News October 21, 2022

CQC report spotlights system-level planning, local partnerships and neighbourhood insight

By Gabriel Blaazer

As well as highlighting “gridlock” across the health and care system amid dire workforce shortages, the CQC’s annual State of Care report outlines several ways ICSs can improve health outcomes and how they can be supported in doing so.

The report cites “historical underinvestment” in health and social care, as well as a “lack of sustained recognition and reward for the social care workforce”. It warns that “without action now, staff retention will continue to decline…services will be further stretched, and people will be at greater risk of harm.”

The CQC stresses that ICSs must improve their understanding of the health and care needs of local populations and highlights several examples of where effective local partnerships are improving health outcomes. For example, findings in the first annual report by the NHS Confederation’s ICS Network show that 90 per cent of system leaders reported an improvement in joint, collaborative working across their system.

Where ICS development needs support

Better system-level planning, along with local and place-based partnerships, the report argues, are central to addressing health inequality across the country.

However, The State of Care cites a study from the NHS Confederation reports uncertainty among primary care leaders about how “the experiences and insights of those leading primary care services at neighbourhood level inform system-level planning and strategy.” This dynamic undermines the integral purpose that ICSs have of using local experience and empirical evidence to inform proactive, localised strategies that will address health and care inequalities.

To improve the links between services and the populations they serve, the State of Care recommends an increase in the sharing of quality data, and advocates that local leaders be given data from providers and other local stakeholders to develop comprehensive understandings of population health at ground level. It argues that it is critical for ICS leadership and stakeholders to “agree success measures that are focused on people’s overall experience of care”, rather than arbitrary targets or outdated metrics.

The report refers to the CQC’s inspection of Cornwall and Isles of Scilly, where community nurses were focused on helping residents avoid hospital admissions and improving hospital discharges. Work in this area spanned health and social care services. Cornwall has developed an agile response framework, whereby an ‘emergency car’ can respond to 999 and 111 calls faster than ambulances typically could. This has allowed patients to be effectively triaged at home, where a decision can be made over whether an ambulance or hospital visit is necessary. This approach has helped take pressure off the local ambulance service and acute admissions in the ICS, and should serve as an example of outcome-based metrics for success.

On health inequalities, the State of Care advocates for an increase in data sharing, particularly demographic data, and especially data on ethnicity and disability, which is described as “not good enough” at present. It states that “better quality data and increased data sharing are critical…to understanding and tackling inequalities in people’s experience of and access to care.”

Citing some of the recommendations contained in the government’s independent Health and Social Care Review, the CQC argue the importance of hardwiring collaborative behaviours into ICS leadership to produce “broader cross-sector awareness and understanding” and address the “institutional inadequacy in the way that leadership and management is trained, developed and valued.”

A gridlocked system – where next?

At the heart of this year’s State of Care report is the presence of “gridlock” within the wider health and care system. A vicious cycle has manifested, in which preventative approaches to healthcare are failing, leaving more people requiring medical interventions. At the same time, a lack of resource in primary care and social care is driving people into hospitals where they do not necessarily need to be; this is evidenced by record-high ambulance and A&E waiting times.

This “gridlocked” system is leading to rapidly deteriorating levels of public trust and satisfaction. public satisfaction with the NHS overall has dropped from 53 per cent to 36 per cent, while those who reported a good overall experience of their GP practice dropped from 83 per cent to 72 per cent. This dissatisfaction is also reflected in levels of staff satisfaction, with more staff than ever before leaving health and social care and providers “finding increasingly challenging to recruit”, leading to “alarmingly high vacancy rates”.

National performance estimates cited in the report show that more than five million A&E attendees waited for more than four hours for treatment in 2021-22, compared to just over 3.5 million in 2019-20. Meanwhile, the number of people waiting more than 12 hours to be admitted to a ward from A&E has risen by nearly 65 times in just three years. While only 452 waited this long in July 2019, in July 2022, the figure rose to 29,317.

Social care has long been viewed as a “pressure valve” to acute care, allowing patients to be discharged from hospital back into the community, but again, this system is failing. Underinvestment in the sector has created an environment where poor wages and morale are driving workers away from social care and into the arms of higher paying careers. Record-high vacancy rates in the sector (165,000 in adult social care alone) mean that social care is effectively operating under a skeleton crew and is not equipped to handle the increase in demand that an ageing population with increasingly complex needs requires.

According to three in four of the system leaders surveyed by the NHS Confederation, the biggest obstacle hindering further progress is national workforce shortages. The CQC calls for “innovative initiatives” to address pervasive workforce shortages across the health and care system, as well as “increased funding and support for ICSs so they can deliver a properly funded workforce plan” that will tackle the “particularly acute” staffing shortages in adult social care.

Although 90 per cent of independent acute services are now rated as ‘good’ or ‘outstanding’ by the CQC, the report makes clear “that it is difficult for health and care staff to deliver good care in a system that is gridlocked.” It urges on the government to “deliver a properly funded workforce plan that recognises the adult social care workforce crisis as a national issue and offers staff better pay.”

As recently reported by the Health Foundation, in-work poverty has risen sharply among the social care workforce; one in 10 social care workers experienced regular food insecurity between April 2017 and April 2020 (before the recent surges in the cost of living), while 13 per cent of the children of social care workers were living in material deprivation during this period. Care home staff were also found to be twice as likely to be in receipt of in-work benefits compared to all workers, with some 20 per cent of the residential care workforce drawing on universal credit and other legacy benefits from 2017-2020. Few could argue that this is a healthy or sustainable situation.

The report continues that: “Without action now, staff retention will continue to decline across health and care, increasing pressure across the system and leading to worse outcomes for people. This will be especially visible in areas of higher economic deprivation where access to care outside hospitals is most under pressure.”

“Ignoring the urgent need to inject funding into the workforce is unthinkable”

Commenting on the State of Care report, NHS Providers’ Interim Chief Executive, Saffron Cordery said: “The regulator’s hard-hitting report makes clear that people’s care is affected by chronic staff shortages across the health and care system and must be a wake-up call for the government.

“Inadequate funding for and lack of capacity in social care have serious knock-on effects on an overloaded NHS. People need support to stay well and live independently in the community which would in many cases prevent, or delay, the need for hospital care.”

The National Care Forum’s CEO, Vic Rayner OBE, said: “This report, like so many others, highlights starkly the real impact on people when social care is underfunded and under resourced. Recognition of the heroic efforts, dedication and hard work of the care workforce to continue to support people in very difficult circumstances despite all the pressures is welcome. The government cannot continue to ignore the very real human impact on the millions of people who need care and support and the people working relentlessly every day to provide it.

“The possibility that the Chancellor is planning to delay social care reform and impose spending cuts is disastrous, especially given current pressure on the NHS and the looming winter pressures. This will impact on the already ‘gridlocked system’ CQC identified. Equally, failing to increase public spending on social care in line with rising costs and ignoring the urgent need to inject funding into the workforce is unthinkable.”

Dr Sarah Clarke, President of the Royal College of Physicians, said: “Usually this would make for stark reading, but unfortunately it is another in a line of reports that show the results of sustained underfunding of both health and social care.

“People are unable to see their GP or dentist, waiting in ambulances and emergency departments, lying on trolleys in corridors and languishing in hospital beds. Inequality in access and outcomes persists. NHS and social care staff are leaving saying conditions and the pressure are too much.

“As we have been saying for a long time now, we need proper workforce planning, funding for that plan, and a cross-government approach to preventing ill health and reducing inequality. This must be a priority for the next Prime Minister.”

Professor Martin Green OBE, Chief Executive of Care England, said: “This report paints a stark reality of the frontline. A gridlocked system, catalysed by a lack of funding and workforce pressures, prevents the system from operating efficiently and sustainably. If this gridlock is to be overcome, there must be an appropriate level of investment to stabilise the immediate and systematic workforce pressures currently experienced in the social care sector.”

The Nuffield Trust’s Deputy Director of Research, Sarah Scobie, commented: “The Care Quality Commission report paints a familiar but deeply troubling picture of a health and care system on the brink. Progress to plug severe staffing gaps across health and care and the effects of years of underinvestment have left the service ill-equipped to work through the backlog it already had, let alone the sharp increases in waits we have seen since the pandemic.”

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Seeing a GPs should not be like “booking an Uber driver”, warns Health and Care Select Committee

By Rusheen Bansal

The wide-ranging Health and Social Care Committee report on the future of general practice, released today, urges ministers and NHS England to acknowledge a crisis in general practice and sets out what steps they are taking to protect patient safety.

The latest Health and Social Care Committee report on the future of general practice, published today, urges ministers and NHS England to acknowledge a crisis in general practice and sets out what steps they are taking to protect patient safety.

MPs warn that seeing your GP should not be like phoning a call centre or “booking an Uber driver”, and note that care based on a doctor-patient relationship is essential for patient safety and patient experience.

Health and Social Care Committee member, Rachael Maskell, commented: “Our inquiry has heard time and again the benefits of continuity of care to a patient with evidence linking it to reduced mortality and emergency admissions. Yet that important relationship between a GP and their patients is in decline. We find it unacceptable that this, one of the defining standards of general practice, has been allowed to erode and our report today sets out a series of measures to reverse that decline.”

However, the report highlights that progress will be difficult unless workforce shortages are addressed. During the inquiry, MPs also heard that continuity of care is more difficult to achieve in very deprived areas, often due to existing GP shortages and patient populations with complex health needs.

The report sets out steps to reverse the decline in the continuity of care, making it an explicit national priority with a new measure requiring GP practices to report on continuity of care by 2024. MPs also urged NHS England to champion the ‘personal list’ model and re-implement it in the GP contract from 2030.

Responding to the Health and Social Care Committee report on the future of general practice, Ruth Rankine, Director of the Primary Care Network at the NHS Confederation, said: “Staff working across primary care have worked harder than ever to recover services and ensure access to services since the height of the pandemic. However, as they continue to grapple with enormous and rising patient demand the government has so far paid lip service to ensuring adequate funding is in place to support services and retain a valuable workforce.

“Our members will welcome many of the recommendations and ambitions set out in this report, but we know that tangible solutions to addressing critical capacity gaps in primary care will not be fixed overnight.

“Within the current workforce constraints, the importance of working at-scale through primary care networks and federations is critical, both to keep general practice sustainable and provide additional capacity to ensure access for those who need it and delivery of important public health programmes.

“Primary care staff will continue to champion continuity of care to those patients who need it most, but to make it real will require a funded and deliverable workforce plan otherwise this will continue to be an aspiration rather than the norm.”

GMC urges removal of barriers to help tackle NHS workforce crisis

By Gabriel Blaazer

The rules preventing thousands of doctors from being deploying deployed to areas of high patient demand must be removed to help tackle NHS challenges, the General Medical Council has said.

The regulator of doctors in the UK is urging the government to relax rules which dictate the roles that specialty and associate specialist (SAS) and locally employed (LE) doctors can undertake.

Published yesterday, the GMC’s The state of medical education and practice in the UK: workforce report 2022, identifies SAS and LE doctors – who are skilled doctors in non-training roles – as the fastest growing part of the medical workforce and a cohort which may become the largest group in the medical workforce by 2030.

The report argues for a relaxation of current rules to allow these doctors to be deployed to areas of high patient demand, including primary care. Rules such as the Performers List, which details those practitioners approved to work in primary care, can restrict the roles that doctors fulfil.

The number of licensed SAS and LE doctors rose from 45,587 to 63,740 between 2017-2021 – a 40 per cent rise. During the same period, the number of licensed GPs rose from 60,6090 to 65,160 – a 7 per cent rise. It is hoped that allowing more flexibility in the roles that doctors are permitted to undertake will help plug staffing gaps where demand is higher than workforce constraints can accommodate.

According to the Chief Executive of the GMC, Charlie Massey, a change to the rules would also help in the recruitment and retention of doctors, as it would allow for greater flexibility over when and where doctors can work. “Lots of these doctors tell us they want better career development and progression, and to have more flexibility in the positions open to them. But there are barriers that hinder their development, and rules that prevent them fulfilling some important roles,” he said.

The report also shows that many SAS and LE doctors come to the UK after qualifying abroad and are more likely to work for in the NHS for relatively short spells. It is hoped that offering more flexibility and career opportunities to these doctors will persuade more to stay in the UK “make the most of these talented and able doctors”.

Mr Massey added: “These are skilled doctors who do hands on work but are not in training to become a consultant or a GP. Many have made a positive choice to work in non-training and non-specialist roles in secondary care, where they do hugely valuable work.”

“But we know there are significant numbers who want wider opportunities. Systems must adapt to make the most of their talents. We need fresh thinking about how these doctors are deployed, and how they can be best used to benefit patients.”

“Now is the time to discard dated ideas and tap into the skills and experience these doctors provide.”

Building sustainable ICS staffing to weather the workforce crisis

By Dr Anas Nader

The advent of integrated care systems (ICSs) across the NHS marks an invaluable opportunity to facilitate greater collaboration, efficiency and more joined-up care for patients.

To be successful, this period of transformation needs to be underpinned by a strong, comprehensive workforce strategy that enables staff to be flexibly and safely deployed in line with fluctuating demand.

Amid present staff shortages and rising waiting lists, and with pressures set to grow over winter, this is, unsurprisingly, no easy task for organisations. As managers rightly address these immediate challenges, it’s understandable that little time or capacity is left to support broader workforce transformation. Yet the benefits of a transition to more collaborative ICS-wide staffing have the power to tackle these same challenges in the long-term.

While it may seem like another hurdle for teams who are already facing extreme pressure, there are a number of ways that ICSs can reap these benefits, without compounding workloads or piling additional pressure on staff. Throughout my time working closely with NHS organisations to tackle various workforce challenges, I have found the following steps essential to successfully enabling truly collaborative staffing. I believe they are also the key to unlocking a more sustainable, long-term workforce strategy.

Harnessing the power of collaborative temporary staffing

Temporary staff are crucial to the successful running of an ICS, helping to plug any gaps in rotas across the region. However, currently, when organisations are unable to source clinicians from their own internal staff bank, they must often turn to more costly external agencies to fill vacant shifts. Instead, by building a collaborative network of approved temporary clinicians, organisations can seamlessly tap into a much larger and more flexible contingent workforce from which to reliably fill shifts.

The key to effectively leveraging a collaborative staff bank is enabling compliant digital passporting for all participating clinicians. This means approved workers can passport their credentials across different participating organisations, without having to repeat compliance or background checks. As a result, they can more easily work across a number of different sites and locations and be deployed effectively in line with demand throughout the ICS.

Increasing data oversight

In order to reliably plan ahead, identify staffing gaps and deploy staff where most needed, access to comprehensive data insights is crucial. This means not only enabling managers to view data from within their own organisation, but granting access to pan-regional workforce data from across the entire ICS.

Dynamic data reporting, which provides timely, granular insights into organisational performance, can help measure the success of workforce planning, enable targets to be reliably met and pinpoint areas where improvements can be made. Individual organisations should be able to assess their own performance data and compare this with others in their region. With clear visibility over regional shift fill rates, workforce spend and staffing trends, it becomes easier to identify areas for improvement, while harmonising pay rates and maintaining safe staffing levels in a truly collaborative manner.

Introducing more flexible rostering

When it comes to rostering, the current systems at managers’ disposal are often slow, outdated and require large amounts of manual input. Introducing more streamlined, digital systems which can safely provide staff with greater flexibility and predictability, while reducing the admin burden on managers, can help open the door to more effective ICS-wide rostering in the future.

Rostering clinicians based on skillset rather than title or grade will allow managers to deploy staff more effectively, in line with patient need. This will also give staff the flexibility to safely work in a wider range of roles, in different locations across the ICS, and to access wider professional development opportunities. These are all essential to helping boost retention.

Meanwhile, multi-organisational rostering could begin to allow more efficient deployment of staff to areas of highest need across the ICS. This makes it easier for managers to reliably plan ahead and gives staff greater control over where they work, in line with their personal and other professional commitments.

Prioritising system integration

System integration is a fundamental prerequisite to the success of every single one of these steps. If the systems being used to organise staffing within different organisations are unable to communicate or share data with each other, genuine collaboration will remain out of reach.

When introducing new workforce management systems, organisations should prioritise those which are fully integrated or interoperable, enabling managers to directly share workforce data, rota planning and temporary staffing networks with other organisations throughout the ICS. This reduces the need for manual data input, minimising admin for managers and speeding up the transfer of vital data and information.

As a result, organisations will be able to collaborate in real-time and deploy staff to the most appropriate services in line with evolving ICS-wide demand.

To reap the full rewards of ICS working, facilitating a collaborative, flexible workforce is vital. This transition does not have to be costly, nor add additional burden to managers or organisations. By working together and implementing these four key areas of change, we can lay the foundations for strong, collaborative ICS-wide working, built to weather the challenges which lie ahead.

Devolution & health outcomes: Getting a seat at the table

By Gavin Bashar

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

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

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

Engaging with citizens

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

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

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

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

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

Collaboration to drive links

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

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

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

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

Providing universal access to technology and software support

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

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

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

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

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

Moving forward

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

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

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

This is a sponsored article.

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

Billions needed to plug growing NHS maintenance backlog

By Integrated Care Journal

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

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

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

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

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

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

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

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

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

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

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

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

By Lucy Catlin

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

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

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

Effects of COVID-19 on infection control in elective care

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

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

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

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

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

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

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

Where are we heading next?

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

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

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

Conclusion

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

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

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

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

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

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

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

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

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

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

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

This is a sponsored article.

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

By Gabriel Blaazer

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cost of living hits social care staff as vacancies soar

By Gabriel Blaazer

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

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

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

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

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

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

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

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

In-work poverty increasing among social care workforce

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

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

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

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

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

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

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

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

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

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

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

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

Redefining place-based care: facilitating system change

By Graham Brown

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

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

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

Defining place-based care

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

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

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

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

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

Person-centred and community care

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

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

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

Funding streams and ICSs

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

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

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

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

The impact of technology

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

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

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

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

Facilitating system change

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

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

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

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

This article was kindly sponsored by Tunstall Healthcare.