Young onset dementia on the rise with 70,800 UK adults affected as health crisis deepens

By Integrated Care Journal

New figures released by charity Dementia UK show a ‘hidden population’ of 70,800 people in the UK who are currently living with young onset dementia — a rise of 69 per cent since 2014.

In a recent study, researchers from the Neurology and Dementia Intelligence Team, Office for Health Improvement and Disparities, analysed datasets from GP practice records in England. By using an alternative method of identifying cases, they found that the estimated number of people with young onset dementia (YOD) in England (where symptom onset occurs under the age of 65), represented an estimated 7.5 per cent of all those living with a dementia diagnosis.¹

The findings, published in the Journal of Dementia Care, were used by Dementia UK to arrive at the ‘hidden population’ of 70,800 – a rise of 28,800 since 2014.²

Awareness of YOD is typically low, with symptoms often attributed to stress or depression when observed in those below 65. According to the Young Dementia Network, prevalence of YOD is higher among black and minority ethnic groups than the population as a whole, as well as among people with certain learning disabilities.

This World Alzheimer’s Month, the Dementia UK is calling for better awareness of young onset dementia and the need for age-appropriate services and care. The charity is warning that the prevalence figures for young onset dementia could be even higher than currently reported.

Dr Hilda Hayo, Chief Admiral Nurse and Chief Executive at Dementia UK, said: “We know that young onset dementia is poorly recognised and misdiagnosed which leads to delays in accessing crucial support. Worryingly, the figure of 70,800 adults who are estimated to be living with the condition in the UK, may just be the tip of the iceberg.

“Dementia is a huge and growing health crisis and with rising numbers, it is now more urgent than ever that families receive the specialist support they need.

“Right now, our specialist dementia nurses, known as Admiral Nurses, are providing life-changing support for families affected by all forms of dementia. I want to encourage all families affected by young onset dementia who are seeking support to visit our website for information and resources and to access our national Admiral Nurse Dementia Helpline and Clinics services.”

Dr Janet Carter, Associate Professor Old Age Psychiatry, UCL and Consultant Old Age Psychiatrist at North East London NHS Trust, who led the research, said:

“There is a misconception that dementia only affects older people and the figure released today using our findings as a basis, shows we need to do more to dispel this myth. Lack of crucial support could negatively impact on not just the individual living with young onset dementia, but also the whole family.”

66-year-old Chris Maddocks who lives in Eastbourne with her partner, was diagnosed with young onset vascular dementia in 2016 at the age of 60. In 2020, she was also diagnosed with Lewy body dementia. On both occasions, Chris was not referred to any services or given any information. She was left to search for answers on her own.

“I attended the Elderly Care Assessment Unit on my own, was given a diagnosis of young onset vascular dementia and told to go home to get my affairs in order. I felt like I had been given a death sentence. I cried for three months and became a prisoner in my home. My partner and I hit many brick walls trying to seek information and find the right support.

“I experienced the same after being diagnosed with Lewy body dementia and was not signposted to any services. Two weeks later, I was connected to an Admiral Nurse who finally gave me the answers that I was looking for. I was talking to somebody who understood what was happening and could explain a lot of the symptoms. And for the first time, it made sense. Without her experience and knowledge, my partner and I would have struggled to prepare for our future with dementia. Post-diagnosis, my Admiral Nurse was my lifeline.”

To find out more about young onset dementia, visit dementiauk.org/young-onset-dementia

¹Over 42,000 people under 65 years of age living with dementia in the UK, 5.2% of the total living with dementia ARUK site – Prince, M et al (2014) Dementia UK: Update Second Edition report produced by King’s College London and the London School of Economics for the Alzheimer’s Society

²Prevalence of all cause young onset dementia and time lived with dementia: analysis of primary care health records. Carter. J, Jackson. M, Gleisner.Z, Verne.J Journal of Dementia Care 2022.vol 30 No 3 — The study findings demonstrates that of the total number of people living in England who have a formal diagnosis, 7.5 per cent (33,454) received their diagnosis under 65 (young onset dementia). This estimate of the national prevalence figure of those diagnosed under 65 as 7.5 per cent, was then applied to the UK accepted estimate of people living with dementia which includes those diagnosed and those who are not — this is the 944,000 figure to reach the 70,800 figure. The young onset dementia estimate was extrapolated from those diagnosed under 65 and still living in England from the GP records studied and reported in the Journal of Dementia Care article.

New report calls for changes to systems leadership in healthcare

By Dr Axel Kaehne; Dr Julie Feather

A team of researchers have produced a landmark rapid review of systems leadership in healthcare, concluding that the NHS must better define what it needs from its leaders to address emerging challenges and policy changes.

Systems leadership in the NHS in England focuses on leading beyond organisational and professional boundaries to implement policy changes and meet budget requirements. However, despite increased recognition, there is no commonly agreed definition of what NHS systems leadership entails.

The NHS Leadership Observatory commissioned a team of researchers led by Dr Axel Kaehne and Dr Julie Feather from Edge Hill University’s Evaluation and Policy Unit to undertake the review of systems leadership, with support from Professor Naomi Chambers and Professor Ann Mahon from the Alliance Manchester Business School at the University of Manchester.

Their report has identified that the NHS lacks a clear definition of what systems leadership means and what qualities NHS leaders need to fulfil their roles. It recommends carrying out further studies to close these gaps and write a clear definition for NHS leaders to adhere to.

Postdoctoral Research Fellow Dr Julie Feather, who is part of Edge Hill’s Evaluation and Policy Analysis Unit, said: “Systems leadership refers to leadership attributes, qualities, behaviours, mindsets and actions which have a system-wide impact.

“This complex set of skills is essential in the modern NHS, but our report identified that leaders in the NHS don’t fully understand their role or the importance of being systems leaders which must be urgently addressed.”

The review is set against a policy background of the formal establishment of 42 Integrated Care Systems (ICS) across the NHS in England in July 2022. These are partnerships between the organisations that meet health and care needs across an area, aiding in cooperation and planning.

The creation of ICS means that more than ever NHS system leaders are required to have the skills necessary to steer and manage dynamic transformations across organisations. Adding to this is the need to balance longer term system sustainability with the reality of limited resources, all while improving population health outcomes and tackling health inequalities.

Existing NHS policies and research do not offer any generic set of skills for this type of work.

Reader in Health Services Research and project leader Dr Axel Kaehne added: “Our report identifies the complexity of being a systems leader and calls for further analysis to determine what training and development will be needed to ensure NHS leaders are properly supported to be able to steer and manage change in an increasingly unpredictable external environment.”

Professor of Health Leadership Ann Mahon from Alliance Manchester Business School said: “One of the important findings of our review was an almost universal absence of research on equality, diversity and inclusion as a critical perspective on the development of effective system leadership either from the workforce or the community perspective. This is a serious gap in the research that needs to be addressed.”

Other recommendations in the report include examining the needs of systems leadership within the context of the newly developed Integrated Care Boards; exploring how Equality, Diversity and Inclusion (EDI) can be embedded into business as usual through the lens of systems leadership; and explore how leaders can embrace technological advances.

The full report can be accessed online.

Dr Axel Kaehne is Vice President of EHMA – European Health Management Association

Dr Julie Feather is a qualified and registered social worker and a Postdoctoral Research Fellow in the Evaluation and Policy Analysis Unit at Edge Hill University.

Acute Care, News, Population Health September 12, 2022

Virtual wards are failing patients and clinicians: we must bridge the gaps before winter

By Elliott Engers; Tom Whicher; Elina Naydenova

With virtual wards vital to the NHS’s ability to function this winter, three experts assess what is needed to bridge the gaps in provision ahead of increased demand.

In early August, NHS England unveiled its new plan to increase the NHS’s capacity and resilience ahead of winter’s inevitable pressures. An increased use of virtual wards featured prominently in this plan, in line with their national target of 25,000 virtual beds to be operational by 2023.

With hospitals overwhelmed like never before, it’s not hard to understand why transferring patient care into the home – in a safe and controlled way – is an extremely beneficial proposition. But existing solutions are missing the mark. Despite much innovation, delays in adoption mean that the full transformative potential of the tech-enabled hospital at home has not yet been realised. We are now at a tipping point: on the heels of a global pandemic and one of the busiest summers yet, a tough winter is looming. It is time to get virtual wards right; for patients, for healthcare professionals and for the NHS.

Existing solutions don’t go far enough

‘Virtual wards’ are not new and versions of the concept – including ‘Hospital at Home’ – are already being used to support unwell and deteriorating patients to stay at home, as well as to discharge patients from hospital sooner.

What is generally considered to be a virtual ward often extends to little more than remote monitoring at home. While this does free up hospital beds, the impact on both clinical time saving and patient outcomes falls well short of potential.

This is because, overwhelmingly, staff must use old, inappropriate tools to manage remote patients – tools that weren’t built for this new paradigm. Many approaches are manual, slow, admin-intensive, and not advanced enough to scale.

New ways of working need new solutions

Remote care requires an entirely different way of working, and needs new technologies to manage it and make it scalable. Right now, communication and the flow of critical information is blocked. Electronic task lists and care coordination features are not flexible enough to fulfil the unique needs of virtual wards, where patients are not co-located with healthcare staff. Integration is near non-existent, and workflows are not built for mobile access, nor do they allow tasks to be allocated and tracked in real-time.

We must go further for patients or clinicians. A true virtual ward solution can do more – should do more – to protect patients and make clinicians’ jobs more manageable.

Creating a true virtual ward

If virtual wards are to be done correctly, and their potential fully realised, innovation and action must focus on six areas:

1. The right information at the right time

For virtual wards to save valuable clinical time and ensure high quality care, data generated in patients’ homes must be of equivalent quality to that captured in hospital. It should also be distilled into actionable insights to save clinicians from filtering large amounts of data. And here lies the problem.

The 2019 Topol Review emphasised that large volumes of unfiltered data can be immensely overwhelming for an already overworked workforce. We know that conventional remote monitoring generates noisy data that wastes clinical time and can mislead clinical assessments, introducing risk.

To overcome this, advanced tools are needed, such as those utilising AI, to take on the time-consuming task of reviewing millions of data points to ensure quality and translate data into insights.

2. Seamless patient engagement

Patient engagement tools must be a core component of virtual wards, ensuring patients have a positive experience and feel confident that they can contact the clinical team if they need.

Good patient engagement provides a seamless experience whether a patient is co-located with clinicians in an acute hospital setting, or in the community.

Patients should receive ad hoc or scheduled contact via a method that suits them. This could be a digital assessment form sent to the patient, providing a low cost but highly effective method that complements data gathered from remote monitoring devices.

Patients should also be able to easily request a phone, video, or in-person appointment at a time that suits them.

In combination with care coordination and remote monitoring tools, effective patient communications are a powerful way to keep patients safe and them and their families reassured.

3. Proactive rather than reactive management of health

Moving from reactive to proactive management of patients’ health means two things for virtual wards:

Firstly, care must be targeted to patients pre-admission to hospital instead of post-discharge. This means initiating virtual care in the community to minimise the risk of admission, especially for ambulatory care sensitive conditions. More importantly, when it comes to avoidable admissions to hospital and frail patients, this could prevent a deterioration in their condition, which could happen off the back of a hospitalisation and could cost them their independence.

Secondly, mechanisms must be in place for early detection of deterioration. Therefore, being able to identify early signs and intervene before complications and readmissions to hospital become inevitable.

4. Health equity by design

The pandemic has revealed the multi-layered inequities that impact healthcare access and healthcare outcomes. One way in which virtual wards must address these is by investing in scalable community workforce models – that include healthcare assistants – to support care delivery to patients who cannot self-administer.

A second way to promote equity is by ensuring that no one is digitally excluded due to, for example, poor WiFi connectivity or lack of digital confidence or capability. Equally important is to look beyond physical symptoms to integrate social determinants of health into the modelling, planning and delivery of virtual wards.

5. Effective skill-mixing and empowerment

Enabling a diverse network of multidisciplinary staff to participate in the delivery of virtual wards is critical to resourcing these new models of care without adding to doctors’ and nurses’ workloads.

From healthcare assistants, to patients, to their friends and family members, different stakeholders should be empowered to fuel a proactive model of care at home. This includes training, decision-support tools and streamlined workflow management – and requires tools to handover and assign the right tasks to the right healthcare professionals – to cover the effective identification and appropriate escalation of health issues.

6. Effective task management

The best outcomes from virtual wards will result from multidisciplinary staff having secure access to a shared list of patients and the tasks that need to be done for them. They should be able to review the list in virtual ward rounds or whenever required, add and allocate tasks, and mark them as accepted, in-progress, or completed for colleagues to see or track. The entire team ought to have visibility and be able to collaborate and coordinate care remotely, ensuring caseload management is efficient and safe.

Automated workflows can make it easy for staff to identify where readings from intelligent remote monitoring devices fall outside of set ranges, supporting safer and more effective clinical decision-making.

Enabling a new era of care delivery

At this moment, NHS organisations have a unique opportunity to begin the virtual wards roll out on the strongest possible footing, with the best solutions in place. A focus on the six pillars that encompass care coordination, patient communication and remote monitoring, will accelerate a successful transition to a new era for care delivery, and help establish virtual wards as a credible, scalable alternative to acute hospital admissions.

Elliott Engers is CEO at Infinity Health.

Tom Whicher is CEO at DrDoctor.

Elina Naydenova is CEO at Feebris.

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GHM Care messaging app integrates with digital care management platform Nourish Care

By Integrated Care Journal

Advancements in nurse call technology unearths a wealth of valuable data for care homes when surfaced alongside daily care records.

GHM Care has announced their flagship nurse call messaging and reporting tool Nexus will now integrate with Nourish Care’s digital care management platform. The ability to integrate personal care records with a nurse call system is a huge step towards a joined-up care environment.

Nexus is a messaging platform that delivers nurse call alerts directly to the smartphones of carers, improving staff efficiencies and response times.

The integration with Nourish will allow Nexus users to link nurse call activity against a resident’s personal care records, driving a greater resident experience through interoperability. Care teams will have complete transparency of the time of the day calls are being made, time of acceptance, reason for the call and the resolution times. This information surfaced alongside daily care records offers contextual oversight, further promoting better care decisions and outcomes. In addition, the integration will enable care teams to run detailed reports and populate care plans within Nourish.

Care homes will benefit from a more comprehensive picture of the personal care provided through more powerful data.

Neil McManus, Managing Director of GHM Care stated: “It’s been great working with Nourish on this project and now we can deliver exactly what our joint customers have asked for. The new functionality has been launched in response to the needs of care homes who previously would not have the time or capacity to record every nurse call alert in a resident’s personal care records. As a result, there is often a disconnect between care records and nurse call activity. The new integration overcomes this by automatically updating Nourish personal care records with any associated nurse call activity.”

Steve Lawrence, Head of Proposition and Partnerships from Nourish Care added: “We are thrilled to be partnering with GHM Care, their leading nurse call solution will open the door to new and exciting data insights when surfaced alongside daily care records housed in Nourish. I look forward to seeing the positive impact this delivers for care teams and those they support.”

Training & Development Lead, Luke Annetts, from Blackadder Corporation said: “I think the integration between Nexus and Nourish has worked well, the information transfers quickly from the Nexus cloud onto Nourish. I think that this information will be really helpful for reporting purposes, especially when we look at accidents/incidents and response times”.

Nourish Care is an app-based care management platform that allows care services to record at the point of care, streamline administrative processes and equip teams with the tools to provide more person-centred care and improve outcomes for the people they support. Nourish works with more than 2,500 care services in the UK and overseas within residential homes, nursing homes, learning disability services, mental health services, and other care settings. Nourish was one of the first recognised as a NHS Transformation Directorate Assured Supplier for the Digital Social Care Records (DSCR) DPS at launch and were also the first accredited by the PRSB as a Quality Partner, working to promote best practice standards for care.

To find out more about how Nourish can help your care service, visit their website www.nourishcare.co.uk to book your free demo today.

To find out more about Nexus by GHM Care, visit www.ghmcare.co.uk.

Health worker sexual abuse reporting site launched

By Integrated Care Journal

Women in Global Health launch #HealthToo Project today, a platform to compile reporting of sexual abuse of health workers.

Sexual Exploitation, Abuse and Harrasment (SEAH) is a considerably under-reported form of violence healthcare workers face, according to Women in Global Health, an organization that campaigns for the protection of women workers in healthcare settings.

“There is a huge gap in data and research related SEAH in the health and care sector from all regions, with the most serious absence of data is in low- and middle-income countries, where women are reportedly the most affected, ” said Dr Magda Robalo, Global Managing Director, Women in Global Health.

A majority 62 percent of 330,000 health workers across a range of countries reported exposure to work related violence and harassment (WRVH) in a single year, according to the Journal for Occupational and Environmental Medicine. But this data is not disaggregated to separate the SEAH component.

In response, Women in Global Health launch today a new platform and research project entitled “#HealthToo”, to seek, compile and document stories from women health workers who have experienced work-related SEAH. The platform is open for individual story contributions from September 5 to November 30, 2022. By submitting their stories anonymously, women will be able to share their experiences freely without risking job security or personal repercussions in their place of work.

Rarely discussed, under-reported

Currently, a large percentage of women in the global health workforce face discrimination, bias and sexual harassment in their work. In some countries, women also experience WRVH either on the way to work or when engaged in community outreach.

The causes vary: many women face unprotected exposure to sexual and violent acts because perpetrators remain unaccountable in work settings owing to a lack of legal and policy frameworks, poor or no follow up, under reporting due to fear of retribution or issues around standard of proof. Other factors have also contributed to the abuse, including women’s segregation into lower status roles, systemic bias and discrimination in the health care sector.

In several contexts, particularly low- and middle-income countries, there is no legislative framework in place to support gender equality at work and no laws to prohibit and punish sexual discrimination and sexual harassment at work.

“Work-related SEAH in the health workforce is an extension of the gender-based violence against women and girls that we witness every day, and in the vast majority of cases, it is perpetrated by male colleagues, male patients/clients and male members of the community,” said Dr. Robalo.

“The presence of women at all levels…makes an immediate difference.”

Dr Magda Robalo, Global Managing Director, Women in Global Health

If not acted upon urgently and consistently, such acts create unsafe and toxic work environments that affect retention of women staff, reduce their physical and mental health leading to increased healthcare costs and a reduction in the quality of care provided.

By addressing the root causes of gender inequity in the health and care workforce and challenging the power and privilege afforded to men, Women in Global Health aims to contribute to the overall reduction of workplace SEAH in global health and therefore strengthen health systems.

This should be backed with concrete action by decision makers to put appropriate laws and policies in place, including ratification and implementation of the International Labour Organization Convention 190 (cILO 190).

“There is no single pathway to solve sexual exploitation and abuse but the presence of women at all levels from leadership down, coupled with adequate laws and policies makes an immediate difference by creating a conducive, motivating and empowering work environment free of such abuse and discrimination,“ said Dr Robalo.

Social care: a sector now in perpetual crisis

By Rusheen Bansal

Association of Directors of Adult Social Services reports dramatic rise in numbers of those seeking review or start of social care provision.

The number of people awaiting review of current provisions, start of a service or direct payment for social care, has increased by 37 per cent from November 2021 to April 2022, according to a count carried out by The Association of Directors of Adult Social Services (ADASS) in 83 councils.

Almost 300,000 people are waiting for an assessment of their needs by social workers, an increase of 90,000 (44 per cent) in five months. One in four has been waiting longer than six months. At this rate, the number waiting can hit 400,000 by November 2022, a two-fold increase from last year.

While demand for care is expected to increase in line with winter pressures, peaking around January and dropping in the spring, the findings from ADASS suggest that the typical ‘cycle’ of system pressure is changing, being replaced by a state of perpetual crisis.

To the outside observer, those stating that social care is in crisis may sound like a broken record. For years now, however, stakeholder groups and think tanks have been warning that crippling staff shortages, precarious pay, working conditions and insufficient funding had left a system on its knees, even before the Covid-19 pandemic hit.

A shrinking (paid) workforce

The crux of the issue is relatively simple, if not profound in scale – as Cathie Williams, ADASS Chief Executive put it: “the big reason why almost 40,000 people are waiting for the care and support they need to actually start is that care providers simply do not have the pairs of hands they need to sustain services.”

A recent PPP report, The Social Care Workforce: Averting a Crisis, quotes a 2021 survey of 2,000 social care services undertaken by the National Care Forum (NCF) that reveals how 74 per cent of providers have experienced an increase in the number of staff leaving since April 2021. Indeed, the vacancy rate for care home providers has nearly doubled in the last year, from 5.9 per cent (in March 2021) to 10.3 per cent (in May 2022).

The NCF survey also states that 50 per cent of those leaving highlighted stress as the main reason for their departure, with 44 per cent citing poor pay. Due to poor retention of the social care workforce, existing employees are experiencing an increase in workload that has not been accompanied by an increase in pay thus far.

Care workers are paid a median hourly rate of £9.50, in line with the National Living Wage. However, a high proportion of these workers are employed on zero hours contracts – 41 per cent of social care workers in London are on such contracts. To that end, social care professionals often leave the sector for less demanding and/or better paid jobs such as retail roles or jobs in the NHS, where similar skills are often more appreciated and rewarded.

ADASS has discovered a similar pattern – almost seven in ten ADASS members surveyed said that care providers in their area had closed or handed back contracts. Many more said they could not meet all needs for care and support because of providers’ inability to recruit and retain staff. The implications of this are significant. When people’s needs are unmet (or unknown), this can place a sizeable burden on their lives and on the lives of unpaid carers who may feel obliged to step in. Indeed, over the last ten years, the number of young people aged 16-25 in England and Wales providing unpaid care to family and loved ones has risen to approximately 350,000.

“The picture is deteriorating rapidly”

Councils are simply overwhelmed. The ADASS Spring Survey found that most councils were facing an increase in numbers of people seeking support: 87 per cent said more were coming forward for help with mental health issues, 67 per cent reported more approaches because of domestic abuse or safeguarding, and 73 per cent reported seeing more cases of breakdowns of unpaid carer arrangements. In addition, 82 per cent of councils were dealing with increased numbers of referrals of people from hospitals and 74 per cent were reporting more referrals or requests for support from the community. To that end, the Health Foundation has estimated that an additional £7.6 billion will be needed to meet demand in 2022/2023.

Sarah McClinton, ADASS President, commented: “These new findings confirm our worst fears for adult social care. The picture is deteriorating rapidly and people in need of care and support to enable them to live full and independent lives are being left in uncertainty, dependency and pain.”

In September 2021, the government announced a new ‘Health and Social Care Levy’, effective April 2023 onwards – a 1.25 per cent increase in National Insurance contributions from employed people as well as pensioners. Yet, now more than ever, policy experts recommend that financial planning and smart allocation, elements that have been lacking in the past, are required to reap the maximum benefits from this additional funding. The Levy, which will aggregate to £5.4 billion over three years, has been reported to fund necessary reforms in the social care sector such as improving staff training and recruitment practices, initiatives for mental health well-being and new avenues for career progression. Yet, many regard this amount as insufficient – according to The Health Foundation, a further £7 billion will be required every year to tackle demographic and inflationary pressures and to increase staff pay.

While it is true that the COVID-19 pandemic significantly worsened the social care crisis, it is only one of the many crises that have exposed and underscored the foundational instability of this system. Since the 2016 Brexit vote, for instance, the vacancy rate of social care workers has increased year-on-year. Prior to this, 1 in 20 social care workers were EEA migrants, and since more than 90 per cent did not have British citizenship, many had to leave England. To mitigate concurrent widespread resignations, the government announced a Health and Care Visa that would help fast-track visa applications for those in the healthcare sector. However, care workers are not categorised in the list of eligible jobs.

More than 600 people are joining waiting lists to be assessed for care and support in England each day. Resolving issues other than funding are key for the successful integration of social care into effective healthcare. Greater efforts should be made for recruiting and retaining social care staff, especially younger people, by improving the pay, workload and working conditions in the sector. Otherwise, broken record or not, the system is in danger of collapse.

Post-pandemic decrease in prescriptions could be leading to avoidable deaths

By Rusheen Bansal

Medicines used to treat serious and long-term conditions are not being prescribed as often as they should be following the pandemic, raising fears that this could be causing avoidable deaths from heart disease and strokes.

New analysis by Analytics firm Lane Clark & Peacock (LCP) LLP, of almost 9 billion prescriptions dispensed by pharmacies in England between 2017 and 2022, has highlighted that blood thinners and hormone treatments for cancer are among the medicines that have seen a marked decrease in prescriptions since Covid hit.

Blood thinners reduce the risk of blood clots and can prevent strokes, but prescriptions are 5 per cent lower than expected, meaning more people could be having avoidable strokes.

Prescriptions for hormone treatments for certain types of breast and prostate cancer are also 4.4 per cent lower than expected, which could be the result of delays in diagnosing people with cancer and starting them on treatment.

Dr Ben Bray, Principal in the Health Analytics team, commented: “We know that heart disease and stroke deaths were the largest contributors to excess deaths in the community for men in 2020 and the changes that we are seeing in prescription patterns could explain why we may be seeing more people dying from these types of diseases. Trying to tackle the backlog is a mammoth task for policymakers, but data like this is crucial to making sure the right patients and issues are targeted.”

Some medicines have seen an increase in use such as treatments for coughs and respiratory diseases – potentially related to the treatment of the symptoms of Covid or Long Covid.

Industry expert, Dr Deborah Layton, PhD FRPharmS FISPE, Director PEPI Consultancy Limited, UK, said: “No-one can deny that the impact of the pandemic on provision of healthcare has been profound. In brief, the results demonstrate a surge in prescribing of medications for symptomatic relief of relatively minor (acute) respiratory conditions and health supplements, with a concurrent decline in prescribing of medications for chronic disease.

“The authors also report that these changes have not returned to pre-pandemic levels. Whilst this elegant study illuminates changes in health service provision arising during the pandemic, it does not necessarily imply a causal relationship. Nevertheless, studies like this inform us further of changes in services, particularly in primary care that we are now just getting to understand.”

New research finds recruitment crisis threatens to undermine virtual ward revolution

By Integrated Care Journal

Nearly half of NHS Trusts need to recruit new roles amid sector-wide staffing crisis to enable the effective operation of Virtual Wards.

Freedom of Information Act data obtained by digital health technology provider, Spirit Health, has revealed the scale of the recruitment crisis that threatens to undermine the delivery of NHS England’s virtual ward ambition.

Spirit Health collected data from 107 NHS Trusts across England and found that 40 per cent need to recruit additional staff to support the delivery of virtual wards. The NHS is increasingly pivoting to virtual wards, which are intended to allow people to receive care outside of hospital settings, whether at home or in domiciliary care facilities. The Covid-19 pandemic saw the NHS establish COVID Virtual Wards, and their success has prompted a renewed ambition for their widespread use outside of treating Covid-19.

The acceleration of digital expansion plans is in response to NHS England’s recent mandate for all NHS Trusts to offer 40 to 50 virtual beds per 100,000 population. This ‘comprehensive development of virtual wards’ comes at a time when hospital waiting lists are exceeding 6.6 million, with the Health and Social Care secretary demanding radical action to avoid a winter crisis.

Of Trusts needing to recruit, a third (32.6 per cent) anticipate making appointments across up to three roles, while some Trusts have stated that they expect to recruit new staff in as many as seven different roles before launching a virtual ward.

Of the 31 Trusts that subsequently provided a breakdown of the roles they intend to hire, 84 per cent anticipate hiring Secondary Care Practitioners (such as consultants, therapists, advanced clinical practitioners, and nurses), with a further 29 per cent seeking primary care practitioners (such as GPs and pharmacists). The projected influx of specialised staff underscores the scale of this initiative – and the recruitment challenge that threatens to undermine the successful rollout of virtual wards.

The impact of workforce challenges on the expansion of virtual wards has been felt directly by Spirit Health’s clinical monitoring team. In recent months, its in-house team has experienced an uplift in the number of requests for flexible clinical support to Trusts to deliver digital programmes and help them onboard staff. This latest research comes after a recent report by the Health and Social Care Select Committee which suggested more than 475,000 NHS staff will be needed by early 2030 to deliver vital care, throwing into question how NHS Trusts plan to recruit and retain key staff.¹

Healthcare authorities hope that the deployment of virtual wards will significantly reduce these pressures by combatting staff shortages and minimising lengthy discharge times. Initial pilots of the programme have offered promising results already: virtual wards have been proven to deliver a 40.3 per cent reduction in the average length of hospital stay and a 50 per cent reduction in re-admission rates.²³ Likewise, Spirit Health’s CliniTouch Vie platform has seen a 67.5 per cent reduction in unscheduled emergency admissions.⁴

The NHS’s adoption of digital healthcare services is also likely to be motivated by the economic benefits of these proven efficiencies. Virtual wards are expected to save the NHS up to £4,000 per patient stay, whilst CliniTouch Vie alone is predicted to save the health service more than £500,000, by building on the successful virtual ward pilot operation it ran to support Leicestershire Partnership NHS Trust.⁵

These significant savings will go a long way in supporting the NHS workforce of the future – with funding being freed up to be reinvested in both the upskilling of the current workforce and enlistment of new staff to further ease the current strains on the health system.

Speaking about the recruitment crisis that is threatening the implementation of virtual wards, Dr Noel O’Kelly, Clinical Director at Spirit Health, said: “Virtual Wards offer a lifeline to enable the continued delivery of first-rate care and be a strong addition to face-to-face services, which have struggled to keep pace with the current workforce challenges and lengthy patient waiting lists across the health sector.

NHS staffing shortages threaten to undermine the exciting opportunity that virtual wards bring: digital healthcare technology cannot support patients without the necessary specialists to operate it. These findings echo the frustrations that we hear from our partner trusts, who are reporting that workforce challenges are hindering efforts to scale this technology achieve its full potential. We must urgently demonstrate the capacity of this technology to ease pressures for the stretched workforce, and thus attract fresh talent to support its delivery.”

^{1 https://committees.parliament.uk/publications/23246/documents/169640/default/}

^{2 Swift, J. et al, 2022. An evaluation of a virtual COVID-19 ward to accelerate the supported discharge of patients from an acute hospital setting. British Journal of Healthcare Management, 28(1), pp.7-15.}

^{3 NHSX. 2022. Remote monitoring for patients with chronic conditions in the Midlands [online] Available at: <https://www.nhsx.nhs.uk/covid-19-response/technology-nhs/remote-monitoring-for-patients-with-chronic-conditions-in-the-midlands/> [Accessed 25 January 2022]}

^{4 Ghosh S, O’Kelly N, Roberts EJ et al. Combined interventions for COPD admissions within an urban setting. BJHCM: 2016;3:122–131.}

^{5 A successful pilot of virtual wards for COPD, Heart Failure, and Covid-19 across LPT produced savings of £529,719 for the health system.}

Social care sector unprotected in energy price rises

By Gabriel Blaazer

With the country facing a stark cost of living crisis, social care representative bodies are calling on the government to do more to protect the sector.

The cost-of-living crisis continues to be the most pressing issue facing thousands of people across the country. Thus far, government policies announced to mitigate the risk to vulnerable people do not appear to apply to much of the social care sector, which so far, is dealing with the brunt of inflationary pressures without support.

Last week, Care England, the largest representative body for independent providers of adult social care in England, called on the government to take immediate action to prevent a widespread catastrophe within adult social care.

Figures released by Care England and Box Power CIC, a non-profit energy consultancy, demonstrate the extent of the problem the care sector faces. Their data estimates that to secure future gas and electricity supplies from October 2022, care providers will have to pay, on average, £5,166 per bed, per annum. This represents an increase of 683 per cent compared to last year, when those same providers would have paid, on average, £660 per bed, per annum.

Based on the October 2022 market rates, and with 454,933 CQC registered beds, the approximated impact of the rising energy prices over the last year on the sector is over £2bn per annum. Further research from the Centre for Health and the Public Interest (CHPI) estimates the sector’s total pre-pandemic profits before tax, rent payments, directors’ renumeration and repayments on loans at £1.5bn per annum.

The expected rise in energy prices will see profit margins generated across the sector eradicated, driving many providers into insolvency and reducing the potential for investment. Care England have written to Members of Parliament asking them to pledge their support for immediate and targeted support for the sector.

Government financial measures announced so far only apply to people living in their own households and not to people living in social care settings where energy costs are running out of control. Nor does the Ofgem energy price cap apply to social care providers.

In a statement issued by the CEO of the National Care Forum, the association for not-for-profit care and support organisations, Professor Vic Rayner OBE said: “The eye watering increases in energy cost is a very serious concern amongst our members. They are facing price rises of 400 per cent in gas and electricity prices which is totally unaffordable and way beyond anything budgeted or forecasted. This is causing immense pressure for social care providers.

“We need an urgent response from the government that will put a protection around people living in residential care settings – it is important to note that these people do not currently benefit from the government’s announced support for energy costs faced by households – all current and proposed schemes will not address the immediate crisis impacting on care homes right now.

The current energy crisis comes at a time when the sector is experiencing the worst workforce pressures the sector has ever known, with the vacancy rate currently resting above 100,000, and expected to grow. Rayner added that: “we must see parity of support for vulnerable people living in care settings; we need care settings to be included in the domestic price cap, and we need an emergency ring-fenced energy fund which could flow from central government to local care providers.

“Social care providers need assurance now of the financial support that will be available in order to effectively plan for the sustainability of their service provision.”

A waiting list approach flipped on its head

By Amy Bowen; Kaye Coholan

This is a sponsored article.

Making the Patient Tracking List (PTL) available to general practice in North Central London (NCL) is proving to be an effective approach.

When thinking about how best to address the backlog of patients, it’s natural to only consider the locations where the patients will be treated, but Amy Bowen, director of system improvement for NCL, says her team saw the value of involving primary care in the conversation. “Initially, everyone considered the PTL from secondary care, but we thought ‘let’s flip it on its head’,” she says.

The approach uses funding from the NHS’s elective accelerator sites initiative to form multi-disciplinary Proactive Integrated Teams (PITs) that can access the PTL using the elective recovery dashboard in the Cerner population health platform, HealtheIntent^®.

waiting list — Figure 1: Northern Central London (click to enlarge)

Like a Formula 1 pit crew supports a racing car driver, the objective for the PITs is to use data to optimise and maintain a person’s health while they await treatment. The need is very real across the NCL catchment area, with over 100,000 people having waited over a year for treatment and 300 waiting for more than two years.

The Patient Tracking List is a forward-looking management tool used by the NHS to monitor Referral to Treatment (RTT) and diagnostic waiting times for all patients across England. Even before the pandemic, demand for hospital treatment was outstripping capacity and, with the pressures on delivering care over the past two years, this has led to increased backlogs and longer waits. By April 2022 there were more than two million patients waiting over 18 weeks, with over six million in total waiting for treatment.¹

The effort leverages the holistic and long-term nature of the primary care relationship to support people on the PTL. “GPs get the concept easily and they welcomed the fact we were making bandwidth for this,” Bowen says. “This stuff floats my boat because it’s giving people a data-driven, health-inequalities-focused rationale for working together.”

The elective recovery dashboard utilises integrated data from across the system – including primary care – to provide a rich system-to-person view of the elective waiting list. This assists primary care and community teams to prioritise cohorts and more effectively manage patients on the waiting list.

The idea was conceptualised by Katie Coleman, clinical lead for primary care, who says that delivering person-centred and coordinated care is the aspiration of everything she does as a GP.

For Coleman, the PITs are primarily aimed at improving the health of individuals on the waiting list so they can “wait well” and be ready for the procedure when their turn comes up.

“If we can get upstream with their care and identify the things that might prevent them from actually having their surgery, we could then potentially ensure that when they do hit the top of the waiting list that they are in the best space possible,” Coleman says.

The second key element is looking at the wider determinants of health and how a person’s condition impacts their day-to-day life – for example, a person waiting for a hip replacement who is unable to work due to pain.

“If we identify those critical cases that if they don’t have their procedure, they might be at risk of spiralling down that social ladder, we would look to try and help to escalate them and to reprioritise their position in the waiting list,” says Coleman.

The approach is expected to lead to a number of benefits – not only improved health outcomes for the population, but also cost savings for the NHS.

“If you can maximise people’s wellbeing in advance of their procedure, then we know from the research that they have a shorter inpatient stay,” Coleman says. “They have a shorter rehabilitation period, so they’re able to get back up and doing what they need to do quicker.”

Enabling people to get back to work sooner reduces the need for social care and sick leave, and can lead to increased productivity in the workforce.

“Also if we support people to lose weight, bring their blood pressure under control, support them to achieve improved diet, sugar control if they’re diabetic, and so on, all of this over time will also help to drive down the risk of complications,” says Coleman.

“And that obviously has cost savings for the inpatient stay, but also cost savings potentially for the system as a whole.”

NCL’s five boroughs have identified priority cohorts and are working to improve the experience for both patients and care professionals. For example, Haringey is stratifying patients with a diagnosis of severe mental illness combined with two or more long-term conditions.

Jalak Shukla, clinical pharmacist and director of operations for the Haringey GP Federation, says the rationale for this was to provide additional support to patients who are less likely to attend for their procedure when they get to the top of the list.

“It’s a proactive approach, but we’re managing a caseload of patients identified for surgery, making sure they make it, looking after them after the surgery in the communications that they should be receiving, plugging them into the right services, and then putting them back into the care of general practice,” Shukla says.

“All of it’s proactive, all of it’s taken care of and then they can go back to business as usual, accessing the system when they need it.”

An additional benefit of the PITs is the relationship building between primary and secondary care, especially given the fact that post-COVID recovery work is a high priority across the system.

“We know secondary care can’t do it on its own,” Shukla says. “Looking at that list jointly is showing how the system is going to work better together, with primary care picking up what it can to ensure that patients are optimised in the interim.”

The proactive population health management enabled by HealtheIntent is encouraging clinicians to think differently about caseload management.

“We can actually do a one-size-fits-all review for patients and that’s only possible because we’ve got this shared platform,” Shukla says. “The filtering of which long-term conditions they have, their clinical context, their background, their age, the number of contacts that they might have had with the system – all of that data allows you to get a high-level view of what’s going on in your own PCN [primary care network].”

Moving forward, Shukla expects this type of approach to be adopted beyond elective recovery, particularly because of the holistic nature of the approach.

“I think it can make a patient’s journey a lot less fragmented,” she says. “Let’s deal with the long-term condition issues. Let’s deal with the social care issues. Let’s sort out the issues they have with referrals with secondary care. And let’s do it all at once.”

As systems continue to explore ways to meet the demand of the backlog of patients awaiting elective treatment, innovators across the country are using data to help prioritise, optimise and reduce redundancy.

To learn more about how Cerner solutions can support your organisation please visit their population health management solution page.

¹ Number of patients waiting over 18 and 52 weeks for consultant-led elective care and number of people on NHS waiting lists for consultant-led elective care | Source: www.bma.org.uk