RPS calls for government action to tackle medicines shortages
By Integrated Care Journal
Endemic medicines shortages need urgent action, says RPS, as supply chain woes and manufacturing consolidation drive worsening outcomes for patients and extreme pressures on pharmacy sector.
A new report from the Royal Pharmaceutical Society (RPS) has called on the Government to create a national strategy to manage medicine shortages and to change legislation to allow community pharmacists to amend prescriptions when medicines are in short supply.
Backed by charities and patient groups, the Medicines Shortages: solutions for empty shelves report explains how medicine supply chains are global and complex, with shortages caused by manufacturing problems and disrupted, less resilient supply chains. The report finds that supply chain issues are in part due to the consolidation of manufacturing outlets and cost-driven pressures.
The report calls on the UK Government to create a national strategy to both prevent and manage medicine shortages that would streamline efforts across the NHS, reduce inefficiencies caused by duplication of effort and ensure information and guidance for professionals and patients is available as soon as shortages occur.
The findings also highlight that supply chain vulnerabilities have combined with unplanned spikes in demand, such as shifts in prescribing practice or increased diagnosis of some conditions, to create a perfect storm of unstable supply.
This has made it harder for patients to access treatment, causing frustration, anxiety and in some cases, harm to patient health. The report cites high profile examples of patients being unable to access hormone replacement therapy, antibiotics, diabetes drugs, and medicines used to treat epilepsy and attention deficit hyperactivity disorder, among many others.
“Taking a new approach to medicine shortages is essential. A properly resourced UK-wide medicines shortages strategy that helps prevent and manage shortages would greatly improve the resilience of the supply chain. This would relieve stress and anxiety for patients and free up time for pharmacists to focus on patient care rather than constantly chasing down supplies.
James Davies, RPS Director for England and co-author of the report
The report also urges the Government to legislate to allow community pharmacists to make minor amends to prescriptions when medicines are in short supply. This simple change would enable a different quantity, strength or form of the medicine to be provided. For example, changing tablets to a liquid version of a medicine, or substituting a pack of 20 mg tablets with 2 x 10 mg packs when necessary.
At present, patients have to return to their GP to get their prescription amended, delaying access to medication, increasing bureaucracy and intensifying pressure on an already overburdened system. This move already has support from medical organisations, patient groups and other pharmacy bodies.
Frontline pharmacy teams are also under added pressure due to medicines shortages; A 2024 Community Pharmacy England survey found that almost three-quarters of community pharmacy staff report spending one-two hours or more daily trying to obtain medicine stock or source alternatives. One acute hospital trust also reported that the number of staff required to manage medicines shortages has increased from one person to five in the last five years – a situation “likely to be reflected in trusts across the country”.
Ohter recommendations in the report include:
Improve reporting by manufacturers: prompt alert of the risk of shortages would transform the impact on patients, and those consistently failing to report should be fined.
Build supply chain resilience: strengthen NHS procurement contracts to ensure manufacturers can meet supply demands and respond to shortages quickly.
Improve data connectivity: Use better demand forecasting and share information across the supply chain to prevent stock issues before they happen.
Enhance systems for life critical medicines: improve collaboration across the health service to coordinate access to specific medicines.
James Davies, RPS Director for England and co-author of the report, added: “Community pharmacists must be allowed to make minor changes to prescriptions during shortages. The current outdated system inconveniences patients, wastes time and causes frustration. The Secretary of State for Health should give pharmacists the authority to act in the best interests of their patients, rather than remain subject to ‘empty shelf syndrome’.”
Bruce Warner, Chair of the advisory group for the report, said: “This report provides a comprehensive assessment of what is causing medicines shortages, their impact on patients, pharmacists and healthcare professionals, and what more can be done to mitigate and manage shortages.”
Sharon Brennan, Director of Policy and External Affairs at National Voices, a coalition of 200 health and social care charities in England, said: “We urge the Department of Health and Social Care to recognise the serious and worsening impact medication shortages are having on patients, and to commit the same level of urgency to improving the situation as it has to other NHS access-to-care issues such as diagnosis and waiting lists.”
New study underway on joint clinical trials between health tech and primary care
By Integrated Care Journal
A groundbreaking feasibility study in Northumbria is exploring the potential of collaborative clinical trials between health tech providers and primary care, with early results showing significant lifestyle and self-management improvements.
A first-of-its-kind randomised control trial in Northumbria is exploring the feasibility of cost-effective collaborative clinical trials, using digital interventions to support people with hypertension and depression and/or anxiety. Over a 12-week period, the Innovate UK-backed research project is involving patients by using Holly Health’s digital coaching service at home, emulating the real-world use of the service.
Cardiovascular conditions are the biggest cause of early deaths worldwide and over 19 million UK adults are affected by hypertension. However, as stated in the NHS Long Term Plan, “cardiovascular disease is largely preventable and the single biggest area where the NHS can save lives”.
Managing and preventing hypertension through lifestyle changes, including an improved diet and increased exercise, is critical. However, for many patients, self-managing the required changes becomes more challenging when combined with conditions such as anxiety and depression. For this reason, the need for innovative and integrated solutions that address both physical and mental health aspects is paramount.
Holly Health’s digital tool has the transformative potential of addressing the challenges posed by the comorbidity, enhancing self-management, reducing NHS costs, and improving national health outcomes.
Dr Justine Norman, Clinical Director for Quality and Research at Northumbria Primary Care, expressed excitement about participating in this unique feasibility study, highlighting the team’s interest in understanding how patients engage with and benefit from an innovative digital approach that address both physical and mental health conditions. Dr Norman added,
“The response from patients to take part in the research has been really encouraging. Now, we’re looking ahead to the study which has concluded this month and analysing the outcomes which will form a bigger six-month trial to measure the longer-term impact for our patients.”
The main outcomes of the study indicate strong patient engagement and positive lifestyle impacts. After using Holly Health for 12 weeks, 64 per cent of patients found the service useful, 69 per cent said they benefited from the service and 92 per cent found it acceptable as a digital health intervention. The app has helped improve participants’ lifestyles in the following ways, including:
● Changes to eating habits
● Reduced alcohol intake
● Increased physical activity
● Using the app to prompt better behaviours/habits
One participant finds the app very valuable and has become an integral part of her daily routine. She finds the ‘discovery’ resources and the notifications extremely useful. She also enjoys the reward feature and being able to tick off/complete a “habit” once she has done it. As an exploratory analysis, the study will look into changes in GP appointments and prescriptions after six months of using Holly Health. As an exploratory analysis, the study will look into changes in GP appointments and prescriptions after six months of using Holly Health.
Daniela Beivide, Chief Science Officer at Holly Health pointed out that prior studies for isolated conditions have demonstrated the positive impact of digital interventions, including a reduction of demand on services. She commented,
“We’re just as excited as our study partner, Northumbria Primary Care, to be investigating whether the same impact can be applied to supporting people with physical and mental health comorbidities.
If successful, there is huge potential to efficiently and cost-effectively scale the service for large populations to reduce strain on NHS services and create significant change in the economy of the country. We’re proud to be part of this cutting-edge approach where digital health companies and the NHS can partner to research and implement solutions at low cost and an accelerated pace”.
Holly Health’s intuitive app provides intelligent AI-powered coaching, habit reminders, education, and in-the-moment support to encourage regular actions for blood pressure and mood management, which empower individuals and improve self-management abilities.
The feasibility study is part of a Future Economy 12-month project funded by Innovate UK that has also enabled Holly Health to develop innovative features within its app, such as the Ecological Momentary Assessment (EMA) feature that gathers real-time user data for current mood and stress levels which can then be used to provide a more relevant and personalised coaching experience.
Addressing NHS productivity could unlock billions to deliver neighbourhood NHS, says IPPR
By Integrated Care Journal
Restoring NHS productivity to pre-pandemic levels would have freed £19 billion more in 2023/24, enough to build a new health centre in almost every neighbourhood, according to a new report from IPPR.
Analysing the “twin crises” hitting NHS performance – low productivity and poor staff retention – the report establishes that in 2023/24, the NHS in England had a budget of £171 billion, but productivity was 11 per cent lower than before the pandemic, according to NHSE’s own estimates. If productivity had matched 2019/20 levels, the report finds, the NHS could have delivered an extra £19 billion worth of care – enough to build 900 new health centres, and almost enough to deliver the Labour Party’s manifesto promise of building a ‘Neighbourhood NHS’ in one year alone.
The new Labour government has now announced a major uplift to NHS spending in the 2024 autumn budget, taking the planned daily expenditure budget to £192 billion by 2025/26. Increasing productivity will be crucial to ensuring maximum benefit for patients. The NHS has a target to improve productivity growth to 2 per cent per year by 2029/30. Achieving this goal next year could deliver an additional £3.8 billion worth of care – enough to more than triple the numbers of MRI and CT scanners in the NHS.
“After years of mounting pressures, the NHS is facing two major challenges: high levels of frustration among staff, and low productivity which is taking a toll on patients.”
Dr Annie Williamson, IPPR research fellow and current NHS doctor
Exacerbating the issues around poor productivity, the report argues that the NHS is facing a parallel crisis of staff frustration and departure. It notes that between 2010 and 2023, the average annual NHS leaver rate was 11.2 per cent, meaning one in nine staff members left each year. This is compared to 2009/10, when the rate was 9.5 per cent, just over one in 11 staff.
If the leaver rate had been kept down at 9.5 per cent, IPPR estimates that an average of 12,000 NHS staff could have been retained each year since 2010. Holding the number of new entrants constant, this would equate to around 150,000 additional staff retained cumulatively.
IPPR argues that the two major crises facing the NHS – low productivity and poor staff retention – reinforce each other. High staff turnover increases costs and impacts care delivery, while inefficiencies, such as outdated equipment, deepen staff dissatisfaction and lower productivity levels.
Low autonomy for NHS workers is a key underlying issue, the report finds. Decision-making in the NHS often lacks information and insights from frontline staff, leading to the wrong priorities and missed improvements. Money may be spent on hiring locum doctors when staff feel new computers are what is needed, or on top-up winter crisis funding rather than community services to keep people well.
IPPR argues for a new approach to NHS reform. Unlocking staff insights and giving them a greater voice could lead to meaningful changes at every level, the report says.
IPPR calls for reforms to incorporate staff voices in clinical service design and national policymaking including:
Empowering frontline staff by establishing channels for service improvement led by Trust-level specialists, with protected time for all staff to participate
Setting up representative staff boards in each NHS trust to put forward ideas from the wider workforce and consult on all matters affecting staff wellbeing, with a duty on main NHS trust boards to consult them
Giving a staff voice in national workforce policy by reforming pay review bodies to include negotiation or embed a formal duty to consult with staff
Dr Annie Williamson added: “By addressing these issues [of low productivity and retention], we could unlock billions worth of better healthcare. More importantly, this would create a more efficient and sustainable health service, where staff voice is central to improving the quality of decisions throughout the NHS.”
Dr Parth Patel, Associate Director of Democracy and Politics, said: “We all know the NHS needs reform, but we keep getting distracted by the same red herring debates. The real issue is that we’re struggling to get the NHS firing on all cylinders again.
“Too many decisions are made at the top, while those on the front lines—who truly understand what’s needed—are left with little say. The status quo isn’t working. We need to empower NHS staff with a genuine voice and a real stake in the decisions that affect them. Only then can we unlock the NHS’s full potential again.”
From innovation to application: How healthcare must adopt an AI approach to patient engagement
By James Neal
Healthcare systems can learn vital lessons from other sectors further along the AI implementation transition, writes James Neal, Chief Revenue Officer at EBO.
Artificial intelligence and machine learning are already mainstream tools in many sectors, helping to automate manual tasks, accelerate processes, and drive innovation. In healthcare, the adoption of this technology will make today’s practices seem outdated in just a few years.
However, as we scale up these innovations, we must look towards other sectors that are further along in their AI journeys to absorb lessons that are prime for application in the NHS.
Meeting patient expectations in healthcare
Across multiple industries, AI is revolutionising user experience, setting new standards that healthcare providers should aspire to meet. Patients, accustomed to seamless digital interactions in other areas of their lives, now expect the same from healthcare. They seek easy access to care, free from bureaucratic hurdles and inefficiencies.
“Embracing AI is not just a choice — it’s a critical step for the NHS.”
As IBM’s Senior Vice President, Paul Papas, has observed: “The last best experience that anyone has anywhere becomes the minimum expectation for the experiences they want everywhere.” This is particularly true in healthcare, where outdated systems can no longer meet modern demands. Lord Darzi’s review has highlighted that many NHS processes remain clunky and inefficient, causing frustration for both patients and staff.
The imperative to adopt advanced technologies is clear. In an era of rising demand and limited resources, embracing AI is not just a choice — it’s a critical step for the NHS to deliver sustainable care.
Taking a leaf out of the financial services playbook
The NHS can learn from the financial services sector’s focus on user experience, innovation, and its shift from one-way communication to interactive, user-centred dialogue. All of these are crucial to the financial sector due to high customer demands and volumes – which are also acutely present in healthcare.
Automating user journeys to dynamically interact with customers 24/7 – in any language, on any channel, at any time – ensures that accurate information can be accessed immediately and at the user’s own convenience.
With the ability to complete thousands of repetitive tasks and workflows simultaneously, AI automation reduces 60-80 per cent of repetitive inbound enquiries from public-facing teams. This saves staff precious time and increases capacity.
Take Exinity, for example. This trading and investing fintech is having great success using EBO’s AI automation technology to process over 80,000 conversations a month across five languages (English, Farsi, Russian, Chinese and Arabic) around the clock.
By adopting AI automation technology, Exinity aimed to automate 40 per cent of incoming requests within the first year, but impressively, surpassed this goal within just three months. Today, 50 per cent of all conversations are fully managed by AI, leading to greater efficiency, enhanced satisfaction, and reduced operational costs. This has also freed up service agents to focus on more value-driven tasks, further enriching the overall experience.
In the context of healthcare, the same technology is empowering patients to have more visibility and control over their healthcare journey, improving the patient experience while reducing the administrative burden on healthcare providers.
How a private hospital is showing the way
Saint James Hospital is setting a remarkable example of AI adoption within the private healthcare sector, significantly boosting productivity, enhancing patient experiences, and reducing staff workloads. With over a million appointments each year and a rapidly growing patient base, the hospital’s patient services teams were struggling to manage appointment bookings, especially during peak hours. The increasing communication bottlenecks led to inefficiencies in workforce coordination.
“The solutions now handles over 12,000 appointment bookings each month.”
Through EBO’s AI-powered Virtual Assistant (VA), the hospital has provided a two-way communication channel which is available on the hospital’s website and via Facebook Messenger. The tool is the first use of AI by the hospital, which integrates directly with its hospital management system and EPR. Today, the VA interacts with patients and service users via two-way automated human-like conversation, answering questions 24/7, and managing appointment bookings from start to finish. Patients can book, cancel or reschedule their appointments without the need for human intervention. Thanks to its AI context and sentiment awareness, the VA identifies customer’s emotions and adjusts the dialogue accordingly.
The results have been transformative. The solution now handles over 12,000 appointment bookings each month, with 93 per cent of interactions being completed end-to-end by the AI tool. At peak times, it absorbs 40 per cent of the call workload, allowing staff to focus on more complex tasks. Patient satisfaction has soared, with a 96 per cent approval rating—demonstrating how AI can dramatically improve both operational efficiency and patient experience.
Shifting from analogue to digital
Adopting AI automation isn’t just about appealing to the ‘modern’ patient and being there 24/7, on any device and available in any language. It’s about making experiences patient-centric, increasing patients’ access to healthcare and enabling patients to navigate their pathways easily and efficiently.
Shifting patient engagement from an impersonal one-sided interaction to a patient-friendly, conversational, and inclusive model promotes a more accessible and natural way for patients to interact with their healthcare provider. By automating repetitive administrative tasks and streamlining processes, AI automation technology makes patient journeys more convenient and engaging – enhancing choice and empowerment.
It’s not just about focusing on technology and moving from analogue to digital. Virtual Assistants are sophisticated enough to foster meaningful conversations and understand patient needs. Engaging patients through two-way conversations simplifies complex inaccessible processes into universally adaptable communication channels that cater to individual patient needs. It’s about using data to turn the currently reactive processes into proactive and predictive models by using the volumes of data captured to forecast scenarious and outcomes in real-time.
Nearly 20 NHS trusts and health boards across the UK are already using EBO’s solutions and are seeing exceptional results helping to reduce workload, increase efficiency, and improve patient satisfaction.
Time to work smarter, not harder
By adopting AI, we can create a more seamless and patient-centred experience. AI can help automate routine tasks, allowing patients to book appointments, access their health records, and manage their healthcare with ease. These innovations aren’t just about efficiency, they’re about making the NHS more accessible, responsive, and patient-centric.
It’s time to work smarter not harder to help the NHS reform and non-clinical AI innovations are going to be a key enabler. AI is the productivity tool the NHS is crying out for, and we have it in the palm of our hands. Now is the time to apply it.
Will NHS England’s medical consultant job planning improvement guide work?
By Phil Bottle
Phil Bottle, Managing Director of NHS workforce planning specialists, SARD, explains how a limited view of workforce data is preventing trusts from workforce planning effectively, and explores whether NHS England’s newly published job planning improvement guide will help solve the problem.
Let me start with a story. Back in 2010, when I was head of learning and development in the NHS, I’d watch our director of workforce in a blind panic every month as they pulled together a board report. The report was simple: who works for the trust, including substantive, part-time, honorary contracts, and temporary staffing costs. So why the panic? Because nobody knew the answers.
Month after month, they scrambled to piece it together. This wasn’t a capability issue — our director of workforce was an excellent leader, and adept in their role. The problem was systemic; nobody had the data, and more concerningly, nobody knew where to look.
This problem existed long before I joined the NHS, and unfortunately, it still exists today. So, when I saw NHS England’s new improvement plan, my initial reaction was, hopefully, a step forward. Workforce planning has been a constant struggle. But the real question is: does this improvement guide truly help solve the underlying issues?
The positives: A step in the right direction
I’ve been around the workforce planning block for almost two decades. I’ve seen countless attempts to kick-start meaningful change. The most notable difference with this guide? It ties job planning directly to patient value, something often overlooked. Too often, job planning has been about capacity without understanding how that capacity impacts patient outcomes. Finally, a patient-centric focus — this is progress.
The plan also discusses some important areas that need addressing; consistency, engagement, utilisation of data-driven insights, leadership focus, capability, process structure, and demand and performance metrics. These are key areas for improvement, and I support these measures.
The familiar oversight
However, here’s the big ‘but’ — this guide, like many before it, focuses too much on procedure, and not enough on resistance, lack of perceived value and inconsistent linkages to demand. These are the familiar hurdles that those doing the job know all too well lead to poor engagement, and the real root causes of 20+ years of subpar workforce planning.
“The data isn’t being utilised effectively, and everyones knows it.”
It’s like telling someone, “just try harder.” No amount of process improvements will solve the underlying barriers unless we address the core issues. As it stands, it feels more like a numbers game. Those who truly understand workforce planning and its relationship with patient safety outcomes and workforce wellbeing know it’s far more complex.
Workforce planning is not as straightforward as finding a round peg for a round hole. It’s more akin to a 1,000-piece puzzle — having the right people, with the right skills, in the right place, at the right time. Without this, a team’s, a department’s, or on a bigger scale, an organisation’s ability to deliver safe services and ensure staff wellbeing can resemble a shaky house of cards ready to tumble.
The root cause of poor job planning
A barrier to improving the consistency of job planning is cultural resistance. This is understandable to a certain degree, as job planning feels incredibly personal, even though it shouldn’t be. There’s a strong resistance to anything perceived as a threat to individual autonomy.
There is also an ambivalence towards the process due to the lack of perceived value. Why should anyone engage in this process if the data isn’t used for anything? The improvement guide talks about triangulating data with HR and Finance, but without demand modelling, it feels empty. The data isn’t being utilised effectively, and everyone knows it.
“Workforce planning… it’s failing because trusts don’t have the time and capacity to make it work.”
The inconsistent link to demand makes it feel like an afterthought. Demand should be at the core of job planning — ‘this is the demand on my service, and here’s the capacity to meet it’, not the other way around.
As a result, people don’t engage in job planning as it is seen as a process that doesn’t improve wellbeing, workloads, service objectives, or patient outcomes. The same applies to safe staffing, reducing backlogs, or achieving service goals.
The biggest issues: Time and capacity
Here’s the crux: workforce planning isn’t failing because of systems, leadership, or metrics. It’s failing because trusts don’t have the time and capacity to make it work. The process is complicated and labour-intensive, requiring significant hours from multiple people to be truly effective.
Until we address this fundamental issue — the lack of time and capacity — job planning, and therefore workforce planning, will continue to fall short.
Familiar solutions, same old problems
I’m not saying the challenges are easy to fix, but they are solvable. We need to think outside the box, beyond risk aversion, regulations, and procurement rules, and focus on what will add real, tangible value. Solutions that flatten the landscape by dealing with all the root problems holistically, rather than manage the hill. Solutions that tackle data analysis, engagement, expertise, tools, and training and provide tangible outcomes like better quality management information, not simply enabling more input methods.
This improvement guide offers procedural fixes, but it doesn’t tackle the deeper, systemic issues that have prevented job planning from being effective for so long. Real change will only happen when we address the root causes that are holding workforce planning back.
The value of partnerships in enabling holistic diabetes care
By Navodi Kuruppu
PPP’s Director of Market Access and Policy, Ameneh Saatchi, spoke with Naj Rotheram, Medical Lead for Partnerships at Boehringer Ingelheim, to discuss their view on primary care, partnerships and how they can best support the NHS in delivering a new holistic approach to diabetes care.
The Diabetes Care programme has been sponsored by Boehringer Ingelheim. Boehringer Ingelheim has had no influence over the agenda, programme development, content or selection of faculty. This Editorial was written by PPP but features content from an interview with Boehringer Ingelheim. Boehringer Ingelheim has therefore reviewed the content for factual accuracy only.
Since their establishment in 1885, Boehringer Ingelheim has evolved into a leading manufacturer of pharmaceutical drugs for both human and animal healthcare. As a research-driven company operating in the UK among many other countries, Boehringer Ingelheim aims to support the NHS in improving clinical outcomes, access to evidence-based care and the quality of life.[1] To make this happen in diabetes care, Boehringer Ingelheim researches and develops innovative medications to support patients throughout their care journey.[2]
Naj Rotheram is Medical Lead for Partnerships at Boehringer Ingelheim. Having worked in the NHS for fifteen years before joining industry thirteen years ago, her experience makes her well-placed to understand how the NHS can deliver successful holistic care to people with diabetes. In her current capacity, Naj collaborates closely with the NHS across all disease areas, including diabetes, to address challenges and improve patient outcomes.
Developing preventative, holistic care
Naj describes a now familiar picture of the NHS: a system burdened by resource constraints, backlogs, workforce pressure, low morale – issues that have been further exacerbated following the COVID-19 pandemic. These challenges have dominated health discourse in recent years, and were recently highlighted in Lord Darzi’s independent investigation, with political figures warning that the system will collapse without reform. In view of this fact, Naj has long advocated for a structural transformation within integrated care systems (ICSs) to enable entire care pathways to deliver care collaboratively and holistically, treating patients as a whole rather than focusing on a single diagnosis.
“The long-term goal of structural transformation is to support better integrated care and therefore a better patient experience, hopefully across the entire pathway and better working together. But it does take time for that integrated way of working to embed itself.”
ICSs were set up with the aim of improving health and care services, prioritising a focus on prevention, better outcomes and reducing health inequalities. The power of prevention in diabetes care has already been demonstrated by the NHS-funded Diabetes Prevention Programme, which has been shown to reduce the risk of type 2 developing by 40 per cent. Yet, a study by The King’s Fund has found that local systems are at risk of going ‘off-track’ due to pressures on services, intense political scrutiny, and extremely difficult economic circumstances – and the impact these conditions are having on the ability of local, regional and national leaders to act.[3]
The challenge for ICSs is reflected in diabetes prevalence and linked co-morbidity figures, which are continuing to rise. Since 1996, the number of people with diabetes in the UK has risen from 1.4 million to more than 4.8 million and is estimated to reach 5.3 million by 2025.[4] The challenge of a growing at-risk cohort is compounded by an ageing population, and the complexities linked with long-term diabetes management, including complications and multimorbidity cases. Recent data from the 2023 National Diabetes Audit shows that more than 3.5 million people registered with a GP were identified with non-diabetic hyperglycaemia, also known as pre-diabetes. [5][6]
Diabetes often “starts with one diagnosis,” explains Naj, “and then accumulates a host of other health risks and problems”. In fact, diabetes is the leading cause of blindness in working-age adults, and around 10 per cent of diabetes patients will develop leg ulcers at some point in their lives.[7][8] Naj’s ideal vision is a model of localised care, centred on early diagnosis, better prevention and early intervention, thereby reducing the risk of these complications developing. Central to this approach is including patient perspectives to better understand their experiences. Naj also emphasises the importance of involving primary care professionals, ICS leaders, commissioners, and national policymakers in the development of multidisciplinary, holistic care pathways.
“Patients want to be treated by someone who considers the impact that disease might have on their heart, on the kidneys, on their brain, on their eyes. They say, ‘please look after me as a whole person,’ but the NHS isn’t necessarily well set up for that.”
-Naj Rotheram
Diabetes outcomes are significantly impacted by health inequality, with rates of undiagnosed diabetes being twice as high in areas in the lowest Index of Multiple Deprivation quintile compared to the top.[9] Naj stressed the importance of harnessing and embedding data-driven insights from population health management (PHM) into diabetes care pathways to allow systems to identify, and target interventions towards, underserved communities. An example of this is the Joint Working Project between Boehringer Ingelheim Limited and Salford Care Organisation.[10] The project aims to implement an integrated, neighbourhood-based, holistic diabetes service to address the complex needs of patients with cardio-renal-metabolic (CRM) diseases in Salford. By employing a workforce with diverse skillsets, and using data to identify individuals with the greatest needs, the project has successfully engaged communities within Salford’s population that have traditionally been reluctant to participate in healthcare.
“Utilising the insights at a very local level can help us understand the challenges affecting specific areas and allow us to develop programmes and care pathways.”
-Naj Rotheram
ICSs have a range of assets available to build more holistic, preventative diabetes care. Utilising all of general practice, community pharmacy, dental services, and optometry, primary care is in a strong position to deliver comprehensive, holistic diabetes care. However, Naj points out that current support for primary care is inadequate due to limited resources and high patient volumes – leading to a more reactive rather than a preventative approach. This means that primary care is often an underutilised preventative asset.
To remedy this, Naj advocates for greater support in terms of resources, training and action on workforce sustainability. “Primary care should feel valued; they are working on issues that matter to patients,” says Naj. “These primary care healthcare professionals are making a difference at a community level, and this long-term holistic focus is the reason why they entered the profession in the first place.” Naj also discusses the importance of supporting and valuing the workforce’s skills, by addressing discrepancies in workforce development, job reimbursement, and fair pay. An international survey has found that primary care doctors in 10 high income nations say that they are overworked, demoralised, and undervalued. [11]
The value of partnership
Another often underutilised asset in improving diabetes care is industry partnership. The NHS and pharmaceutical industry have an opportunity through partnership to redesign local and national pathways, enabling better collaboration for the patient’s benefit. Alongside clinical and care pathway knowledge, industry partners offer a range of practical resources and expertise relevant to NHS system ambitions, including project management, stakeholder involvement and multidisciplinary team mobilisation.[12] Naj has been intimately involved in this work, and posits partnerships as one way of promoting ethical practices and to provide highly regulated and standardised settings in which the NHS and industry can operate. Naj believes that partnerships can help to improve trust between the NHS and industry through greater transparency regarding all parties’ actions, long-term motivations and impacts. For this reason, the NHS could rely more on the “tremendous” skills and resources that industry brings, which extend beyond just the financial resources it provides.
We need to embrace working together and pooling those skills and those resources to overcome some of the NHS challenges that we are collectively facing.
-Naj Rotheram
PPP’s Diabetes Care Programme 2024 has uncovered fascinating insights and developed vitally important recommendations to improve the delivery of diabetes care. Stakeholders and experts present across the roundtables have consistently highlighted the need to move away from treating diabetes as a single diagnosis and condition to treating the whole patient in holistic terms.
The theme of holistic care has shaped the basis of 2025 Diabetes Care Programme, Holistic approaches to diabetes care: treating the whole patient, to discuss the challenges and opportunities for a holistic approach to care that treats the ‘whole’ patient and not just their diabetes. The series will feature a set of roundtables to create insights and strategies for holistic approaches to diabetes management and long-term conditions. We will address key questions including:
• How can systems balance personalisation and population health management to ensure we get population health rights, while meeting the individual needs of people?
• What role can technology, data and digital play in reducing inequalities for those with the highest needs?
• What innovations are game changers and are they sustainable?
• How do we develop our prevention and risk strategy, to break down siloed disease working so that cardio, renal, and metabolic condition are joined-up effectively within the health and care system?
• Where are the overlaps within the multi-morbid patient population and how can we create a one-stop shop in the community?
• How significant is genetic predisposition in causing diabetes compared to dietary and environmental factors?
If your organisation would like to learn more about getting involved in this innovative programme, then please contact Ameneh.saatchi@publicpolicyprojects.com to find out more.
Data-driven, proactive prevention. Are we finally ready for population health management?
By Simon Swift
As we navigate the complexity of modern healthcare, it is clear that preventative, data-led approaches can help solve some of the NHS’ major challenges. But ‘are we finally ready for population health management?’ asks Health Navigator CEO, Simon Swift.
I am sure every generation of health and care leaders think they face unprecedented challenges. I don’t think it is an error to say the current NHS leadership feels this, and with some justification. Urgent and emergency care services are under immense pressure, planned care waiting lists remain very close to the 2023 high of 7.7 million, while persistent health inequalities threaten the foundations of the UK’s universal healthcare model.
We must ask ourselves a crucial question: what, if any, proven approaches are there to deliver better outcomes for patients while ensuring the long-term sustainability of our health systems?
I firmly believe that the answer lies in harnessing the power of data. This data-driven approach takes different shapes at different points across the system. For example, optimising system design and service scale and location at the macro level, while at the micro level, there are cumulative marginal gains to be made through ‘command centre’ type solutions to operational management, optimising efficiency and safety for people in A&E or waiting for planned care. These are impactful uses, but not sufficient.
Another use of data is to enable a shift from reactive to proactive care models. Logically it is attractive; we stop people becoming acutely unwell, which is good for them. If they don’t become acutely unwell, they don’t need urgent and emergency care, reducing demand at the front door. This (in the UK system) means we can allocate resources to focus on other things, and there is plenty to do. If we are going to be responsible custodians of health services, this transition is not just desirable; it’s imperative.
The case for change: A closer look at the crisis
Waiting times for emergency care have reached historic highs, which is a miserable experience for patients, an awful work environment for staff facing intolerable moral hazard and probably dangerous.1 Bed occupancy rates in many hospitals mean managers are in constant firefighting mode, with waits backing up into A&E and elective cancellations routine, without a bed to admit a cold patient into.
Though this pressure on hospitals is universal, emergency department attendance rates are more than twice as high for those living in the most deprived areas compared to the least deprived, demonstrating the deep-rooted inequalities in our health system and society. The inverse care law is alive and well.
The COVID-19 pandemic has exacerbated these issues, creating a backlog of need that will take years to address. Moreover, an ageing population and the rising prevalence of chronic conditions are adding to the complexity of healthcare delivery. These challenges are not just statistics; they represent real people experiencing pain, anxiety, and diminished quality of life for many.
A data-driven approach to prevention
I believe we must use preventative, data-led, approaches to address these challenges, finally taking a step away from sole focus on the traditional reactive model. The evidence base is growing that the logically attractive proactive, preventative approach, leveraging the data at our disposal, actually works.
By harnessing this data (how this works is a sexy thing to some – advanced analytics and machine learning algorithms), we can identify patients at high-risk of unplanned care needs months in advance. This foresight allows us to intervene early, providing personalised support that empowers patients: precision population health management (PHM). The potential of this approach is enormous, offering a way to improve people’s health and so reduce pressure on acute services in the short-term and planned care in the longer term.
At HN, we’ve seen first-hand the transformative impact of this precision PHM approach. Our Proactive solution has demonstrated significant reductions in emergency admissions and A&E attendances.
Empowering patients and supporting healthcare systems
With advice from the Nuffield Trust and with the support of several NHS trusts, HN conducted a randomised controlled trial.2 It meticulously tracked up to 2,000 patient outcomes across multiple trial sites. We demonstrated a 36 per cent reduction in A&E attendances for patients supported by health coaching, which is in line with other studies. This isn’t just about numbers; it’s about people avoiding traumatic emergency visits and receiving care in more appropriate, less stressful settings.
The benefits of proactive, data-driven care extend far beyond reducing hospital admissions. We saw improvements in mortality rates, Patient Reported Outcome Measures (PROM’s), patient activation, and quality of life.
These outcomes are transformative on multiple levels. For patients, it means taking control of their health, understanding their conditions better, and enjoying an improved quality of life. For healthcare systems, it translates into reduced pressure on acute services, better resource allocation, and improved overall efficiency.
This approach helps to address health inequalities. By identifying at-risk individuals early, regardless of their socioeconomic background, we can provide targeted interventions that prevent health issues from escalating. This is particularly crucial in areas of high deprivation, where health outcomes have traditionally lagged. For those close to this type of risk modelling it will be no surprise that deprivation (income and health) is a significant risk factor.
The role of technology
As we navigate the complexity of modern healthcare, it’s clear that innovation and technology will play a crucial role. However, it’s essential to understand that technology is not a panacea. The true power lies in how we apply these tools to reimagine healthcare delivery. Those who have worked in this arena for any length of time know that implementing a technology rarely delivers benefit alone, and is often problematic and unhelpful. Carefully designing the change in process, behaviour, decision making etc. that the technology enables is the key to delivering value.
While the potential of data-driven, proactive healthcare is material, we must acknowledge the challenges in implementing the approaches. Data privacy and security are serious concerns that need to be addressed rigorously. We must ensure that as we leverage patient data for better care, we do so in a way that respects individual privacy and complies with all relevant regulations. However, the current red tape-bound and bluntly obstructive approach to information governance in the NHS needs improving if we are to derive value at a meaningful scale and pace.
Looking to the future
The opportunities are tantalising. By embracing data-driven insights and personalised interventions, we can create a more proactive, efficient, and equitable healthcare system that actively helps people live healthier for longer. This approach not only addresses immediate pressures but also lays the foundation for a more sustainable future.
The change from sickness to health care will require collaboration across all sectors of health and care – from policymakers and healthcare providers to technology companies and, most importantly, patients themselves. We need to encourage innovation, where new ideas can be tested and scaled rapidly.
At HN, we’re committed to being at the forefront of this transformation. Our work in AI-guided clinical coaching is just the beginning. We envision a future where patients receive personalised, proactive care that keeps them healthy and out of the hospital.
References
1 Jones S, Moulton C, Swift S, et al. Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emergency Medicine Journal 2022;39:168-173.
2 Bull LM, Arendarczyk B, Reis S, et al. Impact on all-cause mortality of a case prediction and prevention intervention designed to reduce secondary care utilisation: findings from a randomised controlled trial
Emergency Medicine Journal 2024;41:51-59.
Reforming diabetes care in care homes: training, collaboration, and compassion
By Navodi Kuruppu
Navodi Kuruppu spoke with Lynne Reedman, Founder and Service Lead for DUET Diabetes, and Martin Scivier, diabetes patient and advocate, and #dedoc° member, to discuss the impact of Covid-19 on care home residents with diabetes, the importance of peer support, and the urgent need to prioritise care for vulnerable and older populations.
In 2020, the first wave of the Covid-19 pandemic had a devastating impact on care homes in England; with over 40 000 residents dying by the end of 2021, 97.8 per cent of whom were aged 65 and over. Numerous investigations and the ongoing Covid inquiry have already highlighted major shortfalls in care homes, including lack of testing and personal protective equipment (PPE) for residents and staff. [1][2]
Delivering quality care during the pandemic was an even bigger challenge for residents with long-term conditions like diabetes. A skill gap in diabetes care among staff and deficiencies in technologies resulted in a lack of clarity and coordination regarding who to contact for immediate help, which led to preventable hospital admissions and increased mortality.[3] However, these deficiencies were not the result of the pandemic, but rather pre-existing gaps in the system that the Covid-19 crisis exposed and exacerbated.
Training of staff in social care is fundamentally important says Lynne Reedman
At least one in four care home residents currently has diabetes, however, an estimated 13,500 care home residents live with undiagnosed diabetes.[4] By 2050 the number of people aged over 85 is estimated to exceed eight million in the UK, which is likely to place additional strain on the social and residential care sectors.[5]
Lynne Reedman founded DUET Diabetes in 2015 from a desire to improve the understanding and knowledge of those looking after adults with diabetes. Designed to improve the skills and confidence of carers, nurses and healthcare support workers and the standards of diabetes care they provide, DUET Diabetes seeks to address knowledge gaps that were brutally exposed during the pandemic. Lynne argues that to solve these challenges, social care must be guided by three key principles that DUET Diabetes champions: communication, collaboration and education.
The 2022 National Advisory Panel on Care Home Diabetes (NAPCHD) was established to address the root causes of inadequate diabetes treatment in care homes. Their report identified several issues, including a lack of knowledge of key principals of ethical diabetes care on the part of care home staff, diabetes care teams and social services; ethnicity-related challenges in clinical care; and the importance of residents’ emotional wellbeing – all of which led to poor management of diabetes complications.[6]
Lynne observes that many team members including nurses in care homes lack a basic knowledge of diabetes best practice, reiterating the fact that diabetes training is currently not mandatory for care home staff. She says, when you talk to [the staff], a lot of them don’t have much confidence or knowledge [of diabetes care].
Residents shouldn’t have to wait for a district nurse to come in and manage their diabetes. We need a care sector that knows and fully understands diabetes and knows how to support these people.
Lynne Reedman, Founder and Service Lead at DUET Diabetes
Lynne strongly advocates for the implementation of a basic diabetes awareness programme across the social care sector, coupled with extra training to enable staff to disseminate knowledge within their own organisations. The NHS Diabetes Prevention Programme (DPP), along with campaigns organised by Diabetes UK and other organisations around the country, has played a central role in raising awareness at both national and local levels. Lynne’s proposal is innovative, in that it considers the combined needs of diabetes and social care, with the aim of supporting an all-around prioritisation the condition that is necessary to bridge the gaps specifically found within social care. You have to treat a person as a whole in care homes, she insists, and the care has to be tailored to each resident.
The NAPCHD proposes a multi-disciplinary model, focusing on collaboration between care homes, community and specialist services, primary care, and other key stakeholders. Within this model, the resident with diabetes is placed at the centre, supported by a nurse-led facilitator from the GP-Primary Care Unit and adult social services. Local Primary Care Networks (PCNs) would play a key role in supporting this service, by deploying existing primary care nurses with diabetes experience into facilitator roles, following additional training. While funding for this model may require agreements across multiple agencies, health economic studies are anticipated to demonstrate its cost-effectiveness, showing reductions to hospital admissions, ambulance callouts, GP visits, and medication expenses.
Using insulin pens, checking expiry dates, monitoring technology devices, maintaining a good diet and level of physical activity – there is a lengthy list of a daily actions that diabetes patients must juggle. These challenges are compounded for older patients with diabetes, who may encounter more difficulty caring for themselves daily. Studies have shown that diabetes may decrease mobility and restrict activities of daily living (ADL) by approximately 50-80 per cent, with this decline becoming more pronounced with age.[7]
One important aspect that the review does not touch upon is the role of peer support in diabetes care for older patients. Whether in a care or nursing home, emotional support is just as important as physical care.
Martin Scivier, a diabetes advocate, fully recognises the power and value of peer support. Now 75, Martin was diagnosed with type 1 diabetes (T1D) in 1954. Seventy years later, he feels healthy and lucky, having experienced only a few diabetes-related complications. To give something back to the diabetes community, Martin started running his own blog, Martin Scivier’s Mellitus – Type 1 Diabetes, in 2022, documenting his journey and experiences with T1D.
When I go to the hospital for appointments, I just sit there in the corner and don’t talk to anybody, I keep myself to myself. And then I see the nurse, see the doctor, and then I go out and go home. But thanks to social media I have found this wonderful diabetes community and started to get involved. Thanks to peer support, I am not on my own
Martin Scivier, Diabetes Advocate and T1D Patient
In 2018, Martin joined social media, finding many self-help groups on Facebook, Twitter and WhatsApp, such as the #GBdoc hub. I never went to diabetes camps when I was younger, so I used to be very much on my own, recalled Martin, but now I have all these new friends. This peer support acted as a hugely important space for Martin to feel supported and comforted after his regular check-ups at the hospital.
Martin’s story is testament to the power of peer support and its capacity to provide a safe space where patients like him can find comfort in sharing their experiences, feel supported and be reassured they are not alone. Martin has an optimistic outlook on the future, which he aims to realise through his advocacy and engagement with organisations like PPP. However, he was quick to acknowledge that many others are not as fortunate as him.
Older people need and deserve more says Martin Scivier
The NAPCHD strategic document acknowledges that many care home residents are highly vulnerable, and their diabetes condition is often worsened by complications, including uncontrolled hyperglycaemia, hypoglycaemia, which can lead to eminently preventable hospital admissions. It is estimated that 75 per cent of people with diabetes die because of cardiovascular complications, many of which could be prevented.[8]We have lost too many people along the way because of complications [of diabetes], adds Martin.
However, the condition and complications are often compounded by another factor – loneliness. Age UK has reported that around 1.4 million older people often experience loneliness each year in the UK.[9] Another study has found that loneliness is a bigger risk factor for heart disease in patients with diabetes than diet, exercise, smoking and depression.[10] Loneliness can also lead to decreased daily activity, contributing to increased inflammation and blood pressure, cognitive and motor decline, anxiety and depression.[11] Healthcare systems and providers must recognise that loneliness is a significant risk factor, affecting both psychological and physiological health outcomes, as well as health-related behaviours of older adults with diabetes.[12]
Martin shares Lynne’s belief that better training leads to better care. He recalled the 2016 education model run by Benikent within Swale CCG to improve diabetes management in care homes.[13]
Through this model,unregistered practitioners in care homes were trained diabetes management to improve diabetes care and delegation of insulin, ultimately seeking to provide individualised care plans and appropriate diabetes-specific training for all staff in the care. [14] Martin argues that this proves to me 100 per cent that any training is better than no training. But compulsory training would be brilliant.
PPP’s Diabetes Care Programme seeks to bring different stakeholders to the table. Hearing the stories of patients with lived experience of diabetes, together with the perspectives of experienced professionals, makes clear the importance of person-centred diabetes care. This approach supports both the medical aspects of the condition, such as managing complications, reducing hospitalisations, and lowering mortality rates among the elderly, as well as the human elements of treating patients fairly. As described by Martin, patients deserve to be treated with dignity and respect.
An individual should be cared for with dignity and respect. Their rights should be paramount.
Martin Scivier, Diabetes Advocate and T1D Patient
To learn more about how to get involved in the 2025 Diabetes Care Programme, visit the website here.
Martin Scivier, Author and Diabetes Patient AdvocateLynne Reedman, Founder and Service Lead, DUET Diabetes
A People Powered NHS – A call to all health leaders
By Dr Allison Smith
Dr Allison E Smith, Director of Research & Insight at the Royal Voluntary Service discusses the key role that volunteers can play in delivering on core NHS goals.
The Prime Minister’s speech on 11th September 2024 pledged that this would be the ‘biggest reimagining of the NHS since its birth’. Hence, as we reflect on the plan for the future, we should challenge ourselves to think differently and work in ways which prioritise patient care and staff wellbeing. We should be bold and ambitious as the founders of NHS were in 1948.
In the original blueprint of the NHS, it was always intended to be a partnership between the state, the citizen and their communities. Public participation in the NHS e.g. via volunteering, informal carers and patient groups, has always played a vital role in the delivery of better health care. But in many ways, public involvement is a postcode lottery – a few areas do it really well, some do it (not well), and others have nothing. From the perspective of a volunteer-involving charity like Royal Voluntary Service – who have been supporting the NHS since before it was even founded – it is hard to get volunteering truly embedded in healthcare delivery. It still feels as if we are on the outside looking in or ‘pushing water uphill’. The purview of ‘integration’ appears largely limited to that of the NHS with social care.
With the public consultation on the 10-Year Health Plan, now is the time to rethink how the NHS – and wider healthcare system – works collaboratively with the public for the common good. System leaders need to stop putting up barriers to public participation and think ‘how can I build inclusive blended teams of staff and volunteers?’. Leaders should be embracing and nurturing the public interest and love for the NHS; 66 per cent of those signing up for the NHS and Care Volunteer Responders programme do so because they ‘want to support the NHS’.1
The business case – in terms of the impact of volunteers on the NHS and wider healthcare system – we feel has been made.2 The NHS and Care Volunteer Responders (NHSCVR) programme – first launched during the pandemic – has continuously proved its effectiveness, from driving system efficiencies to better patient care, workforce recruitment, and staff morale. For system leaders and frontline staff that embed NHSCVR within their local delivery there are big gains to be had.
For those unfamiliar with NHSCVR, this programme is a unique partnership between a charity (Royal Voluntary Service), a public service (NHSE) and a tech company (GoodSAM). It can match, via an App in real-time, requests for support from staff or patients with members of the public that can lend a hand. The programme is a key auxiliary service supporting the NHS and patients to expedite patient discharge, provide practical support to patients at home, deliver equipment for virtual wards, and provide support to ambulance crews waiting outside A&E. It is a free resource for local areas, is NHS approved, and can provide a critical safety net to mobilise volunteers at scale at times of high demand on the system.
In the past four years the programme has achieved significant scale; more than 2.6 million activities have been delivered in support of patients and the NHS, 221,000 individuals have been supported, and over 1 million members of the public responded. And while these numbers are indeed impressive, on the ground in local areas the programme delivers significant benefits for the system, staff, and patients – see table below.
Click to enlarge table
The data also finds that those who volunteer report higher wellbeing. In a 2021 study by the London School of Economics, those that volunteered experienced statistically significant higher wellbeing compared to those who did not volunteer, and this wellbeing impact lasted for at least 3 months.6
This article is a call to all NHS system leaders; the breadth of impact – from this programme – plus others (see Helpforce) surely warrant the immediate integration of volunteers in NHS ‘BAU’, and centre stage in our reimagining of the NHS over the next 10 years.
For more information or to connect with a member of our team, please reach out to your Regional Relationship Manager. Contact details are available at nhscarevolunteerresponders.org.
References
1 NHSCVR baseline survey, n=8481)
2 See King’s Fund 2018 Views from the Frontline, Helpforce, 2020, Volunteer Innovators Programme
3 Programme data & Volunteer Annual Survey March, n=6302
10-Year Health Plan must address cancer care failings identified by Darzi
By Gabriel Blaazer
From improving access to care and diagnosis to addressing treatment delays, Lord Darzi’s recent independent investigation highlights the complex web of challenges facing the NHS. In doing so, it also offers a series of starting points for the upcoming 10-Year Health Plan to address.
Cancer remains one of the leading causes of avoidable death in the UK, and despite improvements in survival rates over the past decades, the country still lags behind others in cancer care. Lord Darzi’s recent independent investigation into the NHS in England offers a comprehensive review of the current state of cancer treatment within the NHS and points to several factors that have contributed to its struggles. These include funding constraints, the aftermath of the Covid-19 pandemic, and systemic issues within healthcare management.
Using the failings identified by Lord Darzi as a basis, the upcoming 10-Year Health Plan for the NHS has the chance to radically transform cancer care provision in the NHS.
Rising cancer waits and slowing survival rate improvements
Cancer cases in England have steadily risen, increasing by approximately 1.7 per cent per year from 2001 to 2021. When adjusted for age, the rise is still significant at 0.6 per cent annually. This translates to around 96,000 more cases in 2019 than in 2001. Although survival rates for one-year, five-year, and ten-year intervals have improved, the rate of improvement slowed considerably in the 2010s.
The UK also continues to record substantially higher cancer mortality rates than its peers. International comparisons show the country falling behind not only European neighbours but also the Nordic countries and other English-speaking nations. While survival rates have inched upwards, “no progress whatsoever” was made in early-stage (stage I and II) cancer detection from 2013 to 2021. However, this has recently changed, with detection rates improving from 54 per cent in 2021 to 58 per cent by 2023, partly driven by the success of the targeted lung health check programme. This initiative has helped identify more than 4,000 cases of lung cancer, with over 76 per cent caught at stage I or II, significantly boosting early intervention efforts.
Nonetheless, challenges remain in treatment selection, particularly for brain cancer patients. While genomic testing, critical for tailoring treatments, is now more widespread, only five per cent of eligible brain cancer patients can access whole-genome sequencing. A recent Public Policy Projects (PPP) report has highlighted the inequalities in access to genomic sequencing. Moreover, turnaround times for genomic tests – only 60 per cent of which are processed on time – further hinder timely treatment for many patients.
Access delays and missed treatment targets
One of the key areas within the Darzi investigation is the NHS’ ongoing struggle to meet its cancer treatment targets. The 62-day target from referral to the first treatment has not been met since 2015, and as of May 2024, only 65.8 per cent of patients received treatment within this window. Similarly, over 30 per cent of patients now wait more than 31 days for radical radiotherapy, reflecting growing delays in critical care pathways. Given the importance of timely cancer treatment, the upcoming Plan must consider how to reduce delays in access to treatment.
While the number of cancers diagnosed through emergency presentations has decreased, with the percentage falling from nearly 25 per cent in 2006 to under 20 per cent in 2019, access to primary care services continues to be “uneven”. This affects the timeliness of cancer referrals, especially as the proportion of patients waiting more than a week for a GP appointment rose from 16 per cent in 2021 to 33 per cent per cent by 2024. Darzi notes that declining access to general healthcare services directly reduces the likelihood of timely cancer detection and treatment.
The drivers behind performance issues
Several factors have compounded the challenges facing the NHS’s cancer care system, as identified by Lord Darzi, which the 10-Year Health Plan must seek to address:
Austerity and capital starvation: Funding restrictions and limited capital investments over the past decade have led to under-resourced healthcare infrastructure, making it difficult to accommodate growing patient demand. The underinvestment in estates and facilities is also preventing the NHS from making full use of diagnostic advancements; in many cases, hospitals may be able to purchase new state-of-the-art diagnostic and imaging equipment, but not have a suitable site in which to use it. PPP has explored this topic in detail in a previous report.
Covid-19 pandemic: The pandemic severely disrupted healthcare services, creating a backlog of cases and delaying non-Covid-related care, including cancer treatments. Although efforts have been made to prioritise long-waiting patients, the effects of the pandemic still ripple through the healthcare system, contributing to worsened performance.
Lack of patient voice and staff engagement: The investigation highlights that the perspectives of both patients and healthcare staff have often been overlooked in decision-making processes, resulting in management structures that are out of touch with the realities on the ground. A more engaged and responsive system would likely yield better outcomes. The need for coproduction was reiterated at PPP’s recent Cancer Care Conference, and is increasingly being recognised in Cancer Alliances’ health inequalities strategies.
Management structures and systems: The report also points to inefficiencies within the NHS’ management structures. These systems are often seen as bureaucratic, which slows down decision-making and the rollout of new treatments. Disparities in the adoption of new systemic anti-cancer therapies highlight these inefficiencies, as some regions wait over a year for access to drugs approved by NICE, while others see the same drugs introduced within a month. This inequality in access to drugs is a key driver of the postcode lottery that is seen in cancer care.
The importance of early diagnosis and screening
A clear priority identified by Lord Darzi is the need for more effective early diagnosis strategies. Cancers detected at stages I and II are much more treatable, and early intervention is strongly associated with better survival outcomes, as well as substantially lower treatment costs. Darzi notes, however, that progress in this area had been stagnant until recent years, with no gains between 2013 and 2021. The improvements seen in early-stage detection from 2021 to 2023 offer hope, but Darzi cautions that further efforts are needed.
The 10-Year Health Plan must also seek to address the UK’s lack of CT and MRI scanners relative to other comparative companies – a major inhibitor of greater diagnostic capacity in the NHS.
Screening participation rates have also declined, with breast and cervical cancer screening coverage falling since 2010. Yet there are signs of promise. For example, the bowel cancer screening programme has been highly successful and provides a model that could be replicated for other types of cancer.
However, hopes for improved early diagnosis cannot rely solely on the establishment of national screening programmes. Poor levels of health literacy, particularly among underserved communities, must also be addressed to ensure that people know which signs and symptoms to be aware of, and to seek treatment if necessary.
More sophisticated treatments but growing delays
The development of more sophisticated treatments is a key area of progress, but the availability of these treatments is often constrained by capacity issues. While the NHS is a world leader in incorporating genomic testing as part of routine cancer care, delays in processing these tests and long waiting times for treatments like radiotherapy undermine their potential impact and can lead to poorer outcomes.
As Darzi points out, “turnaround times are poor… [which] can delay the start of treatment,” especially when coupled with the system’s failure to meet its 62-day target for referral to treatment. In a healthcare system already stretched by rising demand and workforce shortages, delays in treatment can make the difference between life and death for many cancer patients.
Addressing the challenges ahead
Lord Darzi’s investigation underscores the critical need for systemic reforms within the NHS to address the growing cancer burden. From improving access to care and speeding up diagnosis to addressing treatment delays, the report highlights the complex web of challenges facing the NHS. In doing so, it also offers a series of starting points for the upcoming 10-Year Health Plan to address.
While recent advancements in genomic testing and early detection programmes offer hope, the NHS must tackle its systemic inefficiencies, funding shortfalls, and management issues if it is to close the gap with its international counterparts and improve outcomes for cancer patients.
For more information about PPP’s Cancer Care Programme, or to request further discussions, please contact: Rachel Millar, Programme Lead for Cancer Care: rachel.millar@publicpolicyprojects.com
