The role of operational platforms in creating system-wide awareness

By Carl Davies

Carl Davies, Solutions Director (Europe), TeleTracking, explains the role that operational platforms must play in the new NHS: enabling more capacity and more effective management of that capacity by providing the foundation for better visibility, coordination, and control across care settings.

NHS pressures and safety risks

There are two types of risk associated with healthcare, clinical risks (associated with direct patient care) and operational risks (risks to the organisation), which both increase the likelihood of adverse events.¹ Interestingly, decreasing operational performance, particularly in the Emergency Departments increases the likelihood of both the operational and clinical risks and has been shown to result in significant increases in excess, and therefore preventable, deaths.²

In the NHS Winter Plan, Amanda Pritchard asked all systems to operationalise 24/7 command centres, to ensure the safety and resilience of the operational function across their local health and social care geographies. Operational systems can be the supportive technologies that provide the missing piece of the puzzle alongside the clinically focused Electronic Patient Records.

The changes being asked for in the Winter Plan require both new structures and processes and, most importantly, ‘people’ to work in different ways. However, these people need to be supported and given the time to engage. Now, more than ever, we need technologies that not only improve the healthcare system, but that help create the type of change that makes the lives of our workforce easier and simultaneously more effective at delivering the outcomes expected from them by NHSEI and the DoH.

ICSs, EPRs and operational platforms

With integrated care systems (ICSs) taking centre stage as the core delivery mechanism for the radical changes to health and care services that are needed, the spotlight is on the processes and systems that will help them achieve this joined-up, patient-centric care – particularly the adoption of electronic patient records (EPRs) or electronic medical records (EMRs).

As a technology for – mostly clinical – data capture, which can support decision-making across the system in relation to an individual patient, EPRs are undoubtedly an essential component of the digital transformation journey that the NHS is on. However, there is a vital function that runs alongside them, that has an arguably greater impact on performance and outcomes: the ability to capture and view in real-time the range of operational processes and where pressures are building or being exerted on the system; to recognise how they can be improved or changed, and support decision-making with regards to relieving those pressures.

Consider the information that is required to ensure effective management of beds across both the Acute Trusts and the wider system, and the coordination of the many workflows that must seamlessly work in unison, but are often linear due to outdated mechanisms for capturing and communicating data. This is where operational platforms can help increase the visibility of that information (providing one single truth), the speed of its transmission and enable flows to run concurrently rather than step-wise – and further support by building in controls, automation and tools for coordination of workflows.

These systems ideally run alongside an EPR as a specialist, operationally-focused suite of technologies that can provide all the necessary tools for releasing time back into the organisation. That is, additional time for people: time for healthcare professionals to spend with patients; time for staff to support the management of their own wellbeing; time for management to create changes in structure to support new ways of working; time to support the delivery of the performance improvement targets as described in the planning guidance; and time for patients to be moved through the hospital as needed, in accordance with their personal needs, providing assurances to the Executive that the system remains safe.

Reform

Effective outcomes are the emergent product of excellent technology combining with excellent people. Maidstone and Tunbridge Wells NHS Foundation Trust (MTW) is one example of an Acute Trust that has deployed an operational platform alongside its EPR to support and enable excellence in its internal management practices.

Great leadership combined with this operational system focuses on how all of the operational components of the Trust work together, supporting the coordination of complex information flows to drive more effective organisational decision-making. It gives full visibility of Trust-level bed capacity and imminent discharges, a system-level control centre dashboard and most recently, with an extension into Kent Community Health NHS Foundation Trust’s community hospitals and virtual wards for management at home, provides everything that is needed for visualising, managing and improving bed capacity and resilience across the integrated care setting.

The result? Organisational change, improved patient flow management and more effective matrix working. They have zero 52-week waits and the best urgent care performance in the region, all achieved alongside clearly identifiable financial savings. Despite increasing pressure at the front door, with extremely high attendances and admissions, it also has one of its lowest occupancy rates in years leading to being the 2nd highest performing Accident & Emergency Departments in the country, and overall 6th best Trust in the country.

Unlocking capacity

Operational platforms are key to identifying known bottlenecks in the system, mainly due to linear, archaic practices and unnecessary administrative activity, providing visibility and improvement of them in real-time. They are instrumental in improving coordination and control across the system and seek to support clinicians and managers by relieving them of unnecessary and duplicative administrative work. They are therefore fundamental to giving clinical staff time back to care; to unlock and allow more effective management of the capacity that is going to be key to, ultimately, improving outcomes and saving lives.

This article was kindly sponsored by TeleTracking.

¹ Cornalba, C (2009) Clinical and Operational Risk: A Bayesian Approach. Methodology and Computing in Applied Probability volume 11, pg 47-63

² Jones et al (2022) Association between delays to patient admission from the emergency department and all-cause 30- day mortality. Emerg Med J 2022;0:1–6

**Carl Davies, Solutions Director (Europe), TeleTracking**

Local authorities call for ICBs to increase council representation and outline success measures

By David Duffy

Councils are working starting to work closer with health partners within integrated care systems (ICSs) but require more representation at system level to drive improvements, this is according to the County Council Network (CCN).

The report, The Evolving Role of County Authorities in ICSs, analyses the progress of ICSs from the perspective of councils. The study, which was commissioned by the CCN and conducted by IMPOWER, is based on a detailed survey and interviews with local authorities in county areas and senior health officials.

County leaders say councils and health partners are forging closer relationships in many ICSs across England, and evidence in the study shows that council leaders are investing significant amounts of time with health colleagues within these arrangements. However, the CCN say there are significant challenges to overcome before councils can consider ICSs a true “partnership” endeavour.

Local authorities feel there is a lack of processes in place to measure the impact of ICSs. In the report’s survey, less than one in five (18 per cent) of councils were confident that their ICS had a clear process for monitoring success against its primary objectives and national data on “integrated” issues was found to be very limited.

The report has also found that across England, just nine of 777 Integrated Care Board (ICB) members are elected councillors. It highlights that both councils and the NHS recognise that local politicians will need to be key allies if ICSs are to deliver transformative change, but that their role in systems is still unclear.

CCN’s report also suggests that council leaders feel that ICS are held back by a continued focus on mandated, top-down targets from the NHS and central government. It argues that this centralised control may hinder the success of local solutions rooted in long-term preventative measures developed within communities.

The report recommends that the government and NHS review the level of centrally imposed targets on ICSs, particularly in shared policy areas with local government, which could help induce a culture shift that gives greater prominence to prevention. ICSs themselves should ensure that funding and decision-making are devolved to the most appropriate level in order to best facilitate local joint-working.

It also calls on council and local NHS leaders to agree on a small number of specific and achievable inclusive ambitions this winter, to build partner confidence in ICSs’ ability to deliver real change.

CCN’s report comes ahead of Patricia Hewitt’s upcoming independent review of ICB oversight, which will be the first major stocktake on the role of councils in ICSs since their introduction in July of this year.

Other key findings of the report:

80 per cent of councils say they have increased their time working with health partners since the inception of ICSs, but that this is in part due to too much of focus being given to immediate NHS pressures.
Local authorities are ‘very cautious’ about pooling further resources with the NHS at a time when finances are stretched, particularly as the NHS is felt to have less focus on living within budgets than councils. Nationally, county authorities have pooled £13.43 per-head from their budgets into the Better Care Fund (BCF) this year; down from £15.56 per capita in 2017-18.
Councils recognise the need for decision-makers in ICBs to tackle immediate issues in the NHS and acknowledge they are also facing real pressures on their own services. However, there is concern that in the medium-term, it will be difficult to shift focus onto overarching, long-term system issues such as investing in preventative measures and out-of-hospital care, as envisioned in the NHS Long Term Plan.

Cllr Tim Oliver, Chairman of the County Councils Network, said: “Councils support the introduction of ICS and their aim to closer integrate health and care services and ultimately drive down costs for both the NHS and local government through preventative measures. Since their inception, evidence shows that councils have been enthusiastic about these arrangements and are spending more time with health colleagues.

“But today’s report acts as a useful barometer to find out what is happening on the ground in ICSs across England. Partly as a result of the funding challenges facing the NHS, and top-down central targets, there is a feeling from councils that there is too much focus on immediate and acute NHS pressures, such as hospital discharge and ambulance waiting times, rather than the preventative agenda.”

Sean Hanson, Chief Executive of IMPOWER said: “This report is the first to consider ICSs from the perspective of councils whose role is central to the integration agenda. It will be essential reading ahead of the Government’s upcoming review of Integrated Care Boards.

“These systems are complex and their implementation varies widely across councils but our report is clear that the desire exists across local authorities and the NHS to reduce health inequalities, boost preventative services and improve outcomes for citizens. However, there is concern that a lack of local autonomy and squeezed budgets will make it difficult to convert that desire into action.”

Governments urged to invest in healthcare systems despite global economic uncertainty

By Integrated Care Journal

There is an urgent need to invest in healthcare systems to build resilience against future crises and the growing burden of disease, according to new research presented at a Global Summit on 22nd November.

The research, commissioned by the Partnership for Health System Sustainability and Resilience (PHSSR), highlights the need for Governments around the world to address weaknesses in healthcare services which leave countries exposed to crises and increase the economic, social and environmental impact of disease.

The PHSSR, of which the London School of Economics and Political Science (LSE) is a founding member, is a collaboration between businesses, academic, non-governmental, life sciences and healthcare organisations. The Partnership aims to study and help build health systems that are resilient to crises and sustainable in the face of long-term stresses.

Commenting on the crisis facing healthcare systems globally, Dr. Shyam Bishen, Head of Health & Healthcare at the World Economic Forum, said: “Healthcare systems around the world are grappling with the same problems, delivering services amid resource constraints and increased demand. Amid aging and growing populations, rises in non-communicable diseases and the impacts of climate change, there is one thing that remains certain – the need to continue investing in our health systems.”

The research examined domestic healthcare systems in 13 countries* using a framework designed by LSE academics. The findings highlight the following weaknesses:

Healthcare systems are underfinanced and the financing mechanisms in place are often ineffective and do not incentivise better health outcomes.
Health services are grappling with staffing shortages and wellbeing issues. In addition, healthcare workforces are inequitably distributed, impacting their capacity to meet needs. In particular this affects people in rural areas, underprivileged and marginalised groups, and those with chronic conditions.
In many of the countries studied, providing coordinated and proactive care remains a challenge. Investments in primary care, prevention and health promotion also tend to be low.
Inequities are pervasive in healthcare and have deepened during COVID-19. Equally the social determinants of health remain under-emphasised in national policies.
Despite the fact human and climate health are inextricably linked, many healthcare systems are struggling to understand, monitor and take action to reduce their environmental impact, and adequately protect their populations from the health impacts of climate change.
Among the countries researched, there is a wide variation in the availability, completeness, and use of health data to drive evidence-informed decision making, policy evaluation and learning. Interoperability of disparate electronic health records systems is also a key challenge in many countries.

Commenting on the findings, Baroness Minouche Shafik, Director of the London School of Economics and Political Science said: “Health systems are there to protect us. They are one of the foundations of a healthy society and a prosperous economy. When a crisis hits, we need them to stand firm. We cannot repeat the same mistakes from the post-2008 financial crisis era which left health systems ill-prepared to deal with COVID-19 and the ever-rising burden of chronic diseases.

“Maximum efforts should therefore be taken to ensure that health systems are made more resilient to future crises, and in turn sustainable in the face of long-term pressures.”

The research also highlighted the importance of collaboration to build more resilient and sustainable health systems. Exchanging knowledge with other sectors and across borders can accelerate improvements and strengthen healthcare systems.

Through its work, the PHSSR and its partners collaborate to build knowledge and guide action through research reports that offer evidence-informed policy recommendations to improve the sustainability and resilience of healthcare systems.

The PHSSR was established in 2020 by the London School of Economics, the World Economic Forum, and AstraZeneca, who were later joined by global-level partners that include Philips, KPMG, the Center for Asia-Pacific Resilience and Innovation (CAPRI) and the WHO Foundation.

This new research builds on evidence gained through an earlier round of work in 2021 that studied health systems in an initial group of eight countries.** Findings from a specific regional cohort, CEEBA Health Policy Network, looking into the Central Eastern Europe and Baltics area will also be presented and discussed at the Global Summit. The new country reports and an overarching summary report will be published between now and March 2023. All research reports are available on the PHSSR website.

* Countries include: Belgium, Brazil, Canada, Egypt, Greece, India, Ireland, Japan, Portugal, the Netherlands, Saudi Arabia, Switzerland, and the United Arab Emirates.

** Countries include: England, France, Germany, Italy, Poland, Russia, Spain and Vietnam.

State of social care and support provision has not improved, new report suggests

By Integrated Care Journal

Care England, as a member of the Care Provider Alliance, which brings together the main national associations that represent independent and voluntary adult social care providers in England, published a report on the current state of social care in England this week.

The Care Provider Alliance (CPA) published a briefing this week, The State of the Social Care and Support Provision in England, that highlights the key issues currently afflicting the social care sector. These issues include, but are not limited to:

· The rising cost of living

· Lack of funding to Local Authorities to adequately raise fee rates for social care

· Impact of financial pressures and uncertainty

· Unmet need is unacceptably high and rising

The key message from the report is that immediate government investment into social care is needed now. Without substantial reform and investment to support that reform, achieving long-term sustainability is impossible in the current economic climate. The implication of continued governmental inaction is continued market instability. Provider failure will impact significantly on both the NHS and Local Authorities, who will be unable to commission care and support packages from providers. Lack of action now will also prevent care providers from enabling those who rely on care support to enjoy their rights to live purposeful lives, as active members of families and communities.

Professor Martin Green, Chief Executive of Care England, said: “We require a 1948 moment for adult social care to establish a long-term and sustainable future that will be to the benefit of all citizens and the economy. It is clear that the reforms introduced under the Johnson administration are a starting point but are by no means going to ‘fix social care’ and the current reform proposals may well be kicked into the long grass again.

“The sector stands ready and willing to support the delivery of a much-needed reform agenda that will deliver a clear funding strategy for social care, whilst also developing a range of careers and opportunities that will provide high-quality care and support local economic development. The health of the UK economy cannot be separated from the health of the social care sector, the two are fundamentally linked.”

The report comes after Care England accused Ofgem of predatory pricing by charging “horrendous and financially crippling rates” in an open letter. Care England, the country’s largest representative body for independent providers of adult social care in England, is calling on the government to launch an investigation into the matter.

Lack of self-care confidence putting pressure on frontline NHS services

By Integrated Care Journal

Study finds one in five do not feel confident treating a headache themselves, and a third would be uncertain about treating a minor burn.

A real-world research poll of more than 2,000 UK adults reveals an alarming lack of confidence and knowledge around self-care for everyday ailments and highlights the threat this poses to struggling frontline health services. The poll, conducted by consumer healthcare association, PAGB, finds that one in five people do not feel confident treating a headache themselves, almost a quarter would not be comfortable self-treating a sore throat and a third would be uncertain about how to treat a minor burn.

Yet, despite the difficulty many consumers face getting GP appointments, there has been a fall in the number of people seeking advice from pharmacists for common ailments. Fewer than half (44 per cent) now turn to these highly qualified health professionals for initial advice, compared to 47 per cent last year.

Deborah Evans, community pharmacist and an advisor to PAGB, said: “These shocking findings show we need to get people back into their community pharmacies and talking to their pharmacist. Pharmacists train to qualify for five years and can help provide expert advice on all self-treatable conditions including minor cuts and burns to aches and pains.

“Pharmacists are well placed to drive a holistic approach to self-care. They can help to advise people on the most suitable and effective over-the-counter treatments as well as self-care techniques.”

However, the PAGB research reveals a worrying lack of knowledge or self-belief among the public when it comes to treating common conditions themselves. Statistics showing how many lack the confidence to self-treat everyday ailments are alarming:

• Conjunctivitis: 73 per cent

• Warts or veruccas: 61 per cent

• Backache: 52 per cent

• Nose bleeds: 45 per cent

• Cold sores: 40 per cent

• Heartburn or indigestion: 38 per cent

• Minor burns: 34 per cent

• Diarrhoea: 33 per cent

• Sore throat: 25 per cent

• Headache: 23 per cent

• Coughs: 18 per cent

Deborah Evans added: “These are all instances where a pharmacist can help and seeking advice from these highly qualified and easily accessible experts ensures consumers get swift treatment and precious NHS resources can be focused on more serious conditions. The potential savings are enormous. In 2020, it was estimated that the average GP consultation cost the NHS £39.32, and the most basic A&E was at least £77.”

Michelle Riddalls, CEO of PAGB, who carried out the research warned: “Our real-world research study presents an urgent call to action for the Government. Even before the pandemic, there were an estimated 18 million GP appointments and 3.7 million A&E visits every year for conditions which people could have treated themselves or for which a pharmacist should have been the first port of call.

“With the increasing pressures over recent years it is clear that the NHS cannot afford to let this continue.

“During the pandemic, we saw a coordinated campaign by NHS England and the Department of Health and Social Care to encourage consumers to stay at home and self-treat. As a result, this had a positive effect on both people’s confidence and ability to self-treat. We need to replicate this for all self-treatable conditions, and this can only be achieved via a national policy on self-care.”

NHS elective and cancer backlog plan “at serious risk”, warns NAO

By Integrated Care Journal and Gabriel Blaazer

National Audit Office warns plans to reduce long waits for NHS elective and cancer care services by 2025 at risk, citing the failure of funding to keep pace with inflation and deeply-rooted workforce and productivity issues.

In December 2021, the NAO reported that at the start of the COVID-19 pandemic, the NHS had not met its standard for elective care for four years, nor its full set of eight standards for cancer services for six years. Over the course of the pandemic, the waiting list for elective care grew from 4.4 million in February 2020 to 5.8 million by September 2021, and currently stands at more than 7 million.

In February 2022, NHS England (NHSE) published a plan to recover elective and cancer care (the recovery plan) over the three years up to March 2025, with the Department for Health and Social Care (DHSC) funding the recovery plan and responsible for holding NHSE to account.

NHSE’s intention is that the number of patients waiting more than 62 days for treatment from an urgent referral for cancer care should return to pre-pandemic levels by March 2023. They also hope to eliminate all elective care waits of more than one year by March 2025.

However, even if the objectives of the recovery plan are met, many patients will still be waiting longer than the NHS Constitution’s standards allow – elective care patients should start their treatment within 18 weeks, and cancer patients within 62 days of an urgent referral by their GP.

Elective care failing to bounce back

NHSE is aiming to increase elective care activity sharply to reach 129 per cent of 2019-20 levels in 2024-25. This would be an historic achievement – it previously took 5 years (2013-14 to 2018-19) to increase elective activity by 18 per cent. Even if NHSE meets this aim, it is unclear whether increasing elective activity to 129 per cent would be sufficient to meet the other commitments in the recovery plan.

During 2022-23 so far, overall elective care activity has remained below the planned trajectory for reaching 129 per cent of 2019-20 levels by 2024-25. By July 2022, the NHS came close to ending elective care waits of more than two years, but the waiting list has continued to increase – reaching 7.0 million patients in August 2022.

This includes 387,000 patients who have already waited longer than a year for treatment, compared with just 1,600 in February 2020. 26 of the 42 NHS integrated care systems have signalled in their plans that they will not reach their 2022-23 target of delivering 104 per cent of 2019-20 levels of elective care activity.

Increasing diagnostic capacity

NHSE’s programme to recover elective care partly relies on initiatives which have potential but for which there is so far limited evidence of effectiveness. It wants GPs to handle many elective cases usually referred to hospital doctors. This might add to GPs’ workload in the context of a 4 per cent decrease in the fully-qualified permanent GP workforce between 2017 and 2022.

Surgical hubs and community diagnostic centres can contribute to recovery, but their impact will need to be closely monitored – capacity could be reduced if their host hospital or other NHS and social care services in their local area come under pressure.

Urgent referrals for suspected cancer have increased compared with 2019-20, but the NHS is not treating all cancer patients in a timely way. Between April and August 2022, GPs urgently referred 15 per cent more people with suspected cancer than in the same period in 2019.

The welcome increase in patients coming forward has, however, highlighted the inadequacy of current diagnostic and treatment capacity. In 2022-23 up to the end of August, only 62 per cent of patients started cancer treatment within 62 days, compared with 78 per cent of patients in the equivalent period in 2019-20.

Funding and productivity

Inflation has eroded the value of both the £14 billion specifically allocated to the recovery plan and the wider planned increases in NHSE’s budget. In the October 2021 Budget, NHSE was allocated an additional £8 billion of resource and £5.9 billion of capital funding for the recovery plan for the period 2022-23 to 2024-25.

At that time, the total NHSE funding settlement provided for average annual real terms growth of 3.8 per cent in resource funding up to 2024-25. But the NAO estimates that, as at September 2022, this settlement represented an average annual growth in funding of just 3.3 per cent in real terms because of higher forecast inflation.

NHSE estimates that in 2021, productivity in the NHS was 16 per cent lower than before the COVID-19 pandemic and has continued to decline in 2022-23. Some of this stems directly from the pandemic, such as increased sickness absence and infection prevention and control measures. An internal NHSE review identified a range of other causes including reduced willingness to work paid or unpaid overtime.

However, organisations that represent NHS workers, including NHS Providers, point out that increasing workloads, burnout among staff and cost-of-living concerns are impacting the ability of healthcare staff to carry out their duties effectively.

There are many challenges threatening to push the recovery plan further off track, including high numbers of unfilled posts and low morale among the NHS workforce. The NAO recommends that DHSC and NHSE review the progress of the recovery plan in early 2023-24, and decide whether targets and funding allocations need to be adjusted.

They add that before April 2023, DHSC and NHSE should clearly and fully define metrics for increasing activity and reducing long waits. In 2024-25, they should publish a strategy for returning elective and cancer care services to a state where legal standards are met, the NAO recommends.

Gareth Davies, the head of the NAO, said: “There are significant risks to the delivery of the plan to reduce long waits for elective and cancer care services by 2025. The NHS faces workforce shortages and inflationary pressures, and it will need to be agile in responding as the results of different initiatives in the recovery programme emerge.

“DHSC has an essential role to play, holding the NHS to account for its delivery of the recovery plan and providing more challenge and support when it is needed.”

In response to the NAO’s warnings, the Interim Chief Executive of NHS Providers, Saffron Cordery, said: ““The NAO’s warning follows our own findings that fewer than half of NHS trusts expect to meet key end-of-year elective recovery and cancer targets.

“The NAO rightly highlights ‘significant workforce and productivity issues’ facing the NHS and that government funding to help clear backlogs hasn’t kept pace with double-digit inflation.

“NHS trust leaders and their staff continue to pull out all the stops to bear down on backlogs in the face of demand for services even higher than before COVID-19. They have slashed the longest waits for treatment and are exceeding pre-pandemic activity in many areas. Mental health services are in contact with record numbers of people and community services are doing their utmost to reduce a waiting list estimated at more than one million.

“But making further headway is hard due to long-standing, fundamental pressures which persist right across the NHS, especially chronic staff shortages and severely stretched budgets.

“With more than 130,000 vacancies across NHS trusts the government must produce urgently a fully costed and funded workforce plan so that the NHS can recruit and retain the people it so desperately needs to give patients first-class care.

News, Tunstall Healthcare November 15, 2022

Using integrated care to live healthier and happier lives

By Angus Honeysett

Angus Honeysett, Head of Market Access at Tunstall Healthcare, discusses putting citizens at the heart of care through technology, partnerships and integrated care to enable people to live happier, healthier lives.

The Government’s white paper, People at the Heart of Care, has a clear focus on integration and recognising the vital importance of improving quality of life and health outcomes. In particular, it promises £150 million of funding for several key areas, including assistive technology; improving the establishment and maintenance of digital records and data; upskilling the adult social care workforce in how to use technology; and bedding in wider digital infrastructure and cybersecurity within systems.

This is translated into the core objectives of integrated care systems (ICSs) as greater integration and more funding will enable them to facilitate the delivery of high-quality local services and citizen-focused outcomes.

The system will operate at three levels – integrated care partnerships, integrated care boards, and provider collaboratives – building better system-level knowledge of the needs of people so that they can receive more support closer to home, which includes some outpatient and diagnostic procedures.

People can stay independent for longer because health providers and community-based services will support those with the most complex needs outside of hospital settings. As the work of ICSs begins, now is a pivotal time that will shape our resources for decades to come.

Technology and cultural change

As ICSs continue to develop, the focus on driving digital systems that place citizens at the centre of service design and delivery will increase. Yet to deploy technology effectively, there are significant cultural challenges to overcome.

Technology has historically been seen as an addition to existing resources – a ‘nice-to-have’, rather than a means of transforming models of support. This has led to difficulties in integrating technology effectively. Cultural change is required which in turn needs early engagement.

Top-down leadership is needed to ensure stakeholders have input at an early stage into how technology can help them and the citizens they support. There are still workforce concerns that need to be addressed and stakeholders need to understand that technology is an enabler for better services, not a replacement for human contact.

Using technology to support people can be low-cost, thereby enabling more people to have digital solutions integrated into their care provision. This in turn gives professionals the ability to provide preventative care and engage with citizens so that they can stay at home for longer with an increased quality of life. Likewise, relatively low-cost telecare systems can help to avoid hospital admission and delay and prevent the need for residential care, and reduce carer burnout.

Understanding the barriers that we face and adapting as things change – not being driven by contracts, but by providing solutions – will ensure innovation continues to flourish. To successfully build solutions however, healthcare services must first understand the problems that are faced by people on a daily basis, with the recognition that this will change between individuals. The more we understand these problems, the easier it will be to co-design straightforward and effective strategies and solutions.

Technology is a quick win for ICSs and if used effectively, can free up the time for the workforce and other stakeholders, enabling them to become more productive in providing support to citizens that need it most.

The aim should be to embed technology so that outcomes are at the centre of all support that is provided, instead of endless form-filling, unnavigable processes and a bureaucracy which sees too many people get lost in the system, rather than receiving the support they need. It puts both power and opportunity in the hands of citizens and communities, providing solutions that are easy and efficient to access.

Collaboration and integration

Working together is in the interests of the public and all stakeholders, and greater integration, co-design and uptake of technology will enable an increase and improvement in the solutions that are available. This will also ensure that services can meet the population’s needs, saving taxpayers’ money through cost-avoidance to the system.

The formation of ICSs provides a unique opportunity to consider and pursue shared common goals. Health and social care must work together to have a positive and long-lasting impact on population health, to ensure citizens are at the heart of decisions about the support they need.

Our services are all intrinsically dependent upon each other which is reflected in the establishment of ICSs. If care delivery is ineffective, it places increased pressure on our health system, therefore leading to an inability to support citizens. Healthcare services need to have a truly joined up, integrated approach where they listen, understand everyday needs and work together to bridge gaps in resource allocation, including funding flow, which needs continued reform to drive system change.

When we deliver successful and integrated services, the benefits flow through the system from primary to secondary care, to community and social care. With the right approach, citizens can stay in the place of their choice for longer, delaying the requirement for more expensive and complex solutions.

Empowerment and control

The UK’s ageing population means there is little choice but to look at alternative ways to deliver support, in order to cope with increasing demand and more complex needs. The increased integration of technology and its use not only enhances the care that people receive, but also enables them to remain at home for longer, increasing the efficiency and capacity of our systems.

As we continue to invest and integrate technology into our services, it gives citizens greater ability to become more involved in how their health and wellbeing is managed. Data plays a particularly important role in empowering citizens to manage their own conditions as through technology such as telehealth, they can take their own readings and share these with the right people at the right time.

For citizens to be fully empowered, they must be engaged with and made a part of decision making around their care, and also understand the benefits that technology can bring, alongside how to use it.

Through the use of clear language, healthcare systems can communicate more effectively with citizens and build links between the technology that they already have and regularly use, and the technology that can support their health and wellbeing through new services. This in turn should reduce fear of the unknown and help drive a culture change at both local authority and citizen level.

By integrating services through ICSs and investing in the next generation of technology, it’s easier to engage families, friends, and communities in supporting early, proactive, and preventative interventions. Digital innovation presents opportunities to improve citizen experience, supporting better quality and greater reliability of service provision, providing enhanced solutions which are tailored to meet specific needs.

Looking to the future

ICSs and their development provide a timely opportunity to revolutionise our health systems and put citizens at the heart of care through the delivery of better outcomes and cost reductions. However, challenges remain, such as the UK’s move from analogue to digital communications networks.

This will require significant investment from the public sector at a time when budgets are already under extreme pressure, however, this brings a once in a generation opportunity to modernise, improve and shift thinking from a reactive, to a proactive delivery model. AI, machine learning and the use of data are hugely important to this.

Using data in a proactive and predictive way means issues can be highlighted early, which is in everyone’s best interest. The more that citizens are involved and engaged with data, including taking their own readings, the more they’ll understand how to more effectively manage their health and wellbeing on a daily basis.

By educating service professionals and the public on the value of data and how it can be used to transform health and care provision, people will become more comfortable with their data being used in a real-time setting.

With increased funding, improved decision making through ICSs, and better integration of technology, we will be able to drive reconfiguration and collaboration. It’s essential that service providers and citizens are involved in the digital transformation if we’re to innovate, embrace technology fully and successfully, and deliver new approaches which create benefits for both citizens and the system.

This article was kindly sponsored by Tunstall Healthcare.

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

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Energy cost support resource launched for care workers

By Integrated Care Journal

As social care workers and providers grapple with sharply rising energy costs this winter, Community Integrated Care has launched a new programme to support social care workers, people using services and family carers.

Free to access and available to all, Taking Charge offers free interactive webinars and accessible resources, specially tailored to the home-life and working routines of people who work in social care, and the people they support.

Launched by Community Integrated Care, a member of the National Care Forum (NCF), it brings together expert advice from leading energy organisations with the insights and perspectives shaped by the people it supports and their colleagues.

The ongoing energy crisis, coupled with spiralling inflation, is seeing many social care workers and their families struggle financially, and many disabled people are paying more than double the energy bill of the average consumer.

The NCF has been drawing attention to the growing energy pressures and its impact on the sector, alongside the ongoing workforce shortages, for several months, and has called on the government for:

A guarantee that adult social care providers are defined as a vulnerable sector as part of the Energy Bill Relief Scheme following April 2023.
A guarantee that those people accessing adult social care support will be able to access the Energy Price Guarantee following April 2023.
Additional, immediate support for providers to reduce the pressures facing social care workers and meet other operational costs due to rising cost of living and inflation

Professor Vic Rayner OBE, CEO of NCF, said: “The eye watering increases in energy costs is a very serious concern among our members, even after the government capped prices through the Energy Bill Relief and Energy Price Guarantee Schemes.

“For social care workers, the steep rises in the cost of living and energy costs alongside the continued reluctance of government to guarantee the funding for better pay, terms and conditions, means that the next few months will be very hard.

“The lives and wellbeing of the people who access care and support services are also significantly impacted, and many are not enjoying the same support the government is giving to other households.

“It’s encouraging to see such an innovative, co-produced, support programme from Community Integrated Care. This will provide much needed practical support to people accessing care services and care workers. However, this can’t be the responsibility of providers alone, we also need more action from government.”

Latest obesity figures for England show a strong link between children living with obesity and deprivation

By Integrated Care Journal

Findings from annual health report on children’s health by NHS Digital reveals a strong correlation between obesity and deprivation of living conditions.

The National Child Measurement Programme (NCMP) – overseen by the Office for Health Improvement and Disparities and analysed and reported by NHS Digital – measures the height and weight of children in England annually and provides data on the number of children in Reception (4-5 years) and Year 6 (10-11 years) who are underweight, healthy weight, overweight, living with obesity or living with severe obesity.

NHS Digital recently published the NCMP England – 2021-22 report which discovered that children living in the most deprived areas were more than twice as likely to be living with obesity, than those living in the least deprived areas.

Indeed, the prevalence of severe obesity was over three times as high for children aged 4-5 years living in the most deprived areas (4.5 per cent) compared with those living in the least deprived areas (1.3 per cent). It was over four times as high for children aged 10-11 years living in the most deprived areas (9.4 per cent) than the least deprived areas (2.1 per cent).

Some key differences were observed between various groups. For instance, the prevalence of children living with obesity in 2021-22 was highest for Black children in both reception (16.2 per cent) and Year 6 (33.0 per cent); it was lowest for children of a Chinese descent in both reception (4.5 per cent) and Year 6 (17.7 per cent). Moreover, boys had a higher prevalence of living with obesity than girls for both age groups.

Although these figures are smaller compared to those discovered last year in 2020-2021, they continue to concern health and care professionals as they remain higher than pre-pandemic levels.

Integrated care systems: reaching disenfranchised communities

By Raj Purewal

Raj Purewal, UK&I Strategic Development Director at Tunstall Healthcare, discusses how technology can be adopted by integrated care systems (ICSs), and how care services can reach all communities and reduce health inequalities.

In October, Public Policy Projects (PPP) launched its ICS Roadshow in locations across the UK. The events endeavour to bring together health, social care and housing professionals and create a new forum for integrated care, which sees national policy delivered at a local level.

Setting the strategy with ICSs

ICSs have taken over the role of Clinical Commissioning Groups, who were previously responsible for commissioning the best health services for their localities. ICSs will also be responsible for implementing strategies across footprints to ensure patients and citizens can access the best services and care possible. They will be able to link the data and insight they have access to from the daily activities of the health and care sector, ultimately transforming the way care services are provided.

The integration of health and social care services will be a key enabler in the transformation of systems for citizens. ICSs, alongside local authorities, will be the driving force behind this as they have been specifically designed as the link between health and social care to improve collaboration, care provision and patient outcomes.

ICSs have also been tasked with ensuring the continuity of care in regions across England, so that national policy aligns with the needs of patients and citizens on a local level. The introduction of new legislation will direct local and regional health and care systems to improve alignment between service providers, while supporting, enabling and educating patients, and when appropriate, to manage their needs.

Tunstall is at a pivotal place when it comes to aligning services through ICSs and it’s crucial that we adapt our strategies as required. Tunstall’s services must support ICSs’ objectives and their focus on driving best practice, transforming services and increasing the use of digital capabilities for patients and citizens.

ICSs will foster closer working between health and care service providers. Tunstall’s longstanding role and remit shall continue, and we will also support providers, commissioners, partners and vendors to deliver the Triple Aim, ROI and best value for these sectors and the public sector pound.

Adopting technology

The importance of technology in service delivery across the health and care sectors shouldn’t be underestimated, particularly when it comes to monitoring and assessing citizens and patients when discharged, or in virtual wards, and when appropriate, pro-actively before a planned attendance. To adopt technology-enabled care services, we must help to educate both citizens and health and care professionals effectively, and leaders must coordinate this across ICSs.

Adopting and scaling the right technology will support many resources, increase utilisation, and improve capacity across the health and care systems, to provide effective care. ICSs will continue to increase the focus on building preventative and proactive care models, which will include investment in the continued advancement of technology.

Technology providers are working on solutions and platforms that will identify changes in patients’ or citizens’ vital signs, mobility or behaviour. For example, Tunstall Cognitive Care® will use advanced AI in combination with technology in the home to detect whether someone’s health could be about to deteriorate, spot a potentially undiagnosed condition, or resolve an immediate social care need.

Since before the pandemic, around 22 per cent of the NHS elective backlog for surgery is for orthopaedic conditions relating to the hip or knee, or cataract surgery; patients who are on these waiting lists can be identified and supported with remote monitoring. For example, if a particular behavioural trend for a citizen who is struggling with mobility can be seen, support can be offered quickly with an appropriate intervention at the right time to minimise the need for urgent, more expensive unplanned emergency care. This type of integration and use of technology will help to reduce stress and pressure on provider resources and service work plans.

As ICSs transform services, and move towards digitisation and digitalisation, the technology that providers deploy needs to facilitate strong foundations for the future of care provision, as ICSs will aim to optimise data and to generate insight. In helping to ensure that the infrastructure and systems are in place, Tunstall can start to have positive impacts on health and care services for all as health care services make these transitions.

Improving care services and reaching all communities

The overall experience of services for all citizens should be improved through the introduction of ICSs, as they will be tasked to ensure equality of care, which historically has not always been the case.

ICSs will also increase focus on improving value delivered for the public purse, improving efficiency by reducing the incidence of unattended appointments (DNAs) and ensuring a continuum of care for the patient and citizen from referral and after discharge. This is critical in ensuring healthcare services are optimised – ranging from effective patient communication, reducing the number of DNAs, and sharing insight with practitioners to inform best practice. ICSs will be able to take an analytical approach to the data they have access to and use this to both inform planning and to allocate resources.

To reduce health inequalities, it will be necessary to take a holistic view. For example, poor housing can have an impact on citizen health if there is a lack of insulation or if there is damp. There is no singular factor or reason that causes health inequality, but ICSs will bring bespoke approaches for their different localities to ensure gaps in health and care are lessened and minimised over time.

Other inequalities can cause communities to become disenfranchised with service providers, for example problems can arise because of travel, logistics and even linguistic challenges. Most recently, we saw an example of this as some communities were excluded from pandemic communications especially digital communications, including the messaging around measures put in place to reduce the spread of COVID-19.

The establishment and progression of ICSs will enable the alignment of technology-based health and social care services and improve health outcomes for every community across the UK.

As service providers and the workforce become increasingly invested in, and understanding of, the role of technology in supporting and empowering vulnerable people, we’ll see a reduction in health inequalities and upgraded services that are better able to meet the demands of our growing and ageing population.