic they stepped up to support stretched healthcare systems, with many taking a leading role in the world-wide response. This has evolved further with more and more pharmacists offering vaccination services for COVID-19, as well as flu, chicken pox and ‘holiday’ vaccinations.

This changing role of pharmacists is helping the health and care workforce to unite to create healthier futures for their local communities.

Monitoring critical power

By Shane Brailsford

An ‘uninterruptible power supply’ (UPS) protects critical loads in the event of a power outage. The UPS, backed up by batteries, will automatically take the place of the mains supply to provide back-up power to elements such as emergency lighting and critical IT equipment.

This is a sponsored article.

For medical facilities, the UPS can be set up to support the load supplying operating theatres and intensive care units. Therefore, regular preventative maintenance and monitoring of the UPS and associated batteries is essential. Monitoring can be one of the cheapest exercises any facility can undertake, and yet, also one of the most valuable.

Unresolved remedial recommendations can lead to system failures, which can literally be life-threatening. UPS systems are designed using essential components which are classed as consumables, such as capacitors, fans and batteries, all of which require regular preventative maintenance checks and have a recommended age for replacement. For example, fan failures can lead to overheating of the UPS causing a potential shut down. In addition, if capacitors are not replaced within the recommended timeframe, this can lead to substantial component failure.

It is usually not practical for on-site personnel to check a UPS visually multiple times per day for a status update. In practice, many UPSs are tucked away from day-to-day business areas and not checked for long periods of time. However, remote monitoring provides a simple solution.

Remote monitoring enables a visual status of the UPS to be monitored without the need to check the system physically. This can be easily achieved using an inexpensive Simple Network Management Protocol (SNMP) card. The SNMP card is connected to the facility’s network which allows an organisation to receive alerts about events taking place in real-time. This means that in the event of an outage or, in the worst-case scenario, a system fault, the reaction time of on-site personnel is significantly quicker, resulting in reduced Mean Time to Repair and increasing the availability of the system.

Setting up the SNMP card is straightforward as it is ‘plug-and-play’ technology. All that is needed is a connection to the facility’s network. Once completed, the UPS supplier will provide support to ensure that specific alerts are set up in-line with UPS system’s events log. For example, in the event of a power outage, an event alert is sent to the assigned destination in real-time so that action can be taken immediately. The SNMP is crucial to the long-term monitoring of the UPS and its environment, as well as for ongoing system management.

In a medical facility, in addition to an SNMP card, the UPS may need to communicate with Theatre Control Panels (TCP) that are located in operating theatres. These TCPs provide a form of monitoring and control for clinical staff, alerting them to any change of status of the UPS and other installed technology during operations and procedures. It is important to note that not all UPS systems are designed with the number of volt free contacts required to send the alarm signals to the TCPs. It is important to check with the UPS manufacturer ahead of purchasing to ensure this can be achieved.

Batteries are also an essential part of a UPS system. To comply with NHS England’s health technical memoranda regulations, medical facilities are required to have a 10-year, fire retardant, screw terminal battery block. In most circumstances, these battery blocks are required to provide 60 minutes of ‘run time’ or autonomy and need to be configured with multiple strings. In the event of an outage, power from the batteries will continue to support critical functions on site for this agreed amount of time. Batteries can also be monitored remotely via a Battery Analysis & Care System (BACS) which can also be integrated into the network.

In addition to constant remote monitoring, regular preventative maintenance visits (PMV) are essential. Twice yearly PMVs by manufacturer trained engineers will ensure that the UPS is performing optimally, and that the correct firmware upgrades are implemented. Critical components such as capacitors and fans are given a full health check to prevent the risk of downtime.

UPS systems are powerful fail safes for medical facilities. The cost of not monitoring could be catastrophic in terms of damage to equipment, not to mention the consequences of loss of the critical load if the UPS is protecting power for patients in the operating theatre. UPS monitoring should therefore be seen as an inexpensive, yet necessary, aspect of facilities management.

Centiel’s experienced team is always available to discuss and help evaluate the best approach, to UPS design, installation and management to suit any facility’s critical power protection needs. For further information please see: www.centiel.co.uk

Shane Brailsford, Area Sales Manager, Centiel UK

“It’s not just a crisis, it’s a national emergency.” NHS leaders in Wales urge action to protect social care

By Gabriel Blaazer

A recent Welsh NHS Confederation survey of over 50 NHS leaders in Wales throws up stark results, painting a picture of a social care system struggling to cope with demand and a pressing need for a long-term pay and funding strategy for the sector.

100 per cent of the 50+ NHS Wales leaders surveyed agreed there is a crisis in the social care workforce, with a subsequent impact on patient care and safety.
Many of the respondents said pressures in the care sector are driving urgent care demand, with a lack of social care capacity having an impact on the ability to tackle the elective care backlog.
94 per cent of those surveyed agreed the crisis is worse than it was 12 months ago and almost nine in 10 expect the situation to deteriorate over winter.

Social care services play a crucial role in care pathways –caring for people at home, keeping people well for longer outside of hospital and enabling faster, safer discharges home. The sector plays a critical part in protecting NHS capacity and its ability to deliver high-quality, safe care.

However, social care services are facing significant challenges, including vulnerabilities in funding and market stability, growing unmet need and high levels of staff vacancies. The impact of these challenges means people are missing out on vital care and support, leaving them less independent and more likely to rely on healthcare services. In a new survey conducted by the Welsh NHS Confederation, NHS leaders have signalled their alarm at the deterioration of social care across Wales, with one labeling the current situation as “the single most important issue for the NHS.”

NHS leaders in Wales have stated their support for their social care colleagues and are urging the government to increase investment in care services. They warn that the crisis in social care is impacting every single part of the NHS, from ambulance services and emergency departments to elective care, diagnostics, GPs, mental health services and community care.

Along with increases in pay, almost nine in ten healthcare leaders surveyed supported an increase in investment to expand overall social care capacity and improve career profession opportunities to boost recruitment and retention. 93 per cent said this would be the most effective action that could be taken with 95 per cent of leaders surveyed felt it would be ‘very’ or ‘quite’ effective to have better integration between health and care services.

They say failure to act will leave more and more vulnerable people without the care and support they need, as well as adding further pressure on frontline NHS services.

Actions are being taken, in partnership, to mitigate pressures across Wales, but without real system change, the Welsh NHS Confederation warns that existing efforts cannot go far enough.

The Welsh NHS Confederation is calling on the government to:

Provide sustainable funding for social care with a fully funded pay rise to enable recruitment and retention, alongside greater overall investment and career progression opportunities.
Support better integration between health and social services to achieve seamless care and support for the patient.
Provide sufficient, ring-fenced funding and longer-term investment to transform out of hospital care and allow and long-term service development.
Publish locality based delayed discharge data so there is clear information and evidence of the current issues in providing packages of care to people leaving hospital.
Introduce performance measures that focus on quality-based outcomes, prevention, community services and whole-system collaboration.

Commenting on the survey and subsequent calls for action, Darren Hughes, Director of the Welsh NHS Confederation, said:

“If we don’t want the system to fall over this winter, we need immediate short-term intervention, as well as a sustainable plan and funding model in the long-term. Decisive action is needed now to commit to making it attractive to work in social care and increase the numbers of social care staff.

“This is not a new problem, but one that has snowballed over the years to the point of crisis. We know steps are being taken to alleviate pressures, but these are not having a great enough impact.

“Of course, this not the only challenge the NHS is dealing with but working together to improve patient flow and ultimately giving more patients the care they need and deserve is the top priority for NHS leaders.

“Without immediate action, both the NHS and social care could face an endless winter where people are being failed by the very systems that should be there to support them at their most vulnerable.”

Jonathan Griffiths, President of Association of Directors of Social Services Cymru, said: “All leaders across health and social care will need to work very hard this winter to find additional capacity in the system.

“However, delayed discharge is just one symptom within a wider set of challenges in the integration of health and social care support for people, and as such it cannot be considered in isolation. We must consider other factors and variables, including inappropriate hospital admissions, risk managed decision making and crucially, workforce supply.”

Delivering a safe recovery: The importance of patient hygiene in improving infection prevention outcomes

By Dr Tod Brindle

This is a sponsored article.

The COVID-19 pandemic has made us all more aware of the risks of developing an infection. Yet, as with so many other areas of patient care, the challenge of COVID-19 has lessened our collective focus on other types of infection, such as healthcare-associated infections (HCAIs).

If left unchecked, the long-term implications of HCAIs could be significant, placing even greater demands on overstretched nursing and infection prevention teams and the NHS as a whole.

The work of nurses in mitigating HCAIs is significant. In reflecting on their importance, it is crucial to ensure that they, and wider infection prevention teams, have the most effective tools available to ensure that patients have the best quality of care. Daily whole body washing with a chlorhexidine gluconate (CHG) based solution, is one such measure that can make a significant difference to patient outcomes.¹

Risk of HCAIs for the NHS

Since the pandemic, HCAI cases have increased significantly.² Their scale and impact are considerable. They constitute a significant financial burden on the NHS, costing an estimated £1 billion per year, with £56 million of this incurred after patients are discharged from hospital.^3,4 Mitigation strategies reliant on soap and water bathing techniques do not adequately address the challenge of HCAIs in at-risk patient demographics.⁵ Improving infection prevention control measures is therefore an effective means of reducing preventable illnesses, bringing down costs and, most importantly, protecting patients across the clinical pathway.

Whole body washing in promoting patient health

Whole body washing helps lower the risk of HCAIs by cleaning patients through skin antisepsis.⁶ In particular, treatments that use a 4 per cent CHG solution have been proven to kill pathogens on contact.⁷ Unlike soap and water preoperative washes, patients offered whole body washes are reported to have less adverse skin conditions, fewer complications and are less likely to be readmitted to hospital.^8,9 This offers nurses a highly effective means to ensure that patients can recover from their surgeries in a safe and healthy manner.

Prevention as the best cure: whole body washing promotes readmissions and promotes a healthy recovery

Whole body washing acts as a preventative tool, which unlike soap and water techniques, can reduce readmission rates and rates of infection.¹⁰ When whole body washes were utilised by Guys and St Thomas’ NHS Foundation Trust, nurses and clinicians found that it led to a sustained reduction and almost total elimination of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia from the ICU units.¹¹ A joint study conducted across eight Trusts found that implementing whole body washing in the hospital environment resulted in a 39 per cent drop in patients developing an infection in hospital. Whole body washing was also found to help mitigate the risks posed by dangerous HCAIs such as Vancomycin-resistant Enterococcus (VRE), MRSA, and Infections from central venous catheters, at surgical sites or from ventilator use.¹²

Whole body washing also serves as a holistic process to promote high quality hospital hygiene, that not only mitigates the risks of HCAIs but also acts as a preventative tool. At a time when NHS resources are spread thin, the initial investment in whole body washes can pay dividends through reduced equipment usage and reduced patient bed days. The Royal Brompton NHS Trust has found that using 4 per cent CHG whole body washes helped patients recover with reduced risks from becoming reinfected.¹³

Conclusion

It is now more important than ever for trusts to reflect on the numerous benefits that daily whole body washing offers for patients. With the heightened risk of HCAIs, we owe it to our patients and nurses to drive a change in hygiene practices that can protect them from illnesses and help to deliver a safe recovery for all.

¹ Lewis, S., Schofield-Robinson, O., Rhodes, S. and Smith, A., 2019. Chlorhexidine bathing of the critically ill for the prevention of hospital-acquired infection. Cochrane Database of Systematic Reviews

² https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/961210/S1056_Contribution_of_nosocomial_infections_to_the_first_wave.pdf

³ Assets.publishing.service.gov.uk. 2022. [online] Available at: <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/212798/Sage-2-percent-Chlorhexidine-Gluconate-Cloth.pdf> [Accessed 5 April 2022].

⁴ Nice.org.uk. 2022. Introduction | Healthcare-associated infections: prevention and control in primary and community care | Guidance | NICE. [online] Available at: <https://www.nice.org.uk/guidance/cg139/chapter/introduction#:~:text=Healthcare%2Dassociated%20infections%20are%20estimated,patients%20are%20discharged%20from%20hospital.> [Accessed 4 May 2022].

⁵ Nice.org.uk. 2022. Overview | Surgical site infections: prevention and treatment | Guidance | NICE. [online] Available at: <https://www.nice.org.uk/guidance/NG125> [Accessed 7 April 2022].

⁶ https://www.who.int/infection-prevention/tools/surgical/appendix2.pdf

⁷ Denton GW; 2001. Chlorhexidine. Chapter 15 in Disinfection, Sterilization and Preservation. Ed. Block SS. Fifth Ed. Lippincott Williams and Wilkins

⁸ Swan, J., Ashton, C., Bui, L., Pham, V., Shirkey, B., Blackshear, J., Bersamin, J., Pomer, R., Johnson, M., Magtoto, A., Butler, M., Tran, S., Sanchez, L., Patel, J., Ochoa, R., Hai, S., Denison, K., Graviss, E. and Wray, N., 2016. Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU. Critical Care Medicine, 44(10), pp.1822-1832.

⁹ Tanner J et al. A fresh look at perioperative body washing. Journal of Infection Prevention. 2012; (13) 11 – 15.

¹⁰ Swan, J., Ashton, C., Bui, L., Pham, V., Shirkey, B., Blackshear, J., Bersamin, J., Pomer, R., Johnson, M., Magtoto, A., Butler, M., Tran, S., Sanchez, L., Patel, J., Ochoa, R., Hai, S., Denison, K., Graviss, E. and Wray, N., 2016. Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU. Critical Care Medicine, 44(10), pp.1822-1832.

¹¹ Wyncoll D, Shankar-Hari M, Beale R; 2015. Daily Bathing with 2% CHG Washcloths Leads to Almost Total Elimination of MRSA Bacteraemia. King’s Health Partners

¹² Assets.publishing.service.gov.uk. 2022. [online] Available at: <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/212798/Sage-2-percent-Chlorhexidine-Gluconate-Cloth.pdf> [Accessed 5 April 2022].

¹³ Rbht.nhs.uk. 2022. [online] Available at: <https://www.rbht.nhs.uk/sites/nhs/files/PILs/Your%20pre-operative%20skin%20wash%20-%20June%202014.pdf> [Accessed 7 April 2022].

Coffey defends GP targets as healthcare leaders continue to raise concerns

By Integrated Care Journal

Health and Social Care Secretary, Thérèse Coffey, today set out revised government priorities for health and care, including a controversial 2-week GP appointment target.

In a statement to the House of Commons on 22nd September, Ms Coffey outlined her department’s “A-B-C-D” of priorities, addressing challenges around ambulances, backlogs, social care and doctors and dentists. The NHS is under renewed pressure amid a soaring cost-of-living crisis, an elective care backlog currently estimated at 7 million, a record-high vacancy rate of 10 per cent, ahead of what is expected to be a difficult winter for health and care services.

The plans were lambasted by Labour’s Shadow Secretary of State for Health and Social Care, Wes Streeting, who said they show that the Conservative government is “out of ideas as to scale of the challenge”.

Among new measures announced were the intention to ensure “that everyone who needs an appointment with their practice within two weeks can get one”, as well as £500 million of additional funding to help with hospital discharge into social care

Outlining the new commitments detailed in Our Plan for Patients, Ms Coffey declared her intention to improve patient access to NHS services, saying that “patients are my top priority, and I will be their champion.” Ms Coffey cited “too much variation in access to care across the country,” and announced a renewed “intensive focus on primary care [as] the gateway” to accessing healthcare for most of the population.

A “Sesame Street” approach

Accused of taking a “Sesame Street” approach to policy by Wes Streeting, Ms Coffey outlined the various measures in the government’s latest plan for healthcare. On ambulances, the ambition is to “reduce waiting times and reduce handover delays” that contribute to pressures elsewhere in acute care.

With 45 per cent of delays in patient transfer from ambulances occurring in just 15 NHS Trusts, Ms Coffey assured the House that the Department of Health and Social Care would be working with these Trusts to ensure fewer handover delays. Also reiterated was the aim to have more patients seen in home settings, with the NHS England’s recently announced Virtual Wards plan aimed at relieving acute care capacity.

There are also plans to increase numbers of 999 and 111 call handlers, and the potential creation of an auxiliary ambulance service, although few further details were provided.

Addressing backlogs, Ms Coffey again cited existing policies, with “new” hospitals and more private sector involvement all cited as part of the plan to reduce the numbers waiting for care. The waiting list for elective care in England stood at 6.84 million in July 2022 and the National Audit Office has warned that this could reach 12 million by 2025 if capacity is not urgently increased.

It is also hoped that the new community diagnostic centres will also relieve some pressure on hospitals, as well as surgical hubs

The government’s policy paper detailing Our Plan for Patients also mentions commitments to expand hospital capacity through 62 hospital upgrade schemes, maximising the use of the private sector and changing elements of the NHS pension scheme to increase retention of doctors, nurses and other senior NHS staff.

On social care, the Secretary of State announced the new £500 million Adult Social Care Discharge Fund. This money will be made available to local health and care systems to target the “greatest challenges” in their area, with the local NHS and local authorities ultimately accountable for its implementation.

To address the social care workforce shortfall, currently estimated at 100,000, Ms Coffey announced a £15 million investment to help boost the international recruitment of care workers. This comes on top of the £500 million announced in April to develop, train and retain the social care workforce. Another previously announced measure mentioned by Ms Coffey is the push to digitise social care records, which is hoped to reduce bureaucracy and free up time to provide vital care.

Community pharmacy and ‘dental deserts’

A key plank of the government’s plans for primary care is the new expectation that patients receive a GP appointment within two weeks. This is hoped to be supported by a new role for community pharmacies, in which pharmacists will be able to manage and supply more medicines without the need for a GP’s prescription and is hoped to free up two million GP appointments annually.

National Pharmacy Association Chair, Andrew Lane, said: “As dedicated health care professionals, community pharmacists can certainly do more to help patients access primary care, but our sector is critically short of money to deliver new clinical services on behalf of the NHS.

“With the right level of investment, we are more than capable of new roles in sexual and reproductive health, and have a long track record in this sphere. As medicines experts, we are also well positioned to take on more prescribing.

“The NPA is wary of incentives to employ pharmacists and other practitioners in GP practices; this has already resulted in many community pharmacists in patient-facing roles being drawn away, adding to our workforce challenges and failing to add genuinely new capacity across the NHS system as a whole.”

The Department of Health and Social Care’s new “expectation” that all patients receive a GP appointment within two weeks was given a mixed reception, with Wes Streeting reminding the House that the two-day target that existed under the last Labour government was scrapped by the Conservatives in 2010.

Professor Martin Marshall, Chair of the Royal College of GPs, said: “It’s a shame that the health secretary didn’t talk to the college and to our members on the frontline before making her announcement because we could have informed her of what is really needed to ensure a GP service that meets the needs of patients and is fit for the future.

“Lumbering a struggling service with more expectations, without a plan as to how to deliver them, will only serve to add to the intense workload and workforce pressures GPs and our teams are facing, whilst having minimal impact on the care our patients receive.”

Also announced were the introduction of new digital tools and improving IT systems to ease administrative burdens on primary care. It is hoped that the introduction of new cloud-based telephone software will create an extra 31,000 phone lines for GP practices, making it easier for patients to contact their practices and book appointments. The government has also committed to publishing GP appointment data online to help patients decide which GP practices can best meet their needs.

On dentists, Ms Coffey decried the existence of ‘dental deserts’, and stated that the government has already changed dental contracts to incentivise dentists to take on more NHS patients, as well as more difficult cases. The recently established integrated care boards will have accountability over the provision of dentistry in their areas and from November, dental surgeries will be contractually obliged to share on the NHS website whether or not they are accepting new patients.

“Targets don’t create any more doctors”

On the proposals aimed at freeing up time for GPs, Helen Buckingham, Director of Strategy at the Nuffield Trust, stated that: “targets don’t create any more doctors. The success of this proposal will rest on whether the Government can genuinely do enough to retain doctors at risk of quitting the profession, as well as how successful it is in recruiting more support staff.”

“The government should step back from micro-managing timescales for appointments and instead focus on the outcomes they want to see in primary care”, Ms Buckingham continued. “With cloud-based telephone systems set to run alongside NHS 111, the NHS app, phoning out of hours and a multitude of other ways to access care, we risk simply proliferating ways for patients to find out the ugly truth of general practice: there just aren’t enough doctors to go around.”

Responding to Ms Coffey’s House of Commons statement the Interim Deputy Chief Executive of NHS Providers, Miriam Deakin said: “leaders across the NHS will appreciate the prompt steps taken by the health and social care secretary today to address her ‘ABCD’ list of priorities as we head into winter.

“The announcement of a new £500mn adult care social care fund to help tackle delayed discharges is a welcome boost, which will free up much needed hospital beds for those that need them most.

“But trust leaders will be seeking categorical reassurances that this funding will not be taken from NHS budgets, which are already severely stretched by inflation, energy costs and unfunded pay deals. And there needs to be recognition that this is a short-term contribution whereas social care needs a long-term funded plan and reform to put it on a sustainable footing.”

David Duffy, Editor of ICJ, said: “our health and care system has been locked in a perpetual state of crisis for some years now and we fear this latest plan from the government will do little to reassure staff across the country that better times are ahead.

“The secretary of state is right to highlight regional variation in access to care, however, today’s announcements will do little to address these long-term disparities. The £500 million in funding announced to assist with hospital discharge will have little impact without a comprehensive, long term workforce strategy for health and social care.

“The two-week target for GP appointments does not take into consideration that GPs find themselves under. The government should resist opting for nationally mandated, arbitrary targets without providing GPs and other primary care professionals with the means of achieving them.

“The government should instead reaffirm the aspirations outlined in its recent health and care bill and the NHS Long Term Plan – which both place addressing long term health inequality through more joined up service provision as a central priority.

“It is concerning that supporting the development of integrated care systems, and their focus on addressing health inequality through population health strategies relevant to specific regions, received so little attention in today’s announcements. Health and care leaders have long wanted to move away from nationally mandated targets in favour of localised approaches to care delivery and some may consider today a step backwards.”

MIRACL announces new partnership with Birmingham Women’s and Children’s NHS Foundation Trust

By Integrated Care Journal

MIRACL – the world’s only single-step multi-factor authentication provider – announces their new partnership with Birmingham Women’s and Children’s NHS Foundation Trust.

With a new directive from NHS Digital to ensure multi-factor authentication (MFA) across IT services within the NHS, MIRACL was perfectly placed to deploy their single-step MFA system in these world- renowned hospitals.

Time is of the essence for all those working in the NHS, so finding a MFA solution that was efficient yet provided the additional layer of security that was now required and, at a cost that met the tight NHS budget, was a challenge. Medical records are highly sought by cyber criminals so any data held by the hospital is always incredibly vulnerable and must be well protected on every level.

MIRACL was able to integrate their single-step MFA codelessly, in just fifteen minutes – minimising disruption to services during the implementation phase, yet providing an added layer of IT security across the organisation. With thousands of users within the Trust accessing IT services on a daily basis, the transfer happened seamlessly and without any unwanted hiccups.

Furthermore, as a passwordless solution, staff weren’t tasked with having to remember yet another password or have to share biometric data. A simple four-digit PIN is all that is required – the patented tech does the rest.

David Marshall, Head of ICT at Birmingham Women’s and Children’s NHS Foundation Trust, added, “numerous staff throughout our sites are having to access NHS IT on a daily basis, but time is always of the essence and it is essential that not only is all data kept safe and private, but staff who need to access information can do so instantly and securely. It was no surprise when we were required to add multi-factor authentication to our systems but finding a solution that would fit our needs was a challenge. MIRACL has provided a single-step MFA that does not require a password and has integrated into our systems seamlessly.”

Rob Griffin, CEO at MIRACL commented, “when we were advised that NHS Digital were directing hospitals to install MFA, we knew our solution was perfect. MIRACL provides MFA, yet requiring just a single-step to use, means that staff can access the IT services as they were before and without the need to remember another password or have a second device at hand to authenticate by SMS. We all know that staff are often working at a high pace across the NHS, so sourcing a solution that did not waste precious time authenticating was really important.”

Since deployment of the service in mid-April, there have been a total of 150,000 authentications and only 283 failures or a failure rate of only 0.18%.

MIRACL is the world’s only single-step multi-factor authentication provider. It can easily be integrated into current company and NHS platforms and is a low cost verification option but with banking level security. It boasts clients such as Experian, Domino’s and Cashfac and has been licensed by big tech names such as Google and Microsoft.

For further press information, interviews or photography please contact the MIRACL press office: sarah.sawrey-cookson@miracl.com | 07765 110438

Insource chosen as trusted data partner for NHSE reporting by Tower Hamlets GP Care Group

By Integrated Care Journal

Tower Hamlets announces Insource as managed services partner for automated data acquisition from EMIS and CSDS commissioner reporting.

Insource Ltd, a leading data management provider to the NHS, has been chosen by Tower Hamlets GP Care Group as its trusted data management partner. The first stage of the engagement will be to take data from the EMIS community system covering the 33 GP practices throughout the borough of Tower Hamlets, standardise it into a fully validated, single source of truth and automate the submission of Community Services Data Sets (CSDS) to NHS England.

Tower Hamlets GP Care Group is an independent healthcare group that brings together 33 GP practices and seven primary care networks to better support the local Tower Hamlets population. As a GP Federation, the group provide a number of primary care and community health services including 0-19 years Health Visiting and School Health, Out of Hours GP services, and the Urgent Treatment Centre based in the Royal London Hospital.

With the recent mandate from NHS England that all community providers formally complete the CSDS submissions, the GP Care Group found they were spending inordinate amounts of time doing searches on EMIS on their KPI activity and downloading CSV files to do the monthly reports for their 0-19 services.

Zainab Airan, Chief Financial Officer at Tower Hamlets GP Care Group CIC, commented, “Whilst we originally brought Insource on board to extract the data from EMIS for our CSDS reporting, we rapidly realised the value of that core data for our own performance and business management.

“The data tables from EMIS are all over the place. Insource takes that data, makes it clean and usable, and automates our monthly NHSE reporting. But now we also have near real-time activity data for our own use. We can sit our own systems, such as Power BI, on top of this unified data to get quite sophisticated analyses.”

This single version of the truth will also be shared with frontline staff, such as health visitors, so they can track where they are with their contractual KPI targets and see how many 1-year checks are due this week, or how many new birth visits are outstanding. It will give everyone from the executives to the frontline the same data at their fingertips. So all have better insight into how they’re performing and how to make service improvements.

The GP Care Group also recently won a tender for 0-19 services in the nearby London Borough of Waltam Forest, whose GPs also use EMIS. They now aim to mirror what they are achieving in Tower Hamlets, within Waltham Forest and ultimately do dual CSDS submissions to the two NHS Commissioners.

Insource are providing the data management and reporting solution as a fully managed service on the Microsoft Azure cloud platform, initially across Tower Hamlets then, when needed, across Waltham Forest.

Zainab Airan concluded; “With over 500 staff, we are a medium sized independent care organisation, but chose not to maintain in-depth data management skills in-house. We prefer to leave the data management to the experts and to get on with our core business of clinical care. We are very excited about this project and Insource are doing a fantastic job. They truly are a trusted data partner that will allow us to scale as our business develops.”

Lee Bellis, Sales Director B2B Partnerships for Insource, stated: “The GP Care Group are innovative thinkers and have some exciting plans in the offing including expanding their services and potentially linking to children’s centres. But the big breakthrough here is being able to access proprietary EMIS data and making it usable, as an application-independent data source, for KPI tracking and internal performance management. This is big news for all GP and Community providers and is an obvious next step for Insource.

“We are seeing more and more of our customers taking up our managed services options. Our ground-breaking data management solutions and deep NHS knowledge, developed over 20 years, is proving very attractive to clients. Our multitude of NHS-tested data feeds is growing all the time and we can get even complex sites operational within weeks rather than months.”

About Insource

Insource leverages powerful data to help healthcare organisations drive better patient outcomes, streamline operational efficiency, and extract essential insight by ensuring all foundational data is accessible for informed decision making – despite the legacy infrastructure.

Their leading elective care solutions suite supports the patient pathway management, statutory reporting, and capacity planning challenges of the whole organisation. With over 20 years’ expertise, more than 55 acute, mental health and community trusts, health boards, ICSs and independent providers currently use our services. The Insource data management platform enables informed trust-wide management, ICS insight and control, and partner solutions innovation.

For more information contact info@insource.co.uk.

About Tower Hamlets GP Care Group CIC

Tower Hamlets GP Care Group is an independent healthcare group that was formed in late 2013 to enable General Practices in the area to be more involved in the local commissioning of health services. It brings together 33 GP practices and seven Primary Care networks to better support the local Tower Hamlets population and to work alongside other healthcare providers in the Borough. As a GP Federation, the group provide a number of primary care and community health services including 0-19 years Health Visiting and School Health, Out of Hours GP services, and the Urgent Treatment Centre based in Royal London Hospital.

Employing over 500 staff, Tower Hamlets GP Care Group also leads the provision of innovative, high-quality, responsive and accessible health care services in the area and is one of six organisations that form Tower Hamlets Together, the borough’s health partnership. This brings hospital, community health, mental health, adult and children’s social services, public health, and the voluntary sector together to provide comprehensive health and social care to the community. This ensures a more coordinated approach to providing services, reducing duplication and improving the overall experience and outcomes for the patients who need them.