NHS procurement criteria set for major changes

By Integrated Care Journal

The NHS is to change its procurement criteria for all medical supplies – which is set to save billions of pounds a year.

New guidance will be issued to all NHS Trusts later this year which for the first time will stipulate that patient experience and outcomes must be considered ahead of cost.

The change comes after an 18-month campaign by hygiene and health company Essity to demonstrate that choosing the cheapest incontinence products alone costs the NHS an extra £520,418,989 annually.

*Dealing with incontinence. Source: Essity (click to enlarge)*

A pilot scheme in Lincolnshire care homes discovered that, despite higher up-front cost, better-quality and more appropriate products save money in the long run.

Patient experience is improved in terms of independence, dignity and relapses, and resources are freed-up as demand on healthcare staff is reduced.

The campaign was driven by Essity in the UK who have met with and presented to multiple MPs who upon seeing the evidence have subsequently then supported the call for change.

The policy change was announced by House of Lords member Lord Philip Hunt, a passionate advocate for Essity’s proposal for Value-Based Procurement (VBP) since meeting with members the company in 2023.

“In announcing the change of policy, Lord Hunt commented: “Who would have thought that the humble absorbent continence pad could have such an impact, so quickly, on something as important as NHS procurement policy and practice – but it shows what can be delivered when a campaign for change is built upon irrefutable evidence that a change will be a win-win for patients, for carers and for NHS and social care providers alike, particularly when it is taken forward in a constructive, cross-party campaign.”

While the change in policy will become guidance for NHS Trusts from this autumn, it will become a mandatory requirement during the procurement process from autumn 2025.

Karen McNamara, business director for Essity’s Health and Medical division in the UK, said: “This is wonderful news for our NHS. Finally, patients can look forward to a better quality of care no matter their illness or condition. Put simply, better quality medical products are more reliable, you need fewer of them, and as a result the associated costs of care are reduced.

“With poorer quality incontinence products, patients were experiencing more leaks and were having to be changed more regularly which not only impacts the dignity for the patient, but for each change a healthcare professional is required and they need disposable gloves, an apron, then linen has to be washed more regularly and very quickly the associated costs add up.

“We have been able to demonstrate how better quality incontinence care products not only improve the lives of patients and the healthcare professionals that care for them but save the NHS money as well. This change in policy is a huge win for patients and for the NHS.”

Symptom-based testing and digital pathway tools combatting delayed breathlessness diagnosis

By Integrated Care Journal

Project in Leicester, Leicestershire and Rutland ICB working to reduce pressure on acute units through improved diagnosis of breathlessness, a symptom affecting around 10 per cent of the UK population.

A new collaboration between Leicester and Hinckley Community Diagnostic Centres (CDCs) and Lenus Health is seeking to digitally transform the breathlessness diagnostic pathway to enhance patient care and streamline healthcare delivery.

Breathlessness is a distressing symptom which affects around 10 per cent of the UK population. It is often notoriously complex to diagnose and can result in long delays to treatment for patients, with over 66 per cent of cases caused by underlying cardiorespiratory diseases.

The project will transform an existing symptom-based care pathway, using digital tools, to reduce delays to diagnosis. It will combine triage, parallel testing and a streamlined, integrated and structured approach to diagnosis data capture. By configuring the Lenus Diagnose pathway product, supplied by Lenus Health, the project aims to evidence significant reductions in time to diagnosis and treatment by bringing in remote specialist input earlier into decision making.

Jim McNair, Director, Lenus Health said: “Breathlessness diagnosis is complex and we are delighted to be working in partnership across Leicestershire healthcare providers to optimise activities and join up data to speed up diagnosis and time to treatment.

“This not only helps the patients themselves but reduces pressure at our hospital front doors because of undiagnosed and untreated disease.”

The project, led by Leicester, Leicestershire and Rutland Integrated Care Board, includes primary care, secondary care and academia to support its implementation. At the forefront of this initiative will be the utilisation of the existing Leicester CDC and the new Hinckley CDC when the latter becomes operational in early 2025, both of which are run by University Hospitals of Leicester NHS Trust. Patients’ test results will be integrated into the pathway aligning with the GP Direct Access guidelines.

Dr Louise Ryan, GP and clinical lead for respiratory illness at Leicester, Leicestershire and Rutland (LLR) ICB, said: “Breathing difficulties affect many patients in our local area and this initiative will help us, in many cases, to diagnose the underlying cause in GP practices, without having to refer patients to secondary care. This will speed up diagnosis for patients and means that they can be treated sooner, without having to visit a hospital.”

Dr Rachael Evans, respiratory Consultant Physician and clinical lead for the existing breathlessness LLR pathway at University Hospitals of Leicester NHS Trust, said: “Our research at University of Leicester shows delays to diagnosis are associated with worse patient outcomes and hospital admissions, and that earlier parallel testing can help. This project has the potential to improve the local situation by effective implementation of the diagnostic breathlessness pathway through the CDC and Lenus software enabling remote earlier specialist input where needed.”

To complement the CDC project, an InnovateUK funded AKT2i project between the University of Leicester and Lenus Health will support, among other activities, evidence generation of the benefits of different interventions.

Dr Gillian Doe, research programme manager and respiratory physiotherapist at the University of Leicester, concluded: “Our team is committed to research in improving the pathway to diagnosis and symptom management for individuals living with breathlessness. The Innovate UK and CDC funding will support the digital optimisation of the Breathlessness pathway in Leicester, Leicestershire and Rutland. We are excited to work in partnership with Lenus and NHS partners to deliver this project.”

The project builds on the Lenus Diagnose product successfully implemented in Heart Failure, wider CVD, and COPD pathways where it has significantly reduced time to diagnosis and treatment and delivered service efficiencies to the healthcare system.

Hep C U Later offers new resources to help eliminate hepatitis C

By Integrated Care Journal

The national elimination campaign is now looking for the estimated 70,000 people living with untreated hepatitis C.

Hep C U Later has been commissioned by NHS England to provide resources to help encourage testing among patients, to provide information to the public and update knowledge among clinical teams.

NHS England’s successful national elimination programme for hepatitis C has so far seen over 80,000 people found and treated through extensive work within drug and alcohol services and other areas of healthcare such as emergency departments. The elimination programme is now seeking to find the estimated 70,000 remaining people believed to be living with hepatitis C.

Risk factors for Hepatitis C can include:

Sharing equipment for injecting drugs
Having a blood transfusion prior to Sept 1991
Had a piercing, tattoo, or acupuncture using unsterilised equipment

Among the resources available to you are:

CPD accredited hepatitis C training module – free to access
National Testing Portal Poster – advertising the free, confidential at home testing kits, available to anyone in England
Information Leaflets – for your community to understand the virus, the treatment and support
Primary Care Toolkit – detailing everything from NICE guidelines to testing methods and treatment

Additionally, follow the Hep C U Later LinkedIn page or take a look at the website – www.hepculater.com.

‘Transformative’ trial boosts prostate cancer patients’ autonomy

By Integrated Care Journal

Patients with lower risk cancer will be reassured radiotherapy alone is effective following surgery, avoiding the need for hormone therapy and its side effects.

Thousands of prostate cancer patients will benefit from results of a ‘practice-changing’ clinical trial which has, for the first time, tested the best duration of hormone therapy to use with radiotherapy following surgery.

Findings published on Thursday evening in The Lancet, showed that there was little benefit of additional hormone therapy for low-risk prostate cancer patients compared to using radiotherapy alone. For patients with a higher risk of their cancer returning, there was a greater benefit to a longer course of hormone therapy across two years, rather than a short course completed over six months.

Each year, around 7,000 people with localised prostate cancer have surgery to remove their prostate. Around 2,000 of these go on to have radiotherapy after the surgery and previously it has been unclear if they would also benefit from hormone therapy.

The study found that 79 per cent of men with lower-risk prostate cancer who were treated with radiotherapy alone survived without their cancer spreading and becoming incurable, after 10 years. This is compared with 80 per cent of those treated with six months of hormone therapy and radiotherapy. Researchers noted that this is a small difference and could be due to chance, showing no significant benefit of hormone therapy for lower risk patients.

For patients with a higher risk of their cancer returning, the benefits of six months versus two years of hormone treatment with radiotherapy were clearer. 72 per cent of those treated with the shorter course of hormone therapy survived without the initial cancer spreading after 10 years, compared with 78 per cent of those treated with the longer course. This showed that an extended course of hormone therapy could be more effective when treating advanced cancers.

The phase III RADICALS-HD trial, led by researchers from The Royal Marsden NHS Foundation Trust and the MRC Clinical Trials Unit at University College London, with funding from Cancer Research UK, outlined that these results will inform discussions between clinicians and prostate cancer patients to help both make decisions around cancer treatment, weighing up the efficacy of hormone therapy for the individual case.

Chief Investigator Professor Chris Parker, Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust and Professor of Prostate Oncology at The Institute of Cancer Research, London, said: “The new information from this practice-changing study will ensure clinicians can better tailor treatment for prostate cancer patients following surgery and help facilitate important discussions. This will mean some patients receive a more effective treatment while sparing others unnecessary intervention.

“The trial showed encouraging results for radiotherapy alone so some patients, concerned with upsetting side effects of hormone therapy, can be reassured this treatment is a good option. Other patients, at higher risk of their cancer returning, can have a better understanding of how effective hormone therapy might be for them and help them to decide the best possible path of treatment.”

Senior author Professor Matt Sydes (MRC Clinical Trials Unit at UCL) said: “These results will help doctors and patients discuss treatment options and take informed decisions about whether having two years of hormone therapy is the right choice for them.

“For patients at higher risk of cancer spread, our study suggests two years of hormone therapy may be a better strategy than six months, although treatment decisions should be based on discussions between doctor and patient.”

Dr Anna Kinsella, a Science Engagement Manager at Cancer Research UK, said: “Every year there are around 52,300 new prostate cancer cases in the UK, that’s more than 140 every day. Comparing different treatment options is important to make sure people with cancer, and their doctors, have the information they need to decide what’s best for them.
The more treatment options we have available, and the more we understand about the best ways to use them, the closer we are to more people living longer, better lives, free from the fear of cancer.”

John Coyne, 62 from Surrey, was diagnosed with prostate cancer in February 2019 and treated with surgery at The Royal Marsden a couple of months later. For 18 months, his Prostate-Specific Antigen (PSA) level was undetectable. However, in December 2020, follow-up tests revealed his PSA levels were climbing, suggesting the cancer had not completely gone. John returned to the hospital where he recently chose to be treated with radiotherapy without hormone therapy.

He said: “My PSA levels, while rising, are still very low, so my doctors and I decided against adding hormone therapy to my treatment plan. I’m a very fit and active person and my weekly kickboxing sessions are important to me. As hormone therapy lowers testosterone and can have effects such as muscle wastage and a lower libido, I felt in my case, the benefit versus adverse effects wasn’t strong enough in favour of hormone treatment.

“The support I’ve received at The Royal Marsden has been excellent. The care I receive is personalised and I feel like I’ve been listened to by my team, with my needs being considered. This news will hopefully help more men in making an informed decision regarding their own personal situation and treatment plan.”

EHR roll-outs need strategies to mitigate clinician overload

By Dr Dominic Pimenta, Jasmine Balloch, Dr Ellie Asgari; TORTUS

Clinicians are increasingly subject to cognitive overload, and recent studies suggest that without mitigation strategies in place, poor implementation of EHR systems can exacerbate the problem.

In April, a narrative review paper was published in the JMIR Medical Informatics titled Impact of Electronic Health Record Use on Cognitive Loads and Burnout Among Clinicians. My fellow authors and I applied cognitive load theory to explore the impact that routine EHR use has on clinicians and to suggest how the risk of negative effects could be minimised.

It’s important to preface the discussion of our conclusions by acknowledging that EHR systems are essential for the delivery of efficient, joined-up patient care: they allow for improved communication between clinicians, remote access to clinical records and to a high volume of clinician data for research and audit purposes. Rightly, years of effort and significant investment have led to widespread EHR implementation across the NHS: 87 per cent of primary, secondary and community care staff surveyed by the Health Foundation reported using EHRs as part of their work, and in the 2024 Spring Budget, the Chancellor pledged that they would be rolled out across all NHS Trusts by 2026.

However, only 57 per cent of respondents in the same Health Foundation survey chose EHRs as the technology saving them the most time, and their rapid review of 72 studies about EHRs and related tools identified that 44 per cent found no time savings delivered. This indicates that the potential of EHRs is not yet being fully realised.

As our new review concludes, taking a considered, evidence-informed approach to the design and implementation of EHRs makes all the difference when it comes to unlocking their full potential, while mitigating significant potential risk. Importantly, by acknowledging and proactively addressing the relationship between EHRs and cognitive burden, organisations can successfully reduce rates of clinician burnout and minimise risks to patient safety.

EHRs and cognitive overload: examining the evidence

Cognitive load theory explains that human capacity to process information is limited to a few elements in working memory at any given time. When this capacity is overwhelmed by an excessive quantity of information, the resulting cognitive overload can impair decision making, interfere with mental performance and elevate stress levels. Clinicians are typically at high risk of cognitive overload, as they must navigate complex patient data, integrate new information rapidly, and make critical decisions under pressure on a daily basis. The transition to digital records has compounded this challenge by significantly increasing the volume and complexity of data clinicians must handle during patient care.

Recent studies indicate that poorly designed EHR systems can exacerbate cognitive load. The factors contributing to this include inefficient user interfaces, excessive documentation requirements, and the need to navigate through cumbersome electronic systems to access relevant patient information. In addition, dealing with overly-frequent pop-up notifications has been shown to cause distraction and alert fatigue, both of which can lead to clinicians missing important information and result in poor patient outcomes.

Experiencing regular cognitive overload is a major risk factor for burnout. In 2023, 55 per cent of surveyed NHS workers had experienced burnout in recent years, a condition characterised by emotional exhaustion, demoralisation, and a reduced sense of personal accomplishment, which not only affects individual health professionals but also the quality of care they provide. Although burnout has multiple root causes, addressing the design and implementation of EHRs to reduce the cognitive load they place on clinicians is a necessary and important step towards tackling the rise in burnout cases.

Practical recommendations:

Improving EHR user interfaces: Simplifying the user interface of EHR systems can reduce unnecessary cognitive effort. This involves designing more intuitive menus, reducing the number of steps to complete tasks, and organising patient data more logically.
Streamlining information presentation: Tailoring the presentation of information to minimise extraneous load is crucial. This could mean displaying critical patient data in a summarised form, with the option to expand details as needed, thus preventing information overload.
Reducing documentation burdens: Automating routine data entry and employing natural language processing can decrease the time clinicians spend on documentation. This not only frees up cognitive resources but also allows clinicians to devote more attention to patient care.
Incorporating decision support tools: Advanced decision support tools can aid clinicians by providing contextually relevant information at the point of care, reducing the need for extensive data retrieval and analysis.
Training and support: Continuous training and real-time support can enhance EHR proficiency among clinicians. Tailored training programs that address the specific needs of users can alleviate stress and improve their interaction with the technology.

Importantly, emerging artificial intelligence and machine learning technologies offer promising avenues to manage cognitive load by automating routine tasks and predicting patient risks through advanced analytics. However, the integration of these technologies must be handled carefully to avoid adding to the cognitive burden – evidencing a need for user-friendly design and time-saving clinical integration.

In summary, clinician burnout is complex and has multiple causes – such as overall workload, inflexibility of rostering and organisational culture – which is why it could never be fully eliminated even by the ‘perfect’ design and implementation of an EHR. However, by scientifically assessing the impact of different EHR technologies and models, it becomes possible to paint a more complete picture of how they alleviate or exacerbate burnout. In turn, this understanding can be used to ensure that clinicians are equipped with the best EHR systems –and the best integrated technologies – that improve their efficiency and improve patient outcomes.

Health Inequality, News May 10, 2024

Study highlights prison cancer inequalities

By Gabriel Blaazer

Those diagnosed while in prison face several barriers to treatment and receive worse experiences of care, according to a study led by King’s College London.

Researchers from King’s College London (KCL), University of Surrey and University College London (UCL), funded by the National Institute for Health and Care Research (NIHR), have found that inequalities in cancer outcomes are persistent across English prisons, with those diagnosed while in prison 9 per cent more likely to die from the disease.

The study analysed cancer data from the National Disease Registration Service, which is part of NHS England, and conducted interviews with cancer patients in prison, and prison and healthcare professionals. It finds that cancer patients in prison are 28 per cent less likely to receive curative treatment than the general population, particularly surgery to remove tumours. Only half of the 9 per cent higher mortality rate can be explained by treatment differences.

Prisoners with cancer also have fewer hospital admissions than the general population, meaning that the cost of NHS hospital care is lower in the first six months due to fewer outpatient visits and planned inpatient stays. However, once emergency care and security escort costs are factored in, overall hospital care costs are higher.

Accordingly, the study emphasises the need to improve cancer care for people in prisons, to ensure that it is equivalent to that received by the general population.

Commenting on the study’s findings, Dr Elizabeth Davies, Clinical Reader in Cancer and Public Health in the School of Cancer & Pharmaceutical Sciences at KCL, said: “There are a number of structural factors that influence how healthcare is organised within the prison system, including the way in which prisons interact with NHS cancer services.

“Unfortunately, these factors can mean the route to diagnosis for people in prison is different to that of the general population, and they may not always receive the same level of treatment and support. People in prison with cancer have so far been a hidden and under-researched population. They should not be impacted by such health inequalities and should receive the same standard of care as they would in the community.”

To improve cancer care for people in prison, Dr Davies suggested, the NHS, HM Prisons and the Ministry of Justice should make better use of existing data to identify and reduce variations in care, as well as to better co-ordinate care pathways between these organisations.

Barriers to care

While finding that cancer patients in prison follow similar diagnostic pathways to the general population, the study shows that those in prison are disproportionately affected by barriers to care. These include lower levels of health literacy among those in prison, which impacts the ability to obtain and understand the information needed to make informed health or treatment decisions. Alongside this, the process for booking GP appointments in prisons is complex and time-consuming, and persistent communication issues between prison staff and NHS clinicians make co-ordinating care difficult.

Prison healthcare professionals interviewed commented that, prior to diagnosis, it can be difficult to distinguish between those with genuine healthcare concerns and those wishing to leave prison for other reasons.

Cancer patients in prison are also at risk of missing appointments if transport to hospital is not available. Persistent staff shortages in prisons also present another barrier. It was reported last year that many prisons are increasingly running more restrictive regimes, where a lack of staff can lead to prisoners being locked down for extended periods. The most restrictive of these, known as “red regimes”, were put into effect at least 22 times across English prisons in 2023. Prisoners have cited being locked up for 23.5 hours a day with no access to showers when under a “red regime”.

The study also highlights the use of handcuffs as a barrier to accessing care and a reason for prisoners to refuse hospital appointments. Further, prisoners are found to be reluctant to answer certain medical questions or raise concerns during appointments when healthcare professionals are present, and the study is the first to highlight discomfort among healthcare professionals and prison officers due to this practice.

After diagnosis, patients reported feeling unable to follow the advice of oncology professionals for managing and reporting side effects, which is especially challenging as they cannot directly communicate with their consultants from prison.
NHS oncology services often advice patients to bring friends or family members to appointments to offer psychological support and assist them with information gathering and retention, yet most of those diagnosed in prison attend appointments without this support, and their families often have little interaction with oncology teams.

“Prisons are designed to take away elements of control and choice for prisoners, however, this should not apply to their healthcare,” said Professor Jo Arnes, Professor of Cancer Care and Lead for Digital Health in the School of Health Sciences at the University of Surrey. “Our findings show that patients experience a number of barriers during diagnosis and similarly, once treatment started, they struggled to follow the advice of oncology professionals for reporting and managing any side effects.”

“Instead, they were reliant on prison officers and prison health professionals to respond appropriately, which undoubtedly impacts on their overall physical and emotional wellbeing. With a growing and ageing prison population there is an increasing need for patients with cancer within the prison system to access equivalent care to those in the community,” Professor Arnes added.

Professor Rachael Hunter, Professor of Health Economics at UCL, commented: “Although the cost of clinical cancer-related care for people in prison is less than in the general population, this does not reflect cost savings or efficiency, but worse access to care. More evidence is needed on cost-effective ways to improve access to curative cancer care for people in prison that is appropriate for the prison service.”

The study was coproduced by peer researchers with lived experience of the criminal justice system, supported by Revolving Doors – a charity dedicated to improving services for people in contact with the criminal justice system. It was presented in three collaborative papers published by The Lancet Oncology and eClinical Medicine.

All news

The Coloplast Wound Care Partnership Programme

By Joseph Singleton and Tracy Vernon

Joseph Singleton, Tissue Viability Nurse, Coloplast, and Tracy Vernon, Clinical Nurse Manager, Coloplast, reflect on the outcomes of Coloplast’s Wound Care Partnership Programme pilot study, which aimed to improve the outcomes for the local patient population with wounds.

Coloplast’s purpose is to make life easier for people with intimate healthcare needs. Requiring both an understanding of patient’s medical challenges and other concerns impacting their lives, Coloplast listens to both patients and the clinicians who care for them. Coloplast’s business includes Wound and Skin Care, and understands that although wound healing can be complex, choosing the right solution doesn’t have to be. By combining effective products and services designed to release clinical capacity, reduce harm, and optimise services, Coloplast works with clinicians to reduce health inequalities and deliver optimal wound care for patients.

In 2021 Coloplast initiated a Wound Care Partnership Programme (WCPP) with Primary Care Warwickshire with the intention of developing a quality improvement programme, which aimed to improve the outcomes for the local patient population with wounds.¹ This focused upon an educational strategy, evidence-based wound care pathway and robust data collection.

The WCPP initiative consisted of three stages:¹

Stage 1: A baseline audit (data-driven approach) which identified three themes:

Post-operative wounds were most common.
More than half of the wounds audited were non-healing (over two weeks with limited progress).
Numerous patients were having frequent dressing changes.

Stage 2: Triage and referral criteria were established with the support of the Coloplast Tissue Viability Support Service:

Two clinics per week were set up with 30-minute appointment times to facilitate holistic assessment.
Patients’ eligibility for supported shared care was established following the National Wound Care Strategy Programme guidelines.
Twelve clinically focused education models were delivered to primary care staff by Coloplast.

Stage 3: An extended 11-month clinical evaluation, where patient satisfaction and staff feedback were attained.

107 patients participated in the extended 11-month clinical evaluation:¹

213.5 hours of clinical time were undertaken by Coloplast. This time allocation had the added benefit of freeing up 427 practice nurse appointments, accounting for 142 hours of clinical time over the 11 months.
31 per cent of patients were eligible for supported shared care resulting in the freeing of an additional 42 hours of clinical time.
48 wounds healed.
46 patients were referred to local leg ulcer services in accordance with the local pathway.
Uplift in healthcare practitioner wound care knowledge evidencing improvements in education assessment scores (35 per cent uplift in learning seen). The education offered within the WCPP has been found to reduce variations of care, as well as support the development of pathways to streamline care and support clinicians in practice.²

The pilot has led to further partnerships in other areas driving quality improvements in wound care.

References

¹ Singleton J, Vernon T, Shaw S (2023) Coloplast Wound Care Partnership Programme: a pilot study. Wounds UK, Vol 19, No 3

² Letchford J, Buckley E, Singleton J, Vernon T (2022) How to deliver essential wound management education in the primary care setting. Poster presentation Wounds UK

People powered healthcare – delivering the NHS blueprint

By Dr Allison Smith and Duncan Macleod

Partnership working can deliver great results. In this example, a volunteer supported service with Royal Voluntary Service contributes to vastly reduced readmission rates – at two per cent compared to a national average of 15.5 per cent.

The pandemic drove us to think differently about the delivery of healthcare, and in many ways, it proved that ‘necessity is the mother of innovation’. In our article of 25th March, we discussed how the NHS and Care Volunteer Responders programme, established at the height of the pandemic in March 2020, exemplified truly integrated partnership working between NHS England, local NHS systems, a charity (RVS) with a social enterprise (GoodSam digital App), and most importantly, the public.

But this is not the only effective partnership of this type we can showcase that yields system efficiencies and improved patient outcomes.

Royal Voluntary Service works closely with the Leicestershire and Rutland ICS, a team of 86 local volunteers, and 11 RVS staff, to deliver several critical hospital discharge and admission avoidance services to more than 2,500 at-risk older adults (aged 55+) per year.

A core objective of these support services is to reduce (re)admissions associated with ambulatory care sensitive (ACS) conditions, focusing on non-clinical interventions which ultimately have clinical consequences. This includes ensuring our clients understand the importance of staying hydrated to avoid admissions associated with UTIs, encouraging clients to mobilise and reduce sedentary behaviour to improve muscle strength and mass, and provide opportunities for socialisation which stimulate both the mind and the body.

The services set out below are integrated in the discharge pathways ‘zero’ and ‘one’ at Leicester’s Glenfield Hospital and Royal Infirmary, as well as at the Leicester General Infirmary. Across the service, volunteers and staff are involved in morning discharge meetings; our staff and volunteers work alongside NHS staff to identify patients who would benefit from a portfolio of services on offer:

Assisted Discharge (three-day day support): The client will be taken home and supported to settle in; this involves checking that the clients’ home is safe, warm, and they have food; if not, a small food shop is undertaken. The next day the client will receive a call to check on their welfare and assess any additional needs. The Trust uses this service to improve discharge (e.g. before 3 pm) and patient flow from ED. It typically runs at full capacity.
Supporting Your Recovery (6-12 weeks): This service is offered to clients that might need a bit more support following discharge and have been identified by the Trust as at-risk, either because of previous admissions with 30 days, lack of family support, and frailty and/or wider wellbeing. Each patient will have an assessment of needs and a tailored ‘Personal Support Plan’; this will focus on social and physical rehabilitation with the aim of building confidence, reducing isolation, and ensuring they are able to manage their ‘activities of daily living’. The service assists clients to go out shopping, attend medical and social appointments, and can provide companionship, either face-to-face or over the phone. This service helps to reduce (re)admissions by improving hydration/nutrition, physical activity, and wellbeing. On average clients are supported with 6.2 visits per month, and readmission rates for these clients are around two per cent versus the national average of 15.5 per cent.
Leicester Patient Transport (Treatment – Oncology): We also work with the Trust/ICS to ensure oncology patients attend their appointments on time and reduce DNAs to outpatients. The service is more than just transport to appointments; it provides invaluable emotional support, respite for carers, and companionship for patients who are often undergoing stressful periods of medical treatment.

The original blueprint of the NHS was rooted in the idea that healthcare provision should be a collective and collaborative responsibility between state and citizen. Our charitable mission, and the services we provide, speaks to these fundamental roots.

There now exists a growing body of medical evidence supporting the health and wellbeing gains associated with well-run, purposeful volunteering.3 In a recent survey, RVS volunteers reported higher rates of happiness (+seven per cent) and lower rates of anxiety (eight per cent) compared to a national sample of UK adults (ONS 2003). In addition, volunteers report that volunteering makes them more physically active; on average volunteers do an extra 147 minutes more of physical activity each week.

Given these health gains, RVS has increasingly reached out to those in the most deprived neighbourhoods (IMD areas 1 and 2) to get them more involved and active in their community as a tool for addressing health inequalities. Our survey suggests that 12 per cent (England), 8 per cent (Wales), and 6 per cent (Scotland) of volunteers come from the most deprived areas (IMD 1 and 2).

There are exemplars of this type of partnership working in many parts of the healthcare system; however rather than be an exemplar, this should be norm. Integration should not just include that of health and social care systems’ the public and civil society organisations both want and should have a stake in its delivery. Greater ‘people powered healthcare’ delivers both improved efficiency and population health gains.

Royal Voluntary Service will be attending the Integrated Care Delivery Forum event in Birmingham on the 9th May.

Switching to decaf could prevent thousands of falls per year, care home trial suggests

By Integrated Care Journal

In a first-of-its-kind trial, care home residents were offered decaffeinated hot drinks in a bid to reduce falls experienced rushing to the toilet.

Switching care home residents to decaffeinated coffee could lead to a substantial reduction in toileting-related falls, data from a trial has indicated. The trial was conducted across eight Stow Healthcare residential care homes over six months and saw roughly 300 residents given the chance to blind taste-test caffeinated and decaffeinated drinks.

The trial was instigated after staff noticed several residents falling on their way to the toilet. They suggested switching residents’ drinks to reduce bladder and bowel urgency for those with an overactive bladder or incontinence. the trial resulted in a 35 per cent reduction in toileting-related falls over three months, between June – November 2023 and follows a similar initiative by University Hospitals of Leicester NHS Trust (UHL) in 2021.

According to a joint report published by Care England, Stow Healthcare and UHL, if scaled across the care sector, the switch to decaffeinated drinks would mean thousands of falls prevented and could save the NHS as much as £85m per year.

Falls are the most common cause of injury-related deaths in people over the age of 75. People living in care homes are three times more likely to fall than those living at home; they are generally more frail, less mobile and have a higher prevalence of incontinence than the general population.

More than 90 per cent of residents chose to take part in the trial after being told about the potential health benefits of making the switch, with the choice of caffeine always available on request.

Residents, staff and families at Stow Healthcare’s facilities have described the “huge difference” made by switching to decaf and pride in being a part of the trailblazing trial.

The report authors describe the simple switch as “ground breaking” and are now encouraging other care providers to “give decaf a go!”

The full report can be accessed here.

Professor Martin Green OBE, Chief Executive at Care England, said: “Falls have a detrimental impact on thousands of older people every year, not to mention the knock-on cost to the NHS. When we first heard about the results of UHL’s decaf trial in a hospital setting, the potential benefits for social care were immediately clear. For such a simple, cost-neutral solution to have such a profound impact is extraordinary. With a huge national focus on reducing pressure on the NHS, this pioneering trial demonstrates that simple solutions can help address enormous challenges. Care England is delighted to have been involved in this project and would encourage care providers across the country to give decaf a go!”

Ruth French, Director at Stow Healthcare, said: “The decaf project has been eye-opening for all of us at Stow Healthcare. Our residents and staff have been fully engaged in this project from the moment we launched. To achieve a falls reduction of 35 per cent connected to going to the loo is a significant finding for us all in social care. The impact of a serious fall can have devastating consequences, and finding simple ways such as decaf drinks that might reduce this risk is ground-breaking. We hope it will inspire everyone in social care to take up the challenge!”

Sarah Coombes, Continence Nurse Specialist at University Hospitals of Leicester NHS Trust, said: “Ever since implementing the original ‘Taste the Difference Challenge’ at UHL, my dream has been to see it rolled out nationally and into the community setting. I hope that this will inspire other care providers to follow suit and to promote this simple change to improve patients’ continence and reduce the risk of falls.”

Andrew Selous MP, Chair of the APPG on Bladder and Bowel Continence Care, said: “The findings from Care England, Stow Healthcare and UHL’s decaffeination trial are extremely encouraging. At a time when our NHS and social care system are facing real pressure, decaffeination appears to have emerged as a solution hidden in plain sight. The APPG on Bladder and Bowel Continence Care is committed to finding wholistic solutions to support people with continence issues to live well and this initiative represents exactly that. We now need to look at how these findings can be expanded to deliver positive outcomes for people nationwide.”

New report finds UK medicines shortages are ‘exacerbated’ by Brexit

By Samantha Semmeling

Nuffield Trust report finds that while medicines shortages are now commonplace globally, they have become the ‘new normal’ in the UK, as organisations call on the government to conduct an urgent review into medicines supply chains.

The latest report in the Nuffield Trust’s Health and International Relations Monitor project, The future for health after Brexit, concludes that while Brexit has not caused UK medicine shortages, it has made it significantly more challenging to address them.

The report finds that over the last two years, shortages of medicines including life-saving antibiotics, epilepsy, and chemotherapy drugs, have become a ‘new normal’. As well as reducing patient access to medicines, the shortages are placing significant burdens on pharmacists and GPs.

The shortages have also resulted in the need for the government to reimburse pharmacies for buying drugs above their standard costs more often. Since 2022, the NHS has spent an estimated £220 million on price concessions, absorbing an increasing sum of NHS England’s prescribing budget.

The research is supported by the Health Foundation and explains that UK shortages are reflective of problems in the global medicines market, and not caused directly by Brexit. The UK, however, is experiencing these shortages more acutely that comparable countries.

Global shortages have occurred due to a combination of factors, including a thinner market caused by manufacturing dominance in India and China, post-pandemic inflation and the war in Ukraine.

The Nuffield Trust’s Brexit programme lead, Mark Dayan, said: “We know many of the problems are global and relate to fragile chains of imports from Asia, squeezed by Covid-19 shutdowns, inflation, and global instability.
“But exiting the EU has left the UK with several additional problems – products no longer flow as smoothly across the borders with the EU, and in the long-term our struggles to approve as many medicines might mean we have fewer alternatives available.”

“The medicines supply chain is broken at every level”

The report explains there are unique factors affecting the UK’s shortage issue. A change to prescription patterns causing a squeeze in supply of certain medicines; HRT prescriptions increased by 40 per cent in 2021/22, while policy decisions around medicines pricing and financing, and Brexit, have all contributed.

Brexit has lowered the value of the sterling and removed the UK from EU supply chains. It has also meant the UK is left out of EU efforts to mitigate the shortages, such as initiatives like the Critical Medicines Alliance, as well as efforts to bring medicines manufacturing back to Europe.

Additional customs checks at the border and greater regulation faced by manufacturers have also led some companies to remove the UK from their supply chains.

Professor Tamara Hervey, of the City Law School, said: “There is nothing inevitable about this ‘new normal’ where Great Britain is isolated in efforts to manage fragilities in global supply of the products and people we need to run the NHS. It is the consequence of policy choices and those could be different.”

Although the report warns that rebuilding the EU-UK health relationship more formally is not a current a priority for EU institutions and representative bodies, it outlines steps the UK government could take to address the issue without requiring renegotiation with the EU. These include anticipating shortages in advance, transparency around them, and taking care to ensure sudden squeezes on cost do not drive instability.

A spokesperson for the Department of Health and Social Care said: “Our priority is to ensure patients continue to get the treatments they need. There are around 14,000 licensed medicines and the overwhelming majority are in good supply.”

The report additionally found the UK’s medicines regulator has been slower to approve new medicines compared to the EU. Between 2022 and 2023, four drugs authorised by the European Commission had been approved faster in UK than in the EU. However, 56 had been approved later and eight had not been approved at all as of March 2024.

Several organisations and individuals are calling on the government to carry out a review of the medicines supply chain.

Dr Leyla Hannbeck, Chief Executive of the Association of Independent Multiple Pharmacies (AIMp), said: “The medicines supply chain is broken at every level and unless the Department of Health and Social Care reviews its processes and procedures, we will never achieve the stability that will guarantee patients their prescription when they need it.”

Louise Ansari, Chief Executive at Healthwatch England, has also urged the government to carry out such a review to “ensure medicine safety and resilience.”

The Royal Pharmaceutical Society has launched a project to investigate the shortages by convening stakeholders from across the supply chain, with recommendations expected later this year.

The recently concluded pharmacy inquiry, conducted by the Health and Social Care Select Committee, also extensively discussed the shortage issue and is therefore likely to make recommendations to government in the near future.

Medicines shortages have placed a significant burden upon many healthcare professionals, but particularly the pharmacy profession. Public Policy Projects (PPP) is contributing to the debate by convening pharmacy professionals as part of a programme to document the challenges and their impact on the wider sector. If you would like further information about PPP’s Pharmacy and Medicines Programme, please contact Samantha Semmeling, samantha.semmeling@publicpolicyprojects.com.