What should integrated care partnerships be prioritising?

By Eliot Gillings

As the wheels of integrated care begin to turn, Eliot Gillings explores exactly what integrated care partnerships should be prioritising, and why.

An integrated care partnership (ICP) is ultimately responsible for the creation of an integration strategy that can inform the work of integrated care boards (ICBs) and partner organisations. Looking at short-, medium-, and long-term challenges to the delivery of health and care (which may impact certain regions disproportionately), the ICP has the opportunity to assess and address health inequalities through system-wide action.

Key to enacting system-wide action will be the development of collaborative networks between ICPs and partner organisations, including social care providers, charity and volunteer groups, primary care networks and others. Beyond enabling a more holistic and personalised provision of care, an institutional emphasis on collaboration will enable an ICP better understand the challenges faced by their systems and their populations.

In building that network, however, it will be key for ICPs to deliver short-term solutions to health inequalities within their systems, which will, in turn, necessitate the rapid establishment of institutional priorities. Accordingly, the following list highlights some key areas of consideration for ICPs as they continue to grow as statutory bodies.

1. Closing the gap on data inequality

One of the central purposes of ICSs is reducing health inequality through population health strategies. However, while ICSs and health organisations already engage and utilise several sources of information, the development of new information-sharing networks should be a key priority to expand the assessment of outcomes and improve the provision of care.

Accordingly, ICPs should seek to explore the variety of local partners and stakeholders engaged with communities whose health data does not currently feed into the system level. This is of particular consideration for systems where deprivation is unevenly distributed amongst certain demographics – but also those that experience high levels of digital exclusion.

2. Finding new solutions to inclusion health challenges

ICSs generally face challenges meeting the health and care needs of socially or economically excluded people. This is especially true of systems that already experience high rates of economic or social deprivation. Meeting the needs of people who are socially excluded and may experience multiple overlapping risk factors as a result, is particularly challenging from a population health perspective as they may be inconsistently accounted for in health databases.

To address these groups, ICSs must work to build information-sharing relationships with third-sector organisations and local groups who may offer services to socially excluded individuals and build relationships with the communities and individuals themselves. This work should also involve regular assessments of the impact of information sharing on health outcomes among these populations. Constant collaboration with partners and stakeholders to adjust the collection of information and the provision of care and outcomes should also be prioritised.

3. Developing novel approaches to information

Building out a network that includes partners and stakeholders engaged with underrepresented and/or excluded groups and individuals is one means to improve access to data. However, the utilisation of new forms and sources of data will also be a key consideration for ICPs. For instance, ICPs may consider exploring a ‘whole-family’ approach to care, where the knock-on impacts of health within family units are considered within a strategy.

Strategies for the use and integration of new information should also be developed in conjunction with partner organisations and designed to address the particular needs of a system. However, it is key that frameworks for information sharing remain consistent to improve collaboration between ICSs.

4. Utilising all levels of ICS functions

Often, individuals or organisations will be better served by engaging with an ICS at the neighbourhood or place level. This is particularly important when health inequalities are considered, as outcomes may drastically differ within a health system and a lack of engagement with health authorities may serve as a blocker to the delivery of improved outcomes to a vulnerable group. Accordingly, ICPs should ensure that well-developed strategies are in place to engage at these levels, and form insights that can inform work at the neighbourhood, place, and system level.

5. Provisioning for social care

The adult social care landscape contains a diverse range of providers. Many are small enterprises which may have competing priorities, but these organisations nonetheless have close ties to the communities and individuals they serve. They may also provide care to individuals whose needs are misunderstood or not met in traditional health care settings. As such, they are an incredibly valuable resource to ICPs, particularly those keenly engaged with finding solutions to the health inequalities faced by the socially excluded.

It will be crucial that ICPs do not come to speak for these providers, but rather serve to connect them to a broad network of information-sharing that can simultaneously improve their provision of care and deliver insights to improve health outcomes elsewhere. ICPs should, therefore, prioritise outreach to adult social care providers for the delivery of short-term solutions to health inequalities.

Paddington life sciences cluster to maximise benefits of industry partnerships

By Rusheen Bansal

Imperial College Healthcare NHS Trust recently set out its vision for a new life sciences cluster in Paddington, founded on its growing partnerships with research, industry and community organisations around St Mary’s Hospital.

The Trust unveiled its ‘Paddington Life Sciences’ vision on a new website, featuring three initiatives already underway:

A new digital collaboration space, opening in autumn 2022, located at Sheldon Square, next to St Mary’s and Paddington station. Housing the National Institute for Health and Care Research (NIHR), Imperial Biomedical Research Centre’s (BRC) expanding digital health programme team. It will provide space for lectures, training, events and meetings. It will also benefit from additional investment in Imperial College Healthcare’s trusted data environment which has already helped to produce new clinical insights.
The creation of a new centre for clinical infection, a specialist clinical and translational research facility to complement Imperial College London’s new Institute of Infection. Together they will be one of only a few facilities in the world to offer ‘end-to-end’ innovation, from initial discovery to improved patient outcomes, for the management of infectious diseases as well as antimicrobial resistance.
Paddington Life Sciences Partners will bring together NHS, academic, local authority and life sciences industry partners with a commitment to the area to help ensure the delivery of significant social, health and commercial value as quickly as possible.

For the longer term, the Trust is progressing a full redevelopment of the St Mary’s estate as part of the government’s new hospital programme. As well as delivering a new, state-of-the-art hospital, the redevelopment is intended to create an additional 1.5 million square feet of cross-functional commercial and lab space for life sciences businesses to develop and grow.

Imperial College Healthcare Chief Executive Professor Tim Orchard said: “Research and innovation are fundamental to the clinical excellence our hospitals are renowned for, from the Nobel Prize-winning discoveries of penicillin, the chemical structure of antibodies and the invention of the electrocardiogram, to pioneering robotic surgery, HIV care and the clinical use of virtual reality technology. Most recently, we have played a key role in developing an understanding of Covid-19 and trialling a range of new treatments.

“We are now entering a new era of discovery, at an even more ambitious scale, by maximising the potential of our existing work areas and joining them up with new opportunities. With Imperial College London, we run one of the largest NIHR biomedical research centres, undertaking hundreds of clinical trials and analysing data from well over a million patient contacts each year. Through the pandemic, many more patients and staff have been encouraged to get involved in research and we are confident this trend will grow as we continue to deepen our relationships with local communities and organisations. We are working together to improve not just healthcare, but also health and wellbeing, creating synergies that will boost education, skills development and employment opportunities in some of the most deprived areas of the UK.

“The regeneration of Paddington is also drawing more and more life sciences and technology businesses to the area, attracted by investment in transport infrastructure and excellent national and international travel connections. This also means strong links to other life sciences hubs, including Imperial College London’s growing campus at White City, adjacent to another of our own campuses, Hammersmith Hospital, and the knowledge quarter in King’s Cross and Euston.”

Dr Bob Klaber, Imperial College Healthcare Director of Strategy, Research and Innovation added: “British life sciences firms raised £4.5bn in 2021, up from just £261m in 2012. But London has not yet reached its full potential to attract investment and innovation in the life sciences sector – MedCity’s 2021 London Life Sciences Real Estate Demand Report identiﬁed an estimated 500,000 square feet shortfall in innovation and lab space. Imperial College Healthcare is ideally placed to help fill that gap.”

There will be a formal launch of Paddington Life Sciences, and the new digital collaboration space, later this autumn.

A person-centred, digital first approach to recovery

By Patricia Wynn

Ensuring that patient pathways are digitally enabled and person-centred is critical to tackling the elective backlog, writes Patricia Wynn, Director and Sales Leader, International Public Sector Health, Cerner Corporation

NHSE guidance states that “our ambition is to improve core digital and data services in hospitals to ensure we have the basics right.” A leading EPR provider in the UK and globally, Cerner supports systems to reach the minimum digital foundation and strive for HIMSS Stage 7 and beyond.

Cerner work across provider collaboratives to enable shared instances of the EPR. ICS-level collaboration reduces total cost of ownership and enables sharing of resources, such as PMO, training, back office and support. For example, a shared instance of Cerner accelerated provider collaboration across North West London ICS.

Imperial and ChelWest began sharing a domain in 2019 and now London North West and Hillingdon are set to join. According to Kevin Jarrold, ICS data and digital lead, “we have a growing agenda around collaboration across care pathways and the shared domain is absolutely fundamental.”

A shared domain has enabled NWL to gain efficiencies and generate much-needed capacity. Leaders can see across the system and transfer patients more effectively from one site to another. Virtual ward capacity is also managed centrally and embedded into the core EPR. Remote patient monitoring is leveraged from a variety of vendors, with all data feeding centrally into virtual wards created within the core EPR, enabling more efficient workflows and the sharing of virtual care staff.

Prioritising care

The national guidance outlines care must be prioritised based on clinical urgency, the impact of waiting on individuals and potential inequalities. To achieve this, North Central London (NCL) ICS uses Cerner HealtheIntent^®, a data and analytics platform that provides a single longitudinal record for every citizen, comprising data from all health and care organisations across the ICS.

According to Amy Bowen, director of system improvement, “[We built] an elective waiting list dashboard in HealtheIntent. Now we can show GPs for the first time ever what their waiting list looks like. We can cut that data by all the demographic factors, e.g. how many people have long-term conditions and how many? We can look and see by ethnicity, by deprivation – we can combine several factors. And we can actually understand that population at a practice level, at primary care network (PCN) level; by specialty, by borough.”

Transforming care

NHS guidance outlines transformation should focus on flexibility, ease of access and citizen control. Re-envisioning patient pathways – and ensuring they are digitally enabled and person-centred – will be critical. Royal Free London (RFL) has standardised and digitised 40 pathways.

Cerner experts are involved from the beginning of pathway design. Dr John Connolly, CEO of the Royal Free Hospital and group director of clinical pathways shares, “The goal of this ambitious programme is to ensure every patient can get the same high-quality treatment in any of the Trust’s three hospitals… and to create value for the entire healthcare system in the locality – not just our hospitals, but also primary care and public health services in an area that has high levels of deprivation.”

Supporting patients

Ultimately, a person-centred, digital first approach must include the person at the centre. Cerner Patient Portal UK, delivered in collaboration with Induction Healthcare, enables interaction and engagement between caregivers and their populations. A prostate cancer survivor in the Wirral explained, “I cannot emphasise how much the patient portal has improved the quality of my life. Those two weeks of waiting – the stress of revisiting the room where I was given my diagnosis – all that is gone now.”

NHSE’s operating priorities will not be achieved by overworking caregivers and staff, but by enabling them to work smarter and more collaboratively. Contact Cerner Corporation if you share a belief in the power of technology-enabled transformation and want to discuss how Cerner can support your system as in tackling the unprecedented backlog of demand.

Why is technology underrepresented in the training of health, housing and care professionals?

By Tunstall Healthcare

Andy Hart, Head of Delivery and Technical Support at Tunstall Healthcare, discusses why educating health, housing and social care professionals is vital to meet the needs of our growing and ageing population.

People today are living much longer. It’s recently been reported that the UK’s population hit a record with over-65s overtaking under-15s, and by 2030 it is estimated that 1 in 6 people globally will be aged 60 years or over.

But living longer does not necessarily mean living more healthily. Long-term health conditions are more prevalent in older people, with approximately 15 million people in the UK requiring health and social care services for chronic illnesses.

Andy Hart, Head of Delivery and Technical Support at Tunstall Healthcare, discusses why educating health, housing and social care professionals in the benefits and appropriate use of technology is crucial if we are to improve service provision, and why technology continues to be underrepresented in training.

Why technology is underrepresented

The urgent need to invest in preventative services and early interventions to reduce pressures on our services is being increasingly recognised. In fact, almost two thirds (63 per cent) of directors of adult social care recently indicated that their local authorities were taking positive investment strategies in digital and technology.

However, large-scale change involving health and care technology is complex and presents many challenges for the stakeholders involved. Key barriers to successful digital evolution include the budget constraints and the cost of implementing new systems, organisational attitudes towards risk, and the relationships that exist between health, housing and social care services.

Most of these barriers can be mitigated through greater training and the education of professionals. Greater education will help to build partnerships, maximise the use of data, drive cultural change and bring staff on the digital journey, whilst supporting them in their roles.

Investing in education

People are the greatest asset of any organisation and, like any other asset, they need investment and maintenance. The next generation of health, housing and care leaders require support if they are to continue to develop themselves, and therefore their teams and services.

The education of professionals within these sectors is crucial in enabling a cultural shift so that staff understand the value and use of technology, and how it can support them in effective caregiving, as well as improving the quality of life of the people being cared for.

With the right education staff should reap a number of benefits, including becoming more aware of the features of telecare devices, developing confidence in assessing and referring end users to the right solutions, and understanding the positive impact of telecare on working practices.

As the Occupational Therapy programme lead at the University of Lincoln, Carol Duff is significantly involved in the education of Occupational Therapists. She commented: “It’s very important that we give our students the opportunity to gain practical confidence in the use of digital solutions in a safe setting that are essential to support their practice in health and social care.

“Technological solutions may mean our patients are able to remain safely at home for longer and avoid or delay moving into hospital or into care. It is essential that our occupational therapists of the future can confidently and creatively explore digital solutions that may also reduce pressure on the system and release time to care.”

A digital future

With the impending changes to our telecoms network, digital is fast becoming the industry standard to ensure the safety of health and social care services, staff and end users.

New kinds of leadership will be needed to deliver change and evolve governance, while at the same time improving the working lives and motivation of employees. Cementing a cultural shift towards technology driven, outcomes-led approaches is required to achieve this, and in turn, this needs early engagement from professionals and an understanding that technology is designed to provide support, rather than to replace.

By harnessing the benefits of training and education, we can raise awareness of the value and potential of technology across the healthcare landscape, and provide enhanced support to users, carers, professionals and providers.

For more information on educating the future generation of health, housing and social care professionals, please visit www.tunstall.co.uk/training-services.

Digital revolution – the benefits of paperless

By Marvin Douglas

The digital revolution is well underway, and the innovative new technologies utilised by start-ups have completely transformed business operations. However, there is still a significant number of SMEs and larger corporations that are completely reliant on paper. 41 per cent of businesses agree that moving to digital would cut operational costs significantly. However, the heavy initial investment and potential skills gap is presenting a tough hurdle for many organisations.

According to a study by Xerox, 55 per cent of businesses across western Europe and North America are still completely reliant on paper. A similar study found that 70 per cent of these businesses admit that they would fail within just three weeks should key documents go missing. With all this in mind, we look at the key benefits of going digital.

Why risk it?

Words like ‘audit’, ‘security breach’ and ‘compromised data’ are enough to raise the hairs on any businesses neck. Physical documents pose a multitude of problems when it comes to security, there is a huge reduction in the level of control the business has over them. Paper documents can be scanned, shared, and viewed indefinitely by anyone at all.

Research by AIIM reported that up to 50 per cent of businesses surveyed were unsure whether they had ever suffered a security breach due to a complete lack of visibility. Moreover, 31 per cent stated they had encountered poor record keeping to the extent that it would negatively impact regulation checks and audits.

Smarter, faster, stronger

Productivity is a key priority on any business’s agenda, to get the most from their employees a business should endeavour to establish streamlined processes, efficient operations and transparency. Utilising digital document management reduces the amount of time spent looking for required information dramatically.

Digitally stored data is easier to find, and the quality of data collected is improved; through digital templates and pre-agreed parameters companies can maintain consistent data standards universally. Lengthy approval processes and over complicated workflows are also a thing of the past, digital signatures make authorisation and communication much more efficient. The ability to access documents anywhere at any time through a centralised digital solution will reduce the risk of missed deadlines when employees need to work remotely.

Going digital provides a centralised view of all documents. Access can be controlled, allowing only the necessary and authorised employees to view confidential data. Clear trails can be established to monitor the progression and movement of key information and backups are easily created to avoid the heart-stopping loss of key business information.

Cutting the cost

The reason behind most business activity is to protect and improve profitability; going digital also has a compelling impact on a company’s operational costs. US research from The EPA found that companies choosing to go digital could save as much as $80 per employee in printing resources and the efficiencies that come with streamlining manual processes. For a business of 400 employees this is a sizeable saving of $32,000 per year.

Small businesses can benefit too. For smaller, less established businesses the transition to digital is likely to be much easier as there is less physical documentation to convert. This could mean the ROI is visible much sooner. Digitalisation will make the business considerably more agile and responsive, where competition is fierce the need to respond quickly and accurately to customer enquiries, competitor activity and market demand is essential – this is made much easier with visibility and strict organisation.

Going green – not to be barked at

Although this could quite easily be tied into an organisation’s profitability, reducing carbon footprint often comes with more benefits than just lower operational costs. Corporate social responsibility is a hot topic globally and is only set to get hotter. Recent data in the US showed that the average employee uses a staggering 10,000 sheets of paper a year, the equivalent of a 100ft fir tree.

In many cases, a company’s activity surrounding CSR has become an integral part of a prospects decision-making process. For those in B2B, many businesses with strong CSR values will actively seek out equally responsible organisations to purchase from.

Digital revolution requires effective physical device management solutions

As part of the digital revolution, businesses will be investing heavily in the devices that enable the process. The increasing number of physical devices in the workplace such as laptops, Chromebooks, tablets, smartphones, and other media devices means it has become necessary to implement effective physical device management solutions, protecting the longevity of the initial investment.

To find out why LapCabby provides the perfect storage, charging and syncing solutions for your new tech please visit our website: www.lapcabby.com.

The Health and Social Care Committee’s report on the care workforce; what is missing?

By Mary Brown

On 25th July, the Health and Social Care Committee (HSCC) published their report, Workforce: recruitment, training and retention in health and social care.

The report calls for the government to provide its workforce plan for the NHS and social care (promised in spring 2022 but still not yet published), and provides several practical recommendations for the plan. Refreshingly, large sections of the report focus specifically on the social care workforce; a workforce often ignored in conversations around health and care.

The report appropriately recognises the gravity of the situation facing the social care sector, stating that, in comparison to the NHS, “the situation is regrettably worse in social care”, referencing incredibly high staff vacancy and turnover rates and poor working conditions.

Key recommendations in the HSSC report regarding the social care workforce include:

Higher baseline pay for care workers, reflecting the true value to society of the services they provide
Sustainable strategies in terms of pay progression, professional development, and career pathways
Contract choices offered to care workers on zero-hours contracts
A call for the government to produce an externally validated care certificate, provided at no cost to care providers, and is transferable between care providers and the NHS

While the report makes some promising recommendations, it falls short in several areas. On 26th July, Public Policy Projects (PPP) launched its report, The Social Care Workforce: averting a crisis.

This report was based on two roundtables with PPP’s Social Care Policy Network, held in May 2022, made up of key stakeholders in the adult social care sector and a lived experience panel (comprising five individuals with first-hand experience of the social care system). While many of the conclusions and recommendations of the HSCC’s report have parallels in PPP’s report, PPP highlights further areas that the workforce plan should address.

A fairer deal for the social care workforce

The reports from HSCC and PPP are broadly aligned regarding their sentiments and recommendations around pay for care workers. It is evident that care workers must be paid more, and equivalent to, their NHS counterparts.

Both reports therefore include recommendations advocating increases to the baseline pay for care workers, to reflect the true value that care workers bring to society and reduce the number of care workers leaving for better paid jobs in retail, hospitality, or elsewhere. Both reports also agree that there must be pay progression in the care sector in line with that of the NHS Agenda for Change pay scale, providing opportunities for care workers to be paid fairly and to advance their careers.

The two reports agree that terms and conditions, as well as pay, must be improved for social care workers. They acknowledge that zero-hours contracts can provide instability for many adult social care workers, and that care workers do not tend to enjoy the same pension options, sick pay or overtime renumeration as equivalent NHS workers, nor do they receive the public admiration or ‘sweeteners’ (including NHS staff discounts offered by many businesses).

It is no secret that the social care sector is severely underfunded. In order to appropriately pay care workers, both reports agree that local authorities must be appropriately funded to provide the fair cost of care to providers, to ensure that self-funders are not subsidising the cost of workers’ wages. This will require substantial investment from government.

However, PPP’s report provides several additional recommendations for the elevation of the social care workforce. Crucially, PPP’s report focuses on the need for an elevation in the status of care work, to raise the profile of those working in care. The report notes the boost in public sentiment towards nursing that followed Florence Nightingale’s work during the Crimean war, and stresses the need for a similar shift to take place for care work. Not only would this ‘Nightingale shift’ boost staff morale, PPP’s report argues that it would help to address recruitment and retention issues, provided it is accompanied by improvements to pay and conditions.

To kickstart this ‘Nightingale shift’, PPP’s report recommends that the government should provide investment for positive advertising campaigns for social care careers, with clear messaging of the immense value of a career in care and its potential to transform lives. In conjunction with this, it recommends that care providers should be working with careers advisors in schools to promote care work to young people as an attractive and fulfilling career.

Another recommendation in PPP’s report, which was not addressed by the HSCC report, is the potential creation of cross-sector roles between health and care, as well as placements and secondments of NHS staff into social care. This would help raise the status of social care by actualising a parity of esteem between the NHS and social care workforces. It would also serve to increase the awareness and visibility of the social care system within the NHS, and aide in the integration of the workforces.

More training is not a panacea

Training was highlighted as a key area in the HSCC report. However, PPP’s Social Care Policy Network argues in the report that extra workforce training should not be conflated with the wider issues around attracting and retaining staff. PPP’s Lived Experience Panel were at pains to express that constant training and annual training renewal is often a poor use of time and resources and cannot be a substitute for meaningful sector reform.

Where PPP’s report addresses training is in their recommendation around the proposed Social Care Leaders Scheme, dubbed the ‘Teach First’ of social care. The care sector is in need of strong leadership, as registered managers are not always sufficiently prepared or trained for a job that carries substantial responsibility.

The Social Care Leaders Scheme, proposed by a steering group of leaders from the social care sector convened by the CareTech foundation, aims to attract high calibre talent to the sector by training bright university graduates for leadership roles in social care, emulating the successful Teach First model. The report calls for the government to reconsider its position on the partial funding of the scheme, which promises to elevate the sector, provide attractive careers, and improve leadership structures.

The HSCC report also focuses on mandatory Care Certificates, which should be offered, at no cost, to care providers, and are transferrable between care providers and the NHS. This is undoubtedly a sensible recommendation, and PPP’s report further recommends the establishment of a Royal College of Care Professionals. The institution of a Royal College would serve the dual purpose of professionalising the workforce and secure an elevation in its status, as well as providing a central body which can represent, support, and oversee the development of, the care workforce.

Finally, the report by the HSCC makes no mention of a vital section of the care workforce: volunteers. PPP finds that volunteers can greatly alleviate the burden on social care professionals and improve the experience of recipients of care. It is essential that volunteers are included in the workforce equation.

PPP recommends that the volunteer sector should be integrated into the workforce strategy and planning for social care, given the substantial value it provides. Further, it warns that the government must act soon to seize upon the enthusiasm for volunteering that built up during the COVID-19 pandemic.

For a truly comprehensive workforce plan which will truly elevate social care and reduce the immense pressure on the sector, these recommendations must, too, be incorporated. For more information on the report, please contact PPP’s Social Care Policy Analyst, Mary Brown, at mary.brown@publicpolicyprojects.com

If integrated care is to be delivered locally, then it must be discussed locally

By Eliot Gillings

Public Policy Project’s ICS Roadshow offers the only opportunity for the wider health and care community to identify challenges and opportunities of integrated care at a truly local level.

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Now that integrated care systems (ICSs) are officially here, it’s time to maximise their value by tapping into their strengths. That is, delivering localised, personalised high-quality care for local citizens and reducing health inequality.

For these systems to bear fruit and make meaningful impacts on the nation’s increasingly complex health challenges, then discourse surrounding integrated care must become more granular. If this is indeed to be ‘national policy delivered locally’, then visiting specific regions and assessing their progress and challenges at a local level will surely be the most effective means to scale success.

Building to a localised approach

The arrival of integrated care systems (ICS) as statutory bodies earlier this month marked the beginning of the UK’s journey towards reframing health and care. Bringing together the NHS, local authorities and the third sector to allocate resources and deliver care to patients, the strength of the ICS is its ability to adapt to a region’s needs.

Central to both the NHS Long Term Plan and Health and Care Act, the 42 ICSs that span across England are all comprised of integrated care boards (ICBs) and integrated care partnerships (ICPs). While the ICB’s essential function is to deliver NHS services in the ICS area, an ICP works to develop and deliver the ICS strategy with a broad range of local stakeholders.

The ICS itself works over three levels – the first being the system level, across which the ICP and ICB work, and where the broad strategy for an ICS area is planned and delivered. The second level is the ‘place’ level, at which localised services and community care are planned in close conjunction with local Health and Wellbeing Boards. The third is neighbourhoods, or localities, which focus on specific areas within places – such neighbourhood organisations include primary care networks. This allows ICSs to respond to needs of specific communities or demographics that may find themselves underrepresented even at the ‘place’ level.

The delivery of health and care within an ICS, as such, will require the ICP to work across all three levels of the ICS area to accurately assess need and develop individualised plans of action. The ICB, too, will need to work closely with stakeholders at every level to ensure their provision of care is maximally responsive. Accordingly, even though the ICS model allows for a more personalised delivery of care than its predecessors, there is a pressing need for stakeholders at every level to establish collaborative working relationships – both within and without their own ICS area.

The PPP ICS Roadshow will take place across five cities across the UK, and will serve as an opportunity for members and stakeholders in local ICSs to discuss their roles in delivering fairer, more adaptive and responsive health and care systems.

The ICS Roadshow will be a valuable opportunity for the members and stakeholders of nearby ICSs to connect, share expertise and best practice, and collaborate with organisations from further afield. It will also, however, serve to showcase the diversity of health and care challenges across the UK – and the need for ICSs to equip themselves to deal with these challenges accordingly.

Below is a brief profile of each of the stops on the ICS Roadshow, outlining the diversity of health and care challenges different ICSs must approach and showcasing their potential to respond to acute needs within their areas.

Birmingham

40 per cent of Birmingham and 12 per cent of Solihull residents live in the most deprived communities in Britain.

Birmingham is demographically one of the most diverse regions in the UK. It is also one of the most socially and economically deprived. This poses a unique set of health and care challenges, particularly as communities may find themselves isolated or underrepresented for myriad social, cultural and economic factors.

Birmingham will be the first stop of the ICS Roadshow and will host systems leaders from the Birmingham and Solihull ICS and Black Country and West Birmingham ICS. The session will not only be an opportunity to discuss how people can be empowered by integrated care, but how these systems can best modify and develop themselves to respond to the needs of their evolving demographics.

Bristol

Bristol reports a higher rate of common mental health conditions than the rest of England, at20.7 per cent, versus 15.5 per cent across the rest of England.

Bristol boasts a high healthy life expectancy, low levels of cancer, and an infant mortality rate that is one of the lowest in the country. However, Bristol still faces unique challenges from an ICS perspective. With the second highest suicide rate in the country, the Healthier Together Partnership (an ICS which accounts for Bristol, North Somerset and South Gloucestershire) has made developing mental health services of all varieties a key priority.

Bristol also has the second highest rate of diabetes in the country, and an ageing population. As such, preventative, early intervention and holistic care system are a particular priority in the region, and are likely to be especially well served by work at the neighbourhood level which focuses on outreach to the elderly.

The Healthier Together Partnership also presides over an area with an acute shortage in its care capacity, having the lowest number of G&A and CC beds per capita in the country. Utilising the ICS effectively to relieve pressures on staff and deliver care more effectively and efficiently will, as such, be crucial to the ICS. Accordingly, this session will be of keen interest to ICS stakeholders seeking to find solutions to capacity problems.

Manchester

As one of the early adopters of the ICS model, and operating under a devolution settlement, the Greater Manchester Health and Social Care Partnership already has more than 5 years’ experience serving 2.8 million people living across ten boroughs.

As one of the first ICS systems in the country, the Greater Manchester Health and Social Care Partnership already boasts a robust governance structure that serves as an example of the potential of the ICS framework.

More than two thirds of early deaths in the Greater Manchester region are the result of preventable causes, such as smoking, alcohol dependency, poor diet or air pollution. As a result, the Greater Manchester Health and Social Care Partnership has embarked on a series of targeted campaigns designed to promote healthier lifestyle choices, improve access to support, and directly engage with the communities most affected.

The delivery of these programmes has relied on Greater Manchester’s strong system of governance, which has established protocols for governance and accountability that deliver the consistency of delivery that other ICSs will strive towards in the coming years. This session will be a valuable opportunity to see how the ICS model can be leveraged to address community-specific issues, and how the frameworks to deliver that support should look.

Leeds

There has unfortunately been a rise in the infant mortality rate in Leeds since 2013/15, and a persistent gap in outcomes between more deprived areas of Leeds and Leeds overall.

The West Yorkshire ICS, who PPP will host at the fourth instalment of the ICS Roadshow, is a prime example of the importance of ICPs within an ICS. There are significant inequalities between the more deprived areas of Leeds and Leeds overall – the third highest in the country – and there is a significant geographical element to this inequality. As such, the role of ‘place’ level leaders will be instrumental to closing the gap and delivering better health and care outcomes within the ICS.

The West Yorkshire ICS is currently prioritising the delivery of improvements to infant mortality and reducing mortality amongst those living with learning disabilities and autism. This instalment of the roadshow will accordingly develop insight into how ICSs can rise to the challenge of delivering highly personalised care based on a social model for health.

London

In 2019-20, those in the 90th net income percentile in London took home 10.8 times more than those in the 10th net income percentile.

The final date of the ICS Roadshow will see PPP play host to the 5 ICSs that serve London. While London faces several unique health and care challenges due to its size and diversity, lessons from the development of London’s ICSs will be valuable to system leaders across the country.

London’s extreme wealth inequality, and the geographical proximity of some of its most affluent and most deprived areas mean that its ICS systems will arguably have the largest gaps in care to close – and how they adapt their governance and outreach across the three ICS levels will be key. Each of its ICS systems are actively working to develop systems of care that reach diverse and often fragmented local communities, and the final instalment of the roadshow will be an opportunity to share their best practice.

The ICS Roadshow kicks off on September 13th and runs through to November 1st 2022. To find out how to get invovled, please visit our ICS Roadshow homepage.

News, Workforce July 29, 2022

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

By Integrated Care Journal

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

At the core of the issue is staffing.

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

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

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

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

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

A new approach to recruitment

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

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

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

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

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

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

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

An evolving workforce

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

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

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

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

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

Bringing down waiting times

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

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

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

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

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

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

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

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

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

Rethinking career progression

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

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

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

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

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

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

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

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

All news

Improving service delivery with benchmarked data

By Capita Healthcare Decisions

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

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

Benchmarking data provided the foundation for improving care and outcomes

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

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

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

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

Using data to reflect on performance and improve service delivery

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

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

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

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

Suzanne Barr, Senior Systems Assurance and Improvement Manager

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

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

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

Suzanne Barr, Senior Systems Assurance and Improvement Manager

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

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

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

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

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

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

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

By Capita Healthcare Decisions

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

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

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

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

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

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

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

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

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

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

Caroline Loxton, Practice Development Lead at Willen Hospice

Improving education and communication to ensure accessibility for all

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

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

Caroline Loxton, Practice Development Lead at Willen Hospice

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

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

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

Caroline Loxton, Practice Development Lead at Willen Hospice

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

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

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

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

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

Caroline Loxton, Practice Development Lead at Willen Hospice

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