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Developing a life sciences superpower – how the General Election will shape support for the medical technology and pharmaceutical sectors

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The life sciences industry’s contribution to the UK economy cannot be understated. One in every 121 employed people in the UK work in the sector, which is worth more than £90 billion to the UK economy, and is responsible for world-leading vaccines, robots, medicines and scanners.

Medical technology and pharmaceutical solutions cover almost all medical diagnosis and treatment, and share a mission to improve health outcomes, right the way through from prevention to treatment and aftercare. Medical technology covers everything from syringes and sticking plasters to replacement joints and surgical robotics; with pharmaceuticals ranging from paracetamol and over-the-counter cold and flu powder to the world’s most innovative cell and gene therapies and MRNA vaccines.

Medical technologies and pharmaceuticals hold the promise to support both the health and wealth of the nation, but face a range of barriers to enabling the UK to become a life sciences superpower.

Given the importance of the life sciences sector for the national health and economy, and the need for strong local links between the medical technology and pharmaceutical sectors and their future MPs, PLMR Healthcomms has developed the Clusters of Change: Key Electoral Battlegrounds for the Life Sciences Sector insights report.

This report maps the hotspots of the pharmaceutical and medical technology across the country, linking them to the constituencies being fought in the general election. Using the PLMR Candidates Portal the report paints a picture of the MPs who will be representing constituencies with the largest life sciences footprints after the General Election.

Why this election matters for the life sciences sector

While they have their operational differences, both MedTech and pharma function through similar prisms, sharing objectives around regulation, support for innovation, and better adoption pathways through the NHS.

As such, the outcome for this General Election is particularly important to both, with the elected representatives due to take their places in Parliament for the first time – and there will be a large number of new MPs – due to hold some power over how the life sciences landscape is shaped and supported over the next five years.

It is these incoming Parliamentarians who can advocate and help to deliver better regulation, support better adoption, and help drive the Department of Health and Social Care, the Department for Science, Innovation and Technology and the NHS to deliver for patients through better use of the life sciences sector.

The life sciences sector is critical to the long-term prosperity and health of the nation, and it is therefore vital that the incoming Parliamentarians are aware of the impact that they have on their own constituencies and the country as a whole.

Political ambition for the sector

Although both the Conservative and Labour Parties have pledged to make the UK a life sciences superpower, there are differences in how all parties pledge to support the sector. The Conservatives have pledged to drive capital investment; deliver a well-equipped MHRA; support more commercial clinical trials; and deliver a new MedTech pathway that rapidly adopts cost-effective tech.

Labour have promised to launch a new Regulatory Innovation Office; oversee an NHS innovation and adoption Strategy; and support a reduction in the re-evaluation of products shown to be clinically safe and cost effective by NICE.

The smaller parties have also recognised the importance of innovation and life sciences in their approach the NHS; but with both the major parties supporting the sector explicitly, this potential to truly deliver a life sciences superpower is within reach.

To realise that vision, each part of the life sciences sector must ensure that they are building advocates across Parliament, who can promote the benefits of innovation, medical technologies and pharmaceuticals; push Government for action on support for the sector; advocate for policies to ensure there is an appropriate regulatory and adoption landscape to support greater investment, development and deployment of the tools that support the NHS and drive further economic growth.

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Making sense of systems

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Thinking afresh as to how to support new ways of thinking and working

The NHS in the UK faces many challenges and at the same time, is guided by an ambition to reform itself to become more geared towards – and responsive to – the needs of the population.

However, there is limited time and space for those who work in the NHS to think creatively about how to respond to these circumstances. The service is extremely busy and it feels as though staff – particularly those responsible for managing and leading – are caught up in a permacrisis, which limits their capacity to think differently and to test out new ways of doing things.

This has led to a fresh corporate imperative for people to embrace systems thinking – and, in practice, to apply the precepts of systems leadership. However, this raises a crucial issue: there are myriad approaches to business leadership these days, as a cursory glance at the groaning shelves of the Airport Academy demonstrates, which can sometimes make systems leadership feel like yet another fad.

As with all fashions, of course, people are sucked into it, partly out of a personal fear of missing out and partly because everyone around them seems to be saying that it’s a trend into which they need to buy.

Current systems thinking

However, approaching the challenges and ambitions of health and social care systemically makes absolute sense. It is a perspective that acknowledges that the whole is greater than the sum of its parts and that a system relies upon meaningful connectivity between agencies – and individual agents – to maximise that effect.

All of which has led to a busy market of workshops, courses, and programmes that aim to induct people into systems thinking. However, these tend to take place at a distance from the practicalities of what it is like to make sense of systemic working in practice and to navigate it in a positive fashion.

There is a paradox at the heart of this. The busyness that managers and leaders in the NHS face at this time denies them the headspace to think systemically in the context of their systems. They are frantically doggy paddling in order to keep their heads above water, which prevents them from learning in the pool the swimming strokes that would make the situation smoother and easier.

On the other hand, there is an effort to teach people about systems – but this is taking place away from the practicalities of work in a quite abstract fashion. It’s as if people are stepping out of the pool to sit in a classroom to be shown the theory behind other swim strokes that might support them better in the water.

Crisis and leadership

Why is proximity to practice so important in this instance? Primarily because our organisational focus in most instances is on structure: we focus constantly on the scaffolding that envelops the work that we are asked to do. Yet the latter occurs systemically, with a passing relationship to the structure but in many ways independently of it.

Importantly, it is arguable that recent experience shows us that systems become apparent, and we are better able to acknowledge their presence, at times when we face crisis. There are examples cited by Rhiannon Firth in her book Disaster Anarchy – for instance, the aftermath of Hurricane Sandy in the US – where disasters outstripped the state’s capacity to respond, due to its structural emphasis, but out of which arose mutual aid arrangements, which were systemic responses.

A clinician with whom I spoke at the peak of the Covid 19 pandemic explained that it used to take her at least three days to organise a patient transfer. Invariably, to action it, she would need to involve people above her in the hierarchy. However, with the arrival of coronavirus, she found it necessary to step into leadership – and she quickly found that she could network with opposite numbers in other agencies at a grassroots level…and suddenly transfers could be achieved in around half a day.

This is important learning about how structures can often constrain innovative approaches to getting things done – and that an experience of crisis can create a tendency for systemic working to come to the fore. The challenge, however, is to preserve that learning about systems that arises out of difficult practice, when organisational elasticity tends to see things snap back into place, with bureaucratic structure reasserting itself.

Learning about systems from systems

Over the course of the past six months, I have been in conversation with my colleague and co-thinker Eitan Reich as to how best to help people with systems thinking and practice. This piece is a summary of a longer and more detailed white paper, which can be accessed HERE.

We have generated several foundational precepts in terms of thinking about this challenge:

  1. Crises tend to cause structures to buckle, which has the positive effect of allowing the systemic underpinning of the workplace to become more apparent – and hence more widely applicable.
  2. Seeking to “teach” people about systems at a distance from the systems is too abstract an approach – which will make it feel like an imposition for many leaders.
  3. A useful starting point is to explore people’s recent experiences of crisis, in terms of what they saw happen; what they initially considered doing, and what eventually emerged as a way forward, which may well have been wholly unexpected but needs now to be acknowledged as a different way of working.
  4. Knowingly engaging with the experience of working systemically that arises inadvertently out of extreme circumstances will give people the permission to unlearn traditional leadership thought and practice and to allow a new way of being and doing at work to emerge. For example, the structural mindset requires us to think about directing: to embrace a systemic perspective means that we focus instead of finding ways of connecting.

Next steps?

Eitan and I are now extremely eager to identify a couple of partners who are interested to work alongside us in collaboration to continue this exploration and development of a way of helping people to think and practice more systemically in the public sector. If this is something that you might be interested to discuss with us, please drop us a line at radicalod@colefellows.co.uk and we’ll schedule an exploratory call.

Email: radicalod@colefellows.co.uk
Website: www.markcole.org
Blog: www.radicalod.org
X: @reflectservices

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Professor Mahendra Patel OBE: Reimagining the role of community pharmacy

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ICJ recently spoke to Professor Mahendra Patel OBE, leading pharmacy expert and Director for the Centre for Research Equity at the University of Oxford, about his vision for community pharmacy, and how multi-professional collaboration can help the underutilised sector play a key role in the fight against health inequalities.

Public Policy Projects (PPP) is hosting its inaugural Medicines and Care Pathways theatre as part of the Integrated Care Delivery Forum in 2024. The first iteration of the event took place in Birmingham on 9 May where pharmacy professionals joined wider ICS leadership to discuss pharmacy’s contribution to the integrated care agenda.

Professor Mahendra Patel OBE, Director for the Centre for Research Equity at the University of Oxford, and a recently appointed Independent Expert Member to the UK Professional Pharmacy Leadership Advisory Board (UK PPLAB), joined the theatre and highlighted the untapped potential of pharmacy to further contribute to system priorities.

PPP spoke to Mahendra about the current developments in UK pharmacy leadership, multi-professional collaboration, and the role pharmacy professionals can play in reducing health inequalities.

The evolving landscape of pharmacy leadership

In 2023, Mahendra brought his expertise to the UK Commission on Pharmacy Professional Leadership acting as Vice Chair of the Leadership, Policy and Professionalism working group. The Commission’s report concluded that there is ‘insufficient collective leadership’ for pharmacy in the UK, and that pharmacy professionals are generally disengaged from professional leadership bodies (PLBs).

The findings prompted the Commission to recommend the formation by the Department of Health and Social Care of the UK PPLAB, as an independent public body. The board has since appointed its chair and independent expert members, involving representatives from both PLBs and specialist professional groups (SPGs). The board will be implementing the Commission’s recommendations over the next 3 years, including the development of new arrangements for pharmacy leadership in the UK.

On the formation of the UK PPLAB, Mahendra says: “The new leadership board, through its broad-based range of independent experts from across the four nations, provides a robust and meaningful structure to steer the line of professional pharmacy leadership moving forward. Whether that is a royal college with different faculties, or two or three professional bodies under one umbrella – that’s for the UK PPLAB to decide.”

Equally, it’s an exciting time for community pharmacy with emerging new services and the increasingly advanced roles of pharmacists and pharmacy technicians. However, Mahendra warns of potential hurdles when it comes to determining new leadership structures. “There are going to be challenges when uniting all pertinent groups under one umbrella, as they are all resourced differently and to varying extents,” he adds.

Despite this, Mahendra remains excited and optimistic that “representation in this new setting will inspire and instil a breath of fresh air, so that those often disengaged, including a significant number from the community pharmacy sector, will come to believe that there is something in it for everyone across the pharmacy spectrum. The board creates a whole new arena of expertise, voice, and experience, including the patient and public opinion, making it a unique place to strengthen the present and shape the future.”

Multi-professional collaboration – bringing community pharmacy to the table

Beyond the Commission and implementing its recommendations, Mahendra seeks to help further elevate the role of community pharmacy. Using the Sigma conference in South Africa as a platform, he brought together pharmacy, nursing, medical and dentistry leaders from across the four UK nations to discuss the opportunity for multi-professional collaboration in the newly integrated NHS.

Using the implementation of the Pharmacy First service in England as an example, the session underscored the potential for pharmacy to engage in multi-professional collaboration. The service involves collaborative working across pharmacy and general practice to free up GP appointments and demonstrates untapped value in cross-sector working within primary care.

For example, the NHS Chief Dental Officer speaking at the event outlined exciting possibilities for the role of community pharmacy in preventative dental care, especially in reducing the levels of tooth decay in children – an increasingly pressing issue in the UK over recent years.

Mahendra feels that “community pharmacy can play a huge role in the prevention agenda. If we have the prevention agenda better resourced while we are coping with a shortage of dentists, at least we are considering longer-term perspectives.”

He concludes that the professions within healthcare are “united by providing the highest standards of health and care. They are all talking about the same problems but shout about them separately.” He calls for multi-professional collaboration for the benefit of patients and the public to ensure that health and care professionals are communicating to government with one clear voice.

Addressing health inequalities through research equity – the role of pharmacy

Throughout a diverse portfolio career, working to reduce health inequalities, especially in cardiovascular disease and type 2 diabetes, has been an underpinning focus for Mahendra. As Director for the Centre for Research Equity (CfRE), his work aims to target underserved communities and black and ethnic minorities through championing inclusivity and community engagement in health research.

Decades of work have exposed deep inequalities in the health of the UK population. As Mahendra explains, “we have seen the same results time and time again, as far back as the Black Report, two consecutive ten-year Marmot reviews, and most recently with Public Health England’s COVID-19 Report”. The Health Foundation has also pointed out that health inequalities in England are some of the worst among developed countries and are likely to persist without sufficient intervention.

Mahendra argues that engaging communities who are most impacted is essential if we want to prevent this projected widening of inequality. He stresses the role of research equity is a key piece of the puzzle and the role of pharmacy within this is crucially important.

He uses the case of the drug Clopidogrel, an anti-platelet medication used to prevent heart attacks, as an example. “One study showed that those from Bangladeshi or Pakistani origin were 30 per cent less likely to activate the drug once taken. These populations are those more likely to die of heart attacks compared to the white population.”

Garnering evidence which is generalisable across all populations is essential for reducing health inequality. The CfRE aims to achieve this by ensuring representative and more equitable health research.

Where does pharmacy come in?

Nearly 90 per cent of the population in England can access a community pharmacy within a 20-minute walk, and importantly, the ‘Positive Pharmacy Care Law’ exists, mandating that access to pharmacies increases to 100 per cent in areas of greatest deprivation. This makes community pharmacy a uniquely placed asset to engage with communities where health inequalities are most stark.

NHS England is supporting pharmacy to leverage this position. The recently published Report of a UK survey of pharmacy professional’s involvement in research has spearheaded the formation of a Pharmacy Research Advisory Group to implement the report’s recommendations. These include aims to “embed a research culture in pharmacy careers, develop a clinical academic pathway for pharmacy and provide a pipeline of pharmacy research leaders”.

This, in addition to the recognition provided to pharmacy in supporting inclusive research by the CfRE at Oxford University, a world class academic research institution, and the formation of the UK PPLAB, provides a huge boost for the sector.

Mahendra concludes that this recognition “demonstrates the ability of pharmacy to shift the dial of healthcare in many directions, inspiring the next generation of pharmacy professionals as well as those who may not have previously considered it as a career”.

PPP will be hosting the Medicines and Care Pathways theatre at the Integrated Care Delivery Forum in London on 5 November.

The Integrated Care Delivery Forum connects system leaders with on the ground innovators and industry experts to highlight exactly how ICSs are making place based, personalised care a reality. Rather than discuss issues such as health inequalities in broad framing and terminology, the Forum asks local systems leaders and stakeholders to demonstrate exactly how integrated care systems can affect change in key health and care challenges.

For further information about the Delivery Forum theatres, please contact:

Medicines and Care Pathways – Samantha Semmeling (samantha.semmeling@publicpolicyprojects.com)

Systems Transformation – David Duffy (david.duffy@pppinsight.com)

Data-driven Transformation – Gabriel Blaazer (gabriel.blaazer@publicpolicyprojects.com)

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£16m Workforce Wellbeing Programme launched to support NHS staff

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The co-designed wellbeing programme will run for three years and will be match-funded by NHS England.

NHS Charities Together, the national, independent charity caring for the NHS, has launched a £16m Workforce Wellbeing Programme to support NHS staff across the UK. The programme, which was announced at the charity’s annual member conference for more than 230 NHS charities, aims to improve NHS staff health and wellbeing, in turn making sure patients are provided with the care they need.

NHS Charities Together will commit an initial £6.0152m to support healthcare staff across the UK, with the fund being shared proportionately across the four nations, along with aspirations to fund a further £5 million over the duration of the programme.

In England the independent charity’s contribution will be match-funded by NHS England, which will contribute £5 million to the programme as part of its People Plan to support staff wellbeing.

The Workforce Wellbeing Programme will run for three years, with initiatives co-designed and co-led by NHS staff. Support will be tailored to the individual needs of the NHS organisations and their workforces, supplementing existing support provided to staff.

After a period of co-design with NHS staff, NHS England and others throughout the summer, the charity will invite NHS charities in partnership with their associated NHS Trusts or Health Boards to apply for grants from the Autumn. The impact of projects will be monitored and evaluated so that learnings can be shared and scaled across the UK.

NHS Charities Together has, to date, allocated more than £153 million in funding for projects supporting NHS staff, patients and volunteers. These include counselling services, helplines, and other mental health support services for NHS staff, as well as training for emergency responders and research into long Covid. It has also funded more than 325 community organisations to tackle health inequalities and prevention services.

Ellie Orton OBE, CEO of NHS Charities Together, said: “NHS staff work under immense pressure with unprecedented staff shortages and vacancies and the extra help we provide to support their wellbeing and mental health is now more important than ever. The NHS needs to be able to attract and retain the caring workforce to look after the ageing population and meet the growing needs of the public, who face more complex and long-term conditions than ever before.

“There’s lot of work going on across Trusts to support the wellbeing and mental health of NHS staff but more needs to be done. We’re delighted that NHS England has matched our £5m investment in support across England, and we are also putting proportionate investment across the devolved nations. We have ambitions for this programme to grow so that we can make sure we continue to deliver this important and much-needed support for as long as it’s needed.”

Amanda Pritchard, Chief Executive of NHS England said: “Our hardworking NHS staff are busier than ever but go the extra mile for patients every day, so it’s right that we look to do everything we can as employers to support their health and wellbeing.

“As part of our NHS Long Term Workforce Plan every local employer should have a comprehensive offer for their staff to help them stay well and stay within the health service, but this new programme will support those small, extra improvements which staff tell us will make a big difference to their working lives.

“Charities have played an important role alongside the NHS throughout our 76-year history, and it’s great to take that relationship to the next level with this first-of-its-kind national partnership, with thanks to NHS Charities Together and all those who have donated or raised funds.”

Making a lasting impact

One example of where previous rounds of funding are having a lasting impact on staff wellbeing is expanding and renovating the faith facilities at Royal Bolton Hospital in recognition of the role spiritual wellbeing plays in staff experience and satisfaction.

Revd. Neville Markham, Head Chaplain at Bolton NHS Foundation Trust, said: “The original prayer rooms were no longer adequately serving the needs of hospital staff and patients, so the new facilities have been transformational. Everyone is just so pleased to have the space they always wanted. Colleagues consistently tell us the quality of the faith facilities conveys a powerful message about how the Trust values and cares for them, and that positivity ripples back into the care and services they provide to patients, families and communities.”

Tahira Hussain, Volunteer Chaplain at Bolton NHS Foundation Trust, added: “We live in a fast-paced world. The things you see and experience through the day can take their toll, so having this space gives people chance to take some time out. Visiting for the first time, I actually felt special. The fact that someone had made the effort to provide a facility for me to reflect, to prayer, to connect, makes a massive difference.”

Another example is the Oasis Health and Wellbeing Centre and Garden in Berkshire – a central, vital wellbeing hub for NHS staff. Jointly funded by the Royal Berks Charity and the Royal Berkshire NHS Foundation Trust, and supported by a grant from NHS Charities Together, it offers a range of activities and services aimed at promoting staff health and wellbeing.

Don Fairley, Chief People Officer at Royal Berkshire NHS Foundation Trust, said: “The Oasis Health and Wellbeing Centre and Garden includes a free gym, wellbeing classes and a vibrant green space where staff can relax and unwind. The centre is also used for events to reward and recognise staff and promote inclusivity, recently commemorating International Day of the Midwife and hosting our cultural diversity celebration event.

“The Oasis campus also provides staff health checks and counselling services, which can be a lifeline. One member of staff was able to access invaluable help and understanding and face to face counselling which prevented them from self-harming and potentially going on to take their own life. We’ve seen a 40 per cent increase in positive responses to staff surveys regarding our support for health and wellbeing since the campus opened, with RBFT now proudly one of the top-performing acute NHS Trusts in this area. With over 3,400 staff accessing the centre and garden over 36,000 times in 2023 alone, its role in boosting staff wellbeing, and consequently enhancing patient care, is clear.”

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NHS procurement criteria set for major changes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Risk factors for Hepatitis C can include:

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

Among the resources available to you are:

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

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‘Transformative’ trial boosts prostate cancer patients’ autonomy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Digital Implementation, News

EHR roll-outs need strategies to mitigate clinician overload

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

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

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

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

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

EHRs and cognitive overload: examining the evidence

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

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

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

Practical recommendations:

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

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

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

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News, Thought Leadership

The future of occupational therapy and the impact of technology

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Leading occupational therapist, Alicia Ridout, discusses her award-winning work and explores the central role of technology in the future of occupational therapy.

Alicia Ridout, a leading occupational therapist, has recently won the Royal College of Occupational Therapists (RCOT) Tunstall Award for Technology Innovation for her work on the pioneering COG-OT – the Clinical Onboarding Guide for occupational therapists, which she and her team have used to continue their discovery work and to progress the project.

Here, she discusses the importance of technology in occupational therapy and why programmes such as COG-OT are essential for health professional development.

The importance of occupational therapy in wider healthcare

Occupational therapy is essential to the health and care sector and as a sector, we need to ensure that robust systems are put in place to keep up to date with digital competencies and boost confidence to use technology safely, in day-to-day practice. This will help the sector to continue supporting the efforts of the wider health and care landscape to digitise services effectively and improve access for people who need it.

Alicia Ridout, independent occupational therapist and creator of the COG-OT app

Occupational therapy is about working alongside people and their families, helping them achieve their personal goals and essential practical skills, using a holistic approach that respects their strengths and assets. This includes physical, sensory, mental health or communication needs. We see people in a wide range of contexts, people who are experiencing a wide variety of challenges, often for very different reasons.

Occupational therapists’ roles are unique in that we provide services to all age groups, across service boundaries. When it comes to supporting the wider care sector workforce in enabling people to safely access digital tools and services, the sector has always been actively focused on seeking out new technology. COG-OT provides a quick and easy means to access evidence and build competency driven technology skills.

The role of technology in occupational therapy

According to a recent study by RCOT, occupational therapists are facing pressures due to increased demand and vacancies within the industry. This potentially risks leaving people needing assessments, with little or no intervention.

There is a huge opportunity for technology to support people accessing services and occupational therapists, particularly when it comes to prioritising their requirements and influencing technology procurements. Using digital solutions offers the chance to reduce variation in workflows and processes, and also facilitate best clinical practice, streamline access to the right technology, at the right time, and ensure the end user’s experience is high quality.

We launched COG-OT as a web app in 2020, as a proof-of-concept approach to supporting practice development, funded by the Elizabeth Casson Trust. To date, we have won further funding from the Trust to evaluate the tool, as well as funding as part of the RCOT awards twice, in 2021 and 2023, which is crucial for the continued development of this vital resource for occupational therapists.

Why COG-OT has made a difference to the profession

COG-OT supports the profession with guide question sets to stimulate their reasoning about the needs of their service users. It can provide areas of focus and exploration when assessing people who have been referred to their service. This is hugely beneficial to less experienced digital practitioners, as it can help to navigate to the correct technology solution for an individual’s needs and ensure effort invested in the onboarding process is effective. The tool can help therapists by instilling confidence and a consistent but personalised approach to the deployment of technology.

Since the pandemic, digital practice has become increasingly prominent and this is no different in occupational therapy. Digitisation offers its own challenges, but by implementing tools such as COG-OT we are aiming to equip professionals with the digital clinical risk management tools they need for effective practice.

Why investment in technology needs to be prioritised, and how ICSs can support the occupational therapy community

ICSs provide a voice for Allied Health Professions (AHP) via Councils, driving improvement programmes and getting research into practice. The COG-OT team have been working with colleagues in an ICS to surface digital requirements across systems of care and we aim to share this insight widely. Digital confidence is one of many challenges facing AHPs at present, and the wider workforce.

However, as a next step, the sector needs to ensure consistent access to digital solutions, both to support workflows and also speed access to the right technology for users of services and their families. This will ensure that no matter the patient pathway, occupational therapists have easy access to recommended platforms that are of high quality, adhere to regulatory requirements and support clinically driven and collaboratively defined solutions for people in need.

Occupational therapists need to clearly articulate their requirements in this respect. They play a key role in personalised care and ensuring a holistic approach to safe digital deployment at every stage in the care journey – from hospital to community or intermediate care and at home. Digital use at home is different to a hospital environment, and we need to ensure holistic clinical risk assessments are completed.

By integrating safe and high-quality technology into our daily practice, working together with service users and their families and with other health and care professionals, we can pave the way for solutions that really make a difference.

For more information about COG-OT, please contact: cog.ot.project@gmail.com

For more information about Tunstall, please visit: www.tunstall.co.uk/our-solutions

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