News, Workforce July 29, 2022

Could a review of cancer and diagnostics staffing and career pathways reverse waiting times?

By Integrated Care Journal

NHS waiting times for cancer treatment and diagnosis in England are now the longest on record, with the Health and Social Care Committee publishing a report urging the government to take action or risk jeopardising patient care.

At the core of the issue is staffing.

The national shortage of nurses, including cancer nurses, is well known – a problem seemingly exacerbated by the pandemic, with a reported 170,000 NHS staff voluntarily leaving the service in the last two years.

Despite being brought into sharp focus most recently, there has, for some time, been mounting concern among healthcare leaders regarding staffing in cancer care, which is why a group of ten NHS trusts and cancer alliances across South East England have been collaborating on scalable strategies and solutions to overcome their workforce challenges.

In partnership with Skills for Health and Health Education England South East, these local NHS Trusts and Cancer Alliances are blazing a trail when it comes to opening up career pathways, finding new and smarter ways of working and streamlining patient journeys, with the aim of transforming cancer care and diagnostic services.

East Sussex Healthcare (ESHT) is one of the NHS Trusts in question and has been a pioneer in the creation of a range of new roles to support Consultants, Doctors, Nurses and Allied Health Professionals (AHPs) caring for patients on the cancer and diagnostics pathway.

Building upon their award-winning rollout of band 3 Doctors’ Assistants across the Trust, which cut the administrative burden of doctors in half, EHST have also developed other new roles to support cancer and diagnostic services.

A new approach to recruitment

Having experienced difficulties recruiting Endoscopy Nurses for its two endoscopy sites in Eastbourne and Hastings, ESHT took the decision to develop the band 3 Endoscopy Assistant role to work alongside an Endoscopist and ease the pressure on its Endoscopy Nurses.

The impact of this new role has enabled EHST to support cancer wait times, says Service Lead for Endoscopy Sue Winser.

“ESHT handles 21,800 cancer referrals, 283,000 X-rays and scans and 7 million pathology tests every year, including 14,500 endoscopy procedures, so the pressure is on.

“Easing the burden on existing staff is crucial in a tight labour market, where specialist skills are in short supply. Our pilot has reduced the need for two nurses being involved in any one procedure – this has massively freed up nursing time, enabling our team to see more patients.” she continued.

Also embracing new roles and routes into cancer care and diagnostics support is University Hospital Southampton NHS Foundation Trust (UHS).

With UHS’s pathology departments handling over 6 million clinical laboratory requests a year, it is hoped that by offering enhanced career progression the Trust will reap its rewards in terms of staff recruitment and retention in harder to recruit services.

Among the various different apprenticeship standards adopted by UHS, the new level 6 Healthcare Science Practitioner apprenticeship provides a platform to achieving the BSc in Biomedical Science and undertaking the role of band 5 Biomedical Scientist.

An evolving workforce

The threat of a mass shortage of cancer nurses including Cancer Nurse Specialists has similarly prompted a rethink of career progression routes by Thames Valley Cancer Alliance (TVCA).

Bringing together cancer leaders, commissioners, service providers and third sector organisations, TVCA takes a whole population approach to improving cancer services across the three Integrated Care Systems of Buckinghamshire, Oxfordshire and West Berkshire (BOB ICS), Bath & North East Somerset, Swindon and Wiltshire (BSW) and Frimley Health and Care ICS.

Key to the approach of TVCA has been to raise the visibility and awareness of careers in cancer. This includes the roles of band 5 nurses as well as of Cancer Nurse Specialist and the Nurse Consultant.

“Faced with an ageing workforce, we took the decision to create a visible cancer nursing (and Allied Health Professional) career progression route from pre-registration nurse through to registered, enhanced, advanced, consultant and strategic leadership to encourage specialisation in this vital field of healthcare.” said Lyndel Moore, Lead Cancer Nurse.

“We want to align to the national Aspirant Cancer Career and Education Development Programme (ACCEND) and in the interim we are supporting the development and training of the different roles for Allied Health Professionals and Cancer Nurse Specialists.’’

Bringing down waiting times

The Royal Berkshire Breast Cancer Service in Reading, which is part of TVCA, has seen patient numbers increase over the last five years. 555 patients were diagnosed with new primary breast cancer in 2021, and a further 211 patients with metastatic breast cancer are in the overall workload, meaning that a total of 1339 breast cancer patients are being monitored by the Centre’s follow-up pathway.

To meet this demand, the Centre conducted a review of the breast cancer pathway and the cancer nursing and other staffing requirements needed to support it.

The Nurse Consultant role was identified as being key in the pathway, and this advanced role, which is embedded in practice, enables care of the patient at an independent autonomous level.

With advanced clinical decision–making and a non-medical prescribing role, running independent chemotherapy and follow-up clinics, giving patients results and discussing treatment options, the Nurse Consultant plays an essential role against the backdrop of a national shortage of Oncologist Consultants.

Better use of resources coupled with clearer career progression routes has provided a platform for Great Western Hospitals NHS Foundation Trust (also part of TVCA) to expand patient support by setting up a new ‘Personalised Care Service’ with the help of Macmillan Cancer Support.

The Service, launched in 2021, is designed to look holistically at the needs of cancer patients, enabling them to self-manage their illness better. The Service received 60 referrals in its first three months alone and is, according to Cancer Nurse Specialist Michelle Taylor of the Macmillan Personalised Care Team, proving highly beneficial in streamlining patient pathways.

“Some newly diagnosed cancer patients can feel overwhelmed and anxious about their diagnosis and pathway. The Cancer Nurse Specialist teams are now able to refer to the Personalised Care Service so we can all work together to help their needs and offer tailored support for improved health and wellbeing requirements.”

Staffing capacity to undertake diagnostic imaging (such as x-rays and scans) too is essential for patients on the cancer pathway and to meet demand for routine imaging.

With the challenges of an ageing workforce, Trusts in the Surrey and Sussex Cancer Alliance (SSCA) struggled to recruit both diagnostic and therapeutic radiographers, before deciding to take a fresh approach to workforce planning.

Rethinking career progression

It was recognised that existing roles had a lack of career progression opportunities. This prompted the Sussex Imaging Transformation Workforce Group – representing services across the region – to facilitate a patient pathway-mapping workshop, which identified a shortfall in the workforce required to undertake routine, elective computerised tomography (CT) examinations.

As a result of this exercise, a competence map was developed with the aim of increasing the skill mix and consistency of roles to meet service needs. Furthermore, it identified the need for a career framework across the CT pathway and to support new roles across the diagnostic workforce, such as the Radiography Department Assistant as an entry point.

Dawn Probert is a Senior Consultant at Skills for Health and has been leading on the project along with Health Education England South East. She comments:

“Workforce planning is crucial to identifying and alleviating blockages in the system that delay diagnosis and treatment of cancer patients.

“Now more than ever, detailed skills analysis and robust workforce planning is required if cancer and diagnostic services as a whole are to meet patient demand in the medium to long-term.

“What this regional project has demonstrated is that there are many positive and transformational approaches and roles which have been developed and utilised to finding solutions to the recruitment, retention and training of the workforce to improve cancer patient journeys and diagnostic services.

“Designed to be scalable, they offer NHS trusts and cancer alliances nationwide innovative tools and strategies to get to grips with recruiting, retaining and developing staff and to meet the increasing demand for cancer and diagnostic services and improve patient care into the future.”

Skills for Health, in partnership with Health Education England South East, has developed 10 cancer and diagnostics workforce case studies and an accompanying Resource Guide to showcase the work of NHS trusts and cancer alliances across South East England. To find out more about the innovative tools and strategies they developed to help with recruiting, retaining and developing staff and to meet the increasing demand for cancer and diagnostic services visit: https://www.skillsforhealth.org.uk/info-hub/cancer-and-diagnostics-careers/

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Improving service delivery with benchmarked data

By Capita Healthcare Decisions

The Southern Health and Social Care Trust provides health and social care services in Northern Ireland across the three council areas of Armagh City, Banbridge and Craigavon Borough Council, Mid Ulster District Council (Dungannon and South Tyrone) and Newry, Mourne and Down District.

It runs Craigavon Area Hospital, Daisy Hill Hospital, Lurgan Hospital, South Tyrone Hospital, Armagh Community Hospital and St Luke’s Hospital. The Trust won the 2022 CHKS Top Hospitals award for benchmarking and is now producing detailed mortality reports which are being used as the basis for quality improvement and assurance.

Benchmarking data provided the foundation for improving care and outcomes

Southern Health and Social Care Trust has worked closely with healthcare intelligence company CHKS to provide an in-depth and comprehensive mortality review that enables benchmarking against other organisations while also providing a comprehensive picture of performance, that can help reshape service delivery, improve care and outcomes.

Using the CHKS quarterly mortality rates, the Southern Trust Quarterly Mortality Report uses the data as a foundation to build a detailed picture of performance and quality for every speciality service within the Trust. Triangulating the quantitative information with qualitative information (sourced through consultant review of highlighted cases, morbidity and mortality meetings, serious adverse incidents and complaints) which can reveal where processes are working well, but also highlight where learning is needed to improve service delivery.

CHKS data comprises a significant part of the report which is presented to the trust board and governance committee, to convey how the trust is performing as a whole and as individual sites, before drilling down further into specialities. The report generates an extra level of assurance with each Divisional Medical Director reviewing the deaths to quality assure the actions taken by their consultants.

As a result, there have been improvements to access to stroke services, development of a Diabetes Education Programme for medical staff and a review of hypoglycaemia management guidelines.

Using data to reflect on performance and improve service delivery

Suzanne Barr, the Trust’s Senior Systems Assurance and Improvement Manager manages the report which helps to provide the maximum assurance for board members that the Trust’s processes are leading to the best possible outcomes.

“The data was telling us what the outcome was, but we needed to link this with our activity to ensure this was good as it could have been. For example, with non-elective surgery, we knew we were doing well in comparison to our peers, but as an organisation we need to ask if we can do better,” she said. “I wanted to give as much assurance to senior managers and the board as possible but sometimes the data doesn’t mean that much on its own. I wanted to make the data the main character in the story and build the narrative around it.”

The regular data review from CHKS allowed for routine benchmarking within the organisation, as well as regionally and with UK peers. Using this as a starting point enabled the trust to review clinical processes, looking inward to see whether the data was truly reflective of the way that they were working and where/if change could be made to improve services and delivery of care.

“The report has evolved over time. The data was giving us assurance but now it has more meaning and value. It helps us to scrutinise what we are doing and ask ourselves, did we follow the processes and did we learn from it?”

Suzanne Barr, Senior Systems Assurance and Improvement Manager

Suzanne believes staff are buying into the new report. The clinical teams knows it is more than just a box ticking exercise and are taking greater ownership because they know there is clear value, purpose and meaning in the processes.

The focus on processes in the report has highlighted the importance of good data and how it can reveal the bigger picture within healthcare systems.

“Data is paramount to the report, you can’t do one without the other. Staff and senior managers are starting to see the point of having data as a narrative and how the process must be right in order for the data to be right.”

Suzanne Barr, Senior Systems Assurance and Improvement Manager

Support from CHKS in creating the report was also crucial. Suzanne built up a good relationship with the team, enabling her to able to work closely with CHKS to ensure she was receiving the information she needed for the report.

“It was good to know I could email them to ask for help or clarification and they would always reply really quickly,” Suzanne commented. “The CHKS team was very helpful and wanted me to have a good understanding of the information that was being sent to me. CHKS support was vital in ensuring I had insight into the data presentation, without this collaborative working, utilising the data would have been much more challenging.”

The report has been well received across the Trust and by the senior management team.

Southern Health and Social Care Trust Chairperson, Eileen Mullan, said: “the CHKS data presented in the Trust report provides the opportunity to benchmark our care against others, not only in the region but also across the UK. The data has become an integral part of assurance that the Trust is delivering safe and effective care, actively identifying areas for improvement and developing services as best we can, for our patients, their families/ carers and our staff.”

The Trust’s Chief Executive, Dr Maria O’Kane, added: “the Southern Trust uses the CHKS mortality data as a key part of our patient safety assurance processes. The data is scrutinised and cross referenced with Trust information and processes including adverse incident information, allowing triangulation of data to inform quality improvement activities and provide assurance on the safety of our services to our Trust Board members.”

To find out more, please get in touch at healthcaredecisions@capita.co.uk or visit capitahealthcaredecisions.com

Improving learning disability experience for those in end-of-life care

By Capita Healthcare Decisions

Willen Hospice is an adult hospice in Milton Keynes, Buckinghamshire which provides specialist care for people with a terminal illness at the end of their life.

Staff and volunteers at Willen Hospice provide specialist support to patients and family members, helping them with the physical and emotional effects of both the illness and subsequent treatments.

The Hospice works closely with GPs, hospitals, community nursing staff and social workers to ensure specialist care is practical, informed, and supportive at all levels. Willen Hospice won a CHKS Top Hospitals Award 2022 thanks to an education project to raise awareness among clinical staff about caring for people with learning disabilities.

How an improvement culture will help to improve experience for those living with learning disabilities

Willen Hospice has been through the CHKS accreditation process three times, and this has helped to create a culture where every individual working there is conscious of the importance of striving for excellence. This culture of continuous improvement drives everything the Hospice does. Encouraging collaborative working across the organisation has laid the foundations for thinking creatively about how improvement can be achieved and how each department can work together for a common purpose.

When Hospice UK highlighted that certain demographic groups were underrepresented in hospice care, Willen Hospice decided to set up an awareness programme to ensure it could provide the best experience for people with learning disabilities.

While, in general, the Willen Hospice does not care for a high number of people with learning disabilities, the Senior Leadership Team recognised that having an understanding and awareness of the daily lived experiences of someone with a learning disability would contribute to staff’s ability to provide the best care possible.

Caroline Loxton is the Practice Development Lead at Willen Hospice. The Trusts and Foundations Manager at Willen Hospice worked with Caroline to apply for a grant to fund the project which has seen a large part of the 83-strong team undertake the Learning Disability awareness training.

The project required cross departmental working led by Caroline who also created and delivered the training in partnership with the Learning Disability Nurse at MacIntyre Charity, which supports and empowers people with a learning disability.

”Working together closely with the charity has helped us meet our shared objectives.”

Caroline Loxton, Practice Development Lead at Willen Hospice

Improving education and communication to ensure accessibility for all

It was seen as vital that an understanding of the needs of people with learning disabilities was reflected across the whole organisation, not just within the clinical team. This included, for example, the importance of accessible literature, including information leaflets.

“We have information in braille and other languages but working with the Learning Disabilities Nurse from MacIntyre highlighted that we also need information accessible in an Easy Read format, which has more images and fewer sentences. The MacIntyre Charity has an Easy Read team whom we now have access to assist our new process of improving accessibility of information we communicate. We want to make sure that everything we are giving out across the organisation is accessible to everyone.”

Caroline Loxton, Practice Development Lead at Willen Hospice

As part of the project, Learning Disability Champions were created, and included representatives from all the clinical teams. This meant that the learning and expertise could continue to be shared throughout the teams once the project and budget had ended.

The Champions spent time with the Learning Disability Nurse from MacIntyre who was able to provide a glimpse into the life of people who have learning disabilities, their experiences and their healthcare needs.

”Staff felt the experience was eye-opening and said they appreciated both the opportunity to see what is was like from the view of a person with a learning disability and also learn about the role of the Learning Disability Nurse.”

Caroline Loxton, Practice Development Lead at Willen Hospice

The feedback and experiences of the Learning Disability Champions were included within the education sessions.

Working with the Learning Disability Nurse, Caroline put together a programme of blended learning consisting of both e-learning (setting out the theory) and a two-hour experiential face to face session. Staff took part in several activities that put them in the place of a person with learning disabilities, highlighting some of the situations that they might encounter, and giving staff the opportunity to empathise with how they might be affected.

Feedback about the programme has been positive, both from those who have taken part and from the Senior Leadership Team, who invited Caroline to present the project at the Council of Management to understand how the project has improved clinical practice.

So far, eight sessions have been carried out with an average of seven people attending each time.

”One of the challenges was how we could support all our teams through this, taking into account the constraints of shift working. We were grateful that staff were released to take part in the sessions and were able to benefit from the Learning Disability Nurse’s experience first hand.”

Caroline Loxton, Practice Development Lead at Willen Hospice

To find out more, please get in touch at healthcaredecisions@capita.co.uk or visit capitahealthcaredecisions.com

More groups join call for fairer deal for social care

By Gabriel Blaazer

As the race to become the next Conservative leader and Prime Minister of the UK heats up, and the government accepts the recommendations from the independent NHS pay review bodies in full, Care England and Access for Social Care have urged the government to act to protect the standing of social care workers, in statements issued yesterday.

The calls echo recommendations contained in a summary document of a recent Public Policy Projects report on integrated care. The report argues that the social care sector should be placed on an equal footing with the NHS, both in terms of its representation within integrated care partnerships and investments made to accelerate digitisation and modernisation.

Representative groups are increasingly urging the government to ensure suitable plans are in place to protect social care, amid an increasingly dire workforce shortage that is threatening the sector’s ability to provide its services. Vacancy rates in social care (9.5 per cent in January 2022) remain stubbornly above the national average (4.4 per cent from December 2021 to February 2022), while more than 400,000 social care workers left their roles in 2021.

A fairer deal for social care must be a priority

On Tuesday 19th of July, the government accepted, in full, the recommendations of the independent NHS pay bodies, meaning more than one million staff who fall under the Agenda for Change contract will receive a pay rise. This includes nurses, midwives, and paramedics, who are set to benefit from a pay rise of at least £1,400 this year, backdated to April 2022.

Groups who represent and advocate for the social care sector are now urging the government to implement a similar deal for care workers.

While rates of pay for social care work have increased in real terms since 2014, the rate of increase has not kept pace with other sectors, decreasing the social care sector’s ability to compete in the jobs market. Data shows that when overall national employment rates fall, vacancies in social care rise, suggesting that the sector is struggling to attract and retain workers.

The King’s Fund cites “high levels of staff vacancies, sickness absence, turnover, and work-related stress [as] having a damaging impact on staff,” and calls “the case for a fully funded, multi-year health and social care workforce plan… overwhelming.” Although many of these factors were exacerbated by the Covid-19 pandemic, the King’s Fund and other groups maintain that they long predate the pandemic and are the results of successive governments neglecting the social care sector.

In October 2021, the Workforce Recruitment and Retention Fund made £162.5 million available to local authorities to help recruit and retain social care workers, along with a further £300 million in December 2021. However, both funds lapsed in March 2022.

A neglected care sector

Poor staff retention is being further compounded by increased pressure on the social care system. The number of new requests for social care support have increased by 5.6 per cent, while costs have risen by more than a quarter, with areas with higher levels of deprivation being disproportionately affected.

Lack of available social care capacity is also increasing pressure on the acute hospital sector as hospitals have fewer methods of discharging patients safely. This is causing unsustainably high hospital occupancy rates and serving to undermine the wider healthcare system.

In a statement issued yesterday, CEO of Access Social Care, Kari Gerstheimer, warned about a “complete lack of discourse about the future of the social care system,” in the current leadership race, and claims the outgoing Prime Minister, Boris Johnson, has all but abandoned his pledge to “fix social care once and for all.”

The concerns mirror those expressed by UNISON Social Care Lead, Gavin Edwards, who said on Wednesday that “the scale of vacancies is alarming, and not just for those who rely on care and their families. The sorry state of social care is having a disastrous effect on the NHS, causing massive treatment waits, letting down patients and putting unbearable pressure on health staff.

“The care sector is acutely underfunded. Wages are way too low leaving staff unable to cope with the rising cost of living. Supermarkets are paying better rates without the stress, so it’s no surprise that people are jumping ship.”
In Care England’s statement, released on Thursday, Chief Executive Professor Martin Green OBE, said: “The adult social care workforce is our biggest resource. The lack of government action has had an inevitable consequence on the nature of employment opportunities within the sector and has hampered providers’ efforts to recruit and retain staff, as evidenced by the 52% increase in vacant posts in the sector over the past year. This has not only affected the overall financial attractiveness of the adult social care sector as an entity, but also providers’ ability to compete with the NHS.

“As a first step, Care England suggests the Government accepts the recommendations of the Low Pay Commission for the 2023 rates, however, this increase must be properly funded. Simply applying National Living Wage inflation without appropriate funding undermines the ability of providers to aid workforce pressures, especially given the fact that providers are having to pay increases above the National Living Wage annual uplifts as a means of recruiting and retaining staff.”

Kari Gerstheimer added that ”as Sunak and Truss fight it out, there is everything to play for by way of their approach to Health and Social Care. The Association of Directors of Adult Social Services has warned that the year ahead will be the most challenging people needing and working in adult social care have ever faced. I am saddened, however, to see social care being kicked down the road with little mention of any commitments from either leadership contender about the future of the social care system.

“Failure to invest in social care amounts to poor fiscal planning and inefficient use of taxpayers’ money – it harms our productivity because people with unmet social care needs can’t reach their potential, and unmanageable caring roles keep people out of work. It harms those working in social care, who are choosing to leave the sector because of problems with pay. And it harms our health system because a failure to invest early in preventative social care leads to more crisis admissions in critical care.”

Reducing trauma for radiotherapy patients

By Capita Healthcare Decisions

The London Clinic is pioneering temporary markings as a replacement for alignment tattoos to help reduce the lasting trauma of radiotherapy treatment.

The London Clinic is one of the UK’s largest independent hospitals, providing medical care to thousands of patients every year and treating a range of diseases and conditions including cancer. As a charity, it continually reinvests in its facilities and technology, seeking to offer the latest advances in cancer diagnostic, treatment and support services.

However, it was not pioneering new technology that saw The London Clinic win the 2022 CHKS Top Hospitals award for innovation. Rather, it was their out-of-the-box thinking, allowing radiotherapy patients the options of having non-permanent alignment tattoos, which caught the attention of the judges.

Challenging the requirement for permanent alignment markings on patients receiving radiotherapy treatment

In its cancer management, The London Clinic declares that it is committed to giving patients choices in their care and always seeks to apply the latest technologies available to facilitate this. Radiotherapy provision is an innovative area, but one aspect of treatment has not moved with the times. This is the practice of tattooing patients who are undergoing treatment.

During the treatment process, radiographers can make between one and five permanent tattoo marks on a patient’s skin to help line up the radiotherapy machine and ensure the same area is treated each time. These tattoos can become a lasting reminder of a traumatic time and can negatively impact body image.

The London Clinic heard from some breast cancer patients who were unhappy with the aesthetic outcome of these tattoos given their location and especially as on occasion the ink can run or bleed under the skin. Patients said this constant visual reminder and effect on aspects of everyday life, such as clothing choice, had a negative psychological impact on their recovery. Their experience was mirrored by one of the keynote speakers at the 2019 Radiotherapy Society Conference.

As a society member and radiographer who had undergone a personal cancer diagnosis herself, the speaker was able to candidly describe the lack of choice or alternatives to tattoos. The London Clinic’s Pre-Treatment Superintendent attended the conference and was motivated to ask on her return: “Why do we still do this?” and “Is there something else we could be doing?”

While sophisticated Image Guided Radiotherapy (IGRT) and Surface Guided Radiotherapy (SGRT) techniques exist, which are less reliant on tattoos, the majority of cancer treatment centres still use them. Over the last few years alternatives have been explored and are in use such as ultraviolet (UV) tattoos and surface-guided radiotherapy and non-ionizing optical devices. However, uptake of these alternatives has been slow, either due to the additional resources or investments required.

By thinking of novel solutions, the radiotherapy team at The London Clinic was able to come up with an innovative way of marking patients for treatment.

Instead of permanent tattoos, pen marks were drawn onto the skin and covered with transparent film dressings. A map of the exact positioning of the marks on the body was reproduced on a sheet of clear acetate as a guide. Daily online imaging was implemented and acted as a control for positioning and verification of treatment accuracy.

This innovative alternative enabled the radiotherapy team to offer tattoo-less treatment which neither compromised patient care nor was constrained by resource or investment pressures. Through extensive auditing, the team identified no additional or significant difference or issues in set up, and that the new method was as accurate as tattooing.

“This innovation in practice has made a significant impact on the way we deliver breast treatments at The London Clinic. It is not the latest or the most expensive innovation, but it provides the patient with a better journey and more choice.”

Deirdre Moran, Quality and Development Superintendent for Radiotherapy and Medical Physics, The London Clinic

This meant that they could confidently tell patients that going tattoo-less would in no way compromise their treatment. Treatment times did increase slightly, but it was concluded that it was not of a magnitude which would outweigh the benefit of providing patient choice.

”Winning the 2022 CHKS Top Hospitals award for innovation helps convey that with very little investment it is possible to change the landscape of cancer care. The ability to offer tattoo-less breast radiotherapy has made a significant impact on our patients’ experience and will contribute to improved body image and self-esteem post treatment for years to come.”

Deirdre Moran, Quality and Development Superintendent for Radiotherapy and Medical Physics, The London Clinic

The tattoo-less option has featured positively in patient feedback and generated numerous patient enquires leading The London Clinic to share its technique and methods with other radiotherapy departments to further encourage those who were considering making the change.

To find out more, please get in touch healthcaredecisions@capita.co.uk or visit capitahealthcaredecisions.com

Innovation uptake in West Midlands reduces A&E visits from care home residents by 30%

By David Duffy

The West Midlands Academic Health Science Network (WMAHSN) has released its 2021-22 Impact Report, highlighting the innovative solutions that have contributed to improving health and generating income growth across the West Midlands, and nationally.

Key achievements outlined in the report include a 30 per cent decrease in A&E visits from care home residents, across the West Midlands, as a result of the spread and adoption of deterioration management tools such as ‘Stop and Watch’.

Over 1,255 West Midlands care homes engaging in the test and adoption of deterioration management tools to improve safety for care home residents. More than 1,365 patients in the region are also benefiting from the prescription of PCSK9i inhibitors, a revolutionary medicine that helps lower cholesterol.

About the West Midlands Academic Health Science Network

The WMAHSN is one of 15 Academic Health Science Networks (AHSNs) across England and plays a pivotal role in ensuring innovations are shared faster regionally, nationally and internationally. Its goal is to make the West Midlands healthier, more productive and deliver the best possible clinical outcomes for patients.

AHSNs connect the NHS and academic organisations with local authorities, the third sector and industry, and create the conditions to facilitate change across health and social care economies.

Over the last two years, the organisation has grown to support the efforts around delivering its strategic programme themes, which includes cardiovascular disease prevention, mental health resilience, and workforce innovation and transformation.

The new report highlights the WMAHSN’s ability to adapt and pivot its services to address the region’s shifting needs and priorities, including supporting the region’s response to the pandemic. This not only demonstrates its ability to remain agile, but also how the organisation is uniquely placed to support the needs of its partners and future proof the region’s healthcare sector, for years to come.

Tony Davis, Director of Innovation and Commercial at the WMAHSN, said: “It is our mission to transform health and social care through innovation. Therefore, it is inspiring and positive to see organisations across the region adopting these innovations to respond to our complex health, and social care system.

“In collaboration with partners, and organizations around the West Midlands, we intend to keep strengthening our ability to work nationally, regionally, and locally, and maintain the environment we have helped create to improve the overall health and wellbeing of our communities.”

As the WMAHSN approaches its tenth birthday in 2023, the organisation continues to aid local health and care systems, looking at how its workforce supports NHS England and NHS Improvement, and the Office for Life Sciences priorities, ensuring that patients in the West Midlands have access to the best health and care services.

Other key highlights from the WMAHSN Impact Report includes:

Four providers in the West Midlands have adopted HeartFlow, a non-invasive, cardiac test for stable symptomatic patients with coronary heart disease. Over 5,000 scans were performed nationally during last year led nationally by the WMAHSN.
A 30 per cent decrease in A&E visits from care home residents, across the West Midlands, as a result of the spread and adoption of deterioration management tools such as ‘Stop and Watch’. Over half of care homes (63 per cent) in Staffordshire and Stoke-On-Trent have fully adopted the deterioration management tools.
The creation of the QI Notify-Emlap application and a pilot scheme in partnership with The Dudley Group NHS Foundation Trust. The app supports clinicians to use their National Emergency Laparotomy Audit data more efficiently to drive their emergency laparotomy quality improvement work. Early results from the pilot suggests regular usage could reduce ‘Door to Theatre’ time.
Promoting alternative forms of treatment to those from an ethnic minority background, living with a learning disability or autism with the STOMP project. The project aims to reduce the over prescription of antipsychotics, often oversubscribed to these groups, by increasing medication reviews.

To read the full impact report, visit the WMAHSN website.

Leading health charities highlight “untapped potential” of pharmacy services

By David Duffy

Leading UK health charities have highlighted the untapped potential of pharmacy services in tackling the nation’s major health conditions.

Just one in ten adults in Britain have turned to their local pharmacy for advice and information on lowering their risk of serious health conditions including cancer, heart disease and type 2 diabetes, according to a new YouGov survey.

The survey, commissioned by the British Heart Foundation (BHF), Cancer Research UK, Diabetes UK and Tesco, suggests that many people could be missing out on opportunities to access free advice via their local pharmacies that could help them make life-changing improvements to their health.

The findings come as the BHF, Cancer Research UK and Diabetes UK have been working with Tesco to deliver specialist training to Tesco pharmacists and pharmacy colleagues to support their conversations with the public. The training will help them provide more information and support as to how people can help lower their risk of these serious conditions through small changes to their day-to-day routine.

The survey also found that, of those who had visited a pharmacist for health-related advice or checks, 43 per cent said talking to a pharmacist had eased their concerns around wasting their GP’s time.

Meanwhile, 24 per cent of those who had visited a pharmacist for health-related advice or checks found it easier to speak to someone in a pharmacy than in other healthcare settings, while 53 per cent identified not having to book an appointment as a benefit of using a pharmacy for information and advice about a health-related concern.

The leading health charities say that supporting people to make lifestyle changes and seek referrals for concerning symptoms could “save thousands of lives” every year from some of the UK’s most prevalent and serious diseases.

More than 7.6 million people in the UK are living with heart and circulatory diseases, while 4.9 million are living with diabetes, 90 per cent of which are cases of type 2 diabetes, and it’s estimated that almost three million people are living with cancer (2020). Yet, around four in 10 cases of cancer, many heart and circulatory diseases and up to five in 10 cases of type 2 diabetes could be prevented or delayed.

Dan Howarth, Head of Care at Diabetes UK, said on behalf of the charities: “Thousands of lives could be saved every year through people making positive changes that lower their risk of type 2 diabetes, cancer, and heart and circulatory diseases.

Far more people could be taking advantage of the advice and support available to them from their Tesco pharmacy while they do their weekly shop, this includes tips and information on stopping smoking and weight management services”

The survey also found that only two per cent of adults in Britain had visited their pharmacist for a blood pressure check in the last twelve months, despite an estimated 4.8 million people in the UK living with undiagnosed high blood pressure.

The three leading health charities, in partnership with Tesco, are encouraging people to use their local Tesco pharmacies for information and support on lowering their risk of cancer, type 2 diabetes, and heart and circulatory diseases.

Tesco and the health charity partners hope that shoppers take advantage of the convenience of having their local pharmacist in store. Customers can easily seek advice when they do their weekly shop and get support for making positive changes or seeking information on concerning signs or symptoms.

Experts urge NHS to leverage position as England’s largest employer to help fight health inequalities

By Integrated Care Journal

Public Policy Project’s ICS Network has urged the NHS to leverage its position as England’s largest employer and to realise its potential for social and economic rejuvenation.

The calls came at a recent webinar, where PPP and ICJ released the latest findings from the ICS Futures roundtable series. The series saw ICS leaders from across the country convened for three Chatham House debates to identify challenges and opportunities in integrated care, to scale best practice and provide ongoing practical advice for system leaders and care providers. The series ended with an open webinar discussing the Next steps for integrated care.

The webinar was held to coincide with ICSs taking statutory footing on July 1st, and was chaired by Matthew Swindells, Joint Chair of West London’s four Acute NHS Trusts & former Deputy Chief Executive of NHS England. Mr Swindells was joined by Dr Penny Dash, Chair, NW London Integrated Care System, Paul Maubach, NHS Midlands’ Strategic Advisor on ICS Collaboration and Laura Stamboulieh, Partner, Strategic Advisory for Montagu Evans.

The role of the NHS

There was a particular focus was on the role of the NHS itself in tackling the wider determinants of health. One lesson from the pandemic that was learnt across the country was the impact of low trust – particularly among more deprived areas of the country. As is well documented, vaccination rates were significantly lower in parts of the country relatively high on the deprivation index, and these sectors of the population tend to have poorer health outcomes more generally.

“Part of the problem is not employing people from those areas”, suggested Paul Maubach, contending that a lack of representation from these areas has contributed to low trust of authorities and public services, healthcare included. It was agreed that choosing to adopt more proactive and inclusive recruitment strategies would align with the wider agenda to address and reverse health inequalities.

The need to differentiate between health inequalities and healthcare inequalities was also a central topic of the session, particularly in view of what the NHS and ICSs can feasibly impact upon. Many drivers of poor health are deeply rooted in socioeconomic trends far outside the purview of health and care professionals, but there is much that can be addressed in the short term with the right focus and the right policies.

For example, one of the greatest drivers of poor health in later life are educational outcomes. In turn, a crucial indicator of lower educational outcomes in the future is poor oral health at the age of two, so ensuring better access to NHS dentistry among more deprived cohorts would allow those more at risk to be identified, engaged, and supported by their local health and care systems, as well as improving access to dental services themselves.

This area of discussion highlighted one crucial, but often overlooked point; that all health and care services are interconnected, and ultimately, are trying to achieve the same outcomes. Part of the role of ICSs, therefore, is to create a culture where all stakeholders collaborate to achieve this shared goal (improving population health).

To this end, Dr Penny Dash argued the importance of those on integrated care boards (ICBs) having clearly delineated areas of responsibility and accountability, to create clarity over how different parts of the system fit together and to ensure that decision making does not become bogged down in bureaucratic hierarchies. “If you can’t answer the question related to your remit, you shouldn’t be at the table.”

The importance of data was emphasised throughout the session – both from a population health management perspective, as well as the effective planning and monitoring of estates and facilities.

It was posited by Laura Stamboulieh that “the role of the estate as an enabler is often overlooked. The ultimate delivery of ICSs will rely on a well-developed health and care estate.” On this point, it was noted that NHS estate planning has evolved little since the introduction of digital healthcare and the increase in remote working. As such, an updated, modernised approach to estate planning will be essential to delivering effective, integrated care, at scale.

Javid out, Barclay in…for now, as Johnson government collapses into chaos

By Gabriel Blaazer

(Disclaimer, story was accurate as of 15:00 on 06/07/2022. At time of writing, only 26 ministers have resigned. We will try to keep up…)

Steve Barclay, Chancellor of the Duchy of Lancaster and former Minister of State for Health, has been formally appointed as the new Secretary of State for Health and Social Care following the resignation of Sajid Javid.

In his resignation letter, which was widely circulated on social media, Mr Javid cited the public’s belief that the Conservatives are no longer “acting in the national interest”, and “that this situation will not change” under the current leadership.

With a slew of resignations following the departure of Mr Javid, including the former Chancellor, Rishi Sunak, it is unclear how long the cabinet will retain its new composition, with Labour welcoming Mr Barclay as the “shortest serving Health Secretary in history.”

Mr Barclay, who became an MP in 2010, will be in charge of overseeing the business and policies of the health department, but it remains to be seen how much divergence of policy there will be between the new appointee and his predecessor.

Of particular focus will be the government’s continuing response to Covid and the major reforms currently underway in the health sector, including the recent establishment of integrated care systems in England, as well as plans to tackle the deepening cost of living crisis.

A keen area of focus for Sajid Javid were plans to address the elective care backlog and put patient choice and the personalisation of care at the centre of health policy.

Recent policy announcements from Mr Javid include the proposal to offer private hospitals to people in England waiting over 18 months for surgery, as well as commitments to fund the modernisation of the health and care services.

Commenting on his appointment, Mr Barclay said: “It is an honour to take up the position of Health and Social Care Secretary.

“Our NHS and social care staff have showed us time and again – throughout the pandemic and beyond – what it means to work with compassion and dedication to transform lives.”

“This government is investing more than ever before in our NHS and care services to beat the Covid backlogs, recruit 50,000 more nurses, reform social care and ensure patients across the country can access the care they need.”

Commenting on the resignation of the former Secretary of State for Health. Matthew Taylor, Chief Executive of the NHS Confederation, said: “Health leaders thank Rt Hon Sajid Javid for the support he has shown the NHS during his twelve months in post but colossal challenges remain for his successor to resolve.

“Leaders recognise the work Mr Javid has done to put health inequalities on the map in a way that his predecessors in Government had not.

“The new health and social care secretary will be joining as cost of living pressures grow and as coronavirus and associated hospital admissions are on the up once again. After everything the NHS has been through over the last two years, health leaders need political stability from the Government alongside immediate acknowledgement from their new health and social care secretary that the present situation is understood and with no sugar coating.”

Also responding to Mr Javid’s resignation, Saffron Cordery, Interim Chief Executive of NHS Providers, the membership organisation for the NHS acute, ambulance, community and mental health services, said: “Trust leaders thank Sajid Javid for his service, particularly in seeing through the biggest health reforms in a decade in the shape of the new Health and Social Care Act and his initiation of the Messenger review of leadership in the NHS.

“All eyes will be on how the new health and social care secretary addresses major challenges including serious workforce shortages right across the NHS, the forthcoming NHS pay award amid the cost of living crisis, and the government’s New Hospitals Programme which promises to give the NHS much-needed capital investment to benefit patients and the quality of care.”

On the appointment of Steve Barclay to replace Mr Javid, Ms Cordery responded: “Trust leaders will welcome the rapid appointment of Steve Barclay as the new secretary of state for health and social care.

“Top of his in-tray must be the serious workforce shortages right across the NHS, with over 105,000 vacancies across the service and the forthcoming NHS pay award, which will be made against the backdrop of a soaring cost of living crisis.”

Digital communications tool provides solution for healthcare data protection

By Joost Bruggeman

Joost Bruggeman, former surgery resident at Amsterdam University Medical Centre, and CEO and co-founder of Siilo, discusses how secure digital communications tools can ensure patient confidentiality and solve healthcare data protection issues.

Instant messaging apps have become essential tools in our daily lives – their convenience, reliability and sheer ubiquity have transformed how most people communicate, both socially and professionally. At the height of the pandemic, their value within the healthcare sector became even more pronounced, as they enabled rapid information-sharing to help medical professionals learn how to deal with a hitherto unknown virus.

In these circumstances, medical staff came to appreciate the benefits of being able to share details about individual patient cases, including photographs and other sensitive medical data. It facilitated timely and seamless collaboration, without which many more lives would have been lost.

The benefits of ‘off-the-shelf’ messaging apps, however, don’t come without risks. Within the medical sphere in particular, a mistaken message could put patient confidentiality and data protection in jeopardy, while threatening one of the most fundamental aspects of healthcare ethics.

Overcoming data protection issues

Since instant messaging apps are clearly of value within the health and social care sectors, a solution is needed to overcome data protection issues. In fact, this challenge was understood some time ago, and was a key influence behind the development of specialist healthcare apps such as Siilo, which places data security and medical compliance at the heart of its development.

Designed specifically for healthcare professionals, Siilo undertook the task of preserving the usability that people expect from the technology, while simultaneously ensuring that patient data could be exchanged safely and compliantly.

Paul Cowley, Chief Information Officer at St. John & St. Elizabeth Hospital (HJE) in St. John’s Wood, London, recognised the importance of adopting a messenger service which has been tailored to the healthcare sector’s unique challenges. “Timely, effective and safe patient care often requires rapid communication with multiple clinicians and sometimes offsite. A secure, easy-to-use app is needed to facilitate this level of care.

“While temporary guidance was issued during the pandemic that allowed the use of well-known commercial messenger services to help reduce the risk of patient care being compromised, as a hospital we recognised that such services increase risk both in terms of patient data security and patient care, particularly because of the need to anonymise communications wherever practical.”

Security and compliance

Unfortunately, many health and social care professionals and organisations are unacquainted with these issues. Indeed, a survey by the European Heart Rhythm Association (EHRA) revealed that 88.3 per cent of its members regularly use commercial instant messaging apps, like WhatsApp, for sharing clinical information with medical colleagues, yet 29.3 per cent admitted they were unaware of EU data protection regulations. A further 46.7 per cent indicated there are no regulations in place at their institution regarding the sharing of clinical data via instant messaging.

Given that specialist tools have been developed, why are they not mandated among healthcare professionals? The problem is that many health and social care providers still don’t understand the risks involved with off-the-shelf messaging apps because of a simple failure to differentiate between security and compliance.

The basic promise of ‘end-to-end’ encryption, which is offered by the best-known messaging apps, certainly provides a strong element of security. It means the servers of the vendor cannot decrypt the message data even if they wanted to because they don’t have access to the encryption keys that belong to this encrypted data. However, this only applies to data while it is ‘in transit’ from one phone to another. What happens when the data is ‘at rest’, i.e. delivered to a phone or other device?

After a phone receives a message, several synchronisations take place with common messaging apps;photos and videos are synced automatically to the photo library of the phone, where the media is not encrypted; all conversations are backed-up by default and automatically go onto the cloud services of the phone provider – where message data is also stored unencrypted. As such, all these unencrypted conversations are exposed to unauthorized third parties.

Importantly, the professional who makes the decision to share information about their patient is always held responsible for protecting the patient’s confidential data. On a messenger app, this remains the same – the sender is always responsible and therefore needs to have control of what happens with the information on the receiving end of that communication. This control is often not possible and means many conversations taking place over common messenger apps are not compliant with medical confidentiality laws.

This is a huge problem because it becomes impossible for any healthcare professional sending an instant message on most services to be able to guarantee patient confidentiality. A way which is often used to get around this is to anonymise patient information within communications, but this also brings problems.

As recognised early on by Paul and his team at HJE, if healthcare teams cannot clearly identify which patient they are communicating about, it will almost certainly lead to confusion and mistakes. Since all healthcare professionals have sworn an oath to “do no harm”, this risk is often one not worth taking.

Communication and collaboration

For staff at HJE, Siilo has become a key tool in improving communication and collaboration between staff, and therefore improving patient care. A good example of this can be highlighted via its use in supporting the hospital’s Urgent Care Clinic (UCC), which is also helping to drive adoption in other departments.

“If a UCC doctor feels the need for input from a specialist consultant or the patient needs onward referral to a consultant, the UCC doctor can now use Siilo to contact a relevant specialist consultant rapidly and securely wherever they are.”

It is also proving to be an invaluable component in the day-to-day running of its medical team. “Siilo is now the ‘go to’ for some of our multi-disciplinary team meetings (MDTs). It solved a problem with a desire to increase the frequency of our MDT meetings without placing undue burden on the clinicians that contribute.

“It also allows ad-hoc MDT meetings where clinical circumstances dictate a patient’s case needs a review ahead of the next scheduled meeting. The messenger app allows clinicians to collaborate securely and contribute from whatever location they are working, regardless of their diary commitments.

We know the opportunities for the app are vast and since adoption, we are already seeing options becoming wider and wider, with more exciting use-cases being frequently put forward by staff.”

A growing number of healthcare organisations in the UK are recognising the tremendous benefits offered by digitalisation to the healthcare sector. While this is encouraging, it is essential that tools and technologies are truly fit to meet the standards expected. For communications technologies, this means applying absolute rigour to ensure patient confidentiality.

Joost Bruggeman is a former surgery resident at Amsterdam University Medical Centre and now CEO and co-founder of Siilo. For more information, please visit www.siilo.com.

For more information about St. John and St. Elizabeth Hospital, please visit: www.hje.org.uk