NCA whitepaper outlines ‘critical’ challenges facing adult social care

By Integrated Care Journal

The adult social care system’s funding shortfall could reach £18.4bn within a decade, according to a new whitepaper from the National Care Association and HCR Law.

The adult social care sector in the UK is facing a critical financial crisis, as outlined in a recent whitepaper that examines key challenges through the lenses of funding, workforce, and regulation. The whitepaper, Adult social care: Steering through change, was published by the National Care Association (NCA) in partnership with HCR Law. It paints a stark picture of a sector struggling to stay afloat, with urgent reforms needed to prevent widespread collapse.

The whitepaper explores three critical areas – funding, workforce and regulation – proposing immediate and long-term strategies to address the challenges and to create and thriving, robust sector. Emphasising the intricate web of the adult social care landscape, the report underscores the need for a unified, cross-party approach to implement meaningful changes, and welcomes the recent announcement of the independent commission led by Baroness Louise Casey.

Nadra Ahmed, CBE, Executive Co-Chairman of the NCA, said: “Despite the challenges we face, we have the appetite to ensure that we start to consider and put forward solutions. The paper considers how to overcome the challenges and create a thriving, robust sector which is fit for purpose. It reconfirms the sector’s commitment to playing our part in overcoming the challenges and delivering the rewards.”

Funding crisis threatening sector’s viability

At the heart of the sector’s instability is a glaring funding gap. The Health Foundation estimates an annual shortfall of £8.4 billion, leaving care providers unable to cover basic operational costs, let alone invest in improvements or expansions. This financial strain has already led to bankruptcies and a reduction in available care placements.

Citing the Nuffield Trust, the report argues that the 2024 Budget exacerbated the problem, adding an estimated £2.8 billion in costs to independent care providers. While the planned National Living Wage increase from April 2025 is a positive step for worker compensation, it adds further pressure to an already fragile financial ecosystem. Projections indicate that without significant intervention, the funding gap could grow to £18.4 billion by 2032/33.

Workforce shortages hitting care quality

The sector employs 1.6 million people, representing 5.8 per cent of the UK workforce. The report stresses that years of low pay and worsening working conditions have led to the sector’s high turnover and difficulty recruiting and retaining workers. The Budget, it argues, has worsened these issues, increasing the risk of safeguarding issues that local authorities must manage.

The report stresses that passion alone cannot sustain the workforce; substantial government investment is required to implement the Skills for Care workforce strategy, which aims to elevate social care as a respected and viable career. Alongside this, the report also calls for development of robust career paths, creation of coaching and networking opportunities – and the empowerment of experienced staff while developing the next generation of care workers.

Looking further ahead, the paper supports the notion of a National Care Service. It argues that although the care industry is already interconnected, a fully integrated system incorporating local care services could provide significant, long-term benefits. The proposal aims to create a cohesive and efficient care system which can better serve the UK.

Regulatory inconsistencies erode public trust

Regulation, critical for maintaining care standards, is another area of concern cited in the whitepaper. It criticises the CQC for inconsistent inspection quality and a lack of public confidence in its ability to enforce high standards. Variations in local government oversight further complicate the regulatory landscape, undermining efforts to safeguard service users. The report suggests that comprehensive reform of the CQC, or even the creation of a new regulatory body, may be necessary to restore trust and accountability.

Rebecca Leask, Partner and Head of Healthcare at HCR Law, commented: “In our work, we see the challenges and opportunities faced by all stakeholders in social care and support, from local government and public sector bodies to private and public care providers. We see firsthand their dedication and passion for their work. We take great responsibility knowing the work we do in advising our clients in this sector helps them navigate these challenges and seize opportunities, enabling them to continue delivering for service users and taxpayers alike.”

The whitepaper is available to download from HCR Law.

Patients increasingly want access to personalised medicine, research finds

By Integrated Care Journal

Nearly two-thirds of UK adults believe that access to both standard and personalised medicine is important, as more than a third of UK adults say standard GP-prescribed medicines often fail to meet their health needs.

New research reveals over a third (36 per cent) of UK adults report that standard GP-prescribed medicines often fail to meet their health needs, leaving both patients and their healthcare providers searching for better solutions. The findings, released by Roseway Labs, a private compounding pharmacy specialising in personalised medicines, underscore the opportunity for personalised medicine to fill critical gaps in care.

Healthcare professionals on the front line see daily the challenges of overwhelmed GP services and mounting patient dissatisfaction with standardised treatment options; for patients, more than a quarter (28 per cent) feel resigned that 2025 won’t bring solutions for their health conditions.

The research underscores the potential of personalised medicine to tackle these pressing issues and highlights the growing demand for this choice. 73 per cent of people expressed openness to using a pharmacy that personalises medicines and supplements to better address their health concerns. While compounded medicine is accessible through private care, the findings indicate a growing number of NHS patients want access to greater choice over the medicines they use.

Additionally, 58 per cent believe having the option between standard and personalised medicines is important, rising to 80 per cent among Gen Z and 76 per cent of millennials. The demand for personalised care among younger generations is likely to grow as they age and encounter age-related conditions, highlighting the need for a step change now to ensure future healthcare options meet their evolving expectations.

The government’s cash incentive scheme highlights the urgent need for innovative solutions to alleviate growing GP and hospital waiting times. Compounding pharmacies like Roseway Labs can help ease this pressure by providing personalised treatments that address individual needs and reduce repeat GP visits caused by ineffective standard prescriptions. The average 10-minute face-to-face GP consultation currently costs £56, so it is hoped that providing more effective treatments first time will reduce the need for repeat GP visits, saving costs and alleviating pressure on general practice and wider primary care.

For healthcare professionals unfamiliar with compounding or personalised medicine, safety is paramount. All processes comply with the General Pharmaceutical Council (GPhC) guidelines and the Human Medicines Regulations 2012, ensuring all compounds are made exclusively from valid UK prescriptions as a fully regulated pharmacy.

Skin conditions and allergies are good examples of where compounded medicines can help patients. Simply changing the medication’s form – from pill to liquid – or removing certain ingredients in the pill that are allergenic, can be the difference between a patient finding relief from an allergy or even being able to take their medication as prescribed.

Miriam Martinez Callejas, Superintendent Pharmacist and Founder of Roseway Labs, commented: “With an ageing population and growing demand for tailored care among Gen Z and millennials, personalised medicine provides an essential option for those whose needs aren’t met by standard treatments. Often likened to the Savile Row of medicine, compounded treatments offer custom dosages, formulations, and combination of ingredients, much like a tailored suit fits where off-the-rack clothing cannot. Our goal is to collaborate with GPs and healthcare professionals to make personalised medicine a key part of future healthcare innovations in the UK.”

Compounding pharmacies play a crucial role in addressing medication shortages by formulating alternative solutions when commercially available drugs are unavailable. They can create customised doses, replicate discontinued medications, or offer equivalent treatments, ensuring patients have access to the care they need without interruption.

Elizabeth Philp, CEO and Founder of Roseway Labs, commented: “A one-size-fits-all approach often fails to address the complexities of individual health needs, leaving many patients feeling despondent about their future. While regular prescriptions work well for some, others face challenges such as inadequate symptom relief, adverse effects, or difficulty adhering to treatment plans. Personalised medicine can complement NHS treatments and care, offering tailored solutions that empower patients and help them lead healthier lives.”

AI software tool aims to use high street eye tests to spot dementia risk

By Integrated Care Journal

First-of-its-kind collaboration offers potential for “step change” in the early detection of dementia, using routine eye scans to gain deeper insight into brain health and monitor cognitive decline.

Data scientists and clinical researchers are working with high street opticians for the first time to develop a digital tool that can predict a person’s risk of dementia from a routine eye test.

The NeurEYE research team, led by the University of Edinburgh, with Glasgow Caledonian University, has collected almost a million eye scans from opticians across Scotland, forming the world’s largest data set of its kind.

The scientists will then use artificial intelligence and machine learning to analyse the image data, along with relevant patient data on demographics, treatment history and pre-existing conditions. This data is anonymised and patients can’t be identified, but it allows researchers to find patterns that could indicate a person’s risk of developing dementia, as well as giving a broad picture of brain health.

Permission to use the data comes from the Public Benefit and Privacy Panel for Health and Social Care, a part of NHS Scotland.

The project is the second funded and supported by NEURii, a first-of-its-kind global collaboration between the pharmaceutical company Eisai, Gates Ventures, the University of Edinburgh, the medical research charity LifeArc and the national health data science institute Health Data Research UK. Together, the partners are giving innovative digital projects the chance to become real world solutions that could benefit millions of patients with neurodegenerative conditions like dementia. The first NEURii project, SCAN-DAN, is using brain scans and AI to predict dementia risk.

Retired mechanical engineer, David Steele, 65, whose mum has Alzheimer’s, said predictive software like this could have saved his family ten years of heartache and struggle. He said:“It took ten years for my mum to be diagnosed with Alzheimer’s.

“She was initially diagnosed with dry macular degeneration, but this masked the underlying issue that we now know to be cerebral blindness linked to Alzheimer’s. The connection between brain and eye was the missing link in her case.

“The missing diagnosis meant that my late father, who was also elderly, cared for mum throughout a difficult period without knowing what was wrong.

“If we had known, then we would have had help with the additional and demanding support that became necessary. Preventing the cliff edge, when it becomes too late for the person to understand what is wrong with them, is so important.”

Professor of Clinical Ophthalmology at the University of Edinburgh and NeurEYE co-lead, Baljean Dhillon, said: “The eye can tell us far more than we thought possible. The blood vessels and neural pathways of retina and brain are intimately related. But, unlike the brain, we can see the retina with the simple, inexpensive equipment found in every high street in the UK and beyond.”

Optometrists will be able to use the software subsequently developed as a predictive or diagnostic tool for conditions such as Alzheimer’s, as a triage tool to refer patients to secondary health services if signs of brain disease are spotted, and potentially as a way to monitor cognitive decline.

Identifying people at risk of dementia could also accelerate the development of new treatments by identifying those who are more likely to benefit from trials and enabling better monitoring of treatment responses.

And being aware of a risk of dementia could also help individuals and medical professionals modify the risk through lifestyle changes such as physical activity and diet, according to a Lancet Commission, which added vision loss this year as one of its dementia risk factors.

Optometrist Ian Cameron, who runs Cameron Optometry in Edinburgh, said: “Optometrists as primary carers is not a new thing, and in Scotland we’re becoming an increasingly allied part of the NHS. We see the same people year on year, whether they’re ill or not, we have all the right equipment, so it makes sense for us to be the GP of the eyes and monitor as much health as we can see.

“What is new is that, with AI, we can see even more, and that is extremely powerful.”

Professor of Computational Medicine at the Usher Institute and NeurEYE co-lead Miguel Bernabeu said: “Recent advances in artificial Intelligence promise to revolutionise medical image interpretation and disease prediction. However, in order to develop algorithms that are equitable and unbiased, we need to train them on datasets that are representative of the whole population at risk. This dataset, along with decades-long research at University of Edinburgh into ethical AI, can bring a step change in early detection of dementia for all.”

Dr Dave Powell is Chief Scientific Officer at LifeArc, one of the NEURii collaborators. Speaking on behalf of the partners he said: “Harnessing the potential of digital innovations in this way could ultimately save the NHS more than £37m a year because the hope is that it will speed up the diagnosis and treatment of neurodegenerative conditions like dementia.

“The UK, with its single healthcare provider, is also well placed to become a global leader in the development of new tests that use health data. This is why we are collaborating to advance promising digital health projects that have the potential to improve millions of lives.”

The data will be held safely in the Scottish National Safe Haven which provides a secure platform for the research use of NHS electronic data. This resource is commissioned by Public Health Scotland and hosted by the Edinburgh International Data Facility through EPCC at the University of Edinburgh.

Unlocking the potential of NHS data: A vision for a unified health data platform

By Ruth Holland and Mark Kewley

By Ruth Holland, Director of Data & Analytics, London Secure Data Environment, OneLondon Health Data Portfolio, and Mark Kewley, Programme Director, London Secure Data Environment, OneLondon Health Data Portfolio.

The landscape of healthcare is increasingly being shaped by the effective use of data, yet the journey towards realising the full potential of NHS data is fraught with challenges. At the core of this transformation is the OneLondon programme, an ambitious initiative that seeks to overcome the fragmentation of health data across the capital and, ultimately, improve patient care, operational efficiency, and research outcomes.

The origins of OneLondon: Addressing fragmentation

The OneLondon programme was born out of a need to address a longstanding issue within the NHS: the fragmentation of health data. Historically, patient information has been scattered across various care settings, making it difficult for both healthcare providers and patients to access a complete picture of an individual’s health. This fragmentation not only hampers the delivery of efficient care but also limits the ability to derive meaningful insights from the data.

In response, London’s healthcare leaders embarked on a journey to create the London Care Record, a unified platform that allows for the sharing of relevant patient data across care settings. Initially focused on providing a ‘view-only’ access to patient information, the programme has now evolved into a more sophisticated data platform capable of generating actionable insights for both direct care and research purposes.

Building a comprehensive data platform to support integrated care

Our efforts have now moved beyond simply making data accessible. The goal, which is supported by funding from the NHS England Data for R&D Programme and London’s integrated care systems (ICSs), is to create a London-wide data platform that can provide insights that inform care decisions at both the individual and population levels. The transition from a ‘view-only’ system to a dynamic data platform represents a significant milestone. It allows us to harness data from across London’s health system to support integrated care, drive proactive care strategies and facilitate advanced research.

In North West London ICS, for example, we’ve seen the success of integrating data across different care settings. Clinicians now have access to a comprehensive view of their patients, enabling them to deliver more informed care. The next step is to expand across London and incorporate data from all other care settings for the population of 10.6 million people.

Leveraging advanced technologies

Central to this transformation is the integration of cutting-edge technologies like Federated Learning Interoperability Platform (FLIP) and AI tools. These tools enable us to bring together different types of data, such as electronic patient records and radiology images, into a single, interoperable platform. By doing so, we can develop predictive models that not only support clinical decision-making but also enhance the accuracy and efficacy of research.

The use of natural language processing (NLP) to convert unstructured data into structured formats is a significant advancement. With approximately 80-90 per cent of healthcare data stored in unstructured formats, such as clinical notes and images, NLP allows us to unlock a wealth of information that was previously inaccessible. This capability is crucial as it significantly increases the insights we can derive from our data, paving the way for more personalised and effective healthcare solutions.

Ruth Holland will be the Chair of a Spotlight session with Dr Jessica Morley at Digital Health Rewired 2025, taking place 18-19 March in Birmingham.

Overcoming challenges through collaboration

The scale and ambition of the OneLondon programme are unprecedented, and so are the challenges. Integrating data across multiple care settings, ensuring stakeholder alignment and navigating complex information governance (IG) issues are just a few of the hurdles we face. However, these challenges also highlight the importance of collaboration.

We’ve worked extensively with the public to understand their expectations around data use, and this feedback has been invaluable in shaping our approach to IG. The public’s support for data integration across care settings has provided a strong mandate for us to push forward with this initiative. Additionally, our collaboration with data controllers, particularly GPs, has been critical in ensuring that the platform brings tangible benefits back to the practitioners who contribute to it.

A vision for the future

The vision for OneLondon is clear: a comprehensive, interoperable data platform that not only supports the immediate needs of patient care but also drives long-term improvements in population health and research. While we recognise that we are still at the early stages of this journey, the progress we’ve made thus far is encouraging. The successful integration of data in North West London serves as a model for the rest of the city, and with continued investment and collaboration, we are confident that we can achieve our goals.

The OneLondon programme represents a bold and necessary step towards a future where data is used to its fullest potential to improve health outcomes. By overcoming the challenges of data fragmentation, leveraging advanced technologies, and fostering collaboration across the healthcare ecosystem, we are laying the foundation for a more integrated, efficient, and patient-centred NHS.

Ruth Holland will be the Chair of a Spotlight session with Dr Jessica Morley at Digital Health Rewired 2025, taking place 18-19 March in Birmingham.

*Ruth Holland, Director of Data & Analytics, London Secure Data Environment, OneLondon Health Data Portfolio*

Report details perilous state of UK adult social care

By Gabriel Blaazer

Latest Sector Pulse Check report calls for a multi-year funding settlement when the government’s Spending Review concludes in summer 2025, alongside a fully funded roadmap towards parity between care workers and NHS counterparts.

An annual review of adult social care services in the UK has warned that thousands of vulnerable adults are at risk of eviction due to mounting and far-reaching cost pressures.

The Sector Pulse Check 2024, produced by Care England and the learning disability charity Hft, is the culmination of a survey of more than 200 independent and charitable providers of adult social care. It says that social providers are operating in “survival mode… sprinting to stay afloat”, arguing that spiralling cost and workforce pressures have put “the entire sector…in a state of acute precarity”.

Financial pressures mounting

The report finds that the financial pressures on social care providers are far-reaching and having a tangible effect on the sector’s ability to provide quality services. In their responses to the survey, 90.9 per cent of providers said that workforce related costs were among the top financial pressures, with 38.8 per cent citing the cost of utilities, and 29.1 per cent unpaid or delayed bills by local authorities. Of these workforce related costs, increases to the national living wage were identified by 95.8 of providers as one of the biggest challenges. Critically, 85 per cent of providers did not experience increases in fees paid by local authorities to cover the national living wage rise

To cope with financial pressures, three in ten providers closed parts of their organisation or handed back care contracts to local authorities in 2024, often evicting some residents in the process. One third of all providers have curbed inward investment in the last year to offset rising costs, rising to two fifths of providers of care for older people, a move likely to impact care capacity and quality over the long-term.

Although the share of providers in deficit fell for the third consecutive year (down to 29 per cent from 40 per cent the year before), 60 per cent of those in deficit reported an increase in the size of deficit from the year before. It is estimated that seven in ten providers currently operating with a decreasing surplus will be in deficit within three years. This is expected to increase if the government does not add exemptions for social care from the rise in Employer National Insurance Contributions (NICS) announced in the 2024 Autumn Budget. Social care providers have been pushing the government for exemption, but the government has yet to announce any policy to mitigate the increased costs for the sector.

“Severe” workforce shortages

The report identifies workforce concerns as an ongoing and “severe problem” for the social care sector, pointing to its 8.3 per cent vacancy rate. The whole UK economy’s vacancy rate is 2.6 per cent, indicating the unique difficulties facing social care. 33 per cent of providers reported a fall in job applications in 2024, compared to 2023. This is partly attributed in the report to changes to legal migration rules introduced in March 2024, which include a ban on foreign care workers bringing dependants on their visa, along with an increase to the minimum baseline salary to be sponsored as a Skilled Worker (rising from £26,200 to £38,700).

While 40 per cent of providers (particularly smaller organisations) reported relying on international recruitment to fill posts, providers reported a decline in international applications following the new immigration restrictions, and expect to see yet further impact with time. Hft and Care England argue that the government should lift the ban on dependents for international social care staff to help protect the sector’s supply of workers.

Due to staff shortages, 29 per cent of providers reported refusing new admissions, while 40 per cent have increased their use of agency workers to fill gaps. Agency workers are typically more expensive and considered “less prepared to deliver quality care compared with their full-time equivalents”.

The sector’s future

The Sector Pulse Check report concludes that “there can be no expansion in the capacity of the social care sector without both more funding and more workers”. Lord Darzi’s recent revelation that the equivalent of 13 per cent of NHS beds are occupied by people waiting for social care support or care emphasises that the NHS cannot thrive without a functioning social care sector. The sector’s high turnover rate of nearly 26 per cent demonstrate social care’s challenge in attracting and retaining skilled workers.

While the government has recently announced the launch of an independent commission to reform adult social care, led by crossbench peer Baroness Louise Casey, some in the sector have voiced concerns over the commission’s three-year scope. Martin Green, Chief Executive of Care England, commented that “waiting until 2025 is not an option,” and voiced concerns that this will be “yet another report that gathers dust while the sector crumbles”. Regarding immediate action, the report highlights Skills for Care’s Workforce Strategy for 2024, which offers a series of policy recommendations to “attract, retain, train and transform the social care workforce”.

The report makes two major policy recommendations:

Commit to a credible, multi-year funding settlement for the adult social care sector when the Spending Review concludes in Summer 2025. Funding increases must cover future increases in the national living wage, and any changes to Employers National Insurance, and inflation, to avoid real-term pay cuts and the large-scale market exit of care providers.
Create a fully funded roadmap toward parity between care workers and workers in the NHS. Pay and conditions are central to this, yet the significance of status and respect must not be ignored. This should include adopting the recommendations of the Skills for Care Workforce Strategy to address the high vacancy and turnover rate in the sector.

Alongside these, it calls on the government to either exempt care providers from the increase in Employer NICS contributions, or to fully fund the rise itself. It also urges the government to ensure that the NHS and local authorities are sufficiently funded to reimburse care providers through the Local Government and NHS funding settlement.

The full Sector Pulse Check 2024 report can be accessed here.

Nominations open for Our Health Heroes Awards 2025, delivered by Skills for Health

By Integrated Care Journal

Nominations are now open for the Our Health Heroes Awards 2025, celebrating the wider healthcare workforce – from porters and cleaners to receptionists, gardeners and security guards – that supports NHS doctors and nurses on the frontline.

Supported by NHS England, NHS Employers, NHS Shared Business Services, NHS Race & Health Observatory and Integrated Care Journal, Our Health Heroes celebrates the wider healthcare workforce that supports NHS doctors and nurses on the frontline.

From porters and cleaners to receptionists, gardeners and security guards, these often unsung heroes make up roughly 40 per cent of the NHS’s million strong workforce.

Our Health Heroes Awards is a national celebration of their achievements and an opportunity to give thanks for the important role that they play in keeping the health service functioning.

Our Health Heroes Awards 2025 categories:

Individual awards

Clinical Support Worker of the Year
Operational Support Worker of the Year
Outstanding Lifetime Contribution to Healthcare
Apprentice of the Year
Healthcare Volunteer of the Year

Team awards

Best Healthcare Workforce Collaboration
Dedication to a Lifelong Learning Culture
Equity, Diversity, and Inclusion Champion
Digital Innovation

Nominations close at midday on Tuesday 4 March. An expert panel of judges will then decide the finalists in each category.

John Rogers, Chief Executive of Skills for Health, comments: “Our Health Heroes is an opportunity to recognise and celebrate the remarkable dedication of the wider NHS workforce.

“The awards shine a much-deserved spotlight on the unsung heroes – cleaners, porters, security staff, receptionists, medical secretaries and many more – who don’t often get the recognition that they deserve.

“The commitment, compassion and hard work displayed day in day out by the wider healthcare workforce is a credit to, and the backbone of, our NHS.”

Erika Bannerman, Managing Director of NHS Shared Business Services, comments: “The Our Health Heroes Awards are an expression of appreciation for those who make such a significant impact on patient care and the wider community.

“It is vital to acknowledge the contributions of individuals and teams who go above and support the delivery of outstanding care, and we are proud to be able to support the awards again this year.”

The winners of the awards will be announced at a glittering ceremony held at the Queen Elizabeth II Centre in London on 22 May 2025.

To make a nomination visit: www.skillsforhealth.org.uk/awards

Harnessing data-led approaches to patient safety: a case study

By Jonathan Webb, Head of Safety and Learning at NHS Wales

Jonathan Webb, Head of Safety and Learning at NHS Wales, relates two data-led approaches aimed at reducing avoidable harm and litigation costs across Wales, demonstrating the success of unified and standardised approaches to patient safety.

NHS Wales faced growing challenges in improving patient safety and reducing harm across its healthcare system. Rising litigation costs, inconsistent training, and fragmented data across health boards limited the ability to identify trends and implement evidence-based improvements. Specific issues, such as preventable harm in maternity services and the lack of a unified approach to handling incidents, complaints, and claims, highlighted the need for systemic solutions.

These challenges created opportunities to:

Implement a unified training programme to improve outcomes in maternity services (PROMPT Wales).
Develop centralised data systems to connect incidents, complaints, and claims and workforce data, enabling shared learning and improvements (Once for Wales Concerns Management System).

The solutions

PROMPT Wales

This initiative introduced a structured, multi-professional training programme for maternity teams across NHS Wales. Designed to improve safety, teamwork, and communication, PROMPT Wales delivered:

Standardised, scenario-based training for all staff.
Data-informed guidance to address identified risks, such as postpartum haemorrhage.
Comprehensive engagement, with 93 per cent of maternity staff trained within a year.

Once for Wales Concerns Management System (OfWCMS):

Led by the Welsh Risk Pool, part of NHS Wales Shared Services Partnership, this platform centralised incident, complaint, and claim management across all health boards. By unifying disparate systems:

Data could be analysed holistically, identifying trends across complaints, incidents, and claims.
Integration ensured consistent national approaches to handling patient concerns and improving quality of care.

Collaboration between healthcare teams, Welsh Government, and RLDatix ensured that initiatives were implemented with consistency and aligned with national safety goals.

Scalability

The scalability of these initiatives lies in their structured and integrative approaches.

PROMPT Wales: Its team-based training model and use of data can be adapted to other clinical specialities or regions. The methodology ensures alignment with local needs while maintaining national standards.
Once for Wales: The centralised framework can be replicated in other healthcare systems to unify and optimise incident management, feedback collection, and data analysis.

Enablers:

National buy-in and strong governance frameworks.
Robust technology platforms for data collection and integration.
Proven impact, such as measurable safety improvements and cultural change.

Constraints:

Initial investment in technology and training.
Variation in local infrastructure and staff capacity.
Need for sustained leadership and stakeholder engagement.

Evidence of success

PROMPT Wales, along with the sheer hard work of staff within services, delivered significant clinical improvements:

33.8 per cent reduction in severe postpartum haemorrhage (≥2500mL).
43.5 per cent reduction in term APGAR scores <7 at 5 minutes.
Enhanced safety culture, as evidenced by improved staff safety attitude scores.

Once for Wales outcomes included:

Uniform data collection across all health boards and trusts.
Real-time insights into patient and staff feedback, enabling proactive safety measures.
Improved learning from incidents and claims, contributing to better service quality and reduced harm.

Quantitative data from PROMPT Wales shows statistically significant improvements in clinical outcomes (P-value <0.0001). Feedback from OfWCMS users highlights enhanced decision-making due to integrated data systems.

Lasting benefits

Patients receive safer care and improved health outcomes across maternity and broader services.

Staff benefit from greater confidence, reduced stress, and better training support.

Systems benefit from enhanced efficiency, reduced costs, and a model for future healthcare improvements.

Digital Implementation, News January 13, 2025

Building confidence in AI telephony tools for primary care

By Max Gattlin

Max Gattlin discusses whether AI telephony tools are ready to deliver transformation in primary care and help end the ‘8am rush’, accelerating patients’ time-to-care.

The latest figures show that general practice delivered a record 38.6m appointments in October 2024 (or more than 40m when counting COVID-19 jabs). That’s the highest ever one-month total on record. Amid this surging demand this, primary care is struggling with overwhelming demand and clinician shortages, and GP leaders have warned that the pressure facing services is not sustainable.

The solution cannot lie solely in hiring more staff at practices – there’s a bigger picture at play. It’s about making better use of the tools and technology already available to ease the load on existing teams. This is an area where AI can help, but in order to maximise benefits and ensure use and adoption at scale, ensuring that clinicians and patients trust in the tools is critical.

Why is AI in digital telephony so important?

Use of the ‘digital front door’ is ever-increasing, but despite advancements, over two thirds (68 per cent) of patients continue to contact their GP practice via telephone as the first port of call. The shift from analogue to digital is something we all know is coming in the 10 Year Health Plan, and as the most used element of the digital front door, it is clear that primary care has a fantastic opportunity to embrace the use of AI in telephony. It’s also something that the Social Market Foundation has touched on recently in its report, In the blink of an AI, which has recommended further integration AI and automation into user-facing workstreams.

What benefits could it bring?

The integration of AI in digital telephony for primary care can offer transformative benefits, addressing some of the pressing challenges facing the sector. Integrating technologies such as cloud telephony, unified communications, and AI-enabled healthcare tools, means practices can alleviate the pressure on GPs and other clinicians. By integrating AI-powered features such as voice agents, call routing, speech-to-text, and automated signposting, practices can alleviate the inbound pressure on call handlers while simultaneously improving access. This will also enable practices to accelerate a patient’s time-to-care by offering an assessment of need at the first point of contact, in line with NHS national priorities.

By removing the notorious 8am rush, AI-powered systems can enable more efficient call handling, prioritising urgent cases and directing patients to other appropriate services, such as pharmacy and community, without delay. This enhanced accessibility not only improves patient satisfaction but also fosters better health outcomes by ensuring timely care. Additionally, these streamlined processes reduce administrative burdens and repetitive tasks for staff, creating a more manageable workload and mitigating burnout. Together, these advancements pave the way for a more sustainable, patient-centred approach to primary care.

How do we get patients and clinicians onboard?

The challenge is how do we ensure that patients and clinicians are harmonised with the progress to build their trust?

To build trust among patients is not a simple process, particularly when considering digital poverty, which creates many disparities and makes it harder for people to access the very tools that are designed to help them. Patients value human interaction, especially when discussing health concerns, so AI tools must simplify communication and prioritise empathy in design. Data monitoring is key here, and should be used to help evidence that effective digital tools will also improve access for all, including those less digitally-abled who require human contact.

Patients should not feel intimidated by the use of AI, and it needs to be introduced in a straightforward way, focusing on the benefits in relatable terms. However, transparency of data usage is vital, otherwise we risk the further creation of a two-tier system for those that trust the data and those that do not, also increasing the burden for GP teams and undermining broader population health management strategies.

Patient empowerment means putting AI in their hands and allowing them to self-serve for non-urgent needs, allowing clinicians to focus on more complex patient needs and preventative care. If we can remove the demand before it flows into the practice then it eases the burden immediately.

For clinicians and practice staff, it needs to be clear that AI is an opportunity to reduce the pressure, not a threat to jobs. Clinicians are more likely to trust tools that they understand how to use, so time dedicated to training can demystify the AI’s capabilities and limitations. The tech may be transformative but it needs the support around it and training for staff to make best use of systems already in place, as well as to integrate additional tools such, as Surgery Assist.

Take for example Tudor Lodge, a practice in South-West London that is an early adopter of AI tools. The implemented Surgery Assist, a digital assistant, as part of a wider Access Optimisation Service and the practice has experienced 54 per cent fewer calls in the 8am rush as a direct result. Applied nationally, it is estimated that this service could result in 9.1 million fewer calls received per month by GP surgeries.

Will AI live up to the hype?

One of the questions asked to the discussion panel at X-on Health’s recent AI in primary care event was ‘will it live up to the hype?’ AI is by no means a magic bullet, and it could be said that it is currently not up to the hype, but applied correctly AI has the potential to move primary care forward beyond all expectations.

As referenced by an integrated care board member at the recent X-on AI in primary care event, AI is a tool, not a solution and must be viewed as such. To my mind it’s the correct approach and AI is just one of the tools available to reduce the burden. There is a crisis at the door of primary care and the technology is needed now to help practices survive. Technology cannot simply be layered over inefficient processes; instead, the two need to be addressed hand-in-hand to build trust and preserve the NHS as we enter the AI era.

What are the next steps?

While some GP partners have pushed on, giving lots of their time to self-appraising AI products in the pursuit of improved efficiencies to support their staff, there have been calls for the formation of an AI advisory board or list of approved AI suppliers to expedite procurement and adoption. To further build trust, the technology testing needs approval at a national level and the creation of a framework of consistency is something that is essential. The In the blink of an AI report supports the creation of a strong Digital Centre of Government in the Department for Science Innovation and Technology (DSIT) and recommends that it becomes a one-stop-shop for all public sector AI and automation needs, highlighting tools that are already working and have been successfully implemented.

One thing is clear – if the NHS doesn’t work out how to become agile enough to embrace the technology and build trust quickly then organisations like Google will do, as is clear from the Public First report, AI and the public sector, that was recently commissioned by Google Cloud.

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Landmark ruling sets critical precedent for adult social care funding and local authorities

By Integrated Care Journal

The landmark judgement on social care finance was handed down on 17th December in Julie Richardson Ltd & Banbury Heights Ltd v Oxfordshire County Council, increasing pressure on local councils to meet adult social care funding obligations.

In late December, Her Honour Judge Walden-Smith handed down a landmark ruling with potentially far-reaching implications for local authorities and their obligations to fund adult social care for eligible residents.

The case, Julie Richardson Limited & Banbury Heights Limited v Oxfordshire County Council, was brought by two family-owned care homes – The Julie Richardson and Banbury Heights Nursing Homes.

Represented by Paul Ridout, Healthcare Regulatory Partner at HCR Law, the claim was filed against Oxfordshire County Council (Oxfordshire CC) on 13 August 2021. The dispute centred on unpaid care costs exceeding £195,000 for two adult social care residents. Both individuals had been assessed by Oxfordshire CC as meeting the care eligibility criteria under the Care Act 2014 and were placed in the respective care homes.

While the care homes provided essential services, the financial resources of the residents fell below the statutory threshold, triggering an obligation for Oxfordshire CC to begin funding their care.

However, as essential care and accommodation continued to be delivered, the bills were being left unpaid. This placed the care homes in the difficult position of delivering unfunded care or discharging residents with nowhere else to go, an outcome no care home would ever willingly choose.

A spokesperson from the nursing homes said, “We are pleased that the court has, so far, ruled in our favour regarding the injustice we faced at the hands of Oxfordshire County Council. We refused to evict vulnerable elderly residents from our nursing homes simply because they had exhausted their funds. The council suggested we should have done so but failed to provide any indication of where these individuals could go to receive the care they needed. When faced with a crisis in the lives of these residents, the council shirked its legal obligation to fund their care, instead expecting a small, family-owned nursing home to bear the financial burden of hundreds of thousands of pounds for their upkeep and care.”

During the legal proceedings, Oxfordshire CC sought to strike out the claim. In response, the claimants filed an application to amend the particulars of their claim, alleging unjust enrichment on the part of the council.

On 17 December, the court ruled in favour of the care homes, granting permission to amend the claim and rejecting Oxfordshire CC’s application to strike it out. The judgment marks the first positive ruling under key provisions of the Care Act 2014 (Sections 8, 13, and 18) and underscores the statutory duty of local authorities to provide care funding for eligible individuals.

Paul Ridout commented: “This is a landmark ruling and the first positive judgment under the Care Act. It serves as a powerful reminder to local authorities across the country of their legal obligations.”

The court reaffirmed that once a resident’s care needs are established, local authorities must ensure those needs are met at a reasonable cost. This ruling sets a significant precedent, highlighting that councils cannot neglect their legal obligations. Paul Ridout added, “I am certain care homes nationwide will take note of this decision and review any outstanding payments owed by local authorities for the essential care they have provided.”

This ruling adds to the strong headwinds surrounding adult social care funding and the financial pressures on local authorities. Care England has recently reported a £2.2bn shortfall in residential care provision, while the 2024 State of Local Government Finance in England report revealed that 16 per cent of councils are planning to cut adult social care services. This judgement could lead to significant national policy implications for the government, who ultimately may need to support local authorities in meeting their obligations, reinforced by the ruling.

The nursing home spokesperson concluded, “This case involved two individuals whom the Council knew required a high level of care and for whom they were responsible under the Care Act. Instead of meeting these obligations and paying the fees for this care the Council decided to use their power within the market to force the costs onto a small care provider. I would be amazed if this was the only council doing this, and we were the only provider that had been forced to bear these costs.”

The judgment reinforces the rights of eligible individuals to access essential care, empowers adult social care providers across England to pursue outstanding payments from local authorities, and serves as a critical reminder to councils of their statutory responsibilities.

The case is now on course to proceed to a full trial in the High Court.

New research calls for action to address risk culture in healthcare management

By Integrated Care Journal

Global survey of healthcare risk and financial professionals highlights the need for integrated approaches to risk management to tackle emerging challenges.

The healthcare sector faces unprecedented risks, from skills shortages and cybersecurity threats to economic pressures and the unintended consequences of AI technologies. A new report by the Association of Chartered Certified Accountants (ACCA) underscores the growing recognition of the importance of a collaborative risk culture to navigate these complexities effectively.

The study of nearly 100 healthcare professionals from across the world identified the integration of clinical, operational, and financial management as a critical step towards achieving enterprise risk management. This alignment fosters better decision-making and enables healthcare organisations to deliver quality patient care – the common purpose shared across the sector.

The report, Risk cultures in Healthcare: The Role of Accountancy, outlines key enablers of a strong risk culture, including effective communication, cooperative education, and a transparent environment. It also emphasises cross-functional knowledge-sharing and ethical decision-making as essential practices for managing interconnected risks, from rising cybercrime and fraud to fast-changing workforce challenges.

Rachael Johnson, Head of Risk Management and Corporate Governance for ACCA, said: “By collaborating and learning from each other, different departments in healthcare can meet shared objectives – of quality care, financial sustainability, and regulatory compliance – more effectively. They also crucially become better prepared for emerging threats and trends.”

The study also reveals regional nuances in risk priorities:

Africa: Balancing the promise of telemedicine with infrastructure challenges and corruption risks.
Canada: Addressing cybersecurity concerns while adapting to regulatory changes.
UK: Striving for talent retention amid rising living costs and advancing technology adoption.
Caribbean: Managing climate-induced risks alongside workforce shortages.
Ireland: Integrating clinical and enterprise risk management to overcome fragmented systems.

The report highlights that while the specifics of risk differ by region, the universal need for collaboration and a shared understanding of risk remains critical.

Mark Millar, past ACCA President and Non-executive Director at East Suffolk & North East Essex NHS Foundation Trust, warned against viewing risk management solely as a financial function, saying: “Understand that risk in healthcare is far more than a financial issue. It is about life and death. Old cultural attitudes viewed people who raised the profile of risk as admitting to failure and they were therefore subject to criticism or censure. A more helpful culture is one that encourages the sharing of information willingly to address challenges and make improvements,” he said.

As healthcare becomes increasingly complex, the role of accountancy professionals is pivotal. From promoting cross-departmental communication to embedding risk cultures, they provide the financial insights and strategic frameworks necessary to achieve resilient and patient-centric systems.

This report is a call to action for the sector to break down silos and embrace a cohesive approach to risk management, aligning financial, clinical, and operational goals for the betterment of healthcare systems globally. Read it here.