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News, Population Health

Innovating beyond digital: A comprehensive ICS approach to musculoskeletal care

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

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

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

The case for self-management

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

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

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

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

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

Enabling people to self-manage their recovery

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

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

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

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

Behaviour change model

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

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

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

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

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

The impact of digital self-management

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

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

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

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

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

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

List of references

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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News, Workforce

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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News, Population Health

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

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

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

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

Seizing opportunities

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

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

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

Agreeing priorities

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

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

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

Making suppliers part of the solution

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

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

Measuring impact

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

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

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

Where to start

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

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

Becky Jones, Social Value and Sustainability Lead, NHS Arden & GEM CSU
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Digital Implementation, News

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

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

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

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

Introduction of sickle cell care plans

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

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

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

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

National Record Locator integration

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

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

NHS App integration

Patients can now also access their UCP in the NHS App, which is another step towards putting patients at the heart of their care planning. It means patients can easily share their plans with healthcare professionals as they move around London and across the rest of the country.

In an emergency, patients may not be able to articulate or communicate their wishes and preferences, in which case they can defer to showing clinicians the plan on the app. The increased accessibility is also empowering patients to take a more active role in managing their information and ensuring it is up to date.

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

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

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

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

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

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Digital Implementation, News

Social care monitoring tech could free up two million bed days and save over £1.2bn for the NHS, new report finds

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New report highlights major potential of lifestyle monitoring technology to address immediate system-wide crisis across health and social care, finding that thousands could avoid hospitalisation from earlier detection of illness, avoiding more expensive residential care.

The NHS could save more than £1.2 billion through widespread use of new non-intrusive lifestyle monitoring technology in social care according to a new independent report. More than two million hospital bed days could be saved, and the extra capacity created in social care able to fund the equivalent of 10,000 additional full-time carers in the system by 2035.

These findings are part of new analysis commissioned by health-tech company Lilli to make the case for urgent digitisation across the health and social care sector. The report uses data from multiple local authorities across the UK who are currently using the AI-driven monitoring technology to address the growing care deficit and mounting social care crisis.

Entitled From passive to proactive: How monitoring technology can help to solve the health and social care crisis, the report follows recent social care promises from the new government to accelerate the adoption of technology in health and care and highlights the ‘domino effect’ that proactive monitoring employed in social care can have not just on council resources but also the NHS and patient outcomes.

It identifies hospital discharge as a key area that can see a significant impact from the technology. Earlier discharge would amount to 2.3 million additional bed days and almost £1.2bn in savings for the NHS, due to reduced costs of providing beds for patients over the next ten years – enough to pay the salaries of 2,000 nurses over the period. It would also lead to better health outcomes for the many thousands of people experiencing delayed discharge every day, with extended stays linked to higher risk of infections, adverse drug reactions and readmissions to hospital.

The report also finds that adopting monitoring technology now would save councils £3bn by 2035 by supporting people to live independently at home for longer and preventing thousands of people entering more expensive care settings, such as residential care. The productivity benefits would help to address the workforce crisis in care, by generating additional capacity equivalent to 94 million hours of carer time across the UK, or to having 10,000 extra care workers. These productivity benefits would be worth an estimated £1.8bn to councils, allowing vital resources to be redistributed to where they are most needed.

Lifestyle monitoring technology works by tracking patterns of behaviour and key indicators of health, such as movement, eating and bathroom activity, and alerting carers to any changes. This allows care professionals to quickly make accurate care assessments, and safely monitor people’s health at home remotely, while being on the front foot to proactively spot signs of health decline before conditions require hospital treatment. Urinary tract infections (UTIs) have been identified as a key area where monitoring technology can help prevent hospital admissions, and the report estimates that the NHS could make savings of £1.8m each year through reduced hospital admissions from UTIs, due to earlier intervention, which could pay for half a million hours of nursing time.

Rebecca Andrew, Service Improvement Manager from Nottinghamshire County Council, said: “The rollout of remote monitoring technology across Nottinghamshire allows our social care staff access to real time data, giving insights into a person’s behaviour over a period of time. This helps them to build a clear picture of what is going on in a person’s life and draw their attention to any potential change in their social care needs. This ensures we can put appropriate care and support in place that is personalised to the individual, and respond quickly to prevent crises, meaning fewer ambulance call outs and hospital admissions.”

According to the report, produced by economists at Policy Points, “there is strong evidence that lifestyle monitoring technology can generate essential, big-ticket savings for both the NHS and for social care, creating a digital dividend by protecting scarce hospital resources at the same time as boosting the productivity of carers”.

Kelly Hudson, Chief Executive Officer at Lilli, said: “Right now, the people who need care are not getting the help that they should, and the problem will only get worse as the population ages. The numbers in this report speak for themselves. The savings and productivity figures highlight the profound difference that an investment in technology now would have not just on the system but on the lives of people up and down the country.”

Lifestyle monitoring technology from Lilli is currently being used by multiple councils across the UK, including Islington, Nottingham and Reading, to enable people to live safely and independently at home.

The report goes on to explain how over the next ten years, the older population will ‘grow by millions’, increasing demand for its services, and for the health and care system to be sustainable, a commitment to overhauling the system at pace and scale is urgently needed. The alternative is a broken system that will continue to be reactive and is unable to meet the care needs of those who need it most.

Kelly Hudson adds: “We are supportive of the new Health Secretary’s ambition for a ‘different politics on social care’ and we urge the new government to tackle the current crisis proactively as they have pledged, by addressing the root cause of the issue. We are urgently calling for more support for the sector to adopt a technology led approach to better support the people in need, reduce wasted costs and deliver better outcomes.”

 

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News, Population Health, Thought Leadership

From fragmentation to integration: Lessons for the NHS from New Zealand

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When David Meates became CEO of New Zealand’s Canterbury District Health Board in 2009, he took charge of a system that was “broken and fragmented”. 11 years later, the system’s fortunes were transformed. At a recent event, Meates shared his experiences and lessons from Canterbury’s transformation, offering vital insight for the NHS as it continues its own journey from fragmentation to integration.

On 14th August, Public Policy Projects (PPP) held a dinner for a group of carefully selected stakeholders to share lessons from international and devolved nations on the delivery of integrated care. Speaking to the assembled guests was David Meates, who, while current interim CEO of Rowing NZ, was CEO of New Zealand’s Canterbury District Health Board (DHB) from 2009-2020. During his tenure, Canterbury DHB undertook an ambitious series of reforms aimed at integrating the fragmented elements of the health service, which turned the ailing system into one of the most integrated health systems anywhere in the world.

Many of the issues Canterbury faced have parallels within the NHS, and as such, it provides valuable lessons for UK health and care transformation. Prior to Meates’ arrival, Christchurch Hospital (the district’s largest) was regularly ‘gridlocked’ due to a shortage of beds, while a fragmented system and growing demand for services were damaging staff morale and the system’s ability to deliver effective healthcare.

Meates took charge of Canterbury DHB in 2009, and noted that by 2007, leaders had already realised the system was unsustainable and needed change. He described it as “broken and fragmented”, siloed by profession, dominated by providers and lacking clear purpose. Exponential increases in funding over preceding years had led to little-to-no improvement in service delivery, productivity or patient outcomes.

Christchurch Hospital, Christchurch, New Zealand

Without reform, the system would have required another 600-bed hospital, a 23 per cent increase in GP practices, 2,000 more aged care beds, and 9,000 additional healthcare professionals (HCPs), simply to meet demand. Meates remarked that even with the necessary funds, the workforce to do this was simply not available. What was needed, Meates determined, was a new blueprint for delivering healthcare to Canterbury’s more than half a million residents, as well as a burning platform that would inspire substantial change.

First steps: identifying the vision

Much of Canterbury DHB’s early work – under the umbrella of Project 2020 – focused on understanding the shared challenges that affect large and complex systems in other sectors, and how these insights could be applied to a healthcare environment. One key initiative was Xceler8, an eight-week experiential leadership development programme that involved 1,500 doctors, nurses, and allied healthcare professionals from across the Canterbury system. Participants, convened in cross-disciplinary groups, spent time with leaders in other sectors to understand their challenges. At the end of the programme, these groups presented ideas for system improvements to a chief executive, with some being subsequently implemented. Beyond the positive changes this brought about, the programme also helped to embed principles of system thinking among the workforce and demonstrated that each part of the system has a role to play in broader system improvement.

Other programmes included Particip8 (a six-week night-school course focusing on change management techniques), and Collabor8 (a short course focusing on skills management).

These programmes also sought to familiarise staff members with Lean and Six Sigma methodologies – prioritising customer value and continuous improvement – as well as chaos theory – the idea that beneath the apparent randomness of complex systems, there are underlying patterns and constant feedback loops that can be quantified, measured and understood.

Through these initiatives, system leaders began identifying commonalities and principles that extended beyond traditional approaches to healthcare system transformation, such as the concept of ‘value.’ While ‘value’ in other sectors might refer to profit or market capitalisation, it was determined that in a healthcare context, creating ‘value’ could be understood as not wasting patients’, and by extension, the system’s, time. This realisation led to the establishment of three strategic goals, forming a framework for “a connected system, centred around people, that aimed not to waste their time”.

  1. People take greater responsibility for their own health
    Prioritising the development of services that support people and families to stay well and take increased responsibility for their own health and wellbeing.
  2. People stay well in their own homes and communities
    Prioritising the development of primary care and community services to support people and families in community-based settings, close to home, and to provide a point of ongoing contact and continuity – for most, this is in general practice.
  3. People receive timely and appropriate care
    Enabling the freeing-up of hospital-based specialist resources which can be responsive to episodic events and the provision of complex care and specialist advice to primary care.

These initiatives also led to a realisation that regardless of how fragmented a system may seem, all components form part of the same ecosystem. Shuffling patients around to meet ‘activity’ targets benefits the system little, whereas prioritising the patient’s best interests—minimising their time spent while achieving the best possible outcomes—benefits both the patients and the entire system. This insight gave rise to the principle of “One system: One budget”, which became the foundation for all subsequent reforms within Canterbury DHB.

One system: One budget

These guiding principles informed the first series of practical changes that Canterbury DHB implemented to better integrate the system and create better value both for patients and the wider system.

A crucial development was the creation of the community-based HealthPathways, aimed at improving the interface between secondary and primary care. This programme was initiated by clinicians who, after reviewing a backlog of referrals, identified that many common issues could have been prevented through better communication between hospitals and primary care providers. General practitioners and hospital specialists were then brought together to agree on optimal management and referral pathways for specific conditions. These pathways were subsequently presented to larger groups of hospital doctors, GPs, nurses, and HCPs for their input. Meates reflected on the traction that HealthPathways was gaining as an approach in the Northern hemisphere, with systems in England and Wales adopting the methodology as the operating system for their integrated systems.

A key lesson from Project 2020, as Meates has argued, is that “too often, we confuse activity with progress,” a criticism frequently directed at the NHS’s Payment by Results tariff system. To better align incentives across the Canterbury system, this approach was abandoned in favour of the newly established Canterbury Health System Outcomes Framework. This change supported the principle of “One System: One Budget,” ensuring that the various components of the system would now be rewarded for achieving the best outcomes for the system or the patient, rather than merely moving patients around and being compensated for this ‘activity.’

Another change was the establishment of the Canterbury Clinical Network – a collaborative of HCPs, health system users and cross-sector partners using a principles-based framework to decide how, when and where health services are provided. These principles included taking a whole systems approach to ensure the integration and sustainability of services, ensuring that people and communities were at the centre of any changes, enabling clinically led service development, and the system operating within its financial means. Crucially, while commissioners were involved, their role was to support the process and then work out how to realise the objectives, not to prescribe the objectives themselves.

An important step towards service integration was also made by the establishment of a connected data platform – HealthOne – an electronic shared care record combining GP, hospital and community pharmacy records, along with laboratory and imaging results. Since this was not replacing existing systems, but drawing on them, its implementation was relatively non-disruptive and enabled the scope of the records to be increased over time. Citizens could opt out of all or part of the system, with the process led by the system’s Consumer Council, while regular “dynamic” automated privacy audits ensured that patient privacy was always prioritised.

Reflections

In reflecting on Canterbury DHB’s transformation journey, Meates was wary of simplistic quick fixes to complex, systemic problems, and the importance of taking a holistic and long-term approach with any proposed solutions. “You need a whole system to work for the whole system to work – focusing on part of the system will not effect the change required,” he told the assembled guests. Considering this, during its transformation Canterbury DHB paid special attention to the language it used to refer to the system and its workforce, emphasising the use of “we” in official communications, and deliberately halting the use of language which went counter to the narrative of a single system.

The principles of integration and collaboration must also be reflected in the redesign of services and pathways by actively involving relevant stakeholders and ensuring their voices are heard. Meates emphasised that “change happens at the speed of trust,” which requires meaningful engagement with frontline teams, as well as input from the clinicians who will deliver the services and the communities who will use them.

Meates also cautioned that in any large-scale system transformation, facilitating cultural change among the people involved is as crucial as any change in process or structure. With the introduction of integrated care systems and their emphasis on collaboration over competition (a significant departure from the previous way of commissioning services), this is a point the NHS could do well to acknowledge. “You can’t expect the same people that have worked in a competitive environment and who have seen their success tied to the success of their organisation to suddenly collaborate,” said Meates. This is a case of both instilling that necessary cultural change, but also of facilitating systems to be collaborative, such as by realigning incentives towards system outcomes as opposed to individual organisational sustainability.

The cultural dimension is also highly relevant to funding issues, as “too often, these involve win/lose discussions” where different parts of a system manage their activity levels to safeguard their budgets and maintain status within the broader system. While outcomes-based remuneration is undoubtedly a key solution, it is equally important to embrace the idea that the best outcome for patients is also the best outcome for the system and its individual components.

On a practical level, Meates emphasised that although reforming contracts can be the most challenging area, it is perhaps the most critical. Contracts significantly limit what healthcare providers can do and how they operate, making them essential enablers of any strategic change. “While the goal is integration,” Meates argued, this is undermined if “existing contracts and reporting requirements continue to move in the opposite direction. Contracts give you all the reasons why you can’t change what you are doing.”

Conclusions for the NHS

The transformative journey of Canterbury DHB under David Meates offers critical insights for the NHS as it continues its transitions towards integrated care. The success of Canterbury’s reforms, driven by a commitment to collaboration, system-wide integration, and a focus on patient-centred outcomes, illustrates the importance of addressing systemic fragmentation holistically. According to Meates, people in Canterbury were “30 percent less likely to be admitted medically unwell compared with the rest of New Zealand” because of these reforms.

Canterbury DHB’s experience shows that applying process and quality improvement techniques like Lean and Six Sigma to complex systems such as healthcare is no simple task; it demands a long-term vision and strong commitment from leadership to act. For too long, the NHS has been consumed by day-to-day pressures, and the introduction of ICSs has not been accompanied by the necessary cultural changes that can only clear, top-down strategic direction can bring.

Additionally, while the NHS has sought to place greater emphasis on citizen-centred care, it still often fails to adequately engage marginalised communities and provide co-designed, holistic care services that meet their needs. The establishment of community diagnostic centres is certainly a positive step in this regard, more needs to be done to ensure that these services are accessible and tailored to the unique challenges faced by marginalised and underserved groups. This includes overcoming language barriers, addressing cultural sensitivities and ensuring that services are easily reachable for those most in need. Citizen-centred care required continuous engagement with these communities, fostering trust and enabling them to have an active role in shaping their own health outcomes.

Key lessons from Canterbury DHB include prioritising cultural change, realigning incentives to emphasise system-wide benefits, ongoing community and patient engagement and leveraging technology like shared care records to enhance communication across care settings. By adopting these principles, the NHS can achieve meaningful, sustainable reforms that deliver value for both patients and the wider healthcare system.

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News, Workforce

Labour urged to support and protect NHS’ temporary healthcare workforce

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The UK’s temporary healthcare workforce needs championing and protecting, suggests the Recruitment and Employment Confederation (REC), as it launches its people-first ‘Voice of the Worker’ campaign. 

The Recruitment and Employment Confederation (REC) is urging the government to champion the UK’s temporary healthcare workforce, with the launch of it’s people-first ‘Voice of the Worker’ campaign.

The campaign comes as the new government is pushing on with its Employment Rights Bill within its first 100 days in power.

The move has sparked robust debate regarding recruitment and employment, because highly regulated agency work already offers employment rights and in-work progression. There are fears that anticipated changes to employment rules could put the temporary worker market at risk.

Further, the new government’s launch of Skills England will also create more opportunities for temporary and contract workers to upskill as the Apprenticeship Levy is reformed. Although not confirmed, the government is expected to expand the Apprenticeship Levy into a ‘Growth and Skills Levy’, allowing companies to use 50 per cent of their levy contributions to fund training via routes other than apprenticeships.

Temporary healthcare work is key in helping the NHS deal with disparate and fluctuating demand, and with the right regulations in place, enable workers greater flexibility in work and control over their work-life balance.

Neil Carberry, REC Chief Executive, said: “Flexibility at work is something to feel optimistic about. It is working for millions of people. Individual choice and employers’ need for a versatile workforce can be brought together to deliver better careers and higher productivity. The government must ensure new rules support temps and that means having a real understanding of their lives.”

REC’s campaign aims to show how and why temping can work for many individuals by placing the real-life stories of temps, including those working in healthcare, at its heart. The campaign urges government, employers and unions to collaborate more closely to support the UK’s growing temporary workforce.

For the campaign, REC commissioned Whitestone Insight to interview 520 temp agency workers across different sectors – not just health – in Britain in June 2024, to hear their thoughts about agency work and why it matters to them. Polling found:

  • Almost eight in 10 temp agency workers (79 per cent) said their work provides an important need for flexibility.
  • More than two thirds of temp agency workers (68 per cent) said that their work provides a greater work-life balance.
  • More than half of temp agency workers (53 per cent) believed that this is the right kind of role for their current stage in life – an active choice.

REC says it hopes its ‘Voice of the Worker’ campaign will prompt far more discussion about reform of the public sector, with public services clearly struggling with demand. Temporary workers are critical in enabling the NHS to deliver services, helping to retain skilled people in the workforce and provide solutions to NHS trusts. But NHS policies for frameworks and banks have reduced the attraction of working for the NHS for medical staff – and forced trusts to use more and more emergency shifts. By reforming frameworks, their rates and the approach taken to permanent staffing, the new government could reduce costs and get better results for patients and the Treasury. But a proper partnership is needed to achieve this, the REC argues.

Neil Carberry added: “Government has repeatedly made the same mistakes in NHS staffing for almost a decade – trying to pay agency staff less year-on-year than they pay substantive staff. And pretending that Banks are cheaper to the exchequer. The result of this is that there are more emergency shifts as medics reject shifts, and spending overall has gone up. Moving on from demonising agency nurses and doctors and other clinicians – and the agencies that supply them – and working in partnership with the sector on a new approach to procurement will give the new government a unique opportunity to build a sustainable supply of short-term staff, at high quality and value for both patient and taxpayer.

“Good and lasting workforce changes that are effective for workers and employers, happen when employers and government work together to determine what works for everyone. Our case studies show the difference talented agency and contract staff are already making in our health service.”

This autumn, the REC will highlight video and written case studies of temporary workers, in which they explain the reasons for wanting flexibility and the benefits of temp working, across a variety of sectors.

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News

Is the UK health system underfunded and underprepared?

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Managing patient care in a digital environment is a challenge to navigate for any health services. The need to store accurate patient healthcare records and share these electronically is undeniable. However, the ability for these systems to communicate across platforms while remaining secure is a bottleneck yet to be unplugged.

The recent cyber attack on Synnovis – a company that provides diagnostics, testing and digital pathology services for hospitals, GPs and other NHS healthcare providers – has highlighted the vital importance of cybersecurity and the potential disruption supply chain organisations can cause.

Consequently, to minimise future disruptions, the Labour government has introduced a Cyber Security and Resilience Bill. While this is a step in the right direction, before enhancing cybersecurity, the government must first ensure that the NHS receives the necessary funding to modernise its IT infrastructure.

Arguably, while the significant disruption across the NHS caused by incidents like the Synnovis attack and the CrowdStrike outage – the largest outage in history – are not the result of strained budgets, some healthcare organisations do struggle to make the necessary investments in cybersecurity when the priority lies with bettering patient outcomes.

While the NHS Chief Executive has warned that there is no financial headroom this year following a £22bn deficit in the nation’s finances, it is imperative for the government to prioritise and allocate increased funding to the NHS or else take a risk with the country’s healthcare.

The importance of adequate funding

The Cyber Security and Resilience Bill is a good start towards better cyber defences. However, it overlooks how critical it is to dedicate adequate funding to public service IT operations, including cybersecurity. The reliance of UK public service organisations on outdated IT systems and insufficient resources for basic cyber hygiene make it an easy target for cyber attacks.

Enlisting the latest AI-enabled cybersecurity technology without first preparing IT foundations is a misstep many organisations make. Existing architectures and systems must first be interoperable in order to integrate new software into the infrastructure. Without taking the first step to overhaul and modernise legacy systems, we essentially plaster over the cracks that will inevitably appear.

The UK government faces a tough challenge here, particularly considering that the volume of cyber attacks on critical infrastructure is on the increase. To prevent potentially catastrophic breaches like those we have witnessed across the NHS in recent years, officials must make funds readily available for critical infrastructure organisations like the NHS, to build cyber resilience and protect its citizens.

The value of our health

There are various industries under particular threat from cybercriminals with nefarious agendas. Telecommunications is a core industry that criminals can use to gather and sort information that provides intelligence on individuals and organisations. Transport is critical infrastructure, but it’s now rooted in IP (Internet Protocol) which lays out the location of vehicles, containers, delivery addresses and tracking systems among other sensitive information. This crosses over when you think about healthcare and the emergency services. Blue light services like ambulances are also at risk of being hacked and derailed if not protected properly but healthcare overall is essentially a high value data industry.

Healthcare organisations handle extensive personal health information, comprising medical histories, lab results, and insurance details. This data is extremely sensitive, potentially embarrassing and holds significant value for cybercriminals. The risks are further amplified by the growing connectivity within healthcare systems, where patient data is shared across networks and accessed through various applications, including APIs (Application Programming Interfaces). Hence, protecting sensitive patient data is the top priority in the healthcare industry.

Enabling digital and physical health

Maintaining confidentiality in healthcare involves ensuring the security and privacy of electronic data. To do this, NHS trusts need tools. However, with limited budgets in place this can be a challenge.

In this situation, using technology that is multifaceted rather than solely focused on security offers the ability to monitor security but also document compliance, while providing visibility into performance and availability.

Additionally, trusts would do well to collect the data that matters. Collecting reams of data with limited tools will only serve to overwhelm systems and professionals. The NHS should first determine its risk tolerance level and then seek to collate data from a minimum of six areas – Identity and Access Management, Audit and Accountability, Continuous Controls Monitoring, Configuration and Change Management, System Communications and Protection, and Incident Detection and Response. Minimising the data collected allows for better governance of that data.

The use of forensics from previous attacks also provides an insight into the vulnerabilities of systems. Reviewing the details of past cyber breaches is a great way for organisations to examine their security posture to find gaps that need filling with tools, processes or people that can reinforce their cybersecurity strategies.

Considering the vast amount of information contained in a single electronic health record, it’s no surprise that they continue to be a target for cybercriminals. Unfortunately, despite an organisation’s risk posture, a cybersecurity event, to varying levels of severity, is inevitable. In those instances, properly collected event log data can provide visibility into the hackers’ journey through infrastructure, networks, devices and software.

While there are some preventable steps that healthcare organisations can take to protect their patients’ trust within critical infrastructures, ultimately the robustness of a cybersecurity posture depends on the intricacy of the policy, the depth of the strategy, and the accuracy of the tools implemented. The strategy is free, the implementation however, is priceless. Our new Labour government would do well to bear this in mind while considering the UK’s digital future and its safety.

Ross Brewer is VP and Managing Director EMEA at Graylog.

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News

Preventing tragedies: The role of advanced sensors in mental health units

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Clive Hudson, CEO of Programify, discusses the importance of door tampering and proof-of-life sensors in mental health units, giving staff the tools they need to provide the best possible care and to prevent tragedies.

CW: This article contains mention of suicide.

A critical issue facing mental health units is the need for advanced safety measures. Indeed, mental health units face unique challenges when it comes to patient safety. One report from the UK showed that 77 per cent of in-hospital suicides between 1999 and 2007 were by hanging. The most common anchor points were doors, hooks or handles, windows, belts, sheets or towels. The use of shoelaces, doors and windows increased over time.

Despite rigorous efforts to eliminate these potential ligature points, mental health units face an ongoing challenge with a crucial weak spot: the patient room door. While other fixtures and items that could be used for self-harm have been systematically removed or redesigned, doors remain an essential yet vulnerable element in the care environment.

A report on suicides that had taken place in Veterans Affairs Hospitals in the US showed that a door, door handle, or door hinge was the most used fixture point (53.8 per cent) in hangings.

Traditional safety measures, while important, have limitations. Hourly checks and standard door alarms may not be sufficient to prevent determined individuals from harming themselves. This is where innovative technology, such as door tampering sensors and proof-of-life sensors, can play a crucial role in enhancing patient safety.

Advanced technology for continuous monitoring

Door tampering sensors are sophisticated devices designed to detect any unusual pressure on any one of the three exposed edges of a door. Unlike simple alarms, these sensors use advanced technology to continuously monitor the door’s status and the integrity of the sensor circuits themselves. One key feature of these door tampering sensors is the use of end-of-line resistors. This technology allows for constant monitoring of the electrical connection between the sensor and the central system. If the line is cut or shorted, the system immediately detects the issue, ensuring that the sensor is always operational.

The sensors are designed to be sensitive enough to detect even slight pressure changes, which could indicate a suicide attempt, while also being robust enough to avoid false alarms from normal door usage.

Implementing door tampering sensors in mental health units offers numerous advantages. By providing real-time monitoring, these sensors can alert staff immediately to potential suicide attempts, allowing for rapid intervention. Sensors can be installed on all doors, including ensuites, ensuring no blind spots in monitoring.

While not replacing human oversight, these sensors provide an additional layer of security, allowing staff to focus on patient care with the assurance of technological backup.

These sensors can provide valuable data on door usage patterns, potentially helping to identify at-risk behaviours or times of increased vulnerability such as sickness. It is also critical that anti-door tampering sensors can be integrated with central monitoring systems, providing a comprehensive view of the entire unit’s safety status.

Future innovations and ethical considerations

The field of mental health safety technology is continuing to evolve, and door tampering sensors are just the beginning. At Programify, we’re also developing “proof-of-life” sensors that use high-resolution radar technology to detect subtle movements indicating breathing or other signs of movement within a room.

These sensors, when combined with door tampering sensors, could provide an even more comprehensive safety net. Imagine a system that not only alerts staff to potential door tampering but also monitors patient movement and can flag unusual periods of inactivity.

While implementing advanced monitoring technology, we must always be mindful of patient privacy and dignity. Our systems are designed to be as unobtrusive as possible, avoiding video surveillance in favour of movement detection. The data collected is anonymised, focusing on patterns and alerts rather than individual identification.

It is crucial that mental health units implementing these technologies have clear policies on data usage and storage, ensuring that patient rights are respected while maintaining safety.

Choosing your technology partner

Mental health units considering the adoption of door tampering sensors or other advanced safety technologies should work directly with the designer-manufacturer to ensure they get technology specifically designed for mental health environments. The designer-manufacturer must also be willing to be flexible to allow for customisation to the hospital’s specific needs. This approach offers several advantages. Firstly, it ensures that the technology is purpose-built for the unique challenges of mental health settings, rather than being adapted from other applications. Secondly, it allows for a more streamlined service and direct access to the expertise behind the product.

When selecting a supplier, it is important that health care procurers enquire about their design process. Have they developed the technology in-house, or are they reselling off-the-shelf components? A company that designs, manufactures and programs their own systems is better positioned to provide tailored solutions and ongoing support. It will also be easier for them to adapt the technology to integrate with existing systems and processes.

It may also be worth starting with a trial implementation. Many companies, including Programify, offer trial programmes where you can test the technology in one or two high-risk rooms before committing to a full rollout. This allows staff to become familiar with the system and provides an opportunity to assess its effectiveness in your specific environment.

Remember, the goal is not just to install sensors, but to create a comprehensive safety system that enhances your staff’s ability to protect patients. The right technology partner will understand this and work with you to achieve it.

It is also important that any new sensors can be integrated with your current monitoring and alarm systems for seamless operation. Proper training is crucial to ensure that staff can effectively use and respond to the new technology. You must also continuously assess the effectiveness of the system and be open to upgrades or adjustments as needed.

As we continue to face the challenge of ensuring patient safety in mental health units, innovative technologies like door tampering sensors and proof-of-life sensors offer a promising solution. By providing constant, reliable monitoring, these sensors can help prevent tragedies and give staff the tools they need to provide the best possible care.

Clive Hudson, CEO of Programify
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News

AI study seeking to improve the prevention and management of pressure ulcers

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The new research study has launched at Doncaster and Bassetlaw Teaching Hospitals (DBTH), with researchers hoping to share their findings across the NHS to help diminish the incidence and severity of pressure ulcers.

A new AI-powered research project is using patient data, including age, height, weight, pressure ulcer risk factors and stage of ulcer, to help improve clinical understanding around the prevention and management of pressure ulcers.

Pressure ulcers are when an area of skin becomes distressed due to prolonged contact with another surface, causing an injury to the underlying tissue. They are sometimes known as ‘pressure sores’ and ‘bedsores’. Daily, the NHS spends over £1.4 million on treating pressure ulcers.

The study aims to tackle this using an AI tool to develop for each patient a personalised care plan based on expected outcomes, suggesting a treatment plan which is also the most efficient and effective treatment, as well as holding the lowest carbon and economic cost.

The study, conducted by Scientists at Tunley Environmental, is currently in its early stages at DBTH, the only NHS Trust involved. Tunley Environmental’s team also works on initiatives in other sectors such as healthcare optimisation, utilising in-house PhD specialisations in artificial intelligence development.

This work was commissioned and funded by SBRI Healthcare. SBRI Healthcare is an Accelerated Access Collaborative (AAC) initiative, in partnership with the Health Innovation Network. The views expressed in the publication are those of the author(s) and not necessarily those of SBRI Healthcare or its stakeholders.

The study is currently in its data collection stage, meaning that clinicians are collecting anonymised data about patients with pressure ulcers, pressure ulcer prevention and treatment plans, and the outcomes and then feeding this data to the AI tool.

An example of required data that is collected is as follows:

  • Basic patient data
  • Category of ulcer
  • Clinical pathway

The data collection phase will last for around a year and then move into the second phase, where, based on the past data it has collected, the AI tool will suggest a personalised clinical pathway for a patient based on all the factors above and considering the economic and carbon cost.

Kelly Phillips, Lead Nurse for the Skin Integrity Team at DBTH, said of the study: “We’re so excited to be involved in this research project, not only will it enable the associated economic and carbon impacts of pressure ulceration incidences and severity to be established but will ultimately be able to predict a truly personalised prevention or treatment pathway for our patients at risk of or living with a pressure ulcer.

“Removing clinical judgement when it comes to developing a personalised prevention or treatment pathway will not only save time, reduce variation in care but will be based on data and evidence, thereby providing that assurance to the patient and the healthcare professional that the right care is being provided at the right time’’.

Dr Nathan Wood, Senior Scientist and LCA Lead at Tunley Environmental, said “It is an exciting project with a lot of scope to make a positive difference to the management of pressure ulcers and make a meaningful impact on patient care”

In the future, the researchers hope to share their findings and tools across the NHS to help diminish the incidence and severity of pressure ulcers and to address the associated economic and carbon impacts of treatment pathways.

To read a full overview of the project and the AI tool, visit Tunley’s webpage here: https://www.tunley-environmental.com/pu-cpa-tool-for-pressure-ulcers

To find out more about how you can be involved in Research at DBTH please visit the dedicated page: Research and Innovation at Doncaster and Bassetlaw Teaching Hospitals – Doncaster and Bassetlaw Teaching Hospitals (dbth.nhs.uk)

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