New data reveals mental health toll on NHS staff

By Integrated Care Journal

Despite challenges facing the service, the NHS remains one of the UK’s most loved institutions, says survey data, as NHS Charities Together launches new campaign urging public to continue supporting NHS and its staff.

More than three quarters (76 per cent) of NHS staff surveyed said they have experienced a mental health condition in the last year, according to new data collected by NHS Charities Together. Conducted by YouGov on behalf of the charity, the survey of more than 1000* NHS professionals also found that 52 per cent reported experiencing anxiety and 51 per cent reported struggling with low mood.

More than two-fifths of respondents (42 per cent) said they had experienced exhaustion in the last year, while three in five (60 per cent) reported feeling concerned for the mental health of colleagues.

Despite these challenges, however, 79 per cent of respondents said they feel proud to work for the NHS and 68 per cent said that they are unlikely to leave within the next 12 months.

The survey reveals the impact of increasing pressure on NHS staff, who are now subject to ‘winter pressures’ throughout the year, and are increasingly facing high workloads, long and unsociable hours and exposure to traumatic, stressful events. 96 per cent of those surveyed said they believe that overall pressure on NHS services is growing, and 69 per cent said that morale is the lowest they have ever experienced. A similar number (70 per cent) said that work-related stress has negatively impacted their mental health in the last year.

The release of these findings comes alongside the launch of a new campaign from NHS Charities Together called Support Goes Both Ways, which aims to raise awareness of need to continue to support NHS staff, so that they can best support the public.

Commenting on the findings, Ellie Orton OBE, CEO of NHS Charities Together, said: “Staff working within the NHS do a hugely challenging job every day, often dealing with traumatic events most of us would never encounter. The majority of NHS staff love doing the job they do, and both NHS staff and the general public feel proud of our NHS. But the nature of the work can have a detrimental impact on their mental health, and stigma can prevent them talking about it.

“Many NHS Trusts are already doing what they can to prioritise the mental health and wellbeing of our NHS staff, but it doesn’t go far enough. We will continue to work closely with NHS England and across the UK to ensure the additional support we provide for NHS staff has the most impact.”

In a separate survey, also carried out by YouGov on behalf of NHS Charities Together, more than 2,000 members of the public were invited to give their opinion on the NHS. Despite the challenges facing the NHS, the 2024 survey revealed that almost four in five (78 per cent) agreed that the NHS is one of the UK’s most loved institutions, compared to three in five (60 per cent) of the 2,000 respondents surveyed in 2022 who stated that the NHS is the best thing about the UK.

The proportion of respondents saying that they would consider a role working for the NHS if they were starting their career again, has risen slightly, from just over one in four (28 per cent) in 2021 to three in 10 (30 per cent) in 2024**.

Author, comedian and former doctor, Adam Kay, whose number-one bestselling book and multi-BAFTA-winning TV show, This is Going to Hurt, provided an insight into the often funny but harrowing daily life of a junior doctor, said: “These figures sadly come as no surprise at all. I know from my own experience just how hard NHS staff work, day-in, day-out, and the mental toll that routinely takes. We are uniquely privileged to have the NHS and should be proud of the wonderful people who sacrifice so much and go so far beyond the call of duty to look after us when we need it. But they desperately need support too, which is why I’m very proud to get behind NHS Charities Together’s Support Goes Both Ways campaign.”

Pat Chambers, Charity Development Manager, County Durham and Darlington NHS Trust Charity, said: “During the pandemic, many staff were affected mentally and emotionally. The extra support from NHS Charities Together enabled us to fund wellbeing spaces, equipment and food and drink for staff, who were working exhausting shifts in the constraints of PPE.

“We also received funding for the Trauma Risk Management (TRiM) project. TRiM is a trauma-focused peer support system helping to prevent extreme trauma and PTSD – similar to interventions delivered for service personnel returning from conflict zones. Funding enabled us to recruit 53 staff volunteers to be trained in providing peer support and interventions. We also funded a staff choir, which was a great outlet for staff and even saw us recording a single during lockdown, which hugely boosted morale.

“The unique challenges of the job means many NHS staff still face mental health challenges today, and the extra support is still needed, allowing us to promote wellbeing across our workforce and therefore ultimately continue to support the delivery of safe, compassionate and quality patient care.”

Hannah Canning is the Health and Wellbeing Coordinator at North West Anglia NHS Foundation Trust. Her role is fully funded by NHS Charities Together, through the North West Anglia Hospitals’ Charity, and was created to support frontline workers in the hospital. She said: “Thanks to the funding from NHS Charities Together, I’m able to support the wellbeing and mental health of staff in the hospital. I’m focusing on individual and team wellbeing and encouraging breaks and rest – considering all things that affect staff while they are on shift. Using this funding, we are able to go ‘over and above’ to support our staff.”

Ellie Orton OBE, CEO of NHS Charities Together, added: “NHS Charities Together already funds extra support such as counselling, green spaces, helplines and wellbeing zones and we’re launching Our Support Goes Both Ways campaign to raise awareness that while those who work for the NHS have a duty to care and protect us all, we all have a responsibility to make sure those who work for the NHS are looked after too.”

Steph Gorman is an intensive care nurse at Guys and St Thomas’s Hospital in London. She said: “I’m passionate about my work as a nurse. It’s hard, and I’ve had my struggles, but despite everything, it’s still one of the best jobs in the world. In the past, I’ve needed to seek help and started one-to-one counselling sessions at the hospital, which was really beneficial.

“Working as a nurse is still incredibly challenging. It’s so vital that we continue to invest in NHS staff mental health. NHS Charities Together have funded wellbeing zones at the hospital, just one example of the types of measures that really help make a difference.”

*Healthcare Professional sample: Total sample size was 1078 NHS staff. Fieldwork was undertaken between 13th – 19th February 2024. The survey was carried out online. The figures have been weighted and are representative of all NHS staff by occupational group.

**GB/UK Omnibus: Total sample size was 2068 adults. Fieldwork was undertaken between 16th – 18th February 2024. In 2022, total sample size was 2132 adults. Fieldwork was undertaken between 13th – 14th January 2022. For the 2021 survey, total sample size was 2120 adults and fieldwork was undertaken between 11th – 12th March 2021. The surveys were carried out online. The figures have been weighted and are representative of all UK adults (aged 18+) while for the 2022 survey, the figures are representative of all GB adults (aged 18+).

Supporting care companies in the digital switchover

By Kristian Torode

As many industries embrace the changes the Public Switched Telephone Network (PSTN) switch-off will bring, there are others that have cause for concern. Vital care devices such as telecare systems will be impacted by the switch off — so how can care companies ensure a smooth transition for their customers? Here, Kristian Torode, Director and Co-Founder of PSTN switch-off specialist, Crystaline, investigates.

Around 1.8 million UK residents use telecare devices, which enable vulnerable people to live independently by providing assistance in the case of accidents. These wearable devices alert family, carers or emergency services when pressed and can also connect to other safety equipment such as fall detectors, smoke alarms and door sensors.

However, the PSTN switch-off in December 2025 means that the copper wire phonelines that have historically connected these systems will be turned off, threatening their functionality.

In recent months, a number of stories of serious incidents that occurred when telecare devices no longer worked after users were switched from analogue to digital phonelines have hit the headlines. In February 2024, it was reported that Ofcom is investigating Virgin Media over its compliance with rules to protect vulnerable customers during the digital switchover. Consequently, Technology Secretary Michele Donelan met with telecoms providers to determine how best to safeguard vulnerable users during the switchover, which resulted in a commitment not to migrate customers if the functionality of a telecare system is at risk.

However, this poses challenges for vulnerable telecare users, telecoms operators and care providers alike.

Digital divide

Telecare systems are most beneficial to people who have communication, mobility or visual impairments, meaning many users are elderly or disabled.

While vulnerable users are likely to be more heavily impacted by changes to their phone service, it is difficult for them to access information relating to the switchover and how it affects them. According to Good Things Foundation data, non-internet users are twice as likely to have a disability or health condition than extensive users, and six times more likely to be over 65 years of age. As a result, many of those who rely on telecare lack the digital skills to find online information relating to switchover dates and to set up routers for digital phoneline services.

Although telecoms providers have put protections in place for those with disabilities and additional needs, many customers are unaware that they should give these details to providers, meaning existing lists are likely inaccurate.

Tackling telecare issues

So, what can telecare providers do to safeguard elderly and disabled residents? Firstly, telecare companies and local authorities offering these services should share data on who has a device with telecoms providers, allowing them to support vulnerable customers during the switch off.

The next step is to ensure that the right technology is in place before the switch off date. On the care provider’s end, upgrading to a PSTN alternative such as Voice over Internet Protocol (VoIP) now will make sure that there is time to perform checks on existing telecare devices before December 2025. As a result, non-compatible analogue systems can be replaced in advance of the switch off.

Finally, care companies and local authorities must make sure that customers are aware of how the PSTN being turned off will affect their telecare systems. This allows clients to test their personal alarm after their phoneline has been upgraded to ensure it is still fully functional.

As the PSTN switch off draws closer, elderly and disabled telecare customers stand to be one of the groups most heavily impacted but least informed about the effects of the digital switchover. Getting the systems in place in advance and performing thorough testing means telecare companies can guarantee a smooth switchover that safeguards vulnerable people.

To learn more about Crystaline’s PSTN switch off support services for SMEs, including those in the care sector, and to explore digital telephony alternatives, visit the website.

“Overwhelmingly positive” results for early years tool pilot

By Integrated Care Journal

Health visitors trialling the Alarm Distress Baby Scale tool reported enhanced understanding of babies’ behaviour and greater confidence in supporting parents to bond with their children.

A new trial testing the feasibility of a novel baby observation tool has taken place at Humber Teaching NHS Foundation Trust, funded by The Royal Foundation Centre for Early Childhood. The tool is intended to support parent-child interactions and increase the ability of a health visitor to interpret baby behaviour.

The four-month trial ran from July to November 2023 and saw participating health visitors receive training to use the tool, known as the Alarm Distress Baby Scale (ADBB). The ADBB looks for social behaviours in babies, including eye contact, facial expressions, vocalisation and levels of activity and seeks to help parents and practitioners understand the ways in which babies express themselves and their feelings.

Health Visitors conduct a number of regular checks on babies during their first years and the ADBB tool is typically drawn upon within the 6-8 week check. Health visitors who undertook the training reported it had helped enhance their understanding and that they had continued to draw upon those skills throughout all their contact with families.

The pilot ran in two areas initially, Humber and South Warwickshire, but the outcome of this trial is the recommendation that training be expanded to further areas. The findings of the trial have been set out in an evaluation report published by The Institute of Health Visiting and The University of Oxford.

Quantitative and qualitative data were collected over the trial period, and health visitors described their experiences of using the ADBB as “hugely beneficial” and “of great importance” to their work. They reported that the tool allowed them to:

Have more meaningful conversations with parents and carers about the emotional wellbeing of their baby;
Promote positive parent-infant interactions, attachment, and bonding; and
Identify those babies and families in need of greater support during this critical period of development.

Karen Hardy, Specialist Health Visitor at Humber Teaching NHS Foundation Trust said: “We were delighted to have been asked by The Royal Foundation for Early Childhood to take part in this trial. Our Health Visitors have found the training extremely useful and an additional element for them to draw upon throughout all their interactions with babies and parents. Having received the training myself, I can speak to its effectiveness at identifying needs of the baby and parent during those early weeks.

We know that babies are born ready to relate and can communicate how they are feeling from a very young age. The ADDB really adds to the health visitor’s skills repertoire aiding observation and interpretation of babies’ social cues and communication. This not only highlights when things are going well but enables early identification of babies that may be experiencing distress associated with adverse or challenging family circumstances, so that we can put appropriate support in place as early on as possible. It is great to hear that the report is recommending the extension of this training to more Health Visitors”.

Executive Director of The Centre for Early Childhood, Christian Guy, said: “The results of the initial phase of testing are so encouraging. We now want to move quickly to ensure we build on this work, bringing the benefits of this model to more health visitors across the country so that, ultimately, more babies and their families get the support they need to thrive.”

It has been noted that during the trial, the health visitors involved identified behavioural concerns in 10 per cent of the babies they met while using the tool. All identified families were subsequently offered additional support, which ranged from follow-up visits, emotional wellbeing visits and video interaction guidance, as well as connections to Child and Family Centres and referrals to Specialist Perinatal Mental Health and other support services.

Dr Jane Barlow, Professor of Evidence Based Intervention and Policy Evaluation at The University of Oxford, who oversaw the evaluation of the trial said: “Babies are born with amazing social abilities. They are ready to relate and engage with the world around them, communicating how they feel through their behaviours.

Whereas previous approaches have focused on the parents’ perspective, this training has really helped health visitors to ‘read’ the baby during interactions and develop greater sensitivity in terms of the observation of potential attachment and bonding issues that would not have been identified without the training.”

Is the push for collaboration causing a retention crisis?

By Rob McDonald

Rob McDonald, NHS Retention Services Manager at NHS Shared Business Services, asks whether exit interviews could hold the key to boosting NHS retention – a key goal of the NHS Long Term Workforce Plan.

Collaboration has been an NHS mantra for years now. According to all sources, no matter what the problem, collaboration (oh, and technology) will solve it.

But is that true? Intriguingly, my experience is that – far from being a panacea – the move towards collaboration might be exacerbating the NHS’s staffing problems.

Don’t get me wrong. I’m a fan of collaboration. It helps to spread good practice. It reduces or eliminates inconsistencies. It enables organisations to pool their resources and benefit from economies of scale. So it’s perhaps not surprising that the entire NHS has been reorganised to encourage (or mandate) partnerships, exemplified by system-wide reorganisations like the establishment of ICSs two years ago.

The drive for productivity is resulting in mergers as services are scaled. The changes affect all organisations – from acute providers to community, mental health and learning disability services and Community Interest Companies. These TUPE transfers (Transfers of Undertakings (Protection of Employment), affecting many thousands of front-line staff every year, are frequently seen by senior managers as routine or benign. After all, the individual’s terms of employment are protected – so what is there to worry about?

The reality is that the changes are often poorly managed, can be unsettling and – I believe – are contributing so much to staff turnover that they’re having a significant impact on patient care.

What does it feel like if you’re one of those staff?

Thankfully, that’s a question we can answer. NHS Shared Business Services provides an exit interview service, which I am privileged to run. We’ve done more exit interviews in the past three years than most people do in a lifetime. I say that as a statement of fact, not a boast!

One of the questions we’ve started to ask leavers is whether uncertainty around, or the impact of, mergers has influenced their decision.

The answer is yes. We’re finding that nurses in particular often cite service mergers as contributing to their desire to leave, frequently in combination with other factors, such as general stresses of the job.

It goes without saying that this is a problem. The NHS’s long-term workforce plan highlights the need for up to 190,000 additional nurses by 2037, requiring retention rates to improve by around 15 per cent over the course of the plan. Losing nurses has knock-on effects way beyond the immediate impact on patient care. The cost of recruitment to backfill; the cost and time of additional training; the stress on team members who have to provide cover and the cost of overtime – all of these erode both money and goodwill.

The recently published NHS staff survey confirms this. Although most of the People Promise indicators showed a modest improvement, many of the numbers are still concerning. Some 30 per cent of respondents said that they felt burnt out by their work, and 34 per cent found it emotionally exhausting, yet only around half said they felt able to make improvements happen or be involved in change.

The good news is that this can be fixed. Mergers and reorganisations do not need to make staff feel disempowered and uncertain. In fact, when handled well, they can have the opposite effect.

To do this takes time, care, and skill – I’ve provided a few hints below, based on the feedback we’ve been getting.

Uncertainty about a merger is often more damaging than the merger itself, so communication really is key. People subconsciously “triangulate” information – that is, they won’t absorb or believe it until they’ve heard it from three different sources. So think about what level of communication you might need, then triple it.

Identify flight risks. This is something we’ve done for years at NHS SBS; we even have an algorithm that predicts people at risk of leaving. Then take proactive action to address their concerns and bring them further into the fold. Leavers often tell us their manager knew they were thinking of leaving; managers, by contrast, tell us the resignation came as a surprise.

Conduct exit interviews – and use the data you collect. I may be biased, but I think exit interviews are possibly the most important conversation you can ever have – more important even than recruitment interviews. Yet, remarkably, the standard approach is for an automated tick box survey to be sent to leavers upon resignation. The response rate is usually around 30 per cent and the greatest reason for leaving is ‘unknown’ – in other words, the path of least resistance to complete the survey without discussing any real issues.

Finally, remember – a resignation doesn’t have to result in a leaver. Is there a feeling that once resignation is given, the horse has already bolted? I think there is. Yet when I ask leavers whether they would have stayed if somebody had done something differently, the answer is often yes.

Resignations can be withdrawn. And sometimes, a conversation is all it takes to retain a valued and valuable member of staff.

Given that the magic roundabout of change in the NHS is unlikely to slow down any time soon, learning to support and empower staff through periods of uncertainty is critical.

I’d love to hear from readers about their experiences of change – particularly the impact of service mergers on retention and how you use exit interviews. Contact me at Rob.McDonald1@nhs.net.

Rob McDonald, NHS Retention Services manager, NHS Shared Business Services

Working in partnership to improve wound care services through a shared care pathway

By Paddy Markey

Lead Medical Specialist at Coloplast, Paddy Markey, relates how a collaborative partnership has helped an NHS organisation introduce a shared wound care pathway, releasing capacity and delivering improved wound healing outcomes.

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

An NHS organisation decided that to succeed in reaching The Commissioning for Quality and Innovation targets set for 2020-21, it would combine the elements of accurate wound assessment and self-care to redesign a wound care service. The pilot’s designated wound assessment clinic was implemented to enhance capacity of community staff, provide early wound assessment, and reduce unwarranted variation in treatment. It also provided an opportunity to introduce a supported shared-care pathway, further releasing capacity.

At initial appointments, patients were assessed for their suitability for supported shared-care. The project is an example of collaboration and partnership with Coloplast who helped develop and produce the shared care resources required.

Coloplast supported the development of the patient shared-care information pack, shared care inclusion criteria, and wound self-care pathway. The self-care pathway was based on a patient’s ability to use one wound bed conforming silicone foam dressing (Biatain Silicone with 3DFit Technology by Coloplast) on wounds up to 2cm in depth*.

Wound audit data suggests that nearly 80 per cent of wounds are less than 2cm in depth, and in an international consensus among wound care specialists, 83 per cent agreed that the best dressing choice for wounds up to 2cm deep is a dressing that conforms to the wound bed. Through previous case studies, Coloplast has demonstrated an avoidance in filler dressings when using Biatain® Silicone on wounds up to 2cm in depth*. The studies also demonstrated 49 and 51 per cent savings on dressing procurement costs respectively.

*Tested in vitro, Conformability may vary across product design.

Prioritise nutrition and hydration to boost broader health outcomes, says new report

By Integrated Care Journal

New report from PPP finds that efforts to implement a multidisciplinary approach to nutrition and hydration are needed to help address the dysphagia burden across the NHS.

A new report from Public Policy Projects (PPP) finds that with the UK becoming a ‘super-aged’ society, declining nutritional and hydrational status among elderly and frail populations will place increasing strain on health and care services.

The report, Prioritising nutrition, hydration and dysphagia in an integrated care context, states that while considerable work and investment has been allocated to reduce the incidence of obesity and the diet-related diabetes, malnutrition and hydration are not given the same focus, despite their significant impact on health outcomes and its role in the management of other conditions.

The report is the culmination of two roundtables held by PPP in 2023, which convened stakeholders to discuss how ICSs embed nutritional and hydrational health into integrated care strategies. The discussions focused on specific elements of the debate, including improving the management of dysphagia and care provided for frail populations in different care settings. Attendees included NHS England clinical leadership, allied health professionals (AHPs), including speech and language therapists (SLTs), social care providers, primary care representation nurses and other key health and care stakeholders.

*Graphic showing levels of elderly population at ICS level in 2021. Source: Census 2021*

According to the report, recent reforms to the health and care sector (most notably, the introduction of ICSs) present new opportunities to develop comprehensive approaches to nutrition and hydration, in a way that improves holistic patient care and saves valuable resource for the NHS.

However, among its recommendations, the report calls on the Department of Health and Social Care to launch a national review into food and drink provided across the care sector, to help improve the nutritional and hydrational status of frail citizens in social care. This review should follow the structure and ethos of the NHS Hospital Food programme, the report argues.

It adds that addressing dysphagia should be central to broader NHS goals of enhancing the quality of life for the elderly population, and that by prioritising the management and screening of dysphagia, the NHS could prevent avoidable hospital admissions and promote more efficient use of resources across the health and care sector.

Download the report here

To address the complex and multifaceted challenge of dysphagia, with various medical, neurological, and anatomical elements potentially contributing, will require systems to adopt a multidisciplinary approach, says the report. This will necessitate close collaboration between diverse teams of healthcare professionals, each with specialised expertise.

It finds that a multidisciplinary approach that includes speech and language therapists, dietitians, and physicians, is essential for managing dysphagia and addressing the complex healthcare needs of the elderly in a holistic fashion. To help enable this multidisciplinary approach, the report argues that the model of speech and language therapy sitting in community settings should be scaled nationwide, and adopted across ICSs within integrated care strategies. These strategies should also closely involve the voluntary sector.

The report also recommends an expansion of the speech and language therapy workforce, with ring-fenced funding for broader allied health professionals – in line with ambitions set out in the NHS Workforce Plan.

“The nutritional and hydrational needs of our elderly and frail citizens has been neglected for far too long. As the UK moves towards a ‘super-aged’ society, NHS organisations, care providers and integrated care systems must increasingly focus efforts on improving nutritional and hydrational health,” said report author and Group Editor at PPP, David Duffy. “It is vital that resources are orientated to support allied health professionals, particularly speech and language therapists, who play a vital role in maintaining nutritional health for elderly and frail citizens.

“Nobody in the UK should suffer from malnutrition or dehydration in this day and age, especially not our frailest and most vulnerable citizens. We hope that this report will help shine a light, not just on the scale of the problem, but also on achieveable solutions that we believe will help address the terrible burden of dysphagia.”

Recommendations:

NHS England must prioritise nutrition, hydration and dysphagia as part of its drive to improve system performance and broader health outcomes. Nutrition and hydration management are underdeveloped areas which can help enable success in key national strategies, such as the elective care backlog plan, workforce strategy, the urgent and emergency care plan and the delivery plan for recovering access to primary care.
Integrated care systems should consider dysphagia and wider nutritional and hydrational health as key parts of preventative health policies that can help future proof local health systems.
The Department of Health and Social Care (DHSC) should commission a national review into food and drink provided across the care sector. This review should follow the structure and ethos of the NHS Hospital Food programme. The review should be led by a range of stakeholders from within the NHS and social care, as well as representatives from industry and the private sector.
As the population becomes a ‘super-aged’ society, an integrated strategy is required to manage the health of the elderly and frail population. This should draw upon global and international frameworks provided by the WHO’s ICOPE framework.
ICSs should ensure that maximising the ‘intrinsic capacity’ of citizens is a key priority within integrated care strategies, to prevent deterioration of health and supplement preventative health policies.
ICSs should work to prioritise evidence-based nutritional and hydrational approaches within the social care sector, harnessing tools such as nutritional supplements where necessary, to assist those who have difficulty eating, drinking and swallowing.
The model of speech and language therapy sitting in community settings should be scaled nationwide, and adopted across ICSs within integrated care strategies. These strategies should also closely involve the voluntary sector.
NHS England should undertake a national dysphagia screening drive to identify individuals as early as possible. Social care staff and AHPs should be trained to conduct dysphagia screenings for all elderly and frail patients in their care, and much like falls, dysphagia should be considered among the primary risks in any risk assessment of elderly and frail patients.
The speech and language therapy workforce should be expanded with long-term ring-fenced funding for broader allied health professionals.

Download the report here.

Optimising DOAC Therapy: A collaborative approach to improved patient care and cost efficiency

By Selma Abed and Duncan Richardson

By Selma Abed, Head of Medicines Optimisation, Spirit Health, and Duncan Richardson, Head of Service Delivery, Spirit Health.

Spirit Health

As an independent service provider to the NHS for over 15 years, Spirit Health do things differently. We specialise in partnering with NHS Medicines Optimisation teams to provide products and clinical services that help deliver cost efficiencies and quality improvements in patient outcomes.

The situation

Direct-acting oral anticoagulants (DOACs) are widely recognised as alternative anticoagulants to prevent strokes in patients with Atrial Fibrillation (AF). There are four DOACs available; the aim was to optimise care for all patients prescribed a DOAC for NV-AF and to review patients prescribed apixaban to see if a lower-cost alternative could be used. When the work was undertaken, apixaban was the highest-costing drug to the NHS in England in the 2022/23 period.

The issue is that stroke and bleeding risks change over time, so medication needs to be reviewed annually. This requires high levels of collaboration between primary and secondary care to review all eligible patient medication for drug interactions, over-the-counter medications and herbal/alternative therapies.

The opportunity was to optimise the quality of care for patients on a DOAC across a locality and review if an alternative lower-priced DOAC was suitable. Carried out between October 2022 to May 2023, the work would ensure patients were on the appropriate DOAC and dose regime for their renal function, liver function, weight, co-morbidities, and medication to ensure optimal oral anticoagulant (OAC) therapy.

Objective

The main objectives were to optimise care for all patients prescribed a DOAC for NV-AF and to review patients’ prescribed apixaban to see if a lower-cost alternative could be used.

The Spirit Active Implementation™ team identified all patients on existing DOAC therapy, checking patient eligibility to change through up-to-date patient blood records, calculating Creatinine Clearance, CHA2DS2-VASc7 and HAS-BLED/ORBIT scores. They also discussed any patients with incorrect doses/significant interactions/safety concerns or identified issues with the appropriate clinician.

To fulfil the objectives, the project required continual collaboration between the Spirit Active Implementation™ team with multiple GP practice staff, secondary care HCPs, and multiple stakeholders across the locality.

The review service not only highlighted those who were eligible to be switched to a lower-cost DOAC alternative but also identified:

Patients requiring alternative medication
Dosage adjustments needed
Enhanced monitoring required
Drug interaction identified

Ultimately, the work improved patients’ care beyond the project’s original scope and highlighted additional patients who required further attention to optimise their DOAC therapy.

Scalability of work

From a patient quality perspective, the project’s learnings hold promise for broader impact, potentially on a national scale. From a cost-savings lens, the works highlight potential roadblocks to scaling. However, these can be overcome using the learnings from the project.

Positive signs for scalability include:

Successful collaboration: The project effectively partnered with secondary care, indicating this approach could be replicated across national localities when specialist advice is required.
Spirit’s resource potential: Utilising our nurses, pharmacists and technicians for patient communication and assessment demonstrates the potential to scale within busy primary care environments.
Identified needs: The project revealed a significant portion of patients requiring updated bloodwork or an intervention, suggesting a broader population likely benefits from similar assessments.
Potential for broader savings: The project identified opportunities for cost savings beyond the initial medication switches. When clinically appropriate, the availability of generic DOAC alternatives presents further avenues for cost reduction, assuming sufficient supply and adherence to clinical guidelines for DOAC selection.

Challenges to consider include:

Return on investment: Existing primary care capacity constraints led to outdated patient bloodwork, impacting potential cost-saving medication switches for 56% of patients, thus affecting the savings benefit of the work.

Evidence of success

The work demonstrates an innovative quality review project to optimise patient care for those prescribed a DOAC for AF. It offers evidence of important changes with the potential to impact multiple stakeholders.

Delivered change:

Improved Patient Care: Identified 1224 patients requiring intervention across 25 practices, including medication adjustments, discontinuation, or additional monitoring, impacting their individual health outcomes.
Cost-Effectiveness: Identified 32 per cent patients potentially eligible for a more cost-effective medication, offering substantial savings for the locality.
Enhanced Collaboration: Actively supported collaboration between nine key stakeholders across primary and secondary care, with an average of three meetings per stakeholder (including two face-to-face and one virtual), across a total of 3489 patients.
Proactive Approach: The project identified 1,938 patients with outdated blood work and weight measurements, these findings were communicated to the locality for further assessment. Additionally, direct intervention was taken by Spirit for 1,551 patients whose records were up to date. This two-pronged approach demonstrates a proactive strategy to address both immediate needs and potential future concerns before symptoms arise.

Number of interventions identified in locality DOAC review service

Potential impact:

Patients: Improved health outcomes, reduced medication errors, and potentially lower medication costs.
Healthcare System: Cost savings through prescription switches and potentially reduced hospital stays due to improved preventative care.
Healthcare Providers: Up-to-date patient records and enhanced AF training, potentially leading to better patient outcomes.
Future Initiatives: Provides valuable insights and a potential model for broader implementation of similar quality review programs.

This quality review service is a compelling example of how such initiatives can improve patient outcomes, optimise healthcare systems, and empower providers.

Next steps

To see how Spirit Health delivers results and to learn more about their success in optimising therapy areas, please click here.

To explore how to improve patient care and reduce costs, contact Spirit Health today to discuss a partnership for your current and future medicines optimisation reviews.

Accelerating remote monitoring innovation in social care

By Fiona Brown

With the number of people who will require at-home care set to increase, innovation to boost capacity and drive efficiencies in social care is desperately needed, writes Fiona Brown, Chief Care Officer at Lilli.

In the ever-evolving landscape of social care, the need for transformational system-wide change has become increasingly apparent. Capacity and demand are reaching a critical level, with 73 per cent of healthcare leaders saying a lack of social care capacity is having a significant impact on their ability to tackle the elective care backlog. This is where new proactive care technology emerges as a vital ally in addressing challenges like workforce shortages and access to services.

However, navigating this path to technology adoption amid a stretched workforce, bureaucratic hurdles and a lack of long-term solutions to social care capacity, presents its own set of challenges. Procurement processes, often burdened by strict and outdated internal controls, can create barriers to meaningful change. Instead of embracing a holistic approach to technology integration, these internal barriers can lead to the development of tenders with narrow specifications, overlooking the wider system impact.

Pilots, while valuable for testing and refining solutions, often fall short of achieving lasting impact due to insufficient time for advocacy or momentum building, unclear outcomes and an organisational requirement for quick financial returns. In addition, lack of early engagement with the market further complicates efforts to drive systemic change. As a result, pilot fatigue can set in across teams. To counteract this trend, there needs to be a shift towards long-term commitment to proven solutions to see real transformation.

Across the sector, central government has launched several types of competitive and highly sought-after technology funds for organisations to apply for, including the Adult Social Care Technology Fund and the Digitising Social Care Fund. Yet more recently a new type of fund has been launched directly from the technology sector. The Proactive Care Fund (PCF) aims to expedite the adoption of home monitoring technology by offering local authorities and integrated care boards (ICBs) up to £1 million of matched funds, ushering in a new era of efficiency and efficacy in care delivery.

Home monitoring technology that discreetly monitors patterns of behaviour and indicators of wellbeing has been proven to help to address many of the key challenges in the system – from staff shortages to shrinking budgets – by supporting carers to right-size care packages, keeping people living independently for longer.

The technology can empower carers to be on the front foot and proactively respond to signs of health decline before conditions become acute. Data from remote monitoring company, Lilli, for instance, shows that it can generate thousands of additional carer hours, and accelerate hospital discharge by up to 16 days. Moreover, for every £1 spent on the technology, £9 can be reallocated into the care budget.

The PCF provides the necessary support and resources for organisations to break free from the reactive delivery of care and adopt a proactive care model to explore and implement innovative technologies with confidence while realising the benefits of saving money, time and resources.

Central to this paradigm shift is the creation of a conducive procuring environment within the sector. The PCF addresses this need head-on by streamlining procurement processes and providing matched funding to alleviate financial pressures. By facilitating quick and easy access to transformative technologies, the PCF empowers organisations to embrace innovation quickly without undue burden. G Cloud contracts, committed to a minimum of 12 months, offer organisations the time and flexibility needed to realise the tangible benefits and assess the broader impact on the care ecosystem.

Last year, several organisations – including borough councils, county councils and ICBs – across the UK saw successful applications through the first PCF. These included Hillingdon Council, Medway Council, Oxfordshire County Council and North Central London ICB, who embraced the initiative to support a variety of adult social care services and enable their residents to live safely and independently.

According to the latest research, the number of people who will require publicly funded care at home in the UK is expected to grow by 36 per cent between 2024 and 2035, so it is crucial that transformation happens now to prevent further crisis in the future. The PCF represents a significant step towards accelerating the adoption of proactive models of care, while having a positive knock-on effect across the rest of the health ecosystem, reducing pressure on emergency services, reducing hospital admissions and speeding up hospital discharge. In current times, where central and local government are struggling to fund basic services, private sector initiatives, with a track record of savings and efficiencies, could prove to be part of the puzzle to help a sector in crisis.

To find out more about Lilli’s remote monitoring technology, please visit www.intelligentlilli.com.

Q&A with Dame Elizabeth Anionwu

By Integrated Care Journal

Professor Dame Elizabeth Nneka Anionwu is Emeritus Professor of Nursing at the University of West London and Life Patron of the Mary Seacole Trust.

As the first sickle cell nurse in the UK, Dame Elizabeth Anionwu is credited with blazing a trail in the treatment of the disease.

Ahead of her keynote address at the Skills for Health’s Our Health Heroes Awards on 16 April, Dame Elizabeth spoke about her contributions to the world of healthcare and why it’s important to recognise and celebrate those of the wider healthcare workforce.

Dame Elizabeth, you’ve had a long and successful career in healthcare, as a clinician, academic and advocate for the treatment of sickle cell disease and thalassaemia. What attracted you to a career in healthcare in the first place?

I was in a children’s home for the first nine years of my life, and I’d always suffered with eczema as a child.

I received excellent care from a nun, a nursing nun, who was the only person that could change my dressings without hurting me. She also had a huge sense of humour and she used to use words like ‘bottom’ in a very religious environment, which as a child made me burst out laughing.

I sensed that this was a kind, caring woman who wanted to avoid hurting me. And then I discovered she was something called a nurse and I thought, nurse, I like the idea of that.

That’s when I decided I wanted to be a nurse and I never changed my mind at all.

I started as a school nurse assistant when I was 16, working in what was then called a residential school for delicate children. It was run in collaboration between the NHS and the local authority for children with conditions like cerebral palsy, asthma and heart conditions.

I went into higher education from working as a sickle cell nurse in the community to the Department of Nursing in a university for the last 10 years of my career.

During that time, I retained links with community nursing, but also with acute nursing by having a clinical link in an NHS Trust on a ward involved with the care of patients with sickle cell disease.

I felt it was very important not to lose touch with the clinical side, so I continued to practice.

You can’t educate students if you are not up to date and involved with care yourself personally.

Looking back on your career, what would you say is your proudest achievement?

My proudest achievement was becoming the very first sickle cell nurse.

Because it was an innovative position, seen as pioneering at the time, I could actually develop quite a lot of it in the way that fitted my ideals of multidisciplinary activity.

I’ve always enjoyed working in a multidisciplinary context and very much in alignment with patients and their families.

I worked in that post for 10 years and it really was the most enjoyable period of my career.

And what’s the legacy of that work in the NHS today, do you think?

There are many, many more sickle cell nurse practitioners, so that’s very good to see.

The value of the nursing contribution, both in the community and in the acute sector, has grown, and that that really wasn’t the case when I first started.

Up until a couple of decades ago probably, sickle cell was very marginalised and quite neglected in terms of its status, if you like, within the hierarchy of illnesses.

That has changed. There’s still work to be done, of course, but I’m delighted that nurses have played their role along with other professionals and families to ensure that the disease is fully understood, and treatment is available across the country.

I’m one of the patrons of The Sickle Cell Society, the national charity, so I am constantly aware that there are still areas that need to be improved, where there’s been, sadly, for example, a couple of deaths that shouldn’t have happened.

I mean, that’s the worst that can happen. They’ve all been taken seriously. They’ve all been investigated. When that happens, thankfully, it’s rare, but it jolts you to realise there’s still work to be done.

For example, nurses need much more education and that is now happening as a result of one of the tragedies. So, you’re never complacent, but you do recognise where improvements have definitely been made. I mean, the prognosis, the life expectancy for individuals with the condition has improved tremendously.

That in itself is a massive step forward.

The Our Health Heroes Awards celebrates the healthcare roles that are often hidden from view. Why do you think it’s important to celebrate this part of the workforce in particular?

Oh, I think it’s vital.

Without them, quality care for patients simply couldn’t happen.

If porters could not take a patient from the accident and emergency department to the ward or if the cleaners are not able to do their work properly the whole system fails.

Following the pandemic, it is even more vital that we say thank you and take time to appreciate the workforce.

They’re not looking for appreciation, but when they’ve had to struggle it not only affects them personally, but their families and their colleagues.

That’s why a celebration is needed – there are some amazing people working in the NHS and we need to let them know that they are appreciated.

Finally, what’s your message to the Our Health Heroes finalists?

First of all, good luck to everybody!

You have all done amazingly in being nominated for the awards, and I cannot wait to see you on 16 April to thank you personally for your contribution to our NHS.

Dame Elizabeth’s memoirs ‘Dreams From My Mother’ were published in 2021 and are available in paperback, Kindle and audiobook editions.

News March 25, 2024

Harnessing local assets – the NHS and Care Volunteer Responders programme: people powered healthcare

By Dr Allison Smith

By Dr Allison Smith, Head of Research and Insight at Royal Voluntary Service.

The NHS and Care Volunteer Responders (NHSCVR) programme was first launched in March 2020 by NHS England to support and protect those individuals who were ‘shielding’ because of clinical vulnerabilities to Covid-19. The programme proved to be a critical auxiliary service adding vital capacity for staff and patients. Today the programme aims to support integrated care systems (ICSs) alongside other voluntary sector provision to improve efficiency, patient care and add capacity. It is free of charge, making it an accessible resource for healthcare teams and patients seeking additional support.

In today’s healthcare landscape, collaboration across sector partnerships is essential to delivering high quality care. NHSCVR exemplifies partnership working between a public service, a charity with a social enterprise (GoodSAM digital app) and citizens. To date over 40,000+ vetted volunteers across England have made themselves available to be deployed in real-time – via the GoodSAM app – to support the needs of local healthcare systems.

Volunteers provide emotional (e.g. welfare calls) and practical support (e.g. grocery/prescription deliveries) to help people stay well and independent. In addition, volunteers play a crucial role in supporting healthcare teams with, for example, quicker discharges and virtual ward assistance through the Pick Up and Deliver service.

Since the programme was relaunched last year, Royal Voluntary Service, with GoodSAM, has been working in partnership with several Trusts, ICSs, and local volunteers to embed and pilot various volunteer activities.

We showcase two below.

Barnsley Hospital – Pick Up and Deliver

The service supports Barnsley Hospital’s Discharge Unit, Virtual Wards, and Haematology Departments. This supports individuals being discharged from the hospital by transporting medication to their homes and enables patients to return home earlier, rather than them waiting for their prescriptions to be ready.

*Delivering medication to a patient through Pick Up and Deliver*

Barnsley Hospital staff load Pick Up and Deliver shifts into the referrer online portal. With real-time support the system ensures fast volunteer deployment. Volunteer Responders across the North-East sign up for shifts via the GoodSAM app, enjoying the flexibility to choose when they volunteer. Discharge staff feel that it both improves patient flow by getting patients off the wards and home quicker but also saves bed days by reducing the number of patients still waiting on-ward past 5pm.

Kerry Evans, the Regional Relationship Manager for North East, North Cumbria and Yorkshire has been working in partnership with Barnsley Hospital and their Discharge Unit and Virtual Ward teams:

“Members of their Discharge/Virtual Ward Teams approached me to see how Volunteer Responders could assist with the delivery of medications. It was a real collaborative effort from the start, involving hospital departments and the Royal Voluntary Service.

“Initially, we implemented an alert-based notification system for volunteers to respond to individual requests. After one month, we gathered feedback and assessed the process. It became clear that the volume of deliveries warranted a shift-based model. This provided hospital staff with greater certainty about volunteer attendance and allowed for contingency plans if shifts were unfilled.

“Volunteers have appreciated knowing their scheduled times, resulting in consistent participation. This has fostered trust and rapport between hospital staff and volunteers. The immediate impact of their actions within their communities has further motivated volunteers.

“The hospital staff have embraced the service and have been happy to explain to other Trusts about the benefits they have experienced and the collaborative nature of working with the voluntary sector. So much so, other Trusts are coming on board.

“It really is a case of listening to what the hospital needs, engaging with the volunteers to fully explain the service and then supporting all parties to make sure the process runs smoothly.”

Jacqueline Howarth, Operational Manager of RightCare Barnsley said:

“We are exploring the possibility of expanding the service to other patient groups and are in the early stages of developing these new pathways. Additionally, we are looking into other services provided by NHS and Care Volunteer Responders that would be useful to our Virtual Wards.

“We have found the Pick Up and Deliver service to be incredibly helpful and necessary. We have already recommended it to other colleagues and department heads in the hospital. The service is available seven days a week and is highly responsive, which is fantastic”.

Yorkshire Ambulance Service – Welfare Vans

The programme also worked in partnership with Yorkshire Ambulance Service NHS Trust and local volunteers to pilot ‘welfare vans’ in October and November 2023 (at York Hospital) to improve the wellbeing and working environment of ambulance crews as they waited outside A&E.

The volunteers were asked to make themselves available to support crews who were waiting to hand over patients at Accident & Emergency departments. They were required to provide ambulance staff with refreshments and the opportunity for a friendly chat. Volunteers undertook shifts of two to four hours – either solo or in pairs; the welfare vans were available from 12:00 to 20:00 and had a range of hot/cold drinks and snacks.

Overwhelmingly, both ambulance crews and volunteers benefited from this role. Crews reported high satisfaction with the welfare vans (n=89): 88 per cent reported that they were ‘very satisfied’ and 9 per cent ‘satisfied’.

“Always a friendly face at the welfare van. Happy to help and chat … A very welcome sight during a busy shift. Very much appreciated.”

“It’s an excellent service, with all the queuing we do to have a friendly face to give you a warm cuppa is great. All the volunteers at York are friendly and helpful so please keep it going. A big thank you to them.”

Volunteers also reported high levels of appreciation and value in doing this activity:

“I just got a really nice feeling about it, and they did appreciate it. They were keen to say thank you very much for being here … ‘We didn’t know you were going to be here.’

“I thought it was a really good idea to do. And so I was quite keen to sign up to it. So I did! They (crews) appreciated it, and it was nice to have an opportunity to chat to them.”

These examples demonstrate what can be achieved with true partnership working. Being able to welcome in local citizens, via volunteering, not only has benefits for the healthcare system, staff, and patients but we also know from an existing breadth of medical evidence it improves health and wellbeing of the volunteers, and can drive future workforce recruitment. In a recent survey (March 2024, n=2817) 21 per cent of Volunteer Responders stated that the programme has inspired them to ‘think’ or ‘actively look’ for a job/career in the NHS/care; 4 per cent stated because of NHSCVR they are now working in the NHS/care.

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

If you would like further information or a conversation with one of our team – please contact your Regional Relationship Manager; details can be found at nhscarevolunteerresponders.org.

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