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Reducing trauma for radiotherapy patients

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The London Clinic is pioneering temporary markings as a replacement for alignment tattoos to help reduce the lasting trauma of radiotherapy treatment.

The London Clinic is one of the UK’s largest independent hospitals, providing medical care to thousands of patients every year and treating a range of diseases and conditions including cancer. As a charity, it continually reinvests in its facilities and technology, seeking to offer the latest advances in cancer diagnostic, treatment and support services.

However, it was not pioneering new technology that saw The London Clinic win the 2022 CHKS Top Hospitals award for innovation. Rather, it was their out-of-the-box thinking, allowing radiotherapy patients the options of having non-permanent alignment tattoos, which caught the attention of the judges.

Challenging the requirement for permanent alignment markings on patients receiving radiotherapy treatment

In its cancer management, The London Clinic declares that it is committed to giving patients choices in their care and always seeks to apply the latest technologies available to facilitate this. Radiotherapy provision is an innovative area, but one aspect of treatment has not moved with the times. This is the practice of tattooing patients who are undergoing treatment.

During the treatment process, radiographers can make between one and five permanent tattoo marks on a patient’s skin to help line up the radiotherapy machine and ensure the same area is treated each time. These tattoos can become a lasting reminder of a traumatic time and can negatively impact body image.

The London Clinic heard from some breast cancer patients who were unhappy with the aesthetic outcome of these tattoos given their location and especially as on occasion the ink can run or bleed under the skin. Patients said this constant visual reminder and effect on aspects of everyday life, such as clothing choice, had a negative psychological impact on their recovery. Their experience was mirrored by one of the keynote speakers at the 2019 Radiotherapy Society Conference.

As a society member and radiographer who had undergone a personal cancer diagnosis herself, the speaker was able to candidly describe the lack of choice or alternatives to tattoos. The London Clinic’s Pre-Treatment Superintendent attended the conference and was motivated to ask on her return: “Why do we still do this?” and “Is there something else we could be doing?”

While sophisticated Image Guided Radiotherapy (IGRT) and Surface Guided Radiotherapy (SGRT) techniques exist, which are less reliant on tattoos, the majority of cancer treatment centres still use them. Over the last few years alternatives have been explored and are in use such as ultraviolet (UV) tattoos and surface-guided radiotherapy and non-ionizing optical devices. However, uptake of these alternatives has been slow, either due to the additional resources or investments required.

By thinking of novel solutions, the radiotherapy team at The London Clinic was able to come up with an innovative way of marking patients for treatment.

Instead of permanent tattoos, pen marks were drawn onto the skin and covered with transparent film dressings. A map of the exact positioning of the marks on the body was reproduced on a sheet of clear acetate as a guide. Daily online imaging was implemented and acted as a control for positioning and verification of treatment accuracy.

This innovative alternative enabled the radiotherapy team to offer tattoo-less treatment which neither compromised patient care nor was constrained by resource or investment pressures. Through extensive auditing, the team identified no additional or significant difference or issues in set up, and that the new method was as accurate as tattooing.

“This innovation in practice has made a significant impact on the way we deliver breast treatments at The London Clinic. It is not the latest or the most expensive innovation, but it provides the patient with a better journey and more choice.”

Deirdre Moran, Quality and Development Superintendent for Radiotherapy and Medical Physics, The London Clinic

This meant that they could confidently tell patients that going tattoo-less would in no way compromise their treatment. Treatment times did increase slightly, but it was concluded that it was not of a magnitude which would outweigh the benefit of providing patient choice.

”Winning the 2022 CHKS Top Hospitals award for innovation helps convey that with very little investment it is possible to change the landscape of cancer care. The ability to offer tattoo-less breast radiotherapy has made a significant impact on our patients’ experience and will contribute to improved body image and self-esteem post treatment for years to come.”

Deirdre Moran, Quality and Development Superintendent for Radiotherapy and Medical Physics, The London Clinic

The tattoo-less option has featured positively in patient feedback and generated numerous patient enquires leading The London Clinic to share its technique and methods with other radiotherapy departments to further encourage those who were considering making the change.

To find out more, please get in touch healthcaredecisions@capita.co.uk or visit capitahealthcaredecisions.com 

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Capita, Digital Implementation, News

Addressing the increased demand in healthcare

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Capita healthcare

With the current increased demand within health and care, it is vitality important for providers to recover from the pandemic and address the challenges faced around growing elective care backlogs, staffing pressures and rising costs.

Addressing these challenges requires industry leaders to come together and adopt value-adding solutions and technology.

In November 2021, Capita Healthcare Decisions announced a partnership with Microsoft, integrating our clinical content into the Azure Health Bot, part of Microsoft’s Health Cloud platform. The key purpose around this has been to address the patient backlogs faced and improving the patient experience through the use of new technology.

How does it work?

Capita Healthcare Decisions’ content on Health Bot uses AI to pre-empt a wide variety of patient conditions and emergencies, with 164 symptom-based algorithms and over 40 scenarios ranging from ‘call an ambulance’ to ‘self-care’. The content is customisable and adaptable, with 500 sets of care instructions, including appropriate medical information and guidance on what to do if symptoms worsen.

Health Bot users can now gain access to Capita Healthcare Decisions’ content, meaning providers have access to the evidence-based healthcare content service. Saving the patient time is a goal of the collaboration and simple everyday language is used in the place of clinical and medical terminology – delivering a more user-centric approach and promoting ease of understanding.

The service aims to give users flexibility through access to information on different devices and channels, enabling a swift referral to appropriate care. Health Bot also aims to reduce the risk to patients of ‘self-triage’ – when a person evaluates their own health concerns to determine what they should do next.

What makes the clinical content unique?

Capita Healthcare Decisions produces content which is peer-reviewed and updated by an internal team of doctors and nurses to ensure robust clinical governance.

The Health Bot is available through Microsoft’s Cloud for Healthcare, a platform that provides the structure which supports health information and patient management across healthcare organisations and health providers, both public and private. The service provides AI-powered medical data which is used by some of the largest healthcare providers, pharmaceutical companies, and tele-medicine services in the world.

How will this help?

Steve Fearon, CEO of Capita Health Decisions, said: “We are proud and excited that our relationship with Microsoft continues to grow and strengthen. With this collaboration of our world-leading clinical content, available within the Microsoft health ecosystem, we have recognised the need to provide instant access to safe and accurate medical and peer reviewed content to support positive health outcomes. We are seeing just how vital the need for this offering has become, especially at a time of growing misinformation online.

“We see this collaboration as a great opportunity for organisations to completely transform and revolutionise access to healthcare, levelling the playing field in terms of equity in access to the most up to date health guidance, and ensuring that health resources are optimised to drive clinical and operational efficiency and effectiveness.”

Hadas Bitran, Partner Group Manager at Microsoft Health and Life Sciences, said: “Capita’s content is a valuable asset in the Health Bot service that empowers healthcare organisations to assist in triaging and directing patients to the appropriate level of care and to navigate the services available to them. Timely access to quality medical information saves lives; and deepening our relationship with Capita will further strengthen the patient-centric approach that is fundamental to our Health Bot service.”

Capita Healthcare Decisions have been at the forefront of tackling the challenges within healthcare systems for over 27 years. To find out more, visit: https://capitahealthcaredecisions.com/healthbot-cs/

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Capita, News

Broader partnerships within ICS essential to reduce hospital admissions

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integrated-care-partnerships

As Integrated Care Systems assume statutory footing from July, broad partnerships with the private and voluntary sectors will be essential to reduce pressure on acute NHS services, writes Charles Waddicor.

The NHS is working through one of the greatest challenges it has ever faced. With the pandemic still part of everyday life, there is an urgent need to reduce the constant pressure on the acute sector. Future plans must be based on a coordinated approach that makes the most of a wide range of partners, including the voluntary sector.

Up to seven million people are thought to have missed out on care during the pandemic, many from more deprived areas. The health system is still in a critical condition, with high rates of Covid-19, hospitalisations and waiting times rising. This perfect storm is ultimately widening the health inequalities that have come into even sharper focus during the pandemic.

The challenge is too great to leave up to the acute sector alone to solve. Every part of the health and care sector has a role to play, from primary and social care to councils, housing and the voluntary sector. The solution must lie in greater collaboration to unlock capacity and avoid preventable admissions.

Managing population health

Although the current ‘Payment by Results’ system does not always lend itself to more integrated system working, integrated care systems (ICSs) can provide an opportunity to broaden partnerships and collaboration, to help pave the way for change.

There is a case for developing health and care services that wrap around traditional care models, promoting healthier living, tackling loneliness and other areas that can impact on hospital admission. The mental health sector is already leading the way by working with other providers and some London trusts are investing £1 million annually in new contracts with the voluntary sector to strengthen support in the community.

Worcestershire County Council has also been working with the local NHS Commissioning Group and the voluntary sector since 2015, to tackle hospital admissions by providing personalised support to older people to deal with loneliness. Social isolation and loneliness reduce older people’s quality of life and are linked to poor physical and mental health outcomes.

Over five years, the reconnections service in Worcestershire supported more than 1,500 lonely older people with a majority reporting a marked reduction in their feelings of loneliness and others seeing increased independence and improvements in health and wellbeing. Once the model was shown to be successful, the service developed a relationship with Independent Age, a leading national older people’s charity, which had the resources and capability to scale up the work. The scheme has now been rolled out to two other sites – Barking & Dagenham and Havering and Guildford and Waverley.

Supporting the whole health system with greater range of partnerships

“Seeing healthcare with a broader view rather than simply through the lens of an acute hospital, can help to provide a more proactive health service”

ICSs cover larger populations than individual CCGs which means they have an opportunity to link up with a broader range of organisations. Rather than pushing back on acute trusts to accommodate a growing need for services, let us work with other non-NHS partners to support the system.

Seeing healthcare with a broader view rather than simply through the lens of an acute hospital, can help to provide a more proactive health service and avoid more hospital admissions through good population health management. Being able to target those who need care before they reach the acute stage is vital, as is proactively creating a healthier population through promotion and education.

Organisations in the voluntary sector can offer an in-depth knowledge of the communities within which they work, highlighting where and what care is needed as well as being able to increase the capacity of the health and social care system.

While quality and money are always likely to be top of the agenda for improvements to the health service, we know that people who are well-integrated into the community, who exercise and are careful with what they eat, generally do better. Therefore, promoting healthier lifestyles through a range of organisations and working in a truly integrated way will introduce good population health techniques, helping people to live independently for longer and reducing the significant pressures that are being felt across the whole system.

About Capita Healthcare Decisions

Capita Healthcare Decisions have been at the forefront of tackling the challenges within healthcare systems for over 27 years. Having served over 100 million patient interactions globally to date, we empower healthcare providers and payers to make the right decisions, driving better quality of care, improving efficiencies, and reducing operational cost at scale.

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