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News

Dartford and Gravesham NHS Trust goes live with ‘big bang’ EPMA deployment

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The implementation of the Better Meds electronic prescribing and medication management system took place over a single weekend, thanks to the efforts of more than 200 staff from across the NHS Kent and Medway Integrated Care System.

Dartford and Gravesham NHS Trust has successfully implemented the Better Meds electronic prescribing and medicine management (EPMA) system across all 18 adult inpatient wards at Darent Valley Hospital. The system, integrated with the trust’s electronic patient records (EPR) provided by Alcidion, was deployed over a single weekend to enhance medication safety and efficiency.

During the two-day transition, more than 500 paper drug charts and 8,000 prescriptions were digitised by a dedicated clinical team, with a team of healthcare staff and digital support assisting throughout the process.

Dr Guy Sisson, Chief Clinical Informatics Officer at the trust, highlighted the collaborative effort: “The implementation was an incredible effort with months of planning which led to over 200 healthcare staff from across the integrated care system joining forces to support the go-live weekend.”

The EPMA system is designed to streamline medication administration and prescribing, reducing time spent on these tasks and improving workflows for both nurses and doctors. Early feedback from staff indicates faster medication rounds and more efficient prescribing. The system also features decision support, including drug interaction alerts, high-dose alerts and allergy checks, enhancing patient safety and offering reassurance to staff providing care.

Additionally, the EPMA system provides real-time access to dose-level data, which was previously data-based, enabling the trust to analyse and improve medication safety practices, further improving patient care quality.

Julia Scott, Pharmacist and Senior Responsible Owner for the EPR Programme said: “This Better Meds implementation will allow us to deliver medication safety improvements on a whole-system scale. EPMA allows us to implement strong barriers to error for high-risk medication, whereas in the past we were reliant on weak barriers such as training and guidelines. We can also build data-driven safety nets to allow us to rapidly identify potential high-risk prescribing and intervene quickly. It is genuinely transformative when it comes to a human factor’s approach to safety”.

Dr Guy Sisson added: “Our vision is to be an outstanding hospital trust providing the best possible care for our patients that is safe, well-coordinated, in the right place and designed around the person’s needs. Our new EPMA system is perfectly aligned and a true digital representation of our aspirations. I want to congratulate everyone involved and personally thank them for getting the system over the line, which is a monumental step towards where we want to be.”

In 2019, Dartford and Gravesham procured Alcidion’s Miya Precision to advance its digital maturity. By integrating Better Meds’ electronic prescribing into the Alcidion EPR, drug information is now seamlessly connected with patient assessments, allergies, key lab results, and more. This enhances safety for prescribers and saves clinicians time by offering standardised order sets and allowing multiple users to view and use the medication record simultaneously.

Future phases of the implementation will include outpatient clinics and other speciality areas, such as maternity and paediatrics. It will also be rolled out across inpatient wards at the trust’s other main site, Queen Mary’s Hospital, to support surgical elective care.

Alja Babič, Better Meds Implementation Consultancy Lead at Better, said: “It’s been a pleasure supporting Dartford and Gravesham NHS Trust to optimise prescribing and medicine management. The ‘big bang’ rollout was one of the best we’ve been involved in. It was smooth, well-planned and expertly managed, and the team should be extremely pleased with the progress made. Dartford and Gravesham’s commitment and great energy have been clear while working together.  We are celebrating this being our 9th Better Meds go-live in the UK and look forward to working further on improving medication management processes.”

Kate Quirke, Alcidion CEO, said: “It was inspiring to witness the dedication and extensive collaboration that led to the success of this rollout. We are proud to support Dartford and Gravesham NHS Trust as they continue to expand and improve upon their digital infrastructure. We are also grateful for our partners like Better, who share in our belief that smart technology can drive meaningful change. We look forward to continuing this journey together, building on our joint commitment to innovation and progress.”

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Health Inequality, News

NHS failing in mental health support for kidney cancer patients

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A new report from Kidney Cancer UK reveals a failure in providing vital mental health support for those diagnosed with kidney cancer in the UK.

A new report combining ten years of data from the Kidney Cancer UK Annual Patient Survey has highlighted ongoing failures in providing vital mental health support to those diagnosed with kidney cancer – currently the 7th most common cancer in UK adults. The findings show that many patients are being let down in some of the most basic areas, impacting their ability to navigate their kidney cancer diagnosis and treatment journey with resilience and hope.

However, the charity believes support services can be improved at minimal cost through greater collaboration with charities that have experience in counselling and supporting kidney cancer patients.

The report, titled ‘Navigating the impact of kidney cancer: A decade insight into patient care and mental health’, is asking for simple changes such as:

  • Providing patients with the contact details of their CNS (clinical nurse specialist) for direct support.
  • Signposting to reliable information on treatments and surgery options
  • Advising patients on how to access counselling to help with the shock of a cancer diagnosis.

Many patients are being failed in some of the most basic areas. For example, 37 per cent of those surveyed were unhappy with the way they were told they had kidney cancer, 30 per cent were not given the name of a CNS and an average of 29 per cent felt abandoned after surgery. Given the minimal cost needed to improve services, the charity is calling for the NHS to implement policies to ensure charities are a higher priority in the healthcare professionals support pathway.

With over 3,200 patients taking part in the Kidney Cancer UK Patient Surveys across the past decade, this is one of the most extensive independent kidney cancer surveys ever undertaken and has led the charity to call for the NHS to implement policies ensuring that charities are more of a priority in the healthcare professionals support pathway.

Malcolm Packer, CEO of Kidney Cancer UK, commented: “We need a nuanced approach to patient care, one that prioritises mental health – as well as physical health. The role of timely, relevant information to individuals with kidney cancer cannot be underestimated, and as a charity we consistently see those who have their information needs met after the shock of diagnosis or following treatment generally experience far better mental health outcomes.

“This comprehensive report combining a decade’s worth of data from kidney cancer patients provides valuable insights into how healthcare professionals and patient organisations can collaborate to meet the complex needs of kidney cancer patients, ensuring they receive the support necessary to navigate their diagnosis and treatment journey with resilience and hope.”

Dr Kate Fife, Consultant Clinical Oncologist at Addenbrooke’s Hospital Cambridge, added: “It is very disappointing to see that 37 per cent of patients are unhappy with the way they were given their kidney cancer diagnosis. Sensitive and clear patient communication is very much a priority for healthcare professionals, but despite training in communication, delivering news of a cancer diagnosis has not improved over the last 10 years of surveys.

“Couple this with the news that there is no change in the amount of information and support shared following diagnosis, the message to healthcare professionals everywhere is that we need to be more sensitive in our actions and work closer with Charities to help better support all cancer patients. There is clearly much room for improvement.”
The 11th annual Kidney Cancer UK Patient Survey is now open, and the Charity is calling for all kidney cancer patients, past or present, to complete the survey. To take the latest annual survey click here.

 
You can read the full report here. For support and information relating to kidney cancer visit www.kcuk.org.uk.

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News, Workforce

Pandemic reflections: What we’ve learned from professional South Asian women in the NHS

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Women from the BAME (Black, Asian, and Minority Ethnic) communities working in the NHS faced unique challenges and risks during the pandemic. Dr Saleema Kauser and Dr Ana-Paula Figueiredo interviewed women working in the NHS to hear the challenges they faced.

Ethnic minorities in the NHS encountered unique challenges during the pandemic, underscoring significant systemic issues within the NHS. Indeed, the pandemic served as a magnifying glass, revealing the vulnerabilities of healthcare systems across the world and the particular pressures faced by ethnic minorities within these systems.

For Asian women in the NHS, these pressures included not only the health risks from being on the front line. Their critical role in the healthcare response also positioned them at the intersection of race, gender, and professional risk.

This demanded focused research to dissect these overlapping vulnerabilities, and that is precisely what this project has been doing – researching the key insights and pivotal lessons that can be learned by interviewing professional South Asian women working in the NHS. Our research broke down into seven key areas of insight:

Preparedness and resilience

Many respondents noted that while the pandemic was challenging for everyone, it was particularly severe for ethnic minority women. A key issue highlighted was the inadequate distribution of personal protective equipment (PPE), which disproportionately affected these women, often leaving them on the front lines without adequate protection.

This lack of resources was compounded by delayed responses from management, who were slow to implement necessary safety measures. These delays not only heightened the risk of virus transmission but also highlighted a failure in crisis management that left staff feeling vulnerable and undervalued. Nearly all of our participants underlined the need for more proactive planning, robust health systems preparedness, resilience planning and the immediate provision of adequate resources like PPE.

Culture, leadership and behaviour

Many participants discussed a lack of cultural competence in healthcare provision and in managing ethnic minority staff. They called for more diversity in leadership roles within the NHS to provide insights into the lived experiences of different communities and to facilitate fair treatment and prevention strategies.

There is a clear need to integrate cultural competence training across all levels of the NHS. This training should target not only clinical staff but also management teams to ensure that decision-making reflects an understanding of the diverse cultural backgrounds of both patients and staff. The women also emphasised the need for regular assessments and feedback mechanisms to ensure that the needs and views of ethnic minority staff are being met.

Empowerment through awareness and advocacy

Women spoke about how enhancing advocacy could have led to significant improvements in addressing workplace inequalities and ensuring that all staff, particularly ethnic minorities, had the knowledge and tools to advocate for safer and more equitable working conditions.

Many participants emphasised how understanding their legal and organisational protections during the pandemic empowered them to advocate more effectively for themselves and their colleagues, and expressed a desire for more channels to raise their concerns. Some participants also felt there was a need to promote leadership roles for ethnic minorities specifically through leadership development programmes that target ethnic minority groups. This would help diversify the voices in NHS decision-making processes.

Transparent communication and focus on EDI

Clear, consistent, and transparent communication from healthcare leadership is critical during a crisis. The pandemic exposed a number of deficiencies in communication that often left women staff feeling confused and fearful. Many suggested that future strategies should focus on improving lines of communication, addressing staff concerns with empathy, and providing clear guidance on safety measures and operational changes, especially for those in high-risk roles.

Many participants expressed that information often did not reach them in a timely fashion or was not fully accessible, was only selectively shared or, in some cases, not shared at all in instances where white managers did not see BAME colleagues as full team members. They also felt excluded from decision-making processes, particularly those decisions that affected their work conditions directly during the pandemic.

Workforce support and sustainability

The dual burden of professional duties and domestic responsibilities was evident during the pandemic, especially for working mothers. It is crucial for healthcare systems to create and maintain support structures that help women manage this balance without compromising their health and well-being. Recognising and actively supporting the work-life balance during crises is essential in reducing burnout and maintaining high levels of care. Those in high-exposure areas such as COVID-19 wards faced intense pressure to manage work risks and family health.

Providing mental health support systems that are robust during and after crises is also essential. The women in our sample faced increased psychological impacts due to systemic biases and high-pressure roles during the pandemic.

Recognition and response to systemic inequities

Our data highlighted a deeply entrenched lack of recognition and systemic inequities towards South Asian women during the pandemic. The most significant was the systemic inequity around the distribution of PPE and critical resources. Participants often found themselves on the front lines without adequate protection, highlighting a stark neglect in the safeguarding of these workers compared to their white counterparts. Such disparities were not only a matter of resource allocation but also reflected deeper racial prejudices and a failure to recognise the equal worth and rights of ethnic minority workers.

Government and NHS coordination

Many participants discussed the need for a well-coordinated response between the government and NHS, which they felt was lacking. The lack of unity in their responses was a significant concern.

The general view was that in the long-term, healthcare policy reforms should focus on making the system fairer and more inclusive, especially in light of the inequalities exposed by the pandemic. This involves re-evaluating existing policies to ensure they truly serve and protect all healthcare workers, with extra attention given to those who are most at risk or disadvantaged.

Our data indicates that the disparities revealed during the pandemic demonstrated that the normal way of doing things wasn’t effective or fair for everyone, particularly minority women healthcare workers who often faced greater risks and fewer protections.

Our work highlighted the urgent need for systemic changes that promote equity, cultural competence, effective communication, and empowerment. By addressing these key areas, the NHS—and healthcare systems worldwide—can not only better prepare for future crises but also create a more just and supportive environment for all healthcare professionals.

The pandemic underlined the importance of the health and social care workforce, who faced extreme pressures. Ensuring the wellbeing, adequate staffing, and continuous professional development of healthcare workers is vital for sustaining health services during and beyond and future crisis.

Dr Ana-Paula Figueiredo, Researcher, Alliance Manchester Business School
Dr Saleema Kauser, Senior Lecturer and Associate Professor in Business Ethics and Strategy, Alliance Manchester Business School
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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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