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].

News September 23, 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.”

All news

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.

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.

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.