Acute Care, Edge Health, News

Elective backlog and care priorities: a call for localised solutions

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Edge Health’s George Batchelor and Lucia De Santis explain the need to develop localised solutions to drive the NHS’s elective care recovery.


March 2020 marked an unprecedented change in the NHS and healthcare provision. As resources were diverted to the pandemic response, virtually all elective activity ceased, and the healthcare system transformed into a huge acute response machinery. We knew this would not be a sacrifice without consequences, but it was worthy of the stakes at play – millions of lives affected by COVID-19.

Fast-forward three years: the pandemic is now over for many people, but its impact on the NHS remains. This impact goes beyond the ever-growing elective backlog to include a fundamental shift in how care is provided, as well as a host of top-down targets that place increasing challenges on care providers.


The state of the elective recovery

Many will be familiar with the dire state of waiting lists for consultant-led elective care that topped 7.2m in October 2022 – a 64 per cent increase from March 2020 and with a median waiting time of 102 days.

Amid efforts to tackle the backlog, the recovery strategy has pushed for “doing more” with an ever-increasing range of performance measures to drive increased throughput and avoid adverse incentives, including: achieving zero 65-week waits by March 2024, increasing completed pathways by 110 per cent, increasing valued activity by 104 per cent, performing all diagnostic tests within 6 weeks, and several more.

Competing targets can be confusing to navigate and add pressures to already stretched systems, but they also fail to account for novel care challenges and regional variation. Working closely with trusts and ICBs, Edge Health has encountered, again and again, a stark increase in patient complexity since the pandemic and the consequences of a depleted, exhausted workforce that don’t show up in figures and targets.

Click to enlarge image.

To add to this, Covid has also prompted a greater focus on prioritisation and clinical urgency in allocating care, as opposed to a first come, first served system, which poses added challenges in correctly allocating services when some patients have been on a waiting list for more than two years.


How targets fuel a new hierarchy of care: emergencies, long-waiters, then everyone else

Despite the impressive efforts and successes of restoring elective activity after the pandemic, as well as the rise of innovative ways to provide care and promote collaboration among providers, we are still far from having room to breathe. In this context of significant mismatch between demand and capacity, the limitations of national targets that would encourage efficient management in a balanced system are laid bare.

A pertinent example of this is elective waiting lists, which have been the object of various targets to reduce long waits. The good intentions behind these targets are undeniable; no one should be made to wait for care for more than a year. In a system where demand is matched with capacity, such long waits should never be an issue. In principle, a sudden surge in capacity directed at these long waiters might be enough – at least for some trusts – to clear them. However, this is problematic for two key reasons: it fails to account for clinical urgency and the resources that must be reserved for the sickest patients, and it directs disproportionate energy to 2 per cent of the waiting list.

Previous experience shows that initiatives to address targets are incredibly energy-consuming for trusts. They may also fail to gain buy-in when they don’t match local clinical priorities. What we have seen at large trusts is that the backlog of elective diagnostics does not stand a chance in front of the volume of emergency and two-week-wait cancer referrals. As patients approach waiting targets, however, they are pushed to the front of the queue to avoid missing them. This is not solving the backlog issue – it merely adds another pressure point.

Click to enlarge image.

Perhaps more throughput-focused national targets, such as setting a maximum number of waiting-list per head of population, would be more effective while allowing trusts to decide how to manage their own waiting lists.


ICBs create an opportunity to focus on local priorities

If there is one thing that the pandemic has demonstrated about the NHS, it is that when empowered, trusts and local systems are pioneers of innovation and can rise to unprecedented challenges. From the London Ambulance Service, which partnered with the London Fire Brigade to deal with rising ambulance demand, to the Royal Surrey NHS Foundation Trust that partnered with a local private hospital to provide excellent palliative care despite the pandemic (NHS Providers, 2020), the pandemic bore witness to numerous examples of unparalleled collaboration and innovation.

There is an inevitability about some targets in that they reflect national priorities and are a way of tracking progress and holding systems to account. There is some evidence to suggest they motivate change and can be a catalyst for improvement. But the flipside is that blanket targets don’t take into account local need and they penalise providers that are otherwise making huge progress on elective recovery. They’re also not particularly good at motivating staff in a positive way—health and care professionals understand that targets are organisationally important, but they’re not always aligned with what professionals and patients think is important. If ICBs are to be held accountable for delivering on targets, it only seems fair that they should have a say in what the targets might be and it can be expected that priorities might change from one locality to another.

This should not be seen as a limitation, but as an opportunity. We think ICBs are the key for a more nuanced approach to designing and setting priorities that might catch two (or more!) birds with one stone: managing the elective backlog and addressing local need with highly relevant targets.

ICBs could set their own targets, that are in line with national priorities but refined to fit local circumstances. Local systems could engage their workforce and patient voices in agreeing what these look like. This approach still creates accountability and sets a direction for change (the point of targets) but also gets buy-in from the teams charged with meeting the targets—targets that reflect their priorities and what they see in their own practice.

It doesn’t have to mean a free-for-all or ducking difficult problems. National bodies can still ensure local systems are ambitious, hold them to account, and provide support and guidance to deliver change. Programmes such as GIRFT do this very successfully. Instead, what we propose would allow local systems to have more freedom to invest in novel care strategies to tackle their unique challenges. Importantly, it could be a mechanism to engage with, value and retain the workforce.

Of course, the counter is that differences will emerge across localities. But the truth is that this is the current reality, demonstrated by the charts above. And those differences would likely start to narrow if – and this is critical – ICBs are given time to flourish, work to meet local priorities and learn from one another.


About the authors

George Bachelor is Co-Founder and Director of Edge Health s

Lucia De Santis is a qualified medical doctor and Analyst at Edge Health, providing

For more information about Edge Health, please visit www.edgehealth.co.uk.

IQVIA, News

How IQVIA is optimising respiratory pathways to enable long-term NHS recovery

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As the NHS continues its recovery from Covid-19, IQVIA has been working with integrated care systems, with its analytics capabilities helping them to deliver on regional and national priorities.


The NHS has been significantly impacted during the pandemic and must prioritise workforce investment, COVID-19 recovery and a reduction in the backlog of care. To support patients, key objectives have been outlined in the NHS Long Term Plan and the NHS Operational Planning and Contracting Guidance. These objectives support the integrated care systems (ICSs) priorities to:

  • Enhance experience of care
  • Improve the health and wellbeing of the population
  • Reduce per capita cost of healthcare and improve productivity
  • Address healthcare inequalities
  • Increase the wellbeing and engagement of the workforce

IQVIA, a human data science company, has been working with ICSs to achieve these priorities as well as the overarching aims of the NHS. Through its Interface pharmacist team, a team of clinical pharmacists and nurses who support primary care and community health services, IQVIA can support with patient identification and treatment actions, therapy reviews, patient and clinical education and flexible capacity support.


Case study: Leicester, Leicestershire & Rutland (LLR) ICS

IQVIA were commissioned by LLR to deliver a Respiratory Optimisation Programme over a seven-week period. This clinical support was intended to ease some of the pressure caused by the backlog of care and allow vulnerable patients to receive timely support due by providing additional clinical capacity. Over the course of the programme, IQVIA were able to:

  • Identify opportunities for improvement, support efficient allocation of resources and deliver patient-centric services which improve access to medicines and optimise care.
  • Identify gaps in care, recognise patients at risk of adverse events and improve patient outcomes.
  • Provide skilled capacity to deliver best care at scale and address healthcare inequalities.
  • Provide mentorship opportunities to the multi-disciplinary team and support and sustain enhanced care.

IQVIA’s Interface pharmacists delivered 3,000 COPD clinic appointments across the LLR ICS, working with 71 practices – with 54 per cent of the pharmacy practices in the LLR ICS. Across these practices, 11,348 patients had a diagnosis of COPD recorded. 8,692 of these (77 per cent of the total) were identified as potential beneficiaries of treatment optimisation, and 7,420 of these patients (85 per cent) were invited to a COPD clinic.

Of those patients seen in clinic,

  • 635 patients received an escalation to their current level of management
  • 100 patients received a de-escalation of their current level of management
  • 2,132 patients maintained their current level of management
  • 1,119 non-pharmalogical interventions were made, including referrals for smoking cessation or pulmonary rehabilitation

Due to the pandemic and subsequent backlog in care, many of these patients had no recorded care process in the last 12 months. After the pharmacist clinics there were significant increases to these key markers, including:

  • A 96 per cent increase in patients who had a COPD review
  • A 171 per cent increase in patients who had their inhaler technique checked
  • A 212 per cent increase in patients with a CAT assessment

The seven-week support programme provided LLR with the additional clinical resource needed to assess and proactively manage patients with COPD. The increased capacity benefited the health and well-being of patients whilst the multi-disciplinary team were engaged with the review to provide ongoing, continued care.


About IQVIA

IQVIA utilises extensive data and analytics capabilities to inform clinical decision-making.  To support and drive key advancements towards improving patient outcomes, IQVIA is at the forefront of unlocking the potential of NHS health data to realise future health improvements for the UK and deliver transformative benefits for the patients of today and tomorrow. IQVIA believes that the value of NHS health data is not in the data per se, but in the clinical decision-making it can inform. As a trusted partner to health systems and providers, we use our extensive data and analytics capabilities to transform health outcomes and deliver pioneering biomedical research within the 95 per cent of NHS Trusts who use one or more of our services.

News, Tunstall Healthcare

Prevention, early access and health inequalities: Redefining place-based care

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Gavin Bashar, UK & I Managing Director at Tunstall Healthcare, discusses the focus on prevention, early access and health inequalities and the need to use technology to redefine place-based care.


If the healthcare system is to are to re-define care and achieve preventative services that reduce health inequalities, it’s important to approach services both holistically and through targeted resolutions to specific areas of care provision.


Redefining place-based care

Place-based care has the potential to deliver multiple opportunities. In order to capitalise on those that are presented, it is important to first define ‘the place’ and what this means to people both providing and accessing care services.

When defining place-based care it’s important to consider the different demographic regions across the UK. There are disparities in the health and wellness of communities with different population characteristics, and differences in access to technology, health and wellbeing, and life expectancy should be accounted for.

By starting with place-based care, it is possible to approach issues around prevention and proactivity and the tailoring of care. This in turn will help care providers to combat health inequalities and improve access to health, social care and housing.


The implementation of ICSs

It is hoped that integrated care systems (ICSs) will drive real system change that removes silos that are currently placing barriers on delivering the most effective services.

Considering single accountability and each step of an individual’s care journey will empower us to support ICSs in their role. This will be further supported by real collaboration and integration across the system. If we address issues and demand earlier, budgets and funding streams can be allocated to the specific areas that need them.


The role of tech

Technology’s role as an enabler can move the prevention agenda forward, however it is only valuable if it drives sustainable system change. In order to integrate technology effectively, we must bring the right skill sets into our services to ensure they can deploy digital solutions successfully.

Technology can have significant benefits for citizens, particularly in terms of using data to provide intelligent insight to inform more personalised and preventative care. We should see the ongoing progress that’s been made around data privacy continue, particularly as future generations are now growing up in a digital landscape. This will lead to citizens being more comfortable with health and care technology, and having a better understanding of how they can be empowered to play a more active role in their own wellbeing.


For more information, please visit www.tunstall.co.uk.

News, Omnicell

Why interoperability is key to transforming the healthcare service and patient safety

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Ed Platt, UK Sales Director for Omnicell UK & Ireland, discusses digital systems and why interoperability is key to transforming the healthcare service and driving patient safety.


Within healthcare, interoperability is the integration of technology and healthcare systems to simplify the communication, delivery and digitalisation of clinical information across an organisation or system. Effective interoperability allows for improved collaboration and clinical workflows to inform crucial decision making, creating time and financial savings – all with the aim of driving better patient outcomes.

Omnicell, as a leading medication management solution provider, is paving the way for interoperable technology to become widespread in the healthcare landscape, as it is in other sectors. Omnicell’s Automated Platforms have been integrated with several leading providers of Electronic Prescribing and Medicines Administration (ePMA) and electronic patient record systems (EPR, more commonly known as EMR outside of the UK) which have led to a reduction in medication errors and better workflows for staff.

These working interfaces are with Better, Cerner, EPIC, AllScript, SystemOne, WellSky and MedChart, to name but a few. However, it is also possible for platforms to link and integrate with medication wholesalers, finance systems and many more stakeholders, with a view of delivering a patient-centric supply chain.


The global challenge

The World Health Organisation recognised the severity of medication errors and more than 5 years ago, introduced a Global Patient Safety Challenge, Medication without Harm, with the ambition of reducing avoidable medication-related harm by 50 per cent. The scale of the issue within the UK is worrying; in 2018 the EEPRU report, Prevalence and Economic Burden of Medication Errors in the NHS in England, further highlighted the sheer scale of medication errors taking place.

The shock of these findings led to a review, which set the healthcare system on the path to technological solutions with the impressive adoption of the ePMA systems. According to a National Institute for Health Research (NIHR) funded study, high-risk medication errors can be reduced by up to 50 per cent with the implementation of this technology.


The next step; interoperability

Linking and integrating ePMA and EPR systems with complementary systems such as inventory management tracking systems, electronic controlled drug solutions, robotic dispensing systems and automated medication dispensing cabinets is the next step in truly driving down medication errors. NHS Trusts are now taking digitalisation a step further by investing in integrated electronic health record (EHR) systems.

EHRs represent a step beyond the standard patient medical history found in paper-based patient medical records and include a broader view, including information from all the clinicians involved in a patient’s care. Importantly, they also share information with other healthcare providers, such as laboratories and specialists. This approach enables NHS Trusts to enhance their operational and financial efficiencies and improve the experience for staff working at multiple sites.

Interoperability with partners helps ‘close the loop’ in the medication management process; not only does it enable optimisation of medication administration, it also provide a full access to patient data records allowing for complete visibility and accountability. For patients, it means healthcare professionals have up-to-date access to all information, irrespective of the treatment venue, enabling the delivery of high-quality, coordinated and informed care. Integration also allows for additional features and shared data with Omnicell pharmacy technology automation and intelligence solutions to drive inventory optimisation, diversion management, medication usage analytics, compliance and population health services.


A collaborative partnership approach

Omnicell prides itself on being a long-term partner to hospitals as a quality, trusting relationship supports a smooth transition to new, technology-enabled ways of working – supporting full buy-in and adoption by staff. Technology solution providers should spend time on-site, understanding different workflows in various departments and proving expert guidance on how adoption can best be used to make significant time and cost savings quickly. For example, the medication needs on an intensive care unit are different to the needs of an orthopaedic ward.

But what is the optimum solution for each of those wards, and which model of interoperable technology is going to be the most effective when it comes to achieving zero errors, zero waste and zero time-consuming process for staff? The future must therefore be one of sharing, co-operation and transparency; between systems, between patients and healthcare providers, between healthcare providers and industry experts and between different healthcare disciplines – all driven by knowledge and supported by data.


Conclusion

Interoperability solutions are a great opportunity for the healthcare sector and could be a crucial factor in realising the future of our much-loved national health service by presenting the sector with cost, safety and efficiency opportunities. With the right partners, Omnicell’s solutions can transform medication management and create synergies across healthcare enterprises. Technology doesn’t stand still and, looking to the future, interoperable technology solutions, data and AI have the power to change the healthcare landscape beyond recognition.

Chesterfield Royal Hospital introduced ward based automation systems for medicines to further reduce the risk of error and increase efficiency, with the ultimate goal of improving the management of medicines in the ward environment and reducing the burden placed on nurses and pharmacy staff. Martin Shepherd, Head of Medicines Management at Chesterfield Royal Hospital NHS Foundation Trust, commented: “This is a significantly better and safer way of dealing with ward medicines. The risk to patient safety is lower as we have reduced our dependence on manual processes. It provides a safety net, reduces the risk of products being wrongly selected and near misses. Integrating the ward-based systems with PMA only strengthens that level of security. It helps us in our drive to ensure that patients receive the right medicines at the right time.”

St Mary’s hospital already had a ward level electronic prescribing system in operation for two years when they decided to take the next step in patient safety and automation by installing Omnicell automated medication dispensing cabinets in all care areas. Jackie Harry, NICU Ward, Isle of Wight NHS Trust, commented; “We have much better stock control and expiry date management, and it’s really easy to use even in an emergency. We have saved time hunting for keys and searching in cupboards – we know we have the stock and the cabinet takes us to it. Invaluable. Really time efficient and safe.”


Ed Platt, UK Sales Director, Omnicell UK & Ireland

This article was kindly sponsored by Omnicell.

To learn more about the importance of interoperability, visit Omnicell.co.uk or email:

UKMASales@Omnicell.com

Call: +44 (0)161 412 5333

Finding the right support to provide the NHS with the capacity needed

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Dr Jean Challiner, Medical Director for Medinet, outlines how the NHS must harness spare capacity from all corners of the health and care sector to meet this period of unprecedented service demand.


As has been made abundantly clear by the Prime Minister earlier this month, the NHS is suffering from a severe capacity crisis. In addition to emergency departments tackling the toughest winter on record, 7.21 million people are currently on an elective care waiting list and staff shortages are crippling service delivery.

The Prime Minister himself acknowledged that these trends existed prior to Covid-19 but the pandemic has escalated the problem beyond what the NHS is able to tackle without added support. “With so many people waiting longer and longer for elective care, patients’ conditions are worsening and becoming urgent for some,” reflects Dr Jean Challiner, Medical Director for independent healthcare provider, Medinet.

Dr Challiner stresses that for Medinet, who have a two decade history of providing dedicated ‘insourcing’ for NHS trusts to boost capacity, the time patients are spending waiting for treatment is having a drastic impact on their work. “We used to almost exclusively offer capacity in the NHS for low complexity day cases, but now the priorities within the NHS are very different, and there is a growing need for us to address more urgent and more complex cases.”

Medinet holds the country’s largest pool of expert clinicians across 20 different specialties, and supplies teams to provide additional clinical capacity to enable hospitals to meet waiting times targets and then work with them to ensure these are not breached. In the last 12 months, 170,000 patients have been seen and treated by Medinet’s clinical teams.

The fact that Medinet teams work in close conjunction with NHS clinical teams and within existing estates means that they can adapt their service offering to include more complex surgery when needed. This includes cancer surgery and other procedures that fall under the realm of specialised commissioning. Medinet’s large pool of consultants, often made up of part-time NHS doctors or recent retirees, can perform most procedures, although they rarely tackle acute emergency procedures.


Reforming the referral process

Beyond directly boosting capacity with additional staff, Medinet have looked to enhance NHS efficiency and bring down backlog figures by reducing time to referral for patients. With cataract surgery, (accounting for one of the largest elements of the elective waiting list with 600,000 patients waiting for a procedure) patients are now having to wait up to two years to have their cataracts assessed.

“We are seeing some trusts getting twice as many referrals in certain areas as before and you can’t instantly train the necessary staff to meet this demand in the short term,” says Dr Challiner. “Part of our process is to not only bring in additional direct expert capacity where required but also help enhance overall efficiency or perhaps deploy existing resource differently.”

Based on a study conducted with a customer in Scotland, Medinet consultants have recently put forward recommendations to bring down cataract wait times across England, particularly for low risk patients. The study set out to determine the suitability of community cataract referrals for a one-stop cataract surgery service and the target areas for referral refinement. The results of the study showed that waiting time was significantly reduced – an average of 30 weeks for one-stop patients. Approximately one quarter of referrals were considered suitable for the one-stop service and many more may have been suitable if there had been more information in their referrals.


Capitalising on system reform

While Medinet services are still primarily commissioned by individual NHS trusts, the development of integrated care and closer collaboration between individual providers could potentially create opportunities for Medinet to expand its service offering elsewhere. “There is a huge opportunity within ICSs to change the model of harnessing spare capacity and applying [it] to other parts of the system. ICSs must provide the framework for providers to break out of regional, professional and organisational silos and boundaries to alleviate the capacity crisis currently being faced by the NHS.

“As providers evolve their service offerings to meet new challenges, they must be able to highlight where new capacity where is required without fear of reprimand.”


Encouraging active dialogue

Under no illusions, Dr Challiner acknowledges that the Medinet model is not a magic bullet to NHS capacity pressures as there are fundamental obstacles that can restrict impact. “Operating within existing NHS estate allows us to work much closer with NHS teams,” she says, “but we face regular challenges with bed availability, as we cannot conduct day case surgery unless there are beds available for recovery if needed. We also often have difficulty in simply finding the space within a trust for Medinet to operate in work or having a trust staff lead on hand to provide trouble shooting assistance or can locate replacement equipment if required.

“We encourage trusts to highlight new ways in which we can boost capacity. We are seeing an NHS that is working tremendously hard, and we want to help them. Nothing is off bounds for us, to help tackle what is most important, so we need the NHS to talk to us, and engage in discussions to look for possible solutions that are risk assessed and will work.”

Medinet’s position as a capacity booster has placed it in a unique position to reflect on the various challenges that lie within the NHS backlog. Last year, the organisation released its Manifesto for Better, outlining how they plan on supporting hospitals across the country to support commitments to improve access to treatment, empower patient choice, and provide the capacity required in response to the growing backlog of elective services.

 

News, Tunstall Healthcare

Using integrated care to live healthier and happier lives

By
Angus Honeysett

Angus Honeysett, Head of Market Access at Tunstall Healthcare, discusses putting citizens at the heart of care through technology, partnerships and integrated care to enable people to live happier, healthier lives.


The Government’s white paper, People at the Heart of Care, has a clear focus on integration and recognising the vital importance of improving quality of life and health outcomes. In particular, it promises £150 million of funding for several key areas, including assistive technology; improving the establishment and maintenance of digital records and data; upskilling the adult social care workforce in how to use technology; and bedding in wider digital infrastructure and cybersecurity within systems.

This is translated into the core objectives of integrated care systems (ICSs) as greater integration and more funding will enable them to facilitate the delivery of high-quality local services and citizen-focused outcomes.

The system will operate at three levels – integrated care partnerships, integrated care boards, and provider collaboratives – building better system-level knowledge of the needs of people so that they can receive more support closer to home, which includes some outpatient and diagnostic procedures.

People can stay independent for longer because health providers and community-based services will support those with the most complex needs outside of hospital settings. As the work of ICSs begins, now is a pivotal time that will shape our resources for decades to come.


Technology and cultural change

As ICSs continue to develop, the focus on driving digital systems that place citizens at the centre of service design and delivery will increase. Yet to deploy technology effectively, there are significant cultural challenges to overcome.

Technology has historically been seen as an addition to existing resources – a ‘nice-to-have’, rather than a means of transforming models of support. This has led to difficulties in integrating technology effectively. Cultural change is required which in turn needs early engagement.

Top-down leadership is needed to ensure stakeholders have input at an early stage into how technology can help them and the citizens they support. There are still workforce concerns that need to be addressed and stakeholders need to understand that technology is an enabler for better services, not a replacement for human contact.

Using technology to support people can be low-cost, thereby enabling more people to have digital solutions integrated into their care provision. This in turn gives professionals the ability to provide preventative care and engage with citizens so that they can stay at home for longer with an increased quality of life. Likewise, relatively low-cost telecare systems can help to avoid hospital admission and delay and prevent the need for residential care, and reduce carer burnout.

Understanding the barriers that we face and adapting as things change – not being driven by contracts, but by providing solutions – will ensure innovation continues to flourish. To successfully build solutions however, healthcare services must first understand the problems that are faced by people on a daily basis, with the recognition that this will change between individuals. The more we understand these problems, the easier it will be to co-design straightforward and effective strategies and solutions.

Technology is a quick win for ICSs and if used effectively, can free up the time for the workforce and other stakeholders, enabling them to become more productive in providing support to citizens that need it most.

The aim should be to embed technology so that outcomes are at the centre of all support that is provided, instead of endless form-filling, unnavigable processes and a bureaucracy which sees too many people get lost in the system, rather than receiving the support they need. It puts both power and opportunity in the hands of citizens and communities, providing solutions that are easy and efficient to access.


Collaboration and integration

Working together is in the interests of the public and all stakeholders, and greater integration, co-design and uptake of technology will enable an increase and improvement in the solutions that are available. This will also ensure that services can meet the population’s needs, saving taxpayers’ money through cost-avoidance to the system.

The formation of ICSs provides a unique opportunity to consider and pursue shared common goals. Health and social care must work together to have a positive and long-lasting impact on population health, to ensure citizens are at the heart of decisions about the support they need.

Our services are all intrinsically dependent upon each other which is reflected in the establishment of ICSs. If care delivery is ineffective, it places increased pressure on our health system, therefore leading to an inability to support citizens. Healthcare services need to have a truly joined up, integrated approach where they listen, understand everyday needs and work together to bridge gaps in resource allocation, including funding flow, which needs continued reform to drive system change.

When we deliver successful and integrated services, the benefits flow through the system from primary to secondary care, to community and social care. With the right approach, citizens can stay in the place of their choice for longer, delaying the requirement for more expensive and complex solutions.


Empowerment and control

The UK’s ageing population means there is little choice but to look at alternative ways to deliver support, in order to cope with increasing demand and more complex needs. The increased integration of technology and its use not only enhances the care that people receive, but also enables them to remain at home for longer, increasing the efficiency and capacity of our systems.

As we continue to invest and integrate technology into our services, it gives citizens greater ability to become more involved in how their health and wellbeing is managed. Data plays a particularly important role in empowering citizens to manage their own conditions as through technology such as telehealth, they can take their own readings and share these with the right people at the right time.

For citizens to be fully empowered, they must be engaged with and made a part of decision making around their care, and also understand the benefits that technology can bring, alongside how to use it.

Through the use of clear language, healthcare systems can communicate more effectively with citizens and build links between the technology that they already have and regularly use, and the technology that can support their health and wellbeing through new services. This in turn should reduce fear of the unknown and help drive a culture change at both local authority and citizen level.

By integrating services through ICSs and investing in the next generation of technology, it’s easier to engage families, friends, and communities in supporting early, proactive, and preventative interventions. Digital innovation presents opportunities to improve citizen experience, supporting better quality and greater reliability of service provision, providing enhanced solutions which are tailored to meet specific needs.


Looking to the future

ICSs and their development provide a timely opportunity to revolutionise our health systems and put citizens at the heart of care through the delivery of better outcomes and cost reductions. However, challenges remain, such as the UK’s move from analogue to digital communications networks.

This will require significant investment from the public sector at a time when budgets are already under extreme pressure, however, this brings a once in a generation opportunity to modernise, improve and shift thinking from a reactive, to a proactive delivery model. AI, machine learning and the use of data are hugely important to this.

Using data in a proactive and predictive way means issues can be highlighted early, which is in everyone’s best interest. The more that citizens are involved and engaged with data, including taking their own readings, the more they’ll understand how to more effectively manage their health and wellbeing on a daily basis.

By educating service professionals and the public on the value of data and how it can be used to transform health and care provision, people will become more comfortable with their data being used in a real-time setting.

With increased funding, improved decision making through ICSs, and better integration of technology, we will be able to drive reconfiguration and collaboration. It’s essential that service providers and citizens are involved in the digital transformation if we’re to innovate, embrace technology fully and successfully, and deliver new approaches which create benefits for both citizens and the system.


This article was kindly sponsored by Tunstall Healthcare.

For more information, please visit www.tunstall.co.uk.

News, Tunstall Healthcare

Integrated care systems: reaching disenfranchised communities

By

Raj Purewal, UK&I Strategic Development Director at Tunstall Healthcare, discusses how technology can be adopted by integrated care systems (ICSs), and how care services can reach all communities and reduce health inequalities.


In October, Public Policy Projects (PPP) launched its ICS Roadshow in locations across the UK. The events endeavour to bring together health, social care and housing professionals and create a new forum for integrated care, which sees national policy delivered at a local level.


Setting the strategy with ICSs

ICSs have taken over the role of Clinical Commissioning Groups, who were previously responsible for commissioning the best health services for their localities. ICSs will also be responsible for implementing strategies across footprints to ensure patients and citizens can access the best services and care possible. They will be able to link the data and insight they have access to from the daily activities of the health and care sector, ultimately transforming the way care services are provided.

The integration of health and social care services will be a key enabler in the transformation of systems for citizens. ICSs, alongside local authorities, will be the driving force behind this as they have been specifically designed as the link between health and social care to improve collaboration, care provision and patient outcomes.

ICSs have also been tasked with ensuring the continuity of care in regions across England, so that national policy aligns with the needs of patients and citizens on a local level. The introduction of new legislation will direct local and regional health and care systems to improve alignment between service providers, while supporting, enabling and educating patients, and when appropriate, to manage their needs.

Tunstall is at a pivotal place when it comes to aligning services through ICSs and it’s crucial that we adapt our strategies as required. Tunstall’s services must support ICSs’ objectives and their focus on driving best practice, transforming services and increasing the use of digital capabilities for patients and citizens.

ICSs will foster closer working between health and care service providers. Tunstall’s longstanding role and remit shall continue, and we will also support providers, commissioners, partners and vendors to deliver the Triple Aim, ROI and best value for these sectors and the public sector pound.


Adopting technology

The importance of technology in service delivery across the health and care sectors shouldn’t be underestimated, particularly when it comes to monitoring and assessing citizens and patients when discharged, or in virtual wards, and when appropriate, pro-actively before a planned attendance. To adopt technology-enabled care services, we must help to educate both citizens and health and care professionals effectively, and leaders must coordinate this across ICSs.

Adopting and scaling the right technology will support many resources, increase utilisation, and improve capacity across the health and care systems, to provide effective care. ICSs will continue to increase the focus on building preventative and proactive care models, which will include investment in the continued advancement of technology.

Technology providers are working on solutions and platforms that will identify changes in patients’ or citizens’ vital signs, mobility or behaviour. For example, Tunstall Cognitive Care® will use advanced AI in combination with technology in the home to detect whether someone’s health could be about to deteriorate, spot a potentially undiagnosed condition, or resolve an immediate social care need.

Since before the pandemic, around 22 per cent of the NHS elective backlog for surgery is for orthopaedic conditions relating to the hip or knee, or cataract surgery; patients who are on these waiting lists can be identified and supported with remote monitoring. For example, if a particular behavioural trend for a citizen who is struggling with mobility can be seen, support can be offered quickly with an appropriate intervention at the right time to minimise the need for urgent, more expensive unplanned emergency care. This type of integration and use of technology will help to reduce stress and pressure on provider resources and service work plans.

As ICSs transform services, and move towards digitisation and digitalisation, the technology that providers deploy needs to facilitate strong foundations for the future of care provision, as ICSs will aim to optimise data and to generate insight. In helping to ensure that the infrastructure and systems are in place, Tunstall can start to have positive impacts on health and care services for all as health care services make these transitions.


Improving care services and reaching all communities

The overall experience of services for all citizens should be improved through the introduction of ICSs, as they will be tasked to ensure equality of care, which historically has not always been the case.

ICSs will also increase focus on improving value delivered for the public purse, improving efficiency by reducing the incidence of unattended appointments (DNAs) and ensuring a continuum of care for the patient and citizen from referral and after discharge. This is critical in ensuring healthcare services are optimised – ranging from effective patient communication, reducing the number of DNAs, and sharing insight with practitioners to inform best practice. ICSs will be able to take an analytical approach to the data they have access to and use this to both inform planning and to allocate resources.

To reduce health inequalities, it will be necessary to take a holistic view. For example, poor housing can have an impact on citizen health if there is a lack of insulation or if there is damp. There is no singular factor or reason that causes health inequality, but ICSs will bring bespoke approaches for their different localities to ensure gaps in health and care are lessened and minimised over time.

Other inequalities can cause communities to become disenfranchised with service providers, for example problems can arise because of travel, logistics and even linguistic challenges. Most recently, we saw an example of this as some communities were excluded from pandemic communications especially digital communications, including the messaging around measures put in place to reduce the spread of COVID-19.

The establishment and progression of ICSs will enable the alignment of technology-based health and social care services and improve health outcomes for every community across the UK.

As service providers and the workforce become increasingly invested in, and understanding of, the role of technology in supporting and empowering vulnerable people, we’ll see a reduction in health inequalities and upgraded services that are better able to meet the demands of our growing and ageing population.

News, Tunstall Healthcare

Tunstall Healthcare launches tech hub in Manchester

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Global pioneering health and care technology firm Tunstall Healthcare has officially opened its new hub in St Peter’s Square, Manchester.  


Tunstall Healthcare, which is celebrating its 65th year, is currently recruiting for a range of hybrid working positions that will be based in the new hub in St Peter’s Square, Manchester. Quality and testing, software development and business analysis roles are available to complement the existing tech teams based in Yorkshire, Sweden, Germany and Spain.

As well as mid-senior tech roles, there will be opportunities for graduates and apprentices to join the firm as part of Tunstall’s drive to mentor and train the very best talent in tech, in addition to positions that will offer support to those who wish to retrain or who have been out of work.

Emil Peters, Tunstall Group CEO at Tunstall, said: “This is undoubtedly a huge and exciting milestone for Tunstall as we open our latest UK office space, in the renowned business and technology hub of Manchester. Our new base is the perfect location to serve our customers across the country and in the north west, as well as attracting new talent to the Tunstall brand.

“A career at Tunstall gives candidates the opportunity to make a real difference in the health and care sector by realising the potential of technology to empower people to have more choice over how they live their lives. Our Manchester base will help us to attract some of the brightest talent in the sector to help us drive our exciting technology roadmap forward, and I’m looking forward to welcoming new colleagues to the business.”

Established in 1957, Tunstall has grown substantially and evolved from an equipment provider to a software solution and technology company that provides telecare and telehealth managed services. In this time, it has almost doubled the number of users supported by its systems, while increasing its geographic footprint across Europe.

Gary Steen, Chief Operating Officer at Tunstall UK, added: “At Tunstall, we put our people first and invest in their professional development. By expanding our base across the North, we will be able to continue our success as a business while forging ahead as the market leader in our sector.

“New technology solutions are vital if we are to support our ageing population effectively. Innovation and development in the health and care sector will allow us to continue moving towards a proactive and preventative model of care provision which improves the quality of people’s lives and enables valuable resource to be targeted where and when they are needed most.”

Tunstall Group works with health, care and housing providers around the world and supports more than five million people through technology. Its technology and service offerings allow its customers to deploy new models of community-based health and care delivery that are more integrated, personalised and proactive.

To find out more about Tunstall, please visit www.tunstall.co.uk.

Fujifilm, News, Thought Leadership

Fujifilm primed for leadership in pulmonary solutions

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Pictured above: Samiran Dey, European Business Development Manager, Fujifilm Europe

An established pioneer in digital X-rays, flexible endoscopy, ultrasound and CT scans, Fujifilm Healthcare has been using these technologies to address pulmonary conditions for nearly two decades.


Yet, the company is better known in gastroenterology, and particularly for its advanced endoscopy products.

The acquisition of Hitachi’s diagnostic imaging business in March 2021 strengthened Fujifilm’s hand as a medical-imaging specialist and a comprehensive provider of healthcare solutions. Now, Fujifilm is leveraging cross-business synergies to pursue a bold new vision as a one-stop pulmonary solutions supplier.

That includes an expanded product portfolio, enhanced with innovations in fields such as image processing and artificial intelligence. With new additions such as the slim EB-710-P bronchoscope, Fujifilm offers a broad suite of pulmonology solutions extending right along the whole patient pathway, from screening to treatment planning.

Integrated, cutting-edge technologies that facilitate and clarify pulmonary screening and diagnosis can help improve patient outcomes in areas such as lung cancer, where survival rates still lag significantly behind other oncology settings. Streamlining patient pathways is also about tackling the capacity and efficiency issues that routinely confront time- and budget-constrained pulmonologists.

These issues, together with the inherent challenges of lung screening and diagnosis, are part of what has historically relegated lung-cancer detection to too little, too late. As Samiran Dey, European Business Development Manager for Fujifilm Europe, notes, hospital endoscopy units tend to have just one room out of five dedicated to bronchoscopy.

Fujifilm’s booth at ERS Conference, Barcelona (click to enlarge)

There are indications, though, that lung cancer is moving up the screening hierarchy. In its recent report on Strengthening Europe in the fight against cancer – towards a comprehensive and coordinated strategy, the European Parliament’s Special Committee on Beating Cancer called on the Commission and Council to consider including targeted lung cancer screening in this year’s updated guidance on cancer screening.

In England, lung-cancer screening pilots are being rolled out across the National Health Service in three phases under the Targeted Lung Health Check programme. Low-dose CT scans are available for anyone aged between 55 and 75 years who has ever smoked.


Unmet needs

This growing recognition of unmet needs brings the benefits of innovations such as the EB-710-P, or of 3-D visualisations to help plot a course through the lung to peripheral lesions, clearly into focus. Pulmonologists are also dealing with limitations of time and space, which is where Fujifilm assets such as faster image processing or compact, portable X-ray machines, come into their own.

Accessing all of this from a single supplier, with joined-up support services and data transfers, plus seamless transitions from disease detection through to surgical modelling, also underlines how important ease of use is to clinicians in the field. In Fujifilm’s experience, what matters most to pulmonologists is not so much technical ingenuity or image quality, but rather how these qualities determine useability.

As Dey comments, “it’s human nature, wanting things to run smoothly. Being able to have that integrated is the main issue for healthcare. Where things can talk to each other, especially the service side from industry, and they come from one provider, that makes it easier for clinicians to run their practice”.

It can also drive efficiency and, potentially, cost-efficiency gains. Fujifilm is not only offering distinctive products, such as the EB-710-P or its FDR Nano X-ray system, but offering them as part of an inclusive package of pulmonology solutions that helps clinicians to do more, better, and in less time.


New ambitions

Patterned on Fujifilm’s EndoSolutions strategy and its successful focus on gastroenterology, the new ambitions for pulmonology started taking shape more than a year ago, with the creation of a dedicated respiratory business unit and Dey’s appointment to head up European business development. Monthly R&D meetings followed, while expert meetings kicked off in September 2022.

A roadmap for the evolving business envisages Fujifilm as a unique solutions provider in a very substantial European pulmonology market. Along with Fujifilm’s one-stop offering, cross-business unit synergies will be a key differentiator in this respect. “What’s really unique is synergising what the cross-business units can offer,” Dey explains. “Over six months, I’ve found out that we actually do have a solution.”

That runs from screening with X-rays and CT scanners, to Fujifilm’s core diagnostics offering with bronchoscopy, and then on to software that facilitates treatment planning. “There are obviously many other companies out there doing many things,” Dey says. “But no one other company has that full solution. We are a one-stop solution for the lung-patient pathway.”

Something else that distinguishes Fujifilm in pulmonology is its commitment to training and education. The company’s mobile training hub, the Endorunner, “allows us to take our products and education to the respiratory community, as opposed to them having to come to us”, Dey observes. “We’re also kicking off two-day pulmonology courses, dedicated to training physicians and all of the staff in the bronchoscopy suite.”


Long-term vision

As Dey points out, “we’ve always been in pulmonology”. However, Fujifilm has realised that “with lung-cancer screening coming to light in European countries, the UK probably being the first, more focus is needed. We had a product range; now we have a broader product range, thanks to some new bronchoscopes. And we can offer solutions to the respiratory community.”

The Fujifilm team at ERS Conference, Barcelona (click to enlarge)

The long-term vision, Dey adds, is to be “the number one provider of pulmonary solutions to the healthcare market”, offering “the products, services and education physicians need for their lung patients”. At the same time, Fujifilm is determined to carry on innovating for even better pulmonology solutions.

That could eventually extend beyond treatment planning and into the surgical space. “We will never stop trying to find the full solution for the pulmonology pathway,” Dey says. “And, for these patients, surgery is still the gold standard.”


This is a sponsored article.

News, Tunstall Healthcare

Devolution & health outcomes: Getting a seat at the table

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Gavin Bashar, UK&I Managing Director at Tunstall Healthcare, discusses the importance of ensuring all key stakeholders, including citizens, get a seat at the table to link up care and ensure access to technology.


As a nation we are living longer and we have the information we need to make healthier and better-informed choices. However, having the right information is only the beginning. The next stage, which integrated care systems (ICSs) and their empowered integrated care boards (ICBs), will provide significant direction on, is using this information in the right way to meet the aims and objectives of our health and social care services.

As ICBs establish themselves, we will begin to see citizens and service providers become more engaged across the board and the beginning of the distribution of the £150m of additional funding to drive greater adoption of technology and digitisation across the health and care landscape. This in turn will create a more connected and intelligent world that enables a collaborative approach to the delivery of efficient, proactive and integrated health and social care services.


Engaging with citizens

If citizens are to have a seat at the table, with health and social care services centred around them, we must engage effectively and actively listen to their concerns and needs. Relationships should be based on partnership, flexibility and a commitment to citizen success, rather than one-off transactional interactions. A sustainable future for the long-term funding of essential services must be a priority if we are to realise a positive vision which puts people at the heart of delivery.

Before ICBs, many public commissioning and procurement processes were hampered by fragmented funding, a shortage of high-quality evidence-based services and a lack of involvement of the appropriate citizens’ voices in decision making. These challenges of course made it extremely difficult for professionals and care providers to fully engage with citizens and deliver effective care that would effectively prevent more complex requirements.

Engaging with citizens can help to ensure that valuable solutions involving technology are appropriate, accessible, practically useful and as such, less likely to be abandoned.

As services become more efficient and citizen outcomes are improved, it will become easier to deliver cost efficiencies. Improved condition management and medication compliance through greater engagement for example has a clear impact on decreasing GP visits, clinicians are able to target patients that need support, and early intervention can prevent future, often high cost, care requirements.

By engaging closely with citizens and their communities with the help of ICSs, it is possible to create an environment in which they have the freedom to live life to the full in a place of their choice, with the people and things that they love, doing the things that matter most, through care and support that is inclusive, accessible and innovative.


Collaboration to drive links

To drive links between social care, primary care and wider community services it’s important to consider the crucial role of collaboration. ICSs will help with the integration of services and drive collaboration between service providers. A large majority of the population have both health and social care needs, and it makes sense for a collaborative approach to become the norm as this will contribute to an improvement in health outcomes and cost savings.

Collaborative services will be the first step to start reducing the silos that currently exist between health, housing and social care and encourage care provision that is tailored to the individual who needs it. Through collaboration we’ll be able to deliver joined up care so that people accessing health and social care services can experience them as seamlessly as possible.

However, local authorities and health and social care providers continue to grapple with workforce shortages, case backlogs and an increase in the complexity and level of need of the population. This hampers the ability to drive forward with collaborative working as we are too focused on meeting these short-term challenges to have the time to consider longer term approaches.

ICBs have a number of aims, with one being to deliver transformation in order to improve how our systems operate. By focusing on this, they’ll be able to encourage collaboration between partners and professionals, with a strong focus and determination on delivering person-centred care and support.


Providing universal access to technology and software support

The integration of technology and its increased use have long been seen as a key part of transforming health and social care. However, the system has been slow to adopt innovations and tends to view technology as a way of managing people’s care. This is partly due to the growing number of solutions that are available, which make selecting, commissioning and implementing a complex task.

With the ICBs now holding statutory powers, we are at a pivotal time that will shape our services and the use and deployment of technology for decades to come. The ability to transition to a system that can provide universal access to new technologies that manage, analyse and harvest actionable intelligence will be crucial to the success of the health and care industry in the future.

Using technology to support people is relatively low cost, meaning citizens can stay at home for longer with an increased quality of life. Digital solutions can also empower staff to work more efficiently, reduce bureaucracy and enable them to spot changes in people’s behaviour.

Integration and investment in technology will enable the reconfiguration and integration of services. It’s essential that service providers and the service users are involved in the digital transformation if they are to innovate, embrace technology successfully, and deliver new approaches which create benefits for citizens.

By working closely with ICBs, technology providers will be able to citizens, their communities and the workforce to invest in value-generating digital solutions that improve lives and drive the prospects of businesses.


Moving forward

Through collaboration and investment in the right services and solutions, such as digital technology enabled care solutions, it will be possible to improve citizen experience and support improved quality and reliability of services, which are tailored to meet the specific needs of individuals. With the engagement of ICBs, there is the potential to move towards a system where it is standard practice to use technology to manage long-term health conditions and deliver efficient and personalised care.

A digital transformation will create a predictive environment that highlights behaviour changes and forecasts the need for extra support. It will join up stakeholders and provide a better opportunity for planning, giving a clearer picture of those with vulnerable needs.

I hope that ICBs will provide a new kind of leadership that can deliver change and tighten up governance, while at the same time improving the working lives and motivation of employees and the health and wellbeing of our population. The healthier the population becomes, and the more they learn about the benefits of technology within health and social care provision, the more able we’ll be to engage with citizens, give them a seat at the table and link up care.


This is a sponsored article.

For more information, please visit www.tunstall.co.uk.