Empowering young people with digital mental health tools

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Beth Gibbons explains how her team created a digital tool that acts as a single source of truth for the mental health resources available to young people in the area, and how it’s given them more control in their care.


Earlier this year, NHS Gloucestershire’s children and young people’s mental health services launched its digital support finder. On Your Mind Glos aimed to get young people to the right support at the right time and improve their experience of accessing mental health support.

We know that young people can find asking for help with their mental health difficult. We also know that Covid-19 disruption caused waiting lists for mental health support to grow significantly and the barriers to support became difficult. Gloucestershire has a wide range of mental health services for children and young people but following the pandemic, there was a clear need to digitalise access to these services so that people are put in touch with the support they need as quickly and easily as possible.

And so, at the start of 2022, the Trust wanted to explore ways to use digital tools to increase awareness of the range of support available.


One collaborative team

With the support of tech specialists, Made Tech and Mace & Menter, NHS Gloucestershire created a team of designers and technologists along with our NHS staff to research and build this new tool. The work was commissioned rather than built in-house because of the specialist skills and capabilities needed around service design and agile service delivery.

The team worked with clinicians, frontline workers, children, young people and the local community to research user needs. We found that interaction with these specific groups was crucial to help us create a tool that truly worked for those that needed it. Mental health support practitioners, GPs, school nurses and mental health leads in schools were also included in the research to help to understand the specific problems that needed fixing.

These conversations highlighted specific challenges – knowing where and how to access support, the length of waiting times once referred and the lack of support whilst waiting. There were already many services (including outside the NHS) where individuals could get support but it became clear that people simply weren’t aware of them.

The discovery and first version of the tool was completed in 8 weeks. We looked for feedback from our users throughout the whole process, meaning that the final tool truly delivers on the needs of children and young people in Gloucestershire.


A single source for local mental health support information

An online support finder on the dedicated website guides users through a series of questions to understand how they’re feeling and what support they might need. They’re then signposted to the most relevant service for their needs and given useful information about mental health.

The results are available to young people, their parents and carers via the website and SMS. Providing SMS access was an important element of the service as it needed to be accessible and secure for any child or young person to use, regardless of their access to a computer. Just three months after the initial launch, a round of user research revealed that young people like using the service, with more than 2,500 visiting the site to date.

Today, the support finder is an easier solution for young people to understand, find and access over 100 mental health support services while giving them more choice and control of their care. For health practitioners it provides accurate advice and helps them signpost to services.

The Trust is delighted this tool helps children, young people and their families get the right support for them. This means that young people are not being passed around multiple services having to repeat their story. It also means that services are less likely to duplicate triage efforts for the same young person. With the introduction of self-referral young people are empowered to access support earlier, removing potential barriers.

It has since been launched in schools alongside a programme of mental health awareness and has reached around 10,000 young people. While it was developed for young people, it’s expected that professionals, parents and carers will use it too.


A wider impact across the health service

The support finder has been designed with security at its core, making sure user data is protected. The baseline architecture and codebase was developed under open standards principles, making it available to other NHS organisations with similar patient needs to use and adapt for free.

Thorough and rapid discovery, alpha and beta testing phases with one fully collaborative team meant we were able to make the best possible version of this technology. We designed the service based on feedback from users, helping us meet their needs. As a result thousands more young people can now access mental health support quickly.


Beth Gibbons is the Programme Manager for Children’s Mental Health & Maternity at NHS Gloucestershire.

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.

 

Featured, Health Inequality, News

Radar Healthcare report ranks UK second on overall healthcare equalities

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Report from Radar Healthcare shows Canada leading the way on overall healthcare equality, with the UK and other northern European Countries making up the rest of the top six.


A new Healthcare Inequalities Report, released by Radar Healthcare, has ranked 35 of the most developed countries around the world, offering a comprehensive insight into which of these countries offers the best healthcare rights to its citizens through their laws and regulations.

The report places Canada, the UK and Norway in the top three for global healthcare equality, with each generally offering fair and equitable access to healthcare for its citizens.

Radar Healthcare’s report also makes reference to a recent Public Policy Projects report, A Women’s Health Agenda: Redressing the Balance, which produced a series of recommendations aimed at improving the design, delivery and outcomes of women’s healthcare.

While the UK places well overall, the report ranks it number 1 for factors relating specifically to women, with Canada coming in second place.

Below is a snapshot of the report’s findings on maternity and paternity leave.


Maternity and paternity leave

The UK lags behind Denmark and Norway on the ‘paid maternity leave’ metric, offering 39 weeks of paid leave and 13 weeks of unpaid leave, compared with 52 weeks of paid leave in Denmark, while Norway offers 49 weeks of paid leave and 59 weeks of unpaid leave.

The report draws key distinction between paid and unpaid maternity leave; a high number of overall weeks of maternity leave may appear impressive but the degree to which this includes paid leave is highly consequential. For example, Italy offers 4 months of paid maternity leave and 17 weeks of unpaid leave, however, leaving a new mother without a salary for 17 weeks places them in a potentially vulnerable situation, perhaps leaving them more reliant on a partner or family for support.

On paternity leave, the UK scores poorly, scoring offering just 14 days of paid leave to new fathers, while Sweden offers 240 days, the Netherlands 182 days and Denmark 168 days. Germany, meanwhile, has no laws mandating employers to offer new fathers paternity leave, either paid or unpaid.

The lower provision of paid paternity leave is a key metric of gender-based healthcare inequality, since less leave for fathers places more of the burden for childcare on mothers, as well as limiting the valuable bonding time between a newborn and their father.

Further to maternity and paternity leave, the report assesses each country’s standing in regard to the following categories:

  • The legal age of consent – the age at which a person is considered to be legally competent to consent to sexual acts
  • Doctor / patient confidentiality ages – the age a resident can speak confidentially to a healthcare professional without parents/guardians being informed
  • Cervical cancer screening – what age they are recommended for women around the world
  • Mammogram screening tests – what age they are recommended for women
  • Flu vaccines – at what age is this offered to elderly residents around the globe
  • IVF treatment age range – how age impacts the chances of becoming a parent via in-vitro fertilisation in different countries around the world
  • Cosmetic surgery – at what ages someone can have a cosmetic surgery procedure
  • Transgender hormone treatment – at what age do healthcare practitioners in different countries allow transgender patients to start hormone treatment
  • Access to birth control around the world – (age requirements/costs/the countries offering free birth control)
  • Abortion laws – how they differ across the world

Commenting on the report, Hayley Levene, Head of Marketing at Radar Healthcare, said: “Radar Healthcare partners with organisations such as Public Policy Projects who are learning from experience (both their own and others) to make contributions to the policy debate which address real-world choices on the basis of real-world evidence.

“As a healthcare supplier, Radar Healthcare is passionate about helping to make a difference and delivering improved outcomes. Working with PPP to produce reports such as ‘The Social Care Workforce: averting a crisis’, ‘The Digital Divide: reducing inequalities for better health’ and ‘Integrating Health and Social Care: a national care service’ is vital in helping to drive change and improve some of these health inequalities.

“For example, technology could offer oversight that 80 per cent of patients or healthcare workers themselves are having suicidal thoughts – and this could prompt a process to be followed to tackle it, which will encourage decisions of change.”


To find out more, please visit www.radarhealthcare.com.

Featured, Thought Leadership

A view from the front line: the Emergency Department is in need of critical care

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Dr Mark Harmon, A&E Clinician and Clinical Entrepreneur at eConsult, shares his experience at the NHS frontline, and discusses the technology that could help protect the NHS.


As an A&E clinician working in the emergency department during the ongoing strike action, my first priority is the care of our patients. Unfortunately, the sad reality is that even without the ambulance strikes, Accident and Emergency departments are no longer just cracking at the seams. We’re at breaking point.

When I signed up to work in the Emergency Department (ED) because I wanted to provide urgent care to patients in critical – and sometimes life-threatening – conditions, I did not anticipate working for a department in need of emergency care itself. Although I feel incredibly passionate about my job, the scale of the challenges we face need more recognition, and immediate action.

At the start of each shift, I worry about how already burnt-out staff and overstretched teams and services are going to cope with the volume of patients flooding through – and waiting outside – the front doors. NHS staff are working tirelessly to care for patients – so where is the system failing?


Resurrecting patient satisfaction with the NHS

At the end of last year, it was reported that public satisfaction with the NHS has fallen to its lowest levels since 1997, according to analysis of the 2021 British Social Attitudes survey (BSA). Concerns over long waiting times (65 per cent), NHS staff shortages (46 per cent) and inadequate government funding (40 per cent) were cited as key reasons for this drop in satisfaction.

With ongoing funding disputes and consequent staff shortages, it is unsurprising that the top three priorities to drive improvement in satisfaction included making it easier to get a GP appointment, improving wait times for planned operations and increasing the number of staff in the NHS.

To drive forward these changes, there needs to be innovation and digital transformation of how we deliver the healthcare service we currently offer.

As it stands, one of the biggest issues we’re tackling in the department at the moment is flow. When the ED pipeline gets blocked, flow is impeded, a backlog builds up and waiting times get significantly longer, all of which has a huge impact on the clinical care we’re able to provide, our patients’ safety and staff morale.

The sad reality is that around 30-50 per cent of patients we see in A&E could be treated more effectively elsewhere – for example, via their GP or pharmacist, or in an urgent care centre.

If we’re to make any headway, we desperately need support in slowing down the flow of people into A&E. We are not discouraging people from attending the ED. Those in need of critical care should absolutely come and see us. Instead, the ED needs support in implementing technology, combined with deep clinical expertise that will help us to automate digital triage upon patients’ arrival.


Reducing patient flow into the ED

In practice, my vision for a safe Emergency Department is one whereby patients can document their own symptoms on arrival at the ED via an iPad at the entrance and that way, we can prioritise the treatment of patients based on clinical need and reduce the flow of traffic into the waiting room. Technology now plays a vital role in rebuilding patient and emergency staff satisfaction, but most importantly ensuring people who need urgent care can get it quickly.

Gathering a patient’s history upfront, in their own time, not only means they can be automatically routed to the right resource, but the time-consuming task of taking the history from every patient, one question at a time, is done in advance. The case summary emergency staff receive through this process means they move from ‘history takers’ to ‘decision makers’, ultimately reducing waiting lists, and speeding up the patient journey.

To make this vision a reality, we need to introduce better safety measures for the long term.

Right now, working in the ED, I can see that there is a clear challenge with how patients are being triaged. To solve the problem, we desperately need clear and concise guidance that directs those in need of support to the right point of care.

Our ED waiting rooms need support in adopting this digital triage technology to correctly signpost patients to the right place, at the right time. Patients need to be guided as to when they need to attend the ED, or whether they can get help from a pharmacist, GP, or self-help tools.

Whatever we do, we need to eliminate queues at the front door, and identify those sick patients early, in order to maintain quality of care, which in turn will improve flow and working conditions for front line staff. This will help with restoring morale, and staff retention so that front line staff are not forced to strike to have their voices heard.

Featured, Thought Leadership

Accessibility, interoperability, and personalisation: the three pillars for the future of digital primary care

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Mike Fuller explores why accessibility, interoperability and personalisation are the three pillars for the future of digital primary care.


The NHS defines digital systems as the foundation upon which it builds a modern, efficient, and responsive health service. With innovation within the healthcare space ongoing and everchanging, the role of digital technologies is going to be crucial for the very future of healthcare provision in this country.

More funding is being provided to healthcare to drive these innovations. The NHS England London Digital First Programme, for instance, has a funding opportunity to pilot automation solutions within primary care. It will be funding automation grants of up to £65k and is encouraging all pilots/projects across London’s Integrated Care Systems (ICSs) to apply.

The long-term success of primary care across the NHS is more than simply dependent on investment, however. If it is to thrive in the future, primary care needs to reset and rethink its role within the wider healthcare ecosystem, and redesign what it means and does.

With this in mind, it has become clear that the future of digital primary care will be driven by three key pillars: accessibility, interoperability, and personalisation.


Making healthcare more accessible

Over the next two years, in particular, the key driver of digital primary care will be a concerted focus on making healthcare more accessible. It is anticipated that there will be a wider digital response to the consumerisation of health and care, with increased service accessibility and service user inclusion using telehealth for appointments, consultation, prescription refills, and mobile access of records.

The sheer range of apps on offer may be confusing to some patients, so to overcome this, it is expected that there will be some aggregation apps emerging in parallel to the general proliferation.

Accessibility will also be extended to more regionally-led packaged services for discrete patient cohorts, with more frequent use of virtual hospital ward and remote monitoring with wearable 5G connected devices for those who need or want it – and can afford it.

Funding this change will inevitably be a challenge, of course. The commercial and cultural hurdles are probably just as big for integrated care boards (ICBs). These boards will want to unlock more primary care data to better manage distributed patient risk and service provision for preventative and personalised care across the wider health economy, especially for public health use.

Healthcare institutions will need far more than just ease of data access, however. They will need the standards-based interoperability capabilities promised by a universal adoption of the latest editions of HL7 Fast Healthcare Interoperability Resources®, with widely fed repositories and standardised reporting.

The NHS will need to enforce the use of these standards, because today some industry stakeholders have only ticked the box of ‘compatibility’, and several have not understood or implemented adequate clinical safety compliance for the DCB0129 and DCB0160 clinical risk regulations.


Delivering proactive change

Scrolling forward five years into the future, ICBs will need to decide how they can help primary care fund change management and digital transformation, with a need for structural changes that fund both primary care provision and digital systems.

Unfortunately, the current batch of periodic data transfers and application interfaces are “too passive.” The information provided is scanned “paper behind glass”, amalgamated records that need human interpretation and action, or simplistic robotic automation processes that save people’s time but automate bad processes. Moving forward, what’s needed is end-to-end process interoperability to automate care proactively and intelligently. This will close the gaps in services and stop people falling through them.

Today, the overheads of separate point-solutions make purchasing decisions easier, with quick-wins and immediate gratification for their direct users. Yet the valuable data generated by these siloed interactions dissipates. Such disconnected systems create a whole iceberg of problems below the waterline that is in danger of being ignored.

To see more transparency, interoperability, and automation within digital primary care, the multiple regional stakeholders across ICBs must think in whole-system terms, with shared access and outcomes that span the patient, service users, and care professionals’ experiences. Every service is responsible for a patient’s care, especially those in their care circle, and so must be on par with acute and primary care funding and management.

This is starting to happen with the creation of the ICSs and has been recently evidenced by the redesignation of the P of integrated care partnerships (ICP) to now mean ‘place’, as in ‘place of care’.

There are also good examples of regional thinking such as regional waiting list triaging, and discussions for regional virtual wards for Ambulance Service patients in transit. Elsewhere, artificial intelligence (AI) is increasingly being used in numerous scenarios. From analysing patient-generated data from wearable and medical devices, and the early diagnosis of Alzheimer’s disease using image recognition, to facial analysis for ADHD, stress, and pain management. All these examples will provide better patient experiences and outcomes – and save money. And they exist now, albeit it small pockets.

To scale such innovation and sustain digital transformation in healthcare we need to connect the operational systems and use the ‘exhaust data’ generated by their workflows to teach machine learning and AI to ensure objective, informed, and timely decisions are made in the entire chain of care.

This must be accomplished with the transparency required to ensure human oversight and processes to avoid the all-too-prevalent, but overlooked, biases present in AI’s machine learning data, algorithms, and the robotic process automation it can enable.

This connectivity and governance will not be easy to achieve but there are grounds for optimism. There is every reason to believe that the larger, better funded, and visionary primary care regions will be able to achieve these advances in the next five years, provided they are willing to ‘flip the iceberg’ and fully integrate with the whole health economy in which they play a pivotal role.


Looking a decade ahead to a world of personalised healthcare

When it comes to ten years from now, recently published insights suggest that “personalised, precision medicine” could be on the horizon. While it may take more than a decade for wide adoption to occur, digital primary care can make a start with gender, age, and demographic aligned diagnosis and care pathways with measurable more effective medicines.

The future may even witness GPs using augmented reality visual tools supplemented by artificial intelligence and rich clinical decision support systems to diagnose patients faster and more accurately.

By extension, they could then automatically and easily publish that diagnosis with a personalised care plan based on the patient’s epigenetics, lifestyle, and agreed compliance to their approved care circle and patient support groups.

These kinds of fundamental digital changes are all very much in the offing over the next decade. However, to make them happen, it is crucial for the sector to reset and rethink the role of primary care in the NHS with its funding, and redesign what primary care means and does. That’s starting to happen today and so this positive vision is, all the time, beginning to look more like a viable future reality.


To find out more, please visit www.intersystems.com/uk/

Mike Fuller, Regional Director of Marketing, InterSystems

Non-emergency transport is crucial for winter resilience 

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ERS winter resilience

Seasonal pressures and existing backlogs look set to increase demand for non-emergency transport this winter. Writing for ICJ, ERS Medical’s Chief Executive Andrew Pooley, and Quality and Governance Director Simon Smith, outline why they are pushing hard for winter transport resilience.


The NHS was already experiencing significant pressures, even before this winter’s challenges. Although a smaller component of the NHS, non-emergency transport services (NEPTS), which provide transportation for patients with non-urgent conditions but who would struggle to travel independently, play a pivotal role in maintaining smooth patient flow.  

Last year, ERS Medical launched a campaign to raise awareness of non-emergency transport. The aim of this, in part, is to emphasise the importance of non-emergency transport and more importantly, to encourage the earlier booking of contingency winter patient transport shifts to support hospitals with patient discharge and alleviate some of the anticipated winter challenges.


Easing system pressure

Delays to patient discharge cause significant patient flow issues, and these are well documented. News headlines often focus on bottlenecks and delays via front door admissions, such as A&E, and the significant pressures being faced by emergency departments.  

However, if beds are not available in hospital wards where patients can be treated after assessment in A&E, there is less capacity for newer patients to be admitted. The traffic jam at the exit route now becomes a problem at the entry points for patients, as well as preventing ambulances from returning to the community, increasing already dangerously long ambulance response times.  

One of the main reasons for the patient flow crisis is the availability of social care. There is a direct correlation between the absence of an ongoing care package and higher rates of readmission. Further, discharging patients too early without any ongoing care and proper safeguards in place will often mean the patient is readmitted sooner or later. Poor discharge protocols can also lead to an increase in complaints and reputational damage for hospitals. It is no surprise then that discharge coordinators and healthcare staff have such a tough balancing act to manage, in addition to their workload challenges. 


The role of transport  

Transport can play a huge role in addressing the discharge backlog, and booking transport early is vital. This may sound simple enough, but transport is an often-overlooked aspect of the discharge process. When patients are ‘made ready’ for discharge, this is often the first point at which transport is considered. However, booking transport in advance, preferably the day or so before the patient will be ready to leave, is usually more efficient. While it is difficult to be a hundred per cent certain that a patient will be ready for discharge on a particular day, clinicians often have a good indication of when discharge might be feasible and appropriate.  

To this end, planning and communication are essential. Planning the transport in advance, booking it and then communicating with the provider if the plans change for any reason are crucial elements in the efficient discharge of patients. This ensures there are enough resources available in the system for trusts and integrated care systems to keep the patient flow running smoothly.  

One solution that is showing promise is to appoint specialist patient transport liaison officers (PTLOs) in hospitals. This “human” point of contact is a specially trained individual who can assess transport needs and then recommend the best approach on a case-by-case basis, often communicating with patients, hospital staff and families to keep everyone informed.  


Lessons from previous spikes in demand 

Contrary to conventional wisdom, one of the key insights from looking at our data (as illustrated below) is that spikes in winter demand often arise, not because of increased activity levels, but because of changes in booking behaviour, patient mobility, an increase in aborted journeys, and the subsequent need for more resources to accommodate these changes.  

 

Let’s take a hypothetical fleet of 10 vehicles servicing a local acute hospital. With the “normal” commissioned pre-planned booking behaviour and mobility mix, the activity matches resource and there are no service issues. Add in just one complex journey – for example, an obese patient that requires an additional crew to assess the property and support the journey – very quickly, that can reduce 10 per cent of available resource for more than half a day.  

Add in multiple issues – for example, bookings made at the last minute, or with incorrect mobility requirements, or patients’ drugs not being ready at the pickup time – and it is possible to see how demand outstrips built-in spare capacity and pressures build in the system. Integrated care boards (ICBs) should act with caution when being presented with supposedly easy fixes. The Uber model does not work with a regulated service that relies on trained staff and specialist equipment, and simply drawing on resources from outside the contract often fails because other services will also be under pressure, as they rarely hold spare capacity. The simple answer is to plan well in advance – it takes time to mobilise a fully compliant NEPTS ambulance crew, communicate with all stakeholders and educate healthcare staff about the correct use and limitations of the NEPTS service.  

Providers should also re-examine the point at which mobility assessments are carried out. When hospitals carry out patient mobility assessments, this is often done at a fixed, predetermined point. If a patient is independently mobile, but has been sitting and waiting for a doctor’s assessment, the patient’s mobility levels could deteriorate. When crews arrive to pick up a patient that has been booked on a seated vehicle to accommodate four patients, the crews undertake what is called a dynamic mobility assessment of the patient. They then establish whether or not the patient can walk independently, and whether they might now require a wheelchair or stretcher. This means that the vehicle originally booked to transport the patient is no longer suitable, and more, or different, resources are required.  

The reality is often different to the perceived activity levels  within NEPTS, where the ideal scenario is multiple patients in the same mobility category travelling in one vehicle. If transport is planned at the last minute for patients with the lowest mobility (patients who need stretchers), this blocks out a significant number of vehicles in one go, thereby increasing delays and placing a greater strain on existing resources.  

Of course, effectively balancing these factors comes down to proper planning, communication and funding contracts on actual resources needed, not just activity levels. This does not mean simply communicating with transport providers, but also between hospital departments.  

Thought Leadership

Britain’s bed backlog: are ‘at home’ sensors the solution?

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Jayne Rooke, Health and Care Sector Lead at WM5G, writes for Integrated Care Journal (ICJ).


The NHS is currently at crisis point with significant funding gaps, staff shortages, record waiting times for patients and extraordinary pressures on ambulance services that are unable to handover patients due to a lack of available beds.

One of the causes of this ‘bed backlog’ is a severe shortage of social care provision, resulting in medically well patients becoming ‘stuck’ in hospital because it is deemed unsafe for them to return home alone. In fact, according to NHS data analysed by The Telegraph, six in 10 patients assessed in October were well enough to be discharged.

In a bid to address this problem, innovative technology is being used to improve healthcare provision for the growing elderly population. ‘Virtual wards’ that make use of a combination of connected technologies and face-to-face care have been introduced by NHS England to provide treatment and rehabilitation in the patient’s own homes.

The aim is not only to prevent unnecessary hospital admissions among vulnerable patients who are most susceptible to infections, but also to allow quicker discharge; increasing productivity, improving patient experience and reducing costs.

Some providers are choosing a combination of technological solutions and adopting a flexible ‘step-up, step-down’ approach that adapts to support patient’s needs.

For example, a virtual ward can be offered to those who are medically stable enough to go home but who require wrap around care until they are well enough to progress to a self-monitoring solution. In the same way, for those who are self-monitoring but show signs of deteriorating or further illness, progress from self-monitoring to the more intensive virtual ward support, can prevent them going back into hospital.

However, relying on self-reporting can lead to problems if there is a lack of patient engagement. It also doesn’t provide a real-time assessment of the patient’s health, with physical visits from healthcare providers still required to ensure the safety of patients.

As specialists in connectivity and digital innovation, WM5G has partnered with IoT Solutions Group to develop ‘At home’ or ‘care’ sensors that can assist the virtual ward model by monitoring patients within their home 24/7, alerting care providers of any change in patient behaviour.

Could sensors in the home provide the solution to the bed backlog?

Placed in the kitchen of vulnerable or elderly person’s homes, at-home sensors use humidity in the room – such as that generated from boiling a kettle, using a toaster or oven – to build an accurate picture of the resident’s daily life, creating a behaviour template or ‘digital twin’. That data is then used to notify healthcare providers in real time if there are changes in behaviour, lack of activity or unusual readings within the home.

These ‘at home’ sensors have been trialled across several council assisted-living residencies in the UK, including Sutton and Wolverhampton, with extremely encouraging results. In fact, Sutton Council believes at least four lives have already been saved by the sensors when alerts triggered visits by carers who found vulnerable residents unable to move following a fall or illness. These included residents already using ‘wearable alarms’ who were unable to activate them and meant that help could be provided immediately, rather than the residents waiting for the next scheduled visit.

While at-home sensors are predicted to play a pivotal role in supporting virtual wards, they could also provide additional benefits, such as monitor temperature with homes to identify those at risk of fuel poverty, as well as playing a role in preventative approaches, managing people’s behaviour and promoting healthier lifestyles.

The sensors are just one of a vast array of technologies that promise to revolutionise how we deliver care and bridge the gap between home and hospital settings. Its progression relies on hospitals engaging with innovation and remaining open to new ways of working the could improve services for patients while freeing up resources for other front-line services. It also needs connectivity to be factored into service and facility design, ensuring patients, carers and clinicians have access to the reliable networks they need to support this more ‘arms-length’ approach. It doesn’t have to be complicated, as demonstrated by the sensor-based pilots referenced above – the sensors used here require no digital skills to set up and convey data using low-powered, wide area networks – but it does need to be thought through and planned in from the earliest stages.

With hospitals constantly being asked to deliver more for less, an ageing population and social care services being stretched to breaking point, can we afford not to investigate how technology could hold the key to unlocking the beds backlog and supporting people safely back into their homes?

Thought Leadership

Automation solutions essential for reducing administration errors

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Ed Platt, Automation and Analytics Director at Omnicell International, describes a step-by-step process for implementing automation technologies across NHS.


There are enough tried and tested technology solutions today to all but eradicate prescription and administration errors from across the healthcare system. It is therefore all the more concerning that 6,000 people were harmed and 29 died last year in England following prescription errors.

Data from NHS England, via the National Reporting and Learning System (NRLS), reveals that almost one in six Trusts in England do not even have a funded plan in place to reduce these errors via electronic prescribing systems – an issue raised in the media recently by Peter Walsh, Chief Executive of Action against Medical Accidents.

It seems baffling that not all Trusts have a suitable plan for adoption of electronic prescribing – why is the adoption of digital technology and more specifically, automation solutions, not front of mind? The UK’s Prime Minister, Rishi Sunak, echoed this message at the recent Confederation of British Industry (CBI) conference in Birmingham, when he called for more investment in automation and technological innovation as part of NHS reforms.

For any Trust at the moment, there is a lot of ‘fire-fighting’ taking place in terms of resources. In the aftermath of Covid, Trusts have had to be focused on a ‘recovery’ strategy, with the added burden of staff retention and recruitment issues. These are, understandably, posing extreme funding challenges and the job of leadership teams is not to be envied.

With a need to justify investment at such a testing time in the sector, many are finding it hard to put a number on the cost of such errors. According to studies, one in ten doses are not given to patients. However, many errors are also under-reported, so hypothesising a number to make a clear-cut case for investment in automation is almost impossible. It is simply not possible to monetise the impact of medication errors to show the economic effect. It is no wonder, therefore, that many Trusts are finding it hard to commit to a plan, despite having an intuitive feeling that they should invest in this area.

I know from personal experience the challenges nursing and pharmacy staff within hospitals are faced with when it comes to medication management; one hospital I visited recently required nurses to locate patient medication from 17 different locations across the ward with the patient and his/her needs at the very core of their service. This is simply not sustainable and makes the risk of mistakes undoubtedly higher. But broad-based challenges such as this, which are difficult to measure, are always going to be secondary for Trusts when compared with the most pressing and immediate concerns.

The ‘gold standard’ for any hospital should be electronic prescribing with automation. These two go hand-in-hand to ensure: improved patient safety; fewer medication errors; fewer missed doses; fewer drugs wasted; fewer instances of out-of-stock medicines, and reduced clinical staff time spent preparing and dispensing medication.

The impact of automation can swiftly be felt across an organisation, especially when key issues such as staff morale are considered. Automation takes the headache out of mundane and repetitive tasks, meaning clinical staff can concentrate on patient care, with a reduced workload and can do what they joined the NHS to do. The process should place patients at the heart of the service, to understand their medicine requirements and feel empowered. importantly, it will also facilitate the faster discharge of patients, either back home or into a community-based care setting, whilst eliminating avoidable waste in the system.

For successful investment and implementation of automation in any NHS Trust, I would recommend the following 7-step process to ensure success:

Ø Assess and understand your organisation’s current challenges – consider the hospital’s geography, ward layout, supply chain from central pharmacy to wards, discharge processes, workflows, date quality and current and future digital systems.

Ø Integration with existing digital systems – can it integrate seamlessly with existing solutions – both electronic prescribing systems and electronic patient record systems? The ability to integrate will help optimise both workflow and data visibility.

Ø Change management – The successful adoption of technology includes the need to have a solid change management plan in place. Immediate employee engagement is key for bringing about change in the workplace – employees have to be part of the planning as much as the execution. Ensure pharmacy, nursing teams and digital leaders work together to put a holistic solution in place.

Ø Training – Ensure there is a clear training plan, clear SOPs, roles and responsibilities, and an ongoing training strategy to maintain standards.

Ø Adoption – It is essential to work with the right partners. Technology solution providers need to spend time on site understanding different workflows in various departments and provide expert guidance on how technology can best be used to make significant time and cost savings very quickly. This should be scalable from a ward, to a hospital, Trust and ICS so that consistent standards and workflows can be adopted.

Ø Execution – A go-live with the correct resource, clear clarity of the future state, at the shoulder support and swift resolution to any challenges.

Ø Life-support and follow-up – Experts should be on-hand to provide guidance and communication materials, and tailor, where possible, the technology to suit the specific case required by the hospital. Clear metrics and measurements to determine the expected outcomes ought to be in place.

Thought Leadership

Improving health outcomes through value-based care 

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As value-base care gains currency, Tim Morris, VP Go-To-Market at Elsevier Clinical Solutions writes for ICJ about how this approach can improve clinical outcomes and boost cost-efficiency.


The value-based care model has gained traction across healthcare systems globally since it was first introduced by Michael Porter and Elizabeth Olmstead Teisberg in 2006.1 It rewards healthcare providers with incentives based on the quality of care they provide to patients and has been shown to improve healthcare outcomes and cost efficiencies.

Discussions focusing on the need to advance value-based care have been ongoing in the NHS for many years. Back in 2009, NHS RightCare was established and rolled out. This was a national programme from NHS England committed to reducing unwarranted variation and promoting the shift to value-based care.2

Most recently, the disruption caused by Covid-19 has accelerated the focus on costs, equity of access to care and reducing variability in healthcare outcomes. This has prompted healthcare leaders and policymakers to rethink how care is delivered to improve patient outcomes in the most cost-effective way.


Defining ‘value’ in health systems

The interpretation of ‘value-based’ care differs globally, mostly around how value is defined per region. According to an expert panel facilitated by the European Commission, there are four broad definitions when it comes to understanding what ‘value’ means.3

  • Personal value – appropriate care to achieve patients’ personal goals
  • Technical value – achievement of best possible outcomes with available resources
  • Allocative value – equitable resource distribution across all patient groups
  • Societal value – contribution of healthcare to social participation and connectedness

Applying value-based healthcare models to the increasingly fragmented healthcare landscape helps improve clinician well-being and recommends strategies to overcome key environmental and organisational barriers to optimal care. Value-based health care connects clinicians to their purpose as healers, supports their professionalism, and can be a powerful mechanism to counter clinician burnout.4


Implementation barriers

Committing to reducing unwarranted variation can improve health outcomes and help to deliver a financially sustainable health system. However, there are common barriers that providers must overcome to establish new organisational structures:

  • Lack of integration – healthcare organisations using isolated technology platforms is one of the most significant challenges of value-based care
  • Limited resources – overburdened staff, insufficient technology that lacks automation capabilities, and continual administrative tasks can slow the adoption of value-based care
  • Fragmented care delivery – poorly managed patient care transitions can result in higher costs and adverse health events
  • Lack of measurement – if effective clinical data capture is not in place, reporting patient information and accurate care coordination becomes challenging

Adopting a multidisciplinary approach to value-based care

To improve outcomes, healthcare providers must adopt a multi-disciplinary approach, ensuring that clinicians from different disciplines are working collaboratively as a team, alongside the patient. Unless they are looking at the impact across all elements of healthcare delivery, healthcare organisations won’t have a full understanding of the total cost of care.

There is also a need to effectively engage patients in their own care. If the patient doesn’t follow post-care advice, outcomes may not improve. The provider should connect with the patient throughout the whole process of care, maintenance and recovery.

It is important to acknowledge that there is a lack of health literacy among patients and therefore a need to support an improved understanding of the care they are receiving. As described in Elsevier Health’s Clinician of the Future report, which gathered insights from close to 3,000 clinicians from 111 countries, patient empowerment has been identified as a key area that could potentially reduce complexity for clinicians.

Putting in place appropriate measurements which focus on the outcomes that matter is vital. The three main outcomes that hospitals can start to measure in terms of the patient experience are:

  • Capability – the ability of patients to do the things that define them as individuals, and enable them to be themselves
  • Comfort – the relief from physical and emotional suffering
  • Calm – the ability to live normally while receiving care

Improving value for patients

Value-based care models in health systems provide the opportunity to lower costs, increase patient satisfaction, reduce medical errors, and improve patient engagement.

When implementing such models, we must look at how we work across primary and secondary care to work with patients and empower them to manage their care effectively.


1 Michael Porter and Elizabeth Olmstead Teisberg https://archive.org/details/redefininghealth00port (sourced April 2022)

2 NHS. (2017). RightCare and the shift to value-based healthcare. NHS. https://www.england.nhs.uk/wp-content/uploads/2017/02/board-papers-090217-item-6-nhs-rightcare.pdf

3 European Commission. (2019) Defining Value in Value-based Healthcare. Available at: https://health.ec.europa.eu/system/files/2019-11/024_defining-value-vbhc_en_0.pdf (Accessed: November 10, 2022)

4 Teisberg, E., Wallace, S. and O’Hara, S. (2019) “Defining and implementing value-based health care,” Academic Medicine, 95(5), pp. 682–685. Available at: https://doi.org/10.1097/acm.0000000000003122 (Accessed: November 10, 2022)

Tim Morris, VP, Go-To-Market, Elsevier Clinical Solutions
Thought Leadership

What Steve Barclay must do for the NHS to survive the winter

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England’s Integrated Care Systems are still finding their feet as another winter sets in. What must the new Health Secretary do if the NHS is to survive the winter?


Three areas in which Steve Barclay, the new Secretary of State for Health and Social Care, could help are backlogs, health inequalities and digital. In each case, the lag between where we are and where we need to be is big enough for the right creative leap to put us ahead of the curve (and everyone else).


Backlogs

The NHS’s waiting list is about 7 million (although under revision). This number exceeds a tenth of the population, so if you are not waiting you probably know someone who is – but how big is this problem?

The NHS costs options in terms of QALYs – the quality adjusted life year. If a person were dying from a road traffic accident, for instance, and A&E enabled them to walk out in perfect heath, they would have received roughly one QALY of benefit by the anniversary of their discharge.

However, most of us benefit in increments. For instance, a knee implant may support an extra 10-15 years of active life – perhaps a benefit of just over 0.2 QALYs per year for 15 years, or nearly 3 QALYs overall. A few years ago, Lomas et al calculated that it cost the NHS around £13,000 for every QALY delivered. Now, we need to know how many QALYs are needed by the average person who is waiting.

Nobody knows the case mix, but we can set limits on the cost of addressing their needs. It’s hard to see how the average can be less than 0.15 QALYs per person (which means a £14 billion problem) or how the average could exceed a whole QALY per person (a £90 billion pound problem). England’s entire health and social care budget in 2021/22 was £190 billion, so these are colossal numbers, even as limits.

This problem is huge and unaffordable if set about in the traditional way. The Secretary of State could use this crisis to leverage innovation at unprecedented scale. As an example of a small success that would scale, I have been working with Badger, a social enterprise that pioneered drive through clinics during lockdown (see articles below). Badger’s approach to smart service design, information management and new pathways could be scaled up to shrink national waiting lists quickly.


Health inequalities

A potentially bigger problem is health inequality (which we can identify but are only just learning to scope). Very simply, the needy die earlier than that the affluent and enjoy poorer health, as do ethnic minorities and other groups recognisable through mental health or long-term conditions. In the UK, there are communities whose healthy life expectancy is 10-20 years shorter than others in the same city. Still more worrying, there are regions where around half the population now suffers from unequal access to health care or unequal outcomes when they do gain access.

Signposting, or creating positions to direct those suffering poor health outcomes towards the services they need, or adding staff to tailor ineffective services is very expensive, while more GP slots cannot improve a system that consistently inconveniences those who need it most. We know that most aspects of service, from appointments to diagnosis and treatment, are difficult even for the majority so it is hardly surprising that anyone with even a small extra challenge in life will be disproportionately affected.

An alternative is to redesign key aspects of ICS delivery so that they work easily for everyone. Better still, use the poor outcomes from health inequalities as a barometer. By focusing on their needs, the care system would be critically reformed at system level, benefitting us all as a by-product.


Digital

Finally, there is a widespread belief that digital can solve many of our care delivery problems – and it’s true, in principle. Digital access and services will certainly work for the affluent, IT literate and whoever uses the most popular services. In doing so, they will also worsen health inequalities, unless designed and rolled out with exceptional skill and ingenuity to narrow the digital divide.

The examples below showcase how smart information systems are critical to innovation. It’s not just about apps – the health system’s entire information infrastructure needs attention. The new Secretary of State can nudge the NHS from simply collecting information to deploying real-time data to identify and serve those who are suffering most.

Every ICS needs advanced information, analytics and simulation, capabilities to continuously improve existing services, deploy new services and track the near-invisible populations who are missing out.

If the new Secretary of State can ease ICSs in this direction, he will long be remembered and for all the right reasons.


For further reading on a small-scale demonstration of smart systems in care deliver: