Reducing misdiagnosis and helping patients back to work

By Mark Thomas

New imaging technology promises to bring affordable, more detailed 3D imaging to care settings around the world, providing faster and more accurate diagnosis and helping patients get the right care.

Scaphoid fractures are notoriously difficult to diagnose, typically presenting among young men following a fall onto an outstretched hand, car accident or contact sport incident. One of eight small bones that make up the ‘carpal bones’ of the wrist, the scaphoid connects two rows of bones: one closer to the forearm and the other closer to the hand. These fractures can present with wrist or thumb pain but not necessarily any visible deformity or significant loss of motion, leading many incidences to be misdiagnosed as wrist sprains.

The scaphoid bone has an avascular blood supply that means, depending on the location and size of the break, there is a real risk of bone death where blood supply is cut off. This leads to a loss of wrist function and dexterity, which can have significant financial implications for those who rely on their flexibility of wrist movement that the scaphoid supports.

This is why MRI and CT images have become the ‘gold standard’ for diagnosis. However, limited resources and long imaging waiting lists mean clinicians across the UK instead rely on X-rays in the first instance. If a scaphoid fracture is suspected, clinicians will typically request four X-ray views, versus two for other wrist injuries, but even that is not a guarantee that the fracture will show as the scaphoid bone can be easily hidden by other carpal bones in a 2D image.

*Traditional 2D film X-ray radiograph showing broken carpal bone (scaphoid fracture)*

It is easy to understand how scaphoid fractures can be easily missed then, particularly in overstretched A&E departments where there may not be sufficient scanner time or radiology cover to diagnose ‘minor injuries’ quickly. Clinical teams usually adopt a conservative approach therefore: Initially treating the injury as if the bone is fractured, with splinting recommended to protect it from further damage, and a follow-up appointment with the fracture clinic in 7-10 days’ time. By this point, if the patient is still experiencing pain, new X-rays will likely reveal initial bone healing more clearly than the original scaphoid break.

It is a sensible approach but one that ultimately causes several problems:

Firstly, where clinicians are concerned about the possibility of a scaphoid fracture but unable to confirm it during the initial visit, splinting the wrist while awaiting further imaging or specialist review means patients can find themselves unable to work unnecessarily, with significant financial implications due to lost earnings.

Scaphoid fractures are usually slow to heal because tiny blood vessels supplying nutrients to the site are often damaged at the time of injury. This means that even though the results of both surgical and non-surgical interventions are very good following diagnosis, both approaches require considerable time in plaster, with knock-on impacts for patients and their dependents, including inability to drive, work and earn normally. Should surgery ultimately be required, it is easy to see how treatment delays of just a couple of weeks can have a real impact on patients’ lives.

Finally, requiring all patients to attend follow-up appointments in fracture clinic has significant resource implications for a healthcare system already under pressure, not least in terms of clinician time and additional imaging requirements.

Improving diagnosis through next-gen imaging

Accepting all of the above, how then can we improve diagnosis for these patients? How can we prevent patients with sprained wrists taking unnecessary time off work, while supporting those with scaphoid fractures to access faster treatment and limit injury-related loss of earnings?

One potential solution lies in a new imaging technology – already proven in the veterinary industry – which promises to bring affordable, more-detailed 3D imaging to the point of care in hospitals and clinics around the world.

This next-generation technology builds on the foundations of digital tomosynthesis (DT) imaging, which is widely used for breast imaging across the NHS. With traditional DT, a conventional X-ray tube moves through a range of angles to derive 3D data – providing better diagnostic information than 2D X-ray but, restricted by its limited depth resolution capabilities, creating difficulties localising some structures and elements.

Adaptix’s unique 3D X-ray technology ‘sweeps’ in two dimensions, enhancing the Z resolution relative to conventional DT. Images are quickly reconstructed – in under 20 seconds – providing slice-by-slice images that can be analysed extremely quickly. This allows for slice thickness adjustments over regions of interest – a particularly important feature when looking for ‘tricky’ fractures, such as those to the scaphoid bone.

The result? A high-resolution 3D image that provides far greater definition and clarity than 2D X-ray techniques, at a cost and radiation dose similar to traditional X-ray. What is more, the compact design of the technology and low-radiation dose, mean it can be brought directly to the point of patient care – reducing time spent moving between hospital departments and allowing clinicians to obtain imaging ‘in clinic’ if needed.

About the author

Mark Thomas, BSc (Hons), PgC, HCPC Reg., Product Manager, Adaptix

Mark spent the first 10 years of his career working as a Radiographer in human healthcare both in the UK and Australia. Later, he focused on CT, managing the Neuro CT Service in Oxford in his final position. In 2008, Mark joined Toshiba/Canon Medical as a CT Specialist, and spent the next 15 years initially providing training, before managing the UK Clinical CT Team. With a strong team Mark drove the adoption of new technologies pushing clinical boundaries, maintaining high clinical integrity and importantly customer satisfaction. Mark’s background gives him real clarity on the future and opportunity for inclusion of Digital Tomosynthesis Imaging in a modern, forward thinking Imaging Service.

Data solutions to solve the South West’s patient discharge crisis

By Professor Christos Vasilakis and Dr Zehra Onen Dumlu

Professor Christos Vasilakis, Founding Director of the Centre for Healthcare Innovation and Improvement – CHI²) and Dr. Zehra Onen Dumlu from the University of Bath discuss the IPACS project – a collaborative, data-driven approach to improving patient flow.

Delayed discharges, often known as ‘bed blocking’, is a serious operational challenge for NHS managers across the country. According to NHS England data, in February 2024 there were between 13,200 and 14,200 patients remaining in hospital each day who did not meet the criteria to stay. This accounts for more than one in eight general and acute beds in England.

While patients are deemed medically fit for discharge, they remain in hospital due to complexities in arranging necessary social care or community nursing support for a safe transition. The knock-on effects are significant, placing immense strain on acute bed capacity and negatively impacting patient flow and their experience.

The IPACS project: A collaborative, data-driven approach

To address the issue, the Improving Patient Flow between Acute, Community, and Social Care (IPACS) project was launched in 2020. This significant three-year initiative received funding from Health Data Research UK (HDRUK), an independent charity focused on using health data research to address major healthcare challenges.

IPACS brought together a diverse team, combining academic expertise with frontline NHS operational knowledge. Collaborators included the University of Bath, the University of Exeter Medical School, and significantly, the Bristol, North Somerset, and South Gloucestershire (BNSSG) Integrated Care Board (ICB).

The goal of the project was to develop an open-source computer simulation model capable of analysing the complex dynamics of patient flow. This tool would offer a potential blueprint for healthcare organisations nationwide grappling with delayed discharge pressures.

Central to the project was the application of Operational Research (OR) techniques – using advanced analytical models to dissect and solve complex systemic problems. Several team members brought extensive OR experience, with affiliations to The Operational Research Society, demonstrating the project’s robust methodological foundation aimed at enhancing healthcare efficiency.

A multidisciplinary, team-driving innovation

The success of IPACS hinged on its multidisciplinary collaboration. BNSSG ICB’s Head of Modelling and Analytics, Dr Richard Wood, and University of Bath Research Fellow Dr Paul Forte provided essential insights into real-world healthcare operations and ensured the project outputs were relevant and accessible to NHS decision-makers.

Academic leadership came from Professor Christos Vasilakis (founding director of the Centre for Healthcare Innovation and Improvement – CHI²) and Dr Zehra Onen Dumlu at the University of Bath, working alongside Professor Martin Pitt and Dr Alison Harper from the University of Exeter Medical School. This combined team undertook the intricate task of designing, developing, and validating the simulation framework.

Focusing on the critical ‘Discharge to Assess’ service

A key focus for the IPACS project was the transition of patients from acute settings into community care, specifically via the ‘Discharge to Assess’ (D2A) service. Optimising this service is key to improving hospital throughput. The project modelled the three core D2A pathways:

Pathway 1 (P1): Enabling patients to return home with domiciliary support.
Pathway 2 (P2): Providing bed-based rehabilitation for those needing more intensive recovery support post-discharge.
Pathway 3 (P3): Catering for complex care assessments, frequently leading to long-term care placements.

The IPACS model aimed to help optimise capacity planning and resource allocation across these vital pathways.

The BNSSG region: A relevant testing ground

The Bristol, North Somerset, and South Gloucestershire (BNSSG) region, serving approximately one million people, served as a practical case study. Its demographic mix and blend of urban and rural environments reflect challenges common across the NHS. The region’s D2A pathways were experiencing significant pressure, with high occupancy and discharge delays, providing a rich, real-world dataset and demonstrating the urgent need for the solutions IPACS explored.

Operational Research and simulation modelling in practice

Professor Vasilakis and Dr Wood pinpointed the core management challenge: the complex interdependencies between acute, community, and social care services. Bottlenecks in community and social care inevitably impact upstream services, contributing to emergency department pressures and ambulance handover delays.

The IPACS team used real-time data on patient occupancy and discharge delays to build their model. This allowed them to establish baseline performance and, critically, to run “what if” scenarios, varying parameters like length of stay and arrival rates to understand potential impacts of service changes.

Computer simulation modelling, a cornerstone of OR, was central to this. The model allowed the team to:

Simulate patient journeys through the D2A pathways in detail.
Test potential interventions virtually to assess their likely impact on flow and delays.
Analyse how best to allocate resources to mitigate discharge delays.
Account for time-varying demand patterns.

Built using the open-source ‘R’ programming language, the model prioritised accessibility and transparency.

Demonstrating real-world impact and future potential

The IPACS model provided valuable quantitative insights. Outputs clearly demonstrated the potential benefits of achieving target pathway splits and reducing lengths of stay within the D2A service. Significantly, estimates generated by the model were used to support a £13 million business case for enhancing the local D2A system – highlighting the project’s tangible value in informing strategic investment decisions.

The team acknowledged the model does have some limitations. It doesn’t yet capture every element of discharge, such as specific social care inputs, palliative care routes, or detailed post-D2A placement dynamics. Data completeness also needs some ongoing attention. Future work could involve expanding the model’s scope to incorporate social care elements more deeply, analyse the impact of acute capacity constraints, optimise home-based care models, and potentially develop faster analytical tools.

The ongoing challenge and strategic steps forward

Tackling delayed discharge requires effective strategies, and the IPACS project highlights the value of OR. Using OR methods such as simulation modelling allows NHS managers to better understand complex discharge pathways, evaluate potential solutions before implementation, and make more informed, evidence-based decisions about resource allocation to improve patient flow and reduce delays.

*Dr Zehra Onen Dumlu, Assistant Professor, University of Bath*

*Professor Christos Vasilakis, Founding Director, Centre for Healthcare Innovation and Improvement – CHI²*

Accelerating NHS net zero goals through medicine carbon footprinting

By Samantha Semmeling

With medicines accounting for a quarter of the NHS carbon footprint, Nazneen Rahman, Founder of YewMaker and co-creator of MCF Classifier, explains how AI-driven medicine carbon emissions data can support practical, scalable strategies that align clinical excellence and environmental stewardship.

The climate crisis is resulting in acute and chronic health challenges, which are putting pressure on global health systems. In turn, the healthcare sector is estimated to account for 5 per cent of global greenhouse gas emissions. This places a unique responsibility on the sector to both manage these impacts and reduce its contribution to climate change.

More than 20 countries have committed to delivering net zero health systems. In the UK, the Health and Care Act 2022 embedded the commitment for the NHS to become net zero by 2045 into legislation, making it the first health system worldwide to do so.

Progress on sustainable medicines

Medicines make a sizeable contribution to the NHS’ carbon footprint (an estimated 25 per cent), so a comprehensive strategy to reduce medicines-related emissions is necessary for the NHS to reach its net zero goals.

The NHS is already making headway. Green plan guidance now recommends that systems and trusts use lower carbon inhalers and anaesthetics, which has already seen successful uptake.

However, of the 25 per cent attributed to medicines, inhalers and anaesthetics only account for 5 per cent. The remaining 20 per cent comes from the manufacture and supply of the billions of medicines prescribed across the NHS every year.

Progress on reducing these emissions has been hindered by a lack of accessible product-level emissions data. Manufacturer data is rarely made available and is not standardised, making it difficult to use as a baseline for carbon reduction strategies.

MCF Classifier – Medicine emissions data at scale

YewMaker creates science-based solutions to help make healthcare more sustainable. Chief Executive Officer, Nazneen Rahman and Chief Technology Officer, Haroon Taylor saw an opportunity to harness industry standards in green chemistry, using AI and data science to develop a standardised methodology for calculating the carbon footprint of individual medicines. The resulting technology suite, MCF Classifier (MCF = Medicine Carbon Footprint), provides data and tools that enable the manufacture, supply, emissions, procurement, and prescription of medicines to be carbon-informed.

“We developed MCF Classifier to make medicine emissions visible, consistent, and usable,” says Nazneen. “Without that foundation, it’s difficult for anyone – whether in procurement, policy or practice – to take meaningful action.”

The methodology behind MCF Classifier has been peer-reviewed and published, bringing transparency and credibility to an area where data has been limited and inconsistent. Research using MCF Classifier has shown wide variation in medicine carbon footprints across all therapeutic areas, highlighting significant opportunities for carbon-informed decisions in procurement, supply chain planning, and prescribing.

YewMaker is now building MCF Classifier tools and products to drive awareness and action. MCF Formulary, supported by NHS funding, provides standardised per-dose carbon ratings for thousands of medicines through a free, user-friendly web portal. It allows healthcare practitioners to explore the relative carbon impact of medicines and integrate sustainability into medicine optimisation strategies.

For manufacturers and suppliers, YewMaker uses MCF Classifier to deliver a range of data products and services, including product carbon footprint reports, large-scale emissions analyses, portfolio-wide carbon assessments, and therapy emission comparisons. These support organisations to understand and mitigate the carbon impact of their medicines and to meet reporting requirements.

Advancing NHS net zero goals

The NHS has committed to reach net zero by 2045 for emissions influenced through the procurement of goods and services, including medicines. To help suppliers align with this goal, the NHS has developed a roadmap outlining key milestones. By 2027, all suppliers are required to publish a Carbon Reduction Plan, and by 2028, they must provide carbon footprint data for individual products.

Reducing supply chain carbon emissions will be essential. However, delivering on these targets will require practical and proportionate approaches. Nazneen highlights the importance of ensuring that new expectations, such as product-level carbon reporting, are introduced in ways that support, rather than disrupt, medicines supply. Tools like MCF Classifier can help by providing suppliers with accessible, consistent data that supports engagement without creating unnecessary complexity or burden.

Nazneen emphasises that carbon data should not be seen as a compliance exercise, but as a resource to support informed, balanced decisions. As understanding of product-level emissions improves, suppliers will be better placed to identify areas for reduction while maintaining stability and quality across the supply chain.

Improving the sustainability of the medicines supply chain will require coordinated efforts among multiple stakeholders. Collaboration at the organisational, sectoral, national and global levels will be essential in creating a supply chain that is not only resilient and cost-effective but also environmentally responsible.

By embedding carbon considerations into decision-making, the NHS can continue to lead in aligning clinical excellence with environmental sustainability and take meaningful steps towards delivering a net zero health system.

Further information

Dr Nazneen Rahman is CEO and Founder at YewMaker, a purpose-driven business building science-based sustainable healthcare solutions, and the Executive Director of the Sustainable Medicines Partnership action collaborative.

If you are interested in this topic or PPP’s pharmacy and medicines work more broadly, please contact Samantha Semmeling, Policy and Programmes Manager, Public Policy Projects (samantha.semmeling@publicpolicyprojects.com).

Benefits of single-handed care highlighted at new qualification launch

By Integrated Care Journal

Level 2 Proportionate Single-Handed Care qualification formalises single-handed care principles into Ofqual regulated training for the first time. The qualification counters the misconception that it is unlawful to provide moving and handling care activities with less than two handlers.

Leading figures in the social care sector, including representatives from Care England, Department of Health and Social Care and the NHS, came together at the House of Lords on Wednesday 2 April for the launch of the Level 2 Proportionate Single-Handed Care Qualification, developed by the Royal Society for the Prevention of Accidents (RoSPA) and A1 Risk Solutions Ltd.

The event was hosted by RoSPA Vice President Baroness Watkins of Tavistock, who reflected on how her own background in nursing has demonstrated both the importance of greater recognition of care workers’ skills, and the need for improved pathways to developing them.

Watkins said: “Working as a nurse myself gave me firsthand experience of how care workers are the backbone of our health and social care system, delivering care, kindness and support to hundreds of thousands of people on a daily basis. Despite the increasing demand for social care, with requests for support from new clients reaching over two million in 2023-24, the vital contributions of care workers often go unrecognised.

“The qualification not only benefits individual care workers by enhancing their skills and job satisfaction but also promotes privacy, independence, and flexibility for service users. It ensures that care is delivered effectively, safely, and with dignity, without compromising the health and wellbeing of either party.

“By investing in our care workers, we are investing in the future of our health and social care system.”

In her keynote address, RoSPA Chief Executive Rebecca Hickman explained how the new qualification builds on the charity’s commitment to ensuring the highest health and safety standards across the whole of society.

Rebecca Hickman said: “The Level 2 Proportionate Single-Handed Care Qualification is a new addition to RoSPA’s suite of highly respected training qualifications for the social care sector, such as our Level 2 Adult Social Care Certificate and our Level 3 Award for Safer People Handling Trainers.

“Developed in collaboration with key partners and supported by sector leaders, this qualification is designed to enhance the skills and knowledge of professionals, empowering them to deliver safer and more effective care.

“This qualification is based on the latest evidence and best practice. By setting high standards, recognising excellence, and delivering comprehensive training, RoSPA continues to lead the agenda in making society safer for everyone.”

The Level 2 Proportionate Single-Handed Care qualification is the first time the principles of single-handed care has been formalised into an Ofqual regulated training programme.

Proportionate/single-handed care encourages a more personalised approach to supporting a person’s moving and handling requirements. This ensures the person receives the optimum amount of care and support in the correct environment. By enabling individuals to do as much for themselves as possible, proportionate/single-handed care reduces the likelihood of them becoming deconditioned and being readmitted to hospital or admitted to long-term care. This also has the benefit of freeing up capacity across the wider health and social care system.

Alongside training staff in areas such as risk assessment and the practical delivery of safe moving and handling, the qualification counters the misconception that it is unlawful to provide moving and handling care activities with less than two handlers. Care should not be over prescribed and should be proportionate to the needs of each person to ensure that it does not foster dependency.

Find out more about the Level 2 Proportionate Single-Handed Care qualification.

Acute Care, Community Care, News, Secondary Care, Systems April 10, 2025

Embedding social prescribing in secondary care: A toolkit from Barts Health

By Gabriel Blaazer

Barts Health NHS Trust and its partner organisation, Transformation Partners in Health and Care, have released a toolkit detailing their pioneering work embedding social prescribing in secondary care and specialist acute pathways. The toolkit aims to help providers address unmet social needs, improve patient outcomes and reduce demand on acute services, shaping a holistic, prevention-focused model for the future NHS.

Social prescribing attempts to address the social determinants of health. These are the non-medical factors influencing 84 per cent of a person’s total health, with clinical care impacting the remainder. Social determinants of heath include income security and employment, education, housing and food insecurity, or social isolation.

Introduced in England in 2018, it typically involves signposting or referrals to appropriate services, but can also include emotional and mental health support for people experiencing social isolation or low-level mental health issues. Social prescribing is a holistic, person-centred and preventative approach and as such, is a key enabler of the government’s efforts to shift more care into the community and bolster prevention initiatives.

Emerging evidence suggests that social prescribing is an effective, yet low-cost, preventative intervention. However, its implementation has been more frequent in primary and community care, compared to secondary care. In 2023, Barts Health NHS Trust (Barts Health), one of Europe’s largest acute healthcare providers, started implementing social prescribing across multiple pathways, using different integration models to support a whole system approach to prevention and personalised care.

These services, delivered by social prescribers in collaboration with clinical and wider multi-disciplinary teams, support residents with their social needs while aiming to reduce demand on high-pressure services, including cardiovascular (CVD), renal, emergency care, and children and young people’s (CYP) services.

Encouraged by positive outcome data, the Trust and its partner organisation, Transformation Partners in Health and Care (TPHC), have developed a toolkit to help secondary care services embed social prescribing, public health and other community-led prevention initiatives within their specialties and pathways. The toolkit serves as a practical guide and checklist for secondary care providers looking to implement social prescribing and explore integrated, whole-system approaches to prevention.

Addressing unmet needs

While NHS England has established a standard model for embedding social prescribing, this has primarily focused on integration within primary care. In 2023, Barts Hospital’s Endovascular Team, led by Vascular Surgeon Dr Tara Mastracci, identified a high prevalence of unmet social need among patients in the hospital’s cardiovascular pathway – a well-evidenced correlation. Given that CVD disproportionately affects socially deprived populations, Dr Mastracci theorised that integrating social prescribing could benefit those at highest risk, simultaneously alleviating pressure on the pathway and improving patient outcomes.

A key data point supporting the use of social prescribing in secondary care was the gender split between typical users of social prescribing services and those presenting with acute cardiovascular issues. While 84 per cent of patients within cardiovascular pathways were men, 60 per cent of social prescribing users were women. Research has shown that women consult primary care services 32 per cent more frequently than men, suggesting that secondary care could play a central role in engaging men, who might otherwise remain underserved by traditional social prescribing models.

“Overall, we have found that we encounter a different group of patients compared with those who access social prescribing in primary care.”

Dr Tara Mastracci, Endovascular Lead for Complex Aortic Surgery, Barts Health

This reinforced Dr Mastracci’s belief in the merit of social prescribing within secondary care – clearly, more effort was needed to engage men, particularly for CVD patients who could benefit from greater social support.

Building a collaborative approach

Several specialties within the Trust had also identified unmet social needs as a key driver of service demand, and had begun implementing social prescribing programmes within their pathways. However, these initiatives were siloed, staff-led and reliant on temporary funding or fixed grants. To enhance collaboration and sustainability, Dr Mastracci established a multidisciplinary network of staff across primary and secondary care to drive a more integrated and formalised approach.

Finding limited guidance on implementing social prescribing within secondary care, Dr Mastracci’s CVD team set out to develop a replicable model for implementing it as part of secondary care pathways. Keen to apply the same rigorous standards as with a medical intervention, the team partnered with health economists at the University of East London. They incorporated EQ-5D instruments and QALY (quality-adjusted life years) metrics to evaluate the potential impact of social prescribing on both patients and the wider health and care system.

Recognising the need for greater institutional knowledge and community expertise, the team also partnered with the Bromley by Bow Centre (now Bromley by Bow Health), a leading VCSFE (Voluntary, Community, Social, and Faith Enterprise) community health organisation. This collaboration led to the embedding of a social prescriber within the hospital’s heart attack pathway, screening patients entering the pathway for financial or other social needs.

Implementation and outcomes

Once identified, social prescribers provided patients with six to eight support sessions, connecting them to local services and community groups tailored to their specific social needs. Beyond financial deprivation, patients received support for needs including housing, talking therapies, and healthy lifestyle support such as smoking and alcohol cessation, or physical activity and weight management – all of which play key roles in determining a person’s risk of developing CVD-related conditions.

The social prescribers were drawn from diverse backgrounds and communities, to work in collaboration with clinicians and consultants from secondary care, patient advocate groups, VSCFE organisations and others. This multidisciplinary approach facilitated a holistic and patient-centred approach. The experiences and lessons from creating the CVD social prescribing pathway were later used to inform other specialties as they implemented similar services within their pathways.

“We believe strongly in the importance of ‘place’ and thus many of our social prescribers meet patients in the community where they live to engage and provide support.”

Dr Tara Mastracci, Endovascular Lead for Complex Aortic Surgery, Barts Health

Dr Mastracci acknowledges that it will take years to fully assess the impact of Barts Health’s social prescribing programmes. “We know these target groups are admitted at higher rates than their peers,” Dr Mastracci told ICJ, “but it will take years to evaluate the long-term effects.”

Despite this, early results have been promising, notably within children and young people’s (CYP) diabetes services. Led by Dr Myuri Moorthy, Diabetes Consultant and Clinical Lead for Young Adult Diabetes (YAD) at Barts Health, clinicians in the pathway had noticed a concerning increase in non-adherence to self-management protocols, often linked to concurrent financial and psychosocial issues. The service also saw high numbers of patients not attending appointments (DNAs), largely due to distress, burnout, and the intense mental health toll associated with diabetes.

Poor diabetes self-management is well known to increase the likelihood of complications. This prompted the diabetes team to adopt a co-designed and personalised model, including a multi-disciplinary team of social prescribers, youth workers and a psychologist. The aim of the YAD Social Prescribing Service was to improve patient engagement, reduce DNAs and maximise the impact of each clinical appointment.

Together with service users, the team co-developed a series of interventions, including monthly peer support meetings, a WhatsApp group and a ‘walk and talk’ group, securing funding from NHSE for two and a half years. During this time, the team successfully:

Reduced the DNA rate across the Trust from 39 per cent to 12.5 per cent
Cut diabetes-related hospital admissions of CYP by 36 per cent across all Barts sites
Generated financial savings of an estimated £62,500 per year across the Trust

More outcomes from the prevention initiatives across Barts Health, including economic and demand savings, stronger integrated community networks and improved outcomes and patient experience, can be found on pages 26-30 of the toolkit.

Gaining leadership buy-in

As with many prevention-based interventions, the impact of social prescribing on health and care systems can take years to fully assess. In its paper on integrated neighbourhood teams (within which social prescribers typically sit), The National Association of Primary Care suggests that “savings will be non-cash releasing, but this is not as issue as what is required is capacity and health improvement.” However, this long-term approach does not easily align with NHS funding cycles, which typically require demonstrable return on investment within 12 months.

Currently, all of Barts Health’s social prescribing pathways are funded individually, on an ad hoc basis. The CVD project, for example, was initially funded by NHSE, but is now supported by Barts Charity. To move towards trust-wide funding, TPHC’s Secondary Care Project Manager, Mollie McCormick, emphasises the need to develop:

Robust databases and coding frameworks to accurately track interventions and outcomes over time
Qualitative data collection from patients benefiting from social prescribing, with an emphasis on reduced need for healthcare services and thus cost savings

Bridging the gap between identifying social needs that drive demand and demonstrating short-term cost savings remains a challenge. However, securing the backing and support of senior clinical leadership is critical in building the case for long-term investment.

For social prescribing initiatives to gain trust-wide funding in future, structural changes are needed to prioritise long-term prevention and strengthen outcomes-based commissioning. Different approaches could involve integrated care systems incentivising prevention by:

Setting realistic and appropriate prevention targets for NHS trusts to influence commissioning decisions towards the implementation of personalised care and prevention initiatives
Introducing penalties for avoidable readmissions

These targets could be assessed by monitoring readmission rates for specific condition cohorts or high-demand service areas, ensuring a measurable focus on prevention.

The toolkit: Embedding and Connecting Prevention in Specialist Pathways

Barts Health and TPHC have now published their toolkit, Embedding and Connecting Prevention in Specialist Pathways. Along with background information on the benefits of social prescribing and community-led prevention, the toolkit addresses some of the key systemic barriers that Barts Health encountered while implementing initiatives across various pathways and specialties.

Using case studies and the first-hand insights from patients, social prescribers and clinicians, the toolkit offers practical guidance for those looking to implement community-led prevention approaches, such as social prescribing, in secondary care. It also provides an overview of key Barts Health prevention networks and identifies the leaders driving this work across the Trust. The toolkit offers a valuable resource for anyone working in an acute setting wanting to embed social prescribing into their services or to prioritise the prevention of ill health in NHS Trusts across London and nationally.

Social prescribing: A key enabler of NHS prevention goals

Emerging evidence strongly supports social prescribing as a cost-effective intervention for tackling the wider determinants of health and addressing the often-overlapping health inequalities that contribute to high demand for NHS services.

Further, as the government seeks to move more care from hospitals to communities as part of its ‘three shifts’, initiatives like social prescribing will be increasingly vital. By reducing pressure on secondary care services and helping local systems meet their financial and operational goals, social prescribing plays a crucial role in shaping the future of preventative, person-centred and sustainable healthcare.

Special thanks to Dr Tara Mastracci, Endovascular Lead for Complex Aortic Surgery at Barts Health, and Mollie McCormick, Secondary Care Project Manager at Transformation Partners in Health and Care, for their time and input in developing this article.

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UK digital health company launches Prevention Innovation Fund to support ICSs

By Integrated Care Journal

Holly Health has announced a £320,000 fund, offering systems access to psychology-based digital health services, enabling system leaders to move forward with prevention initiatives.

Long-term conditions (LTCs), mental health challenges, and multimorbidity rates are rising, with lifestyle risk factors the biggest cause. This is impacting system costs (£18.4 billion, or over three quarters of NHS expenditure, is spent on long-term care per year) and workplace sickness (38 per cent of people of working age on long-term sickness, report having 5 or more LTCs). The vast majority of people living with these challenges currently get no tailored support for lifestyle health improvement.

Holly Health has today announced a £320,000 Prevention Innovation Fund, offering up to four integrated care systems (ICSs) (or equivalents in Scotland and Wales) up to £80,000 credit each towards deploying a proven, psychology-based digital health coaching service, to increase self-management support across their region.

The goal of the fund is to help NHS system leaders to move forward with large scale prevention initiatives efficiently, supporting progress towards the three new UK healthcare strategy ‘shifts’, from treatment to prevention, hospital to community and analogue to digital.

Holly Health is a fully digital, yet personalised, health coaching service which supports patients to develop sustainable health habits across mental and physical health and most lifestyle risk factors.

Backed by the NHS Innovation accelerator, and with more than 200 GP practices partnerships around the UK, Holly Health outcomes show significant average health improvements across areas like exercise, mental wellbeing, weight and blood pressure. Additionally, GP appointments show consistent reductions after using Holly Health, especially in more frequent service users.

Steve Woodford, NHS Non-Executive Director at NHS England, said: “The NHS has an opportunity to shift towards a proactive, preventive and personalised care system, with the help of technology. Services like Holly Health can help to drive these changes affordably and efficiently. This is a great opportunity for ICB teams, enabling scalable self-management support for people living with or at risk of long-term conditions.”

There are two main ways in which ICSs will be able to launch Holly Health at scale. One is via traditional routes, deploying Holly Health via primary care and public health services. The second, a route fit for the future NHS, is to launch Holly Health to members of the public, via the NHS App, made possible by a brand-new collaboration between Holly Health and Patients Know Best, also announced today.

Patients Know Best (PKB) is the UK’s leading personal health record platform, enabling patients to access and contribute to their health records using the PKB website and via the NHS App. The new Holly Health and PKB integration allows the Holly Health digital health coaching service, and PKB records to ‘speak’ to each other, so that members of the public can transfer blood pressure readings and lifestyle health data into their personal records. ICS teams will also have the new opportunity to reveal access to Holly Health coaching, via PKB and the NHS app, supporting the government’s vision for a single place for people to manage their health.

Grace Gimson, chief executive at Holly Health, said: “We’re extremely excited to make this double announcement: the launch of our Prevention Innovation Fund, and go-live of our partnership with PKB. Both have the potential to drive huge systemic changes in UK healthcare, driving prevention and personalised patient care forward, at population scale.”

Mohammad Al-Ubaydli, chief executive at PKB, said: “Holly Health’s pioneering approach to preventative care, perfectly complements PKB’s mission of empowering patients with their health data. Together, we’re creating a seamless experience where patients can proactively manage their wellbeing and maintain a complete, holistic view of their health, all in one place to share with whoever they need to.”

ICSs, and their equivalents in Scotland and Wales, wishing to find out more about the Prevention Innovation Fund, and to apply, should contact hello@hollyhealth.io.

Catherine Davies, Director of Digital Healthcare Council, commented: “Holly Health’s new Innovation Fund is a great opportunity for NHS systems to deploy evidence-based solutions at scale. Their digital health coaching helps accelerate the Government’s three shifts, particularly from treatment to prevention, delivering measurable outcomes for the NHS while empowering patients to take control of their health.”

AXREM launches imaging IT Manifesto at the home of code breaking

By Integrated Care Journal

On 2nd April, almost 100 AXREM members and key external stakeholders gathered at Bletchley Park Museum for the launch of the AXREM Imaging IT Manifesto: Here to Enhance Patient Care and Improve Outcomes.

AXREM, the Association for Healthcare Technology Providers for Imaging, Radiotherapy and Care, has released its latest manifesto, Here to Enhance Patient Care and Improve Outcomes, at a specially convened event hosted at Bletchley Park. AXREM is the trade association representing the suppliers of diagnostic medical imaging, radiotherapy, healthcare IT and care equipment in the UK.

Bletchley Park was the headquarters of the British Military Intelligence Government Code and Cipher School during World War II. The estate employed 12,000 code breakers and staff. Bletchley Park was where Alan Turing and other agents of the Ultra intelligence project decoded the enemy’s secret messages, most notably those that had been encrypted with the German Enigma and Tunny cipher machines.

The event and venue were supported by headline sponsors Medihive, Sectra and Soliton IT and our other event sponsors Barco and Magentus.

The event kicked off in the Fellowship Auditorium with an opening address by AXREM Chief Executive Office, Sally Edgington, who told the audience: “I am sure you will agree in the world of healthcare, imagination is a powerful tool. It fuels innovation, creativity, and the breakthroughs that transform lives. Every medical advancement we’ve seen and every life-saving treatment, every new technology, every improvement in care began with someone imagining what could be. From the discovery of penicillin to the invention of imaging technologies that AXREM members provide today, that allow us to see inside the body, it all began simply by imagining.

“Imagine a world where communication was entirely encrypted, hidden behind layers of codes and puzzles, making it impossible for anyone to understand the information unless they had the key. For centuries, such encryption kept secrets safe, but it also prevented progress. It was only when brilliant minds like those who broke the Enigma code during World War II decided to challenge the impossible, to unravel the mysteries hidden within the most complex puzzles, that the world began to change. And from that pivotal moment, we saw the birth of a revolution that would eventually shape the future of information technology, transforming every aspect of our lives including healthcare.

“Code-breaking, at its core, is about unlocking potential—breaking down barriers that prevent us from accessing the full power of knowledge. In the field of healthcare, code-breaking represents the key to unlocking new possibilities for how we diagnose, understand, treat, and prevent diseases. It symbolises the ongoing evolution of data, communication, and technology, where each innovation leads to new ways of using information to save lives and improve our well-being.”

The event welcomed Bletchley Park historian Dr Thomas Cheetham who spoke about the history of codebreaking at Bletchley Park and how it is related to modern day cyber security.

David Lawson, Director of MedTech at the Department for Health and Social Care (DHSC) spoke about getting the basics right to support the adoption of new technologies and discussed some of what DHSC is doing to support this. Richard Evans, Chief Executive of the Society and College of Radiographers spoke about the importance of industry collaboration and the College of Radiographers Industry Partnerships Scheme (CoRIPS). Gareth Lambe, Medihive CEO, spoke about the work of Medihive, while Chris Scarisbrick, Customer Operations Director & Deputy Managing Director UK&I, spoke about Sectra’s work with medical technology and encrypted communication systems.

The focus of the event, however, was on the launch of AXREM’s Imaging IT Manifesto. AXREM Imaging IT Convenor and Chief Commercial Officer at Soliton IT, Bob Childe spoke about the manifesto in detail and concluded with the manifestos calls to action. Bob ended his speech by advising attendees, that AXREM members are our strength, and he hopes that key external stakeholders will call upon AXREM member expertise to assist in addressing many of the things in the manifesto.

Health leaders call for national redundancy pot to fund NHS job cuts

By Integrated Care Journal

NHS leaders are urging the Chancellor to rapidly create a national staff redundancy fund to smooth the pathway to the major budget cuts they are being required to make this year by the government.

Integrated care boards (ICBs) have been charged with cutting their running costs by 50 per cent from October 2025, with individual plans to be submitted for government approval by the end of May 2025. Alongside this, NHS trusts have been told to reduce their “corporate cost growth” by half the amount from the year before the pandemic.

But without a national fund that NHS trusts and ICBs can access, NHS leaders say the redundancy programme will take much longer to deliver and will reduce the level of savings from job cuts that can be delivered this year.

This would mean that the NHS would then start the following financial year, the point at which the government’s Ten-Year Plan for Health would begin its implementation, in a state of financial deficit. Health leaders fear that doing this would put the reform agenda, including the commitment to reduce waiting times to 18 weeks by the end of Parliament and to shift more care into the community, at risk.

While recent media reports have suggested up to 30,000 roles across the NHS could be removed, including through the planned abolition of NHS England, and that the total bill could reach £1bn, the NHS Confederation has heard varying figures from leaders on the extent of their expected cuts.

Some leaders of NHS trusts have said they are each looking to cut between 200 and 500 roles, while some ICB leaders have said they are likely to remove anywhere between 300 and 400.

Several trust leaders said that they were budgeting for around £12m worth of redundancy payouts and associated costs.

When looking at the proportion of the workforce that could be removed across NHS trusts, individual estimates from leaders have varied from 3 per cent to more than 11 per cent.

Health service leaders have warned that without access to a dedicated redundancy fund, as was confirmed for NHS England staff in its abolition in the Spring Statement, the process of scaling down will take much longer than the government has asked.

If they are forced to provide the necessary payouts from their own budgets, they say the process will be markedly slowed down and risks stalling the efficiency savings they can make. Recent analysis has already revealed that the gap between trusts’ regular income and expenditure is £6bn, and that this underlying deficit could derail the government’s reform plans.

One NHS trust CEO said: “Essentially, without clear guidance on underwriting redundancy options, whether these are voluntary, mutual, or compulsory, we are dependent on natural turnover and … [other] processes, which are slow and cumbersome.

“Accelerating savings would be possible if the underwriting of impacts could be funded within the year.”

Another said: “We are not planning a redundancy programme as it will be unaffordable, our plan is to reduce headcount through natural turnover although this puts a level of risk on delivery.”

Matthew Taylor, Chief Executive of the NHS Confederation, called on the government to commit to urgently establishing a redundancy fund for NHS trusts and ICBs. He said: “Health leaders understand the troubling financial situation facing the country and the need to improve efficiency where they can, as they have already demonstrated by significantly reducing their planned deficit for the year ahead.

“However, the scale and pace of what has been asked of them to downsize is staggering and leaves them fearful of being able to find the right balance between improving performance and implementing the reforms needed to put the NHS on a sustainable footing.

“They have told us that unless the Treasury urgently creates a national redundancy fund to cover these job losses, any savings the government hopes to make risks being eroded, at best and completely wiped out, at worst. If the Ten-Year Plan for Health is to be realised, it requires the NHS to be in a position of financial stability.”

The call from NHS leaders to create a national redundancy fund comes as the government finalises its Ten-Year Plan for Health as well as the three-year funding settlement that will be announced as part of the Spending Review in June.

NHS leaders anticipate the settlement will be much less than the long term historical average increase of around 4 per cent per year with the government’s latest Spring Statement already revealing that the funding increase for 2026/27 will drop to 1.8 per cent in real terms.

BSI to deliver quality assessment across the Age UK Network through new partnership

By Integrated Care Journal

A new partnership designed to assess quality across the Age UK network, in order to ensure the safety and well-being of older people, has been agreed by BSI and Age UK.

Business standards and improvement company BSI will support Age UK, a leading charity for older people, with the delivery of quality assessment services as part of a new partnership agreed between the two organisations. The partnership will see BSI provide an external quality assessment programme for organisations that use the name ‘Age UK’ against the Age UK Network Charity Quality Standard (CQS). Previously, this had been conducted by a different assessment company.

With a rapidly ageing society in the UK, the services and support the Age UK network provides to older people are increasingly important to managing demand on health and care services. This also comes at a time when a reported nine in 10 charities face increased demand, meaning it has never been more crucial to ensure that a consistent level of quality is offered across the country.

The Age UK network includes 118 Local Age UK Partners, as well as four National Partners – Age UK, Age Scotland, Age Cymru and Age Northern Ireland. While all organisations that are part of the Age UK network are independent charities with their own funding, governance and management arrangements in place, they are all required to meet an agreed set of quality expectations which are outlined in the Age UK Network Quality Assurance Framework.

The CQS is one of several quality standards within the Quality Assurance Framework, which is designed to help charities operate more effectively and efficiently. The standard covers 13 quality areas including governance, managing people, managing money and safeguarding. It also focuses on ensuring that each member of the Age UK Network is legally compliant and practices effective risk management to ensure quality and consistency, alignment with strategy, and the effective use of resources in the provision of services to ensure the well-being and safety of older people.

BSI has designed the assessment programme to ensure that all members of the Age UK Network meet the requirements of the CQS. The initial programme will commence from April 2025 for three years with BSI.

Simon Healey, UK&I Operations and System Certification Director at BSI, said: “BSI is delighted to be partnering with Age UK, a fellow purpose driven organization, on this important initiative, which aims to help make a positive impact on society. As an organization committed to driving quality and ensuring positive outcomes, we are proud to be running an assessment program that will support Age UK in its mission to improve the lives of older people across the country. We look forward to working closely with the team to help them achieve their goals and continue their vital work in the community.”

Victoria MacGregor, Chief Network Officer at Age UK, said: “We are thrilled to be working with BSI to deliver our Charity Quality Standard assessment programme. We consulted with our Partners to select the new assessment provider and were all impressed by BSI’s partnership approach in which they work with their clients to have a positive impact and offer solutions that enhance continual improvement and meet best practice.

“We are also pleased that the BSI ‘mark’ will provide external recognition and demonstrate that we take quality seriously through our standard now being assessed by these external experts.”

Psychology integrated into trust-wide EPR at LHCH NHS FT

By Integrated Care Journal

The innovation at Liverpool Heart and Chest Hospital NHS Foundation Trust sees a single digital system delivering a unified patient record, supporting patients’ psychological needs as they undergo treatment.

The Clinical Health Psychology team (“Psychology”) at Liverpool Heart and Chest Hospital NHS Foundation Trust (LHCH NHS FT) has extended, digitised and integrated its service into its established trust-wide EPR. This digital change is enabling a patient’s psychological care to be documented alongside medical care for a fuller record.

The innovation is releasing considerable and far-ranging benefits, such as streamlined processes, time savings, improved communication and care co-ordination, and enhanced patient safety.

Discussing the difference the system is making, Dr Alexandra Boughey, Principal Clinical Psychologist – Cystic Fibrosis Service and Operational Lead at LHCH NHS FT, said: “With our patient’s psychological notes now managed on the EPR and integrated with the patient’s full medical record, we can set up a team of specific users that have access to view the psychological notes. We’re saving so much time from being able to input our notes directly into the system and automatically sharing with the multi-disciplinary team (MDT).

Psychology set out to deliver the service using a single digital system which could manage a unified patient record, to better support the team and patient care. To be effective, they needed a flexible solution that was capable of making notes available or confidential to other members of the MDT. This was crucial functionality given the confidential nature of psychology case notes and being able to maintain a patient’s privacy wishes, if required.

The Trust decided to utilise its existing Sunrise™ EPR system provided by Altera Digital Health. In a matter of months, Psychology, Altera and the trust’s digital team worked together to configure the system to meet the unique needs of the psychology service. Today, the service is using the system to manage patient questionnaires, appointments, referrals, discharges and communicate with the MDT.

Sunrise™ is also facilitating the collection of meaningful data to monitor and report on specific psychology key performance indicators (KPIs), which differ hugely to medical KPIs.

With all patient data together in one place, in real-time, it’s providing staff with a fuller picture of a patient, supporting all members of the MDT to make more informed care decisions at the point of care.

Paula Dyce, Advanced Nurse Practitioner – CF Diabetes at LHCH NHS FT, commented: “Since being able to have Psychology on our EPR system it has helped us improve patient care and communication across professionals. It has streamlined the link between physical health and mental health appointments.”

LHCH manages a lot of critically unwell patients and nearly 130,000 patient visits every year. This makes the service that the Psychology team provides to the Intensive Therapy Unit (ITU) vital. The increased risks to patients cared for in the ITU makes an integrated system even more important, supporting the team to manage escalations and monitor patients more effectively with accessible notes and alerts for patients that require mental health support. The risk of losing paper notes and electronic files has also decreased which is contributing to enhanced patient safety.

Dr Alexandra Boughey added: “It’s been game changing, when you consider how time consuming the process was before. Previously, we would have to make notes on paper, transcribe them into word documents, file the document, and email/visit the wards to update the MDT with our recommendations.”

Prior to the Psychology digitisation, the EPR was already enabling the Trust to be 99.9 per cent paperless and complete all clinical documentation, order communications and prescribing. The integrated EPR has supported the LHCH’s digital transformation, enabling it to receive an ‘Outstanding’ CQC rating twice and achieve HIMSS EMRAM Stage 7 in its latest digital maturity assessment.

Rachael Fox, Executive Vice President, UK & EMEA at Altera Digital Health, said: “This latest digital transformation is a fantastic addition to Liverpool Heart and Chest Hospital NHS Foundation Trust’s exemplary digital journey so far. They are leading the way as digital-first trust and showcasing how it can support outstanding service delivery.”