NHS-backed study shows 73% reduction in GP waiting times using AI triage system

By Integrated Care Journal

An independent, NHS-funded evaluation has validated the transformative impact of an AI-powered Smart Triage system on primary care delivery in England.

The Groves Medical Centre, a leading family GP practice in Surrey and South West London, has achieved unprecedented improvements to patient access, practice capacity and sustainable staff working patterns after implementing Smart Triage.

Smart Triage, an AI-powered autonomous patient triaging system developed by health technology company Rapid Health, was implemented at The Groves Medical Centre in October 2023. The system has transformed patient access, enabling equitable and safe care based on clinical need rather than on a first-come-first-served basis.

An independent real-world evaluation, funded by Health Innovation Kent Surrey Sussex – one of 15 health innovation networks across England – and conducted by Unity Insights, has measured the impact of autonomous patient triage between October 2023 and February 2024. The evaluation assessed the system’s acceptability, implementation, effectiveness, and impact on health inequalities.

Key findings of the evaluation include:

Patient waiting times reduced by 73 per cent, from 11 to 3 days, for pre-bookable appointments
The practice had 47 per cent fewer phone calls at peak hours, with a 58 per cent reduction in the maximum number of calls, all but eliminating the “8am rush”
Same-day appointment requests fell from over 62 per cent to 19 per cent, significantly expanding the capacity for pre-bookable appointments
70 per cent fewer patients needed a repeat appointment, having received the right care on their first visit
85 per cent of appointments booked via the new system were delivered face-to-face, a 60 per cent increase compared to the pre-implementation period
Only 18 per cent of all patient requests were initiated over the phone after the system was implemented versus 88 per cent prior to it being implemented
91 per cent of appointments were automatically allocated without staff or clinical intervention

These changes have culminated in a better overall experience for patients at The Groves Medical Centre. GPs now spend 15 minutes with patients, rather than 10 – a 50 per cent increase. Additionally, the practice has achieved an 8 per cent increase in the number of appointments delivered per working day without hiring additional staff. Patients now have a wider selection of appointment slots to choose from, with an average of 61 slots available per patient appointment request. This has resulted in a 14 per cent reduction in patient no-shows, despite the practice already maintaining low DNA (did not attend) rates.

In contrast to traditional online consultation and triage tools that only collect information, Smart Triage fully automates the patient navigation process from the initial contact with their GP practice. Whether requesting care online, by phone, or in person, patients are guided through a series of questions based on their concerns. The system then assesses their symptoms and directs the patient to the most suitable care, even enabling immediate self-booking into the right appointments. This streamlined process empowers patients to access care at their convenience while relieving the practice from direct involvement in each request. This is the first time a study has proven an autonomous clinical system is safe and effective in doing this process end to end.

Dr Andrea Fensom, GP Partner at Groves Medical Centre, remarked: “Smart Triage has completely changed how we work. It has not only optimised our resources but increased patient access. Feedback shows that patients find it easy to use our online tool and it’s convenient for them, giving them multiple options for appointments where safe to do so and booking them with the most appropriate clinician for their problem. We are all very proud of these results.”

Jake Kennerson, Group Manager at Groves Medical Centre, added, “The positive outcomes we’ve seen in such a short period are a testament to the effectiveness of this innovative system. There’s been a significant decrease in the number of patients requiring same-day appointments and wait times have been drastically reduced. All of this change was achieved during the peak winter months and without any additional staff. If others were to adopt a similar approach, it could lead to transformative results for patients and the NHS as a whole”.

Carmelo Insalaco, CEO of Rapid Health, expressed his pride in the system’s success: “We’re really proud to see the extraordinary impact of autonomous patient triage at The Groves Medical Centre. These results reflect what we consistently observe with our customers across the country – the remarkable potential for Smart Triage to dramatically enhance patient access and choice, while solving the persistent challenges of lengthy waiting lists and disruptive morning bottlenecks. We look forward to further collaboration and expansion across the wider NHS to benefit more patients and healthcare providers”.

By implementing the software, GP practices and Primary Care Networks (PCNs) can improve patient access, reduce workload, unlock capacity and manage patient demand more effectively. With better access for patients online, call volumes are reduced and peaks in demand can be smoothed out, eventually eliminating the ‘8am rush’. This ultimately enhances and automates the Modern General Practice Access Model which was introduced by NHS England last year.

Greater Manchester lauded for approach to population health

By Integrated Care Journal

A new report from the King’s Fund had praised Greater Manchester’s progress on improving population health, emphasising the importance of addressing the wider determinants of health.

The King’s Fund has praised Greater Manchester for its work improving key measures of health and health inequalities. The influential national charity has called Greater Manchester “the poster child for devolution” in England and has recognised the time, effort and resources put in place helping people to live good lives, improve wellbeing and prevent illness.

The new report, published this week, shows how health is influenced by wider determinants such as high‑quality and secure housing, a good job and a healthy environment. It highlights the vital link between health, and the communities we live in as well as the value in aligning strategies to ensure improvement of both the economic and health status of the population.

Since 2015, Greater Manchester has had a wide-ranging devolution deal with Government on health which has led to improvements in life expectancy and other measures (see here for information). Greater Manchester’s model was integral to the creation of statutory integrated care systems in 2022 with improving outcomes in population health and health care a key aim.

The King’s Fund report reiterates the importance of population health being a core goal of integrated care systems and the value in different government departments below the national level working more closely together, including at mayoral level. It underpins Greater Manchester’s ‘live well model’ that aims to transform the relationship between work and health.

While this new publication recognises the financial challenges that the NHS and other public sector organisations face, it makes the case for continuing with a population health approach and the strong evidence that improvements in health can have for the economy at large.

Andy Burnham, Mayor of Greater Manchester and NHS Greater Manchester Integrated Care Partnership co-chair, said: “Greater Manchester’s health devolution journey has a simple but fundamental principle at its heart: that more local decision-making can deliver better outcomes for people.

“This report from the King’s Fund sets out clearly the wider social factors that impact people’s health and wellbeing, but also the power of devolution to draw the connections between those issues and tackle them systematically.

“That is the strength of our devolved approach, and the mission of the new Live Well service that we want to pioneer here in our city-region. There are still challenges and pressures that we face. But we’ve made progress already, including on healthy life expectancy, and by bringing together partners and joining up the support offer for residents – whether that’s health and social prescribing, housing advice, or employment support – we can deliver better, more efficient public services, and improve people’s life chances.”

Jane Pilkington, Director of Population Health for NHS Greater Manchester Integrated Care said: “The King’s Fund spotlighting Greater Manchester as leading the way in population health is pivotal to re-emphasise the important role the NHS plays in improving the health and wellbeing of residents, by focusing on preventing ill-health in the first instance rather than just treating sickness, as well as relentlessly working to reduce health inequalities.

In Greater Manchester we need to continue to work together with communities and the voluntary sector, local government, and the NHS to help create a place where everyone can live a good life, growing up, getting on and growing old in a greener, fairer more prosperous city-region – focusing on improving both the health and economic circumstances of our residents.”

Lord Hunt: Wound care is pivotal to “tackle some of the malaise in the NHS”

By Fredrik Matre and Ameneh Saatchi

Public Policy Projects’ (PPP) Ameneh Saatchi sat down with long-standing ally, the Rt Hon Lord Hunt of Kings Heath OBE, former President of the Royal Society for Public Health and newly appointed Minister for Energy Security and Net Zero. Having been an early and vocal supporter of PPP’s Wound Care Programme, Lord Hunt discussed with Saatchi how his campaigning has informed the mission to bring wound care reform up on the political agenda.

PPP is continuing its 2024 Wound Care Programme following a successful inaugural year. Their 2023 Insights Report, Going further for wound healing, was endorsed as “excellent” by Lord Hunt, who described it as “essential that Government and the NHS take note and act on the report’s recommendations.” With the new government working to enact its legislative agenda, we reflect on Lord Hunt’s desires for wound care reform and how PPP’s Wound Care Programme is facilitating the necessary discussions about how to build a consistent national experience of wound care.

Recently appointed Minister for Energy Security and Net Zero, Lord Hunt served as President of the Royal Society for Public Health from 2010 to 2018. In 2017, he put wound care on the parliamentary agenda when he called for a debate to ask the government for its plans “to develop a strategy for improving the standards of wound care in the NHS”. He continued his advocacy for wound care reform even after his presidential tenure at the Royal Society of Health, being an early supporter in the establishment of PPP’s Wound Care Programme.

Now in its second year, PPP’s Wound Care Programme is building on last year’s success, further challenging the status quo in wound care provision. Ahead of the Wound Care 2024 Conference, we look back at the conversation between the Director of PPP’s Wound Care Programme, Ameneh Saatchi, and Lord Hunt, discussing what is needed to secure political buy-in for wound care reform.

Need for political recognition

Having raised the issue of wound care in the House of Lords in 2017, Lord Hunt has since pushed for greater recognition of wound care from NHS leaders and policymakers. A lack of political will from the previous government has led to inaction in improving wound care provision.

“If ministers or the top of NHS England are convinced that dealing with wound care would be one of the ways to improve the efficiency and effectiveness of outcomes of the NHS, then they will devise the method by which you do it. But I don’t think there’s any evidence that they believe that”.

A focus for Lord Hunt in the run up to the general election was to elevate wound care on the political agenda. While Saatchi’s suggestion to establish an NHS England National Clinical Director for wound care is welcomed by Lord Hunt, he argues further that establishment of such a role “is less important than whether you have some political direction or direction from the top of NHS England” convinced of the need to tackle wound care.

The National Wound Care Strategy Programme was set up to provide such direction, though its continued operation is under fiscal scrutiny and buy-in from NHS leaders is required to act on its recommendations. Without such direction, insufficient attention is paid to how wound care is provided across the NHS, leading to major inefficiencies.

“The evidence is pretty convincing that we do a pretty poor job now, [and] that there is enormous cost to the NHS, because we don’t deal with wound care properly.”

The problems don’t necessarily lie in a lack of solutions; “we know what to do,” says Lord Hunt. Rather, he insists, it requires buy-in from government and the NHS to recognise the need to reform wound care.

‘Big spenders’ in health

Lord Darzi’s recent Independent Investigation of the National Health Service in England found that “the NHS budget is not being spent where it should be”. PPP’s Insights from 2023 Wound Care report was accepted as evidence by Lord Darzi. Wes Streeting has committed to being “honest about the problems the NHS faces and serious about fixing them”. Lord Hunt is conscious that the Health Secretary would likely welcome the identification of “a limited number of clinical areas where you could have a big impact on outcomes and finances”. Wound care, he argues, is just such an area.

Lord Hunt emphasises that “one of the ways to tackle some of the malaise in health is to tackle some of these ‘big spenders’ in health”. With 67 per cent of wound care expenditure spent on unhealed wounds, a focus on prevention and early intervention (echoing Labour’s desire for a “prevention first” approach) could make significant savings in costs avoided. Lord Darzi echoes Hunt’s sentiment that “that many of the measures needed to tackle the current malaise are already well known” and what is needed is implementation rather than invention.

By tackling particular clinical areas — with wound care seen by Lord Hunt as an obvious candidate — “in a cohesive way”, major savings can be made, simultaneously improving patient outcomes in a consistent manner across the country. Wound care is, in fact, an NHS ‘big spender’: it’s the third biggest clinical expense across the NHS, only after cancer and diabetes. Health economists have calculated that patient management cost for chronic wounds increased by 48 per cent in real terms between 2012/13 and 2017/18. Since wound care happens across systems (though predominantly in community settings), joined up working for integrated care could improve patient experiences and potentially streamline resource use.

Of the £8.3 billion spent by the NHS on wound management in 2017/18, 67 per cent was spent on managing unhealed wounds. The Prime Minister made it clear in his response to Lord Darzi’s investigation that there will be “no more money without reform”. If wounds are seen to quickly and treated according to standardised best practice, the need for longer and more complex treatment in future can be prevented. While only six per cent of NHS wound care expenditure goes towards treatment products, more than 70 per cent is associated with nurse, doctor, or healthcare assistant visits. Savings here would therefore be both fiscal and temporal, freeing up valuable workforce capacity.

Coalition-building

Wound care is currently, by virtue of affecting patients with a wide range of ailments, underrepresented in patient advocacy. Patients with chronic wounds can be found across health and care settings and are represented by many condition-specific charities. Yet, the lack of an overarching voice to represent wound care patients hinders efforts to bring about policy change. Lord Hunt notes that there is no all-party parliamentary group for wound care and sees the need for a “wound care alliance” representing the estimated 4.6 million people in the UK living with a wound, to rally political attention.

“Building an alliance is one way to get a better voice and also to get some outside external people, prominent external people to perhaps [come onto] the board of trustees or something like that.”

To elevate wound care on the political agenda, Lord Hunt envisages the need for “an alliance of charities looking at it from the point of view of the patient and their family, starting to ask questions about poor outcomes.” PPP is taking on Lord Hunt’s challenge, convening stakeholders to form a “wound care alliance” at its upcoming Wound Care Conference in London on 2 December.

Convening such stakeholders as the Queen’s Nursing Institute, the European Wound Management Association, the Society of Tissue Viability, the Royal College of Podiatry, the Lindsay Leg Club Foundation and more, the future of wound care is being discussed at PPP events with patients alongside. While it’s the patients that Lord Hunt wants to foreground, there are pertinent questions about “how much can be patient-led”.

With a myriad of “quite small charities that have usually been set up by relatives of people affected by a particular condition,” it can be hard to present a cohesive message reflective of diverse experiences. But these patients deserve a voice and should inform the future of wound care, given their lived experience.

The way forward for wound care action

Lord Hunt has been a wound care advocate for many years, and that is unlikely to change. Having “trod this territory some years ago,” he finds the lack of political progress “so frustrating”, but he is not one for giving up:

“The evidence, I think, is convincing, although the work that has been done over the years […] one should never sort of say you’ve ever completed the work. That work always needs updating.”

In Lord Hunt’s own words: “we know what to do”. With a new government in charge looking to rebuild an NHS classified as “broken” by Wes Streeting, there is a significant opportunity to not only save money by reforming wound care; reforming wound care can improve patient outcomes and transform peoples’ lives.

The way forward is clear and defined, as Lord Hunt points out. The political motivation should be obvious and apt for politicians to seize upon, with substantial opportunities for cost savings, improvement in clinical outcomes and patients’ quality of life identified. The potential returns on investment, both financial and social, could alleviate pressures in an NHS already overstretched, thereby supporting Wes Streeting’s mission to fix the “broken” NHS.

Prime Minister Sir Keir Starmer is keen to move health policy away from “sticking plaster politics” that implements short-term emergency measures to avoid the breakdown of the NHS, while neglecting the need for long-term reform. As anyone familiar with wound care will know, there’s more to it than a plaster. As the government implements its agenda for healthcare reform, wound care will (as a system-wide action area) need to be addressed.

PPP’s Wound Care programme brings together key stakeholders across the NHS, industry, charity and politics to advance the conversation on reform and innovation of wound care provision in the UK. Building on the foundation of a solid first year that identified the major obstacles, PPP is continuing to gather nuanced insights on possible futures for patients and healthcare providers alike.

On 2 December, PPP will be hosting an all-day Wound Care Conference in London, convening national health and care experts to discuss all aspects of wound care provision and forging a path forward for innovation and reform. Reflecting on the insights presented during the programme and facilitating conversations on the latest developments in UK wound care provision, it is a prime opportunity to gain a comprehensive understanding of sector developments.

Free to attend for NHS staff and other public sector workers, you can register for the conference here.

For further information about PPP’s Wound Care programme, please contact:
Director of Market Access & Policy – Ameneh Saatchi (ameneh.saatchi@publicpolicyprojects.com)
Programme Executive – Fredrik Matre (fredrik.matre@publicpolicyprojects.com)

Dartford and Gravesham NHS Trust goes live with ‘big bang’ EPMA deployment

By Integrated Care Journal

The implementation of the Better Meds electronic prescribing and medication management system took place over a single weekend, thanks to the efforts of more than 200 staff from across the NHS Kent and Medway Integrated Care System.

Dartford and Gravesham NHS Trust has successfully implemented the Better Meds electronic prescribing and medicine management (EPMA) system across all 18 adult inpatient wards at Darent Valley Hospital. The system, integrated with the trust’s electronic patient records (EPR) provided by Alcidion, was deployed over a single weekend to enhance medication safety and efficiency.

During the two-day transition, more than 500 paper drug charts and 8,000 prescriptions were digitised by a dedicated clinical team, with a team of healthcare staff and digital support assisting throughout the process.

Dr Guy Sisson, Chief Clinical Informatics Officer at the trust, highlighted the collaborative effort: “The implementation was an incredible effort with months of planning which led to over 200 healthcare staff from across the integrated care system joining forces to support the go-live weekend.”

The EPMA system is designed to streamline medication administration and prescribing, reducing time spent on these tasks and improving workflows for both nurses and doctors. Early feedback from staff indicates faster medication rounds and more efficient prescribing. The system also features decision support, including drug interaction alerts, high-dose alerts and allergy checks, enhancing patient safety and offering reassurance to staff providing care.

Additionally, the EPMA system provides real-time access to dose-level data, which was previously data-based, enabling the trust to analyse and improve medication safety practices, further improving patient care quality.

Julia Scott, Pharmacist and Senior Responsible Owner for the EPR Programme said: “This Better Meds implementation will allow us to deliver medication safety improvements on a whole-system scale. EPMA allows us to implement strong barriers to error for high-risk medication, whereas in the past we were reliant on weak barriers such as training and guidelines. We can also build data-driven safety nets to allow us to rapidly identify potential high-risk prescribing and intervene quickly. It is genuinely transformative when it comes to a human factor’s approach to safety”.

Dr Guy Sisson added: “Our vision is to be an outstanding hospital trust providing the best possible care for our patients that is safe, well-coordinated, in the right place and designed around the person’s needs. Our new EPMA system is perfectly aligned and a true digital representation of our aspirations. I want to congratulate everyone involved and personally thank them for getting the system over the line, which is a monumental step towards where we want to be.”

In 2019, Dartford and Gravesham procured Alcidion’s Miya Precision to advance its digital maturity. By integrating Better Meds’ electronic prescribing into the Alcidion EPR, drug information is now seamlessly connected with patient assessments, allergies, key lab results, and more. This enhances safety for prescribers and saves clinicians time by offering standardised order sets and allowing multiple users to view and use the medication record simultaneously.

Future phases of the implementation will include outpatient clinics and other speciality areas, such as maternity and paediatrics. It will also be rolled out across inpatient wards at the trust’s other main site, Queen Mary’s Hospital, to support surgical elective care.

Alja Babič, Better Meds Implementation Consultancy Lead at Better, said: “It’s been a pleasure supporting Dartford and Gravesham NHS Trust to optimise prescribing and medicine management. The ‘big bang’ rollout was one of the best we’ve been involved in. It was smooth, well-planned and expertly managed, and the team should be extremely pleased with the progress made. Dartford and Gravesham’s commitment and great energy have been clear while working together. We are celebrating this being our 9th Better Meds go-live in the UK and look forward to working further on improving medication management processes.”

Kate Quirke, Alcidion CEO, said: “It was inspiring to witness the dedication and extensive collaboration that led to the success of this rollout. We are proud to support Dartford and Gravesham NHS Trust as they continue to expand and improve upon their digital infrastructure. We are also grateful for our partners like Better, who share in our belief that smart technology can drive meaningful change. We look forward to continuing this journey together, building on our joint commitment to innovation and progress.”

NHS failing in mental health support for kidney cancer patients

By Integrated Care Journal

A new report from Kidney Cancer UK reveals a failure in providing vital mental health support for those diagnosed with kidney cancer in the UK.

A new report combining ten years of data from the Kidney Cancer UK Annual Patient Survey has highlighted ongoing failures in providing vital mental health support to those diagnosed with kidney cancer – currently the 7th most common cancer in UK adults. The findings show that many patients are being let down in some of the most basic areas, impacting their ability to navigate their kidney cancer diagnosis and treatment journey with resilience and hope.

However, the charity believes support services can be improved at minimal cost through greater collaboration with charities that have experience in counselling and supporting kidney cancer patients.

The report, titled ‘Navigating the impact of kidney cancer: A decade insight into patient care and mental health’, is asking for simple changes such as:

Providing patients with the contact details of their CNS (clinical nurse specialist) for direct support.
Signposting to reliable information on treatments and surgery options
Advising patients on how to access counselling to help with the shock of a cancer diagnosis.

Many patients are being failed in some of the most basic areas. For example, 37 per cent of those surveyed were unhappy with the way they were told they had kidney cancer, 30 per cent were not given the name of a CNS and an average of 29 per cent felt abandoned after surgery. Given the minimal cost needed to improve services, the charity is calling for the NHS to implement policies to ensure charities are a higher priority in the healthcare professionals support pathway.

With over 3,200 patients taking part in the Kidney Cancer UK Patient Surveys across the past decade, this is one of the most extensive independent kidney cancer surveys ever undertaken and has led the charity to call for the NHS to implement policies ensuring that charities are more of a priority in the healthcare professionals support pathway.

Malcolm Packer, CEO of Kidney Cancer UK, commented: “We need a nuanced approach to patient care, one that prioritises mental health – as well as physical health. The role of timely, relevant information to individuals with kidney cancer cannot be underestimated, and as a charity we consistently see those who have their information needs met after the shock of diagnosis or following treatment generally experience far better mental health outcomes.

“This comprehensive report combining a decade’s worth of data from kidney cancer patients provides valuable insights into how healthcare professionals and patient organisations can collaborate to meet the complex needs of kidney cancer patients, ensuring they receive the support necessary to navigate their diagnosis and treatment journey with resilience and hope.”

Dr Kate Fife, Consultant Clinical Oncologist at Addenbrooke’s Hospital Cambridge, added: “It is very disappointing to see that 37 per cent of patients are unhappy with the way they were given their kidney cancer diagnosis. Sensitive and clear patient communication is very much a priority for healthcare professionals, but despite training in communication, delivering news of a cancer diagnosis has not improved over the last 10 years of surveys.

“Couple this with the news that there is no change in the amount of information and support shared following diagnosis, the message to healthcare professionals everywhere is that we need to be more sensitive in our actions and work closer with Charities to help better support all cancer patients. There is clearly much room for improvement.”
The 11th annual Kidney Cancer UK Patient Survey is now open, and the Charity is calling for all kidney cancer patients, past or present, to complete the survey. To take the latest annual survey click here.

You can read the full report here. For support and information relating to kidney cancer visit www.kcuk.org.uk.

Pandemic reflections: What we’ve learned from professional South Asian women in the NHS

By Dr Saleema Kauser and Dr Ana-Paula Figueiredo

Women from the BAME (Black, Asian, and Minority Ethnic) communities working in the NHS faced unique challenges and risks during the pandemic. Dr Saleema Kauser and Dr Ana-Paula Figueiredo interviewed women working in the NHS to hear the challenges they faced.

Ethnic minorities in the NHS encountered unique challenges during the pandemic, underscoring significant systemic issues within the NHS. Indeed, the pandemic served as a magnifying glass, revealing the vulnerabilities of healthcare systems across the world and the particular pressures faced by ethnic minorities within these systems.

For Asian women in the NHS, these pressures included not only the health risks from being on the front line. Their critical role in the healthcare response also positioned them at the intersection of race, gender, and professional risk.

This demanded focused research to dissect these overlapping vulnerabilities, and that is precisely what this project has been doing – researching the key insights and pivotal lessons that can be learned by interviewing professional South Asian women working in the NHS. Our research broke down into seven key areas of insight:

Preparedness and resilience

Many respondents noted that while the pandemic was challenging for everyone, it was particularly severe for ethnic minority women. A key issue highlighted was the inadequate distribution of personal protective equipment (PPE), which disproportionately affected these women, often leaving them on the front lines without adequate protection.

This lack of resources was compounded by delayed responses from management, who were slow to implement necessary safety measures. These delays not only heightened the risk of virus transmission but also highlighted a failure in crisis management that left staff feeling vulnerable and undervalued. Nearly all of our participants underlined the need for more proactive planning, robust health systems preparedness, resilience planning and the immediate provision of adequate resources like PPE.

Culture, leadership and behaviour

Many participants discussed a lack of cultural competence in healthcare provision and in managing ethnic minority staff. They called for more diversity in leadership roles within the NHS to provide insights into the lived experiences of different communities and to facilitate fair treatment and prevention strategies.

There is a clear need to integrate cultural competence training across all levels of the NHS. This training should target not only clinical staff but also management teams to ensure that decision-making reflects an understanding of the diverse cultural backgrounds of both patients and staff. The women also emphasised the need for regular assessments and feedback mechanisms to ensure that the needs and views of ethnic minority staff are being met.

Empowerment through awareness and advocacy

Women spoke about how enhancing advocacy could have led to significant improvements in addressing workplace inequalities and ensuring that all staff, particularly ethnic minorities, had the knowledge and tools to advocate for safer and more equitable working conditions.

Many participants emphasised how understanding their legal and organisational protections during the pandemic empowered them to advocate more effectively for themselves and their colleagues, and expressed a desire for more channels to raise their concerns. Some participants also felt there was a need to promote leadership roles for ethnic minorities specifically through leadership development programmes that target ethnic minority groups. This would help diversify the voices in NHS decision-making processes.

Transparent communication and focus on EDI

Clear, consistent, and transparent communication from healthcare leadership is critical during a crisis. The pandemic exposed a number of deficiencies in communication that often left women staff feeling confused and fearful. Many suggested that future strategies should focus on improving lines of communication, addressing staff concerns with empathy, and providing clear guidance on safety measures and operational changes, especially for those in high-risk roles.

Many participants expressed that information often did not reach them in a timely fashion or was not fully accessible, was only selectively shared or, in some cases, not shared at all in instances where white managers did not see BAME colleagues as full team members. They also felt excluded from decision-making processes, particularly those decisions that affected their work conditions directly during the pandemic.

Workforce support and sustainability

The dual burden of professional duties and domestic responsibilities was evident during the pandemic, especially for working mothers. It is crucial for healthcare systems to create and maintain support structures that help women manage this balance without compromising their health and well-being. Recognising and actively supporting the work-life balance during crises is essential in reducing burnout and maintaining high levels of care. Those in high-exposure areas such as COVID-19 wards faced intense pressure to manage work risks and family health.

Providing mental health support systems that are robust during and after crises is also essential. The women in our sample faced increased psychological impacts due to systemic biases and high-pressure roles during the pandemic.

Recognition and response to systemic inequities

Our data highlighted a deeply entrenched lack of recognition and systemic inequities towards South Asian women during the pandemic. The most significant was the systemic inequity around the distribution of PPE and critical resources. Participants often found themselves on the front lines without adequate protection, highlighting a stark neglect in the safeguarding of these workers compared to their white counterparts. Such disparities were not only a matter of resource allocation but also reflected deeper racial prejudices and a failure to recognise the equal worth and rights of ethnic minority workers.

Government and NHS coordination

Many participants discussed the need for a well-coordinated response between the government and NHS, which they felt was lacking. The lack of unity in their responses was a significant concern.

The general view was that in the long-term, healthcare policy reforms should focus on making the system fairer and more inclusive, especially in light of the inequalities exposed by the pandemic. This involves re-evaluating existing policies to ensure they truly serve and protect all healthcare workers, with extra attention given to those who are most at risk or disadvantaged.

Our data indicates that the disparities revealed during the pandemic demonstrated that the normal way of doing things wasn’t effective or fair for everyone, particularly minority women healthcare workers who often faced greater risks and fewer protections.

Our work highlighted the urgent need for systemic changes that promote equity, cultural competence, effective communication, and empowerment. By addressing these key areas, the NHS—and healthcare systems worldwide—can not only better prepare for future crises but also create a more just and supportive environment for all healthcare professionals.

The pandemic underlined the importance of the health and social care workforce, who faced extreme pressures. Ensuring the wellbeing, adequate staffing, and continuous professional development of healthcare workers is vital for sustaining health services during and beyond and future crisis.

*Dr Ana-Paula Figueiredo, Researcher, Alliance Manchester Business School*

*Dr Saleema Kauser, Senior Lecturer and Associate Professor in Business Ethics and Strategy, Alliance Manchester Business School*

News, Population Health September 25, 2024

Innovating beyond digital: A comprehensive ICS approach to musculoskeletal care

By Dr Carey McClellan

Physiotherapy practitioner, Dr Carey McClellan, explores how supported self-management tools can help integrated care systems to support MSK patients across their entire care pathway.

Musculoskeletal (MSK) injuries and conditions impact approximately 20 million people in the UK, making them the leading cause of disability. They affect people’s daily lives, the NHS, the workplace and the economy.¹

In fact, MSK problems cost the NHS £5 billion ever year, account for 14-18 per cent of all GP appointments in England, and result in 24 million lost working days annually.^2,3 Despite this already substantial burden, the prevalence of MSK conditions is rising due to a combination of an ageing population and lifestyle factors.⁴

The case for self-management

The value in supporting people to self-manage MSK conditions as early as possible is well researched, and recommended within national guidelines and policy.^5-13 However, it is not delivered consistently or at scale. A recent report by The Arthritis and Musculoskeletal Alliance (ARMA) highlighted the variation in strategy, leadership and prioritisation of MSK conditions across integrated care boards (ICBs) despite it being one of six priorities in NHSE’s major conditions strategy.

NHS England’s ‘Best MSK Health Collaborative’ and Getting It Right First Time’s (GIRFT) community MSK workstream have both highlighted the absolute need to adopt evidence-based digital technology to support people with MSK injuries and conditions.¹⁴ At the same time, there is a growing emphasis on the link between health and economic inactivity and a new government focused on improving both.¹⁵

Early intervention holds the key, but people are waiting too long

GIRFT has highlighted the need for early intervention in the MSK care pathway to reduce the primary impact and longer-term consequences. Additionally, not enough is being done to support people, or minimise the time they spend, on waiting lists. The BMA estimates that 8 million patients are currently waiting for consultant-led elective care.¹⁶ However, the number does not include the ‘hidden backlog’ – those who have not yet presented for care or are waiting for other services (e.g., physiotherapy or investigations).

There are up to six waiting stages before an orthopaedic procedure, each offering a chance to reduce deconditioning, encourage self-management, support a person’s return to work, and possibly avoid costly surgical intervention. Extended waiting times for MSK treatment at any point on this journey take a toll on patients’ physical and mental health, leading to deconditioning, increased pain, lesser quality of life, difficulty to work and, in some cases, irreversible deterioration.¹⁷

Enabling people to self-manage their recovery

Digitally supported self-management tools help integrated care systems (ICSs) to support MSK patients across their entire care pathway. They help people to trust their recovery, utilise less healthcare resource and return to work more quickly and safely.

For maximum impact, digital self-management pathways should be made available to people at the earliest possible opportunity wherever they connect with the health system or seek help – in the community (pharmacies, libraries, leisure centres), primary care (GP, first contact practitioner), urgent care or secondary care (elective care). Self-management support is suitable for 80 per cent of all new, recurrent, or long-term MSK conditions, including people on waiting lists.¹⁸

Tools like getUBetter enable people to self-manage their recovery by following a recovery and prevention pathway defined by their local healthcare system. And, because it’s digitally enabled, it supports people to manage their condition 24 hours a day, 365 days a year, taking them through their recovery day-by-day, and providing them with the knowledge, skills, and confidence to help themselves. Support is provided through triage, advice and guidance, exercises, outcome measures, dynamic safety netting and referral when necessary.

getUBetter also supports people by connecting them to treatment, local support and public health services (e.g., smoking cessation, weight reduction and return to work).

Behaviour change model

For a digital platform to have a positive impact on people and the NHS, it must be trusted, and help people change their behaviour. That’s why getUBetter was designed with an underpinning COM-B behaviour change model as its foundation.¹⁹ The COM-B model is a theoretical framework that incorporates key components (capability, opportunity, and motivation) considered to affect behaviour.

For example, all content has been created with behaviour change at its core and tailored depending on the individual’s stage of their recovery and how they are feeling. Content includes support to mitigate against negative behaviours and promote positive behaviour; it is personalised, targeted, and localised to clinical pathways, health services and community support. getUBetter includes support for safety netting as well as other factors such as psychological elements of MSK recovery, the relationship between work, home, and health and system obstacles to work. All can influence someone’s ability to recover, live and work well.

Digitising isn’t enough to drive clinical transformation and positive impact

The NHS is littered with examples of poorly designed patient-facing applications that have not been co-designed with their users. This leads to a frustrating experience and short-lived engagement.

An iterative design process ensures content is accessible, intuitive, inclusive, and easy to follow, while barriers to adoption such as digital exclusion are minimised.²⁰ Working in partnership with ICB clinicians, champions and transformation stakeholders is essential. Their local expertise is crucial for ensuring that any digital tool integrates seamlessly into routine care. This ensures the best approach for deployment and adoption, and creates a blueprint for NHSE scale and adoption.²¹

The impact of digital self-management

Lord Ara Darzi’s Independent Investigation of the NHS in England confirms that it must move care into the community, enable patients to take active involvement in their own care, digitise, and help tackle economic inactivity. MSK digital self-management tools are ideally placed to play a central role in realising this.²²

Earlier this year, NICE published an Early Value Assessment approving the use of five digital tools for use in the NHS for non-specific low back pain – the biggest cause of days taken off work.

An economic evaluation conducted by Health Innovation Network (HIN) South London highlighted the scale of the burden of back pain, and the possible return on investment that can be achieved by deploying digital self-management tools. The independent report demonstrated that a cost saving of more than £1.9 million for back pain alone could be achieved per area (place) of an ICS with a population of 330,000 through deploying digital self-management.²³

Further research conducted by the HIN demonstrated that when using getUBetter, an ICS can expect a 13 per cent reduction in GP follow-up appointments, a 50 per cent reduction in MSK-related prescribed medication, a 20 per cent reduction in physiotherapy referrals, and 24-66 per cent fewer urgent care attendances. A Somerset NHS Foundation Trust evaluation revealed that 50 per cent of patients awaiting MSK physiotherapy appointments felt their needs were met after using getUBetter, prompting them to remove themselves from the waiting list. Those in NHS South East London ICS who utilised getUBetter before their physiotherapy appointments required 40 per cent fewer sessions compared to patients who did not use the app.²⁴ NHS Frimley ICS reported 11 per cent fewer sick notes, helping people back to work.

The MSK problem in the UK is a complex one to solve and requires close collaboration with patients, clinicians, ICB leads, transformation experts, health systems, and the government to ensure the solution reflects local needs. While technology has a role as an enabler in digitising ICS-wide MSK pathways, it is not achievable without clearly defined methodologies of co-design, behaviour change and clinical transformation.

If you’d like to hear more about this approach and blueprint, please sign-up for the forthcoming webinar, Transforming MSK care across complex health systems with digital self-management support: Technology vs methodology on 26 September 2024.

List of references

^1. Versus Arthritis. The State of Musculoskeletal Health 2023. 2023;1–65. Available from: https://www.versusarthritis.org/media/duybjusg/versus-arthritis-state-msk-musculoskeletal-health-2023pdf.pdf

^2. Public Health England. Musculoskeletal Health: A 5-year strategic framework for prevention across the lifecourse [Internet]. PHE publications gateway. 2019. Available from: https://www.gov.uk/government/publications/musculoskeletal-health-5-year-prevention-strategic-framework

^3. NHSE. Musculoskeletal health: What are musculoskeletal conditions? [Internet]. 2024. Available from: https://www.england.nhs.uk/elective-care-transformation/best-practice-solutions/musculoskeletal/#:~:text=In%20fact%2C

^4. Community MSK – Getting It Right First Time – GIRFT [Internet]. Getting It Right First Time – GIRFT. 2024 [cited 2024 Sep 12]. Available from: https://gettingitrightfirsttime.co.uk/cross_cutting_theme/community-msk/

^5. National Voices. Supporting self-management: Summarising evidence from systematic reviews. 2014. Available from: https://www.nationalvoices.org.uk/publication/supporting-self-management/

^6. Ofcom. Online Nation: 2022 Report. 2022. Available from: https://www.ofcom.org.uk/siteassets/resources/documents/research-and-data/online-research/online-nation/2022/online-nation-2022-report.pdf?v=327992

^7. Hunter R, Beattie M, O’Malley C, Gorely T. Mobile apps to self-manage chronic low back pain: A realist synthesis exploring what works, for whom and in what circumstances. PEC Innov [Internet]. 2023;3(September 2022):100175. Available from: https://doi.org/10.1016/j.pecinn.2023.100175

^8. Hewitt S, Sephton R, Yeowell G. The effectiveness of digital health interventions in the management of musculoskeletal conditions: Systematic literature review. J Med Internet Res. 2020;22(6). Available from:https://pubmed.ncbi.nlm.nih.gov/32501277/

^9. Kloek CJJ, Van Dongen JM, De Bakker DH, Bossen D, Dekker J, Veenhof C. Cost-effectiveness of a blended physiotherapy intervention compared to usual physiotherapy in patients with hip and/or knee osteoarthritis: A cluster randomized controlled trial. BMC Public Health. 2018;18(1). Available from: https://pubmed.ncbi.nlm.nih.gov/30170586/

^1o. Wanless B, Berry A, Noblet T. Self-management of musculoskeletal (MSK) conditions: What is most useful to patients? Protocol for a mixed methods systematic review. Musculoskeletal Care. 2022;20(2):271–8. Available from: https://pubmed.ncbi.nlm.nih.gov/34859560/

^11. Kelly M, Fullen B, Martin D, McMahon S, McVeigh JG. EHealth interventions to support self-management in people with musculoskeletal disorders: A scoping review protocol. JBI Evid Synth. 2021;19(3):709–20. 10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994513/

^12. Babatunde OO, Jordan JL, Van Der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One. 2017;12(6):1–30. Available from: https://pubmed.ncbi.nlm.nih.gov/28640822/

^13. Razai MS, Oakeshott P, Kankam H, Galea S, Stokes-Lampard H. Mitigating the psychological effects of social isolation during the covid-19 pandemic. Available from: https://pubmed.ncbi.nlm.nih.gov/32439691/

^14. Department for Health and Social Care. Major conditions strategy: case for change and our strategic framework. 2023. Available from: https://www.gov.uk/government/publications/major-conditions-strategy-case-for-change-and-our-strategic-framework/major-conditions-strategy-case-for-change-and-our-strategic-framework–2

^15. Improving our nation’s health | NHS Confederation [Internet]. www.nhsconfed.org. Available from: https://www.nhsconfed.org/publications/improving-our-nations-health-whole-government-economic-inactivity 14

^16. British Medical Association. NHS Backlog Data Analysis [Internet]. BMA. 2024. Available from: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis

^17. Hoy et al (2016),The global burden of low back pain: estimates from the Global Burden of Disease 2010 study downloaded from http://ard.bmj.com/ on June 23, 2016 – Published by group.bmj.com

^18. Savingy P, Kuntze S, Watson P, et al. (2009). Low back pain: early management of persistent non-speci c low back pain. London: National Institute of Clinical Evidence; 2009. http://www.nice.org.uk/CG88. Accessed Jun 4th, 2010.

^19. Berry A, McClellan C, Wanless B, Walsh N. A Tailored App for the Self-management of Musculoskeletal Conditions: Evidencing a Logic Model of Behavior Change. JMIR Formative Research. 2022 Mar 8;6(3):e32669.

^20. Wanless B, Hassan N, McClellan C, Sothinathan C, Agustín D, Herweijer T, et al. How Do We Better Serve Excluded Populations When Delivering Digital Health Technology? Inclusion Evaluation of a Digital Musculoskeletal Self‐Management Solution. Musculoskeletal Care [Internet]. 2024 Aug 23 [cited 2024 Sep 12];22(3). Available from: https://pubmed.ncbi.nlm.nih.gov/39180193/

^21. Health Service Journal. HSJ Partnership Awards 2023: HealthTech Partnership of the Year [Internet]. Health Service Journal. Health Service Journal; 2023 [cited 2024 Sep 12]. Available from: https://www.hsj.co.uk/partnership-awards/hsj-partnership-awards-2023-healthtech-partnership-of-the-year/7034403.article

^22. Independent investigation of the NHS in England [Internet]. GOV.UK. 2024. Available from: https://www.gov.uk/government/publications/independent-investigation-of-the-nhs-in-england

^23. getUBetter evaluation report NHS SWL ICB/Health Innovation Network

^24. Edward R, Hill A, Hooper S, Thurlow J. getUBetter Report: Somerset NHS Foundation Trust Pilot. MSK Physiotherapy.

All news

Staff urged to sign up for course co-produced with autistic people to improve mental health care

By Integrated Care Journal

November marks the deadline to sign up to the ‘Train the Trainer’ course, to support staff to provide workplace training to improve support for autistic people.

Staff working in mental health services in England are being urged to sign up for a ‘ground-breaking’ series of courses that provide training to improve care for autistic people as it reaches its final months.

The National Autism Trainer Programme (NATP) is delivered by Anna Freud, a mental health charity for children and young people, in partnership with AT-Autism, a non-profit UK autism training, clinical services and consultancy provider, for NHS England. Both organisations share a commitment to creating lasting positive change for autistic people, as well as their families and staff working with them.

The programme – which closes in November – supports staff to deliver training within their own workplaces to improve support of autistic people.

Staff working in mental health and other settings can sign up for NATP here.

Research indicates s even out of 10 autistic people develop a mental health condition such as anxiety, depression, or obsessive-compulsive disorder (OCD). They are more likely to require mental health services than non-autistic people, but they don’t always get appropriate care. For example:

Mental health problems are often misdiagnosed among autistic adults, who are more likely to be given a sequence of diagnoses for their mental health problems and to disagree with the diagnosis they receive.
On average, autistic adults spend about 5 years within inpatient mental health services once admitted, compared with 39 days for non-autistic people.
Autistic people are up to seven times more likely to die by suicide than non-autistic people.

Since launching in 2023, more than 4,000 professionals across England have been trained through NATP and more than 600 are registered for the remaining places so far. 

The programme has been co-designed, co-produced and co-delivered with more than 110 autistic people to improve the knowledge, skills and confidence of professionals within mental health services in supporting autistic individuals. This includes challenging stereotypes about autism, building understanding of mental health conditions in autistic people and developing neurodiversity and trauma-informed and experience-sensitive approaches to their care.

Staff working in mental health and other settings can sign up for NATP here.

The course is open to eligible NHS England staff who currently work or may work with autistic people, including those without a diagnosis, in inpatient and community mental health services.8 Staff from residential special schools and colleges, and children and young people health and justice services, can also sign up.

Full details on training dates and available settings are on Anna Freud’s website. The charity, which has been supporting children and young people for 70 years, is working to close the gap in children and young people’s mental health. NATP is helping to achieve this ambition by closing the gaps in the skills and knowledge needed to support autistic people of all ages within mental health settings.

Dr Georgia Pavlopoulou, NATP Strategic Co-Lead and Programme Director at Anna Freud and Associate Professor at University College London, said: “Without counting those not formally diagnosed, autistic people are massively overrepresented in mental health services, yet many don’t receive appropriate care. This ground-breaking programme was established to help spread a new understanding of autism across the country. We are training staff within mental health settings to better support and recognise autistic people through experience-sensitive and person-centred care.

“Seeing the changes that the thousands of staff trained through NATP so far have implemented in their own workplaces has been a joy. From recognising and making adjustments for sensory and communication differences to developing environments where autistic voices are listened to and respected, so many working cultures have become more neurodiversity-informed and inclusive.

“After we deliver the final set of NATP courses, we will work closely with experts by experience, NHS England and partners to provide recommendations for a sustainable national model that promotes neurodiversity-informed practices within mental health services.”

Alexis Quinn is an autistic campaigner and author who, after attempting to seek mental health support following the birth of her daughter and death of her brother, was detained in 2012 under the Mental Health Act for almost four years. Alexis – who is also a content developer for NATP – said: “After major life changes, my mental health declined, and troubling autistic sensory seeking and cognitive needs arose. I couldn’t sleep, and I was more sensitive to touch, light and sounds. I also found I needed to move around all the time and became fixated on researching death processes. People around me became worried and I went to my GP for help. I thought I would be able to find somewhere to share my experiences and distress and have these supported.

“Instead, I faced countless barriers to accessing health care services. Some of these were environmental and some were caused by staff not understanding me. For example, I found the GP’s waiting area noisy and tried to move around to cope, but I was told I needed to sit down or leave. On one occasion, the police were called, and I was so overwhelmed, I had a meltdown. Not long after, I was sectioned and labelled mentally ill. I was given medications that caused scary and severe side effects, all of which compounded the distress I was experiencing.

“None of this needed to happen. If you understand autistic people, you can make reasonable adjustments such as providing a double appointment. You can also listen beyond the observation of autistic ‘symptoms’ by truly getting to know the person and their needs. That’s why NATP is so important. The course offers a neurodivergent-friendly approach to thinking about and supporting autistic people. Designed and delivered by the population it seeks to serve, it trains staff to recognise, understand and empathise with difference, and adapt care for neurodiverse people accordingly.”

Ellie Tidy, Child Wellbeing Practitioner at Islington Child and Adolescent Mental Health Service (CAMHS) was trained through NATP. She said: “The training provided incredible insights into the experiences of autistic people, including helping us understand the importance of an experience-sensitive approach. We now have a box of sensory tools for face-to-face sessions that young people can access during therapeutic sessions to feel more comfortable, and we have developed a form where they can share sensory and social needs before appointments.

“We have also adapted some resources, including our adolescent anxiety interventions, to better reflect the potential cognitive styles of young people. To achieve this, we incorporated learnings from NATP, including on masking – a strategy used by some autistic people consciously or unconsciously to appear non-autistic – and alexithymia, when a person has difficulty experiencing, identifying, and expressing emotions. We are also expanding and improving our way of working with neurodivergent children and young people beyond the clinic, including advocating for better adaptations in other settings such as at home and in school.

“In the future, we aim to focus more on co-production. We’re currently working with autistic young people and their families in the service to gather feedback and find out which adaptations work well and what could be changed. Listening to the voices of autistic young people will help us to better support them.”

Staff working in mental health and other settings can sign up for NATP here.  

How ICSs can benefit from a strategic, system-wide approach to social value

By Becky Jones

By Becky Jones, Social Value and Sustainability Lead, NHS Arden & GEM CSU

Creating healthier, more resilient communities and reducing our environmental impact are essential elements in delivering a more sustainable NHS. These ambitions are reflected in the four core aims assigned to integrated care systems (ICSs), which are: to improve outcomes in population health and healthcare; tackle inequalities; enhance productivity and value for money; and, support broader social and economic development.

The NHS has set an ambitious target to become net zero by 2040, while public bodies have had a legal responsibility to commit to the social, environmental and economic sustainability of their communities for many years. As a result, social value and environmental commitments are increasingly embedded in procurement and other legislative requirements. But how we translate these often-fragmented commitments into quantifiable achievements is less clear. Social value could have a major role to play in tackling our most pressing health and social care challenges, but this will require ICSs to adopt a more cohesive and proactive approach.

Seizing opportunities

Social value advocates for looking much more broadly at the wider determinants of health and considering how system partners can work together to achieve more for their communities. This holistic approach encompasses social, economic and environmental areas such as education, housing, work, crime and community services, and how these connect and contribute to the overall wellbeing of an area and its population.

Using population health data to inform priorities, system-wide collaboration gives health, public and voluntary sector organisations an important opportunity to develop a coordinated, strategic approach to delivering social value. This requires bringing the right mix of skills and disciplines together to identify programmes that will have the greatest impact, and mapping out the connections that need to be made for this to work. We know, for example, that poor quality housing can affect health. The health service could invest resources in treating a patient’s pneumonia only to discharge them back to their draughty or damp home, which is likely to cause a return to ill health.

Similarly, if a voluntary organisation runs activities to help tackle social isolation but people cannot afford the transport to get there, the initiative won’t achieve its aims, despite appearing on paper to meet population needs. Sharing information and planning interventions across system partners creates opportunities to break these vicious cycles and move towards disease prevention and wellness.

Agreeing priorities

Organisations will typically have specific activity, savings or outcome targets to meet, or be used to working in certain ways. This is where data can help identify common challenges and demonstrate the value of becoming more aligned. What are your staff surveys telling you about workforce priorities? What recruitment and retention pressures does your system face? Where are the gaps in your health provision? Which patients are driving demand, and which communities are you not reaching? Engaging effectively across your ICS, and with your patients and communities, will help determine priorities at system, place and organisational levels.

Some initiatives may be unique to individual organisations or communities but aligning them to a broader set of strategic priorities will make it easier to evaluate overall impact and share learning. In Coventry and Warwickshire ICS, for example, the ICB is taking a system-wide approach to tackling health inequalities, drawing on partners’ roles as anchor institutions to deliver social value across the region. The system is establishing a charter that aims to act as a framework, enabling each partner organisation to do what it needs to do to meet its own requirements, albeit contributing to a wider strategy to deliver a more proactive and sustainable health and care service. The charter aligns to the system’s long-term planning process while giving a specific approach to delivering social value through an overarching framework.

In Cheshire and Merseyside, the ICS developed a Social Value Charter which defines what social value means to them, using a coproduction approach that enabled system partners, voluntary organisations, the private sector and citizens to contribute. The Charter sets out the principles and approach signatories sign up to, including how social value will be measured using a Social Value Outcomes Framework.

Making suppliers part of the solution

Setting social value priorities helps organisations seek meaningful contributions from suppliers. To fulfil procurement requirements, bidders are commonly required to come up with social value initiatives and carbon reduction plans which tend to be silo projects that are difficult to monitor and manage. By inviting them to show how they would contribute to your existing social value priorities, your system can start to harness a collective contribution towards priority programmes which can be measured and evaluated against agreed criteria.

This means working with procurement colleagues much earlier in the commissioning process and challenging established ways of working that prioritise savings and lower cost contracts. If your system has prioritised paying a real living wage, for example, contracts need to be assessed not just for efficiency but for the long-term, wider benefits that may come with using suppliers that pay their staff well.

Measuring impact

Social value is not about quick wins but long-term sustainability. It requires taking a step back from continuous day-to-day pressures to consider initiatives that it may take us years to fully benefit from. This makes measurement even more important – we need to be able to see steps towards achieving sustainability goals, which in turn will lead to better, broader outcomes. NHS Arden & GEM has been working with the Social Value Portal to adapt their social value themes, outcomes and measures system (TOM system) for healthcare which incorporates five key themes:

Jobs – opportunity for all
Growth – inclusive growth
Social – empowering communities
Environment – safeguarding and restoring our world
Innovation – new ideas to deliver social value.

The TOM system is endorsed by the Local Government Association and maps to both major external frameworks and the Government Social Value Model. Using robust data, proxy values are applied to each objective and outcome which helps organisations convert their progress into a quantifiable value. Using consistent standards across systems enables more reliable assessment and benchmarking, which in turn will strengthen best practice and accelerate learning across regions.

Where to start

ICSs and their individual partner organisations will be at different stages of maturity and will have varying support needs. In recognition of this, NHS Arden & GEM has established a Social Value Network to encourage information-sharing and innovation across England, and a Future NHS social value workspace where organisations can access free resources. More recently, we have partnered with the Social Value Quality Mark CIC and the Social Value Portal to create the Social Value in Health Excellence Programme, providing independent assessment, support and monitoring to help organisations move successfully through their social value journey. This is not about adding to the to-do list, but about developing best practice in social value to help ICSs deliver the four core aims they are already tasked with.

Understanding and adopting a system-wide approach to social value has the potential to deliver significant strides towards preventative care but it’s not an overnight solution. Although today’s pressures must be tackled, it is equally important to build the knowledge and confidence needed to make long-term investments in social value that will improve community health and resilience in the long-term.

*Becky Jones, Social Value and Sustainability Lead, NHS Arden & GEM CSU*

Universal Care Plan breaks usage records with new integrations and sickle cell care plans

By Integrated Care Journal

More than 5,000 people with sickle cell disease now have a plan on the integrated care platform, covering nearly all of those receiving care for the disease in London.

The Universal Care Plan (UCP), OneLondon’s shared care planning solution powered by Better, has in the last year integrated with the NHS National Record Locator (NRL) and the NHS App, while also extending the care plan support for people with sickle cell disease.

These latest developments within the solution, which spans five integrated care boards across the whole of London and has recently marked two years of existence, are helping to further integrate care, improve patient outcomes, and drive up engagement, in some cases at record-breaking levels.

Introduction of sickle cell care plans

Expanding the UCP to support individuals with sickle cell disease is an important step, following the No One’s Listening report, calling for major changes in sickle cell care. Sickle cell disease affects approximately 15,000 people in the UK. Approximately 60 per cent of people diagnosed with the disease have their treatment in London. With symptoms ranging from anaemia to severe pain episodes known as sickle cell crisis, managing this condition effectively requires comprehensive care planning and prompt treatment interventions.

Since the launch of the care plans, 5,000 people with the disease now have a plan on the integrated care platform, meaning the service is close to supporting everyone who is cared for in the capital.

“I think this is a real game changer for people with sickle cell disease,” said Nick Tigere, Head of the UCP Programme. “They are now able to confidently seek the medical attention they need while in crisis, knowing fully that the services they attend, wherever they attend in London, will be aware of consolidated key information on diagnosis, symptom management, and treatment options.

“Supporting healthcare professionals with immediate access to this critical information is facilitating timely interventions and improved care. It really has been transformative for people’s care pathway.”

National Record Locator integration

With the new National Record Locator (NRL) integration in place, London and out-of-London urgent care services are now able to view a UCP en route to responding to a patient in need. This means that a patient’s care plan, particularly their symptom management requirements, can be delivered immediately as the paramedics make contact with the patient, even when they are away from London. Following the go-live, the number of plans accessed by the Ambulance Service has increased by 20 per cent due to the increased access the integration is providing.

The NRL is an NHS service that allows health and care professionals to find and access patient information shared by other health and care organisations across England to support the direct care of a patient.

NHS App integration

Patients can now also access their UCP in the NHS App, which is another step towards putting patients at the heart of their care planning. It means patients can easily share their plans with healthcare professionals as they move around London and across the rest of the country.
In an emergency, patients may not be able to articulate or communicate their wishes and preferences, in which case they can defer to showing clinicians the plan on the app. The increased accessibility is also empowering patients to take a more active role in managing their information and ensuring it is up to date.

In four months, the app has seen 20,000 jump-offs to care plans, and if a plan isn’t in place, it’s helping to initiate conversations with clinicians to create one, which is in turn contributing to an increase in overall care plans created. During July, the service celebrated a record-breaking 4,200 care plans being generated on the platform.

Concluding on the new integrations and sickle cell care plans, Nick Tigere added: “The UCP platform has become a well-established tool for health and care professionals and is helping to ensure people have their care wishes and preferences respected. Our role is to enable all parts of the system to quickly access relevant patient information at the right place and right time. I am proud that we continue to enable this for people and our health services with these latest developments.”

Darren Ransley, Managing Director UK & Ireland at Better, said: “By expanding access to patient data through the NHS National Record Locator and NHS App, we are advancing interoperability and making healthcare data available anywhere, anytime. These integrations mark a significant step forward in delivering person-centred care and ensuring equitable access to healthcare services.

“By leveraging innovative technology and a person-centred approach, the UCP continues to redefine care delivery standards, setting a new benchmark for integrated healthcare solutions.”

At the end of 2024, the UCP will be transformed into a personalised care and support plan with the introduction of new forms and data fields to create a richer picture of the person receiving care. The new information will cover the PRSB ‘About Me’ standard, living arrangements, medical devices, communication and accessibility requirements, and daily activities and support needs.