Driving innovation: a case study using a simple evaluation tool


Professor Terry Young, Dr Fay Wilson, Alan MacDonald and Mr Simon Dodds describe for ICJ an evaluation tool that was used to support the development of a rapid access clinic in an existing health centre in Erdington.

Project management is simple: look after people, plan well, monitor effectively and intervene as needed. However, people, planning, monitoring and intervening are complicated, so good project managers mix in experience and tools they pick up over a lifetime.

Figure 1: Map of the project design to extend the capacity of an existing health centre (in blue) with rapid access care
Figure 1: Map of the project design to extend the capacity of an existing health centre (in blue) with rapid access care (click to enlarge).

Case study

The team from Badger (Birmingham and District GP Emergency Room) Group used a 6M Design® approach with three pre-implementation stages (map, measure, model – a prototype based on a simulation), and three phases of implementation (modify, monitor, maintain).

Once a working upgrade of the facility was in place, two reviews were conducted in January 2022, using a simulated set of patients (based on a typical case-mix) and putting this stream of virtual patients through the service to see how it was responding.

Across the two days, the workforce involved in the review included: heath care support workers; receptionists; and clinicians – around 8 people in all. A 4N framework was used for collecting and analysing the feedback.

To understand 4N, figure 2 (used with permission from SaaSoft) shows a creative journey into new territory – leaving behind what is already there and implementing what is desired. Specifically, 4N feedback uses the dimensions of time (present/future) and emotions (positive/negative) to create a chart which is split into quadrants, defined as:

  • Nuggets (relates to the present and the things about which the stakeholders have positive feelings)
  • Niggles (relating to the present but capturing features where the feelings are negative)
  • Nice Ifs (similarly, relating to the future and positive feelings)
  • No Nos (finally, relating to the future and negative feelings)

Niggles identify what hasn’t gone to plan to date. To grasp this feedback, an improvement tool called a Niggle-o-gram® was used, based on the familiar failure modes and effects analysis (FMEA). The list of niggles was graded based on three scores:

  • Incidence: how often does this niggle occur (never, 0 to 9, always)?
  • Impact: what is its effect (no impact, 0 to major impact, 9)
  • Influence: how much can we do (nothing, 0 to 9, change it completely)

Using this scheme, niggles that nobody could do anything about were assigned low priority. In this case, the top 5 niggles came out as shown in table 1.

Figure 2: Bridging the creative gap, while taking what works well with you.
Figure 2: Bridging the creative gap, while taking what works well with you (click to enlarge).
Table 1 (click to enlarge).

A more intuitive way of grasping the feedback is to produce a word cloud, weighting the size of words in each quadrant by their priority in the rankings.

Figure 3: Word cloud of key issues raised in all four quadrants of the 4N feedback process.
Figure 3: Word cloud of key issues raised in all four quadrants of the 4N feedback process (click to enlarge).

Using the findings to address key issues

One tension to emerge was around staffing, since booking patients in at reception takes less time than appointments with the healthcare worker or clinical staff. With everything running absolutely smoothly, a single receptionist might have coped, but interruptions and sporadic other tasks meant that having two receptionists was important for safety.

In turn, this created a tension between having a workload that would utilise two receptionists, and the capacity for healthcare and clinical appointments. In the end, a system designed for 10-minute appointments was fine tuned to 12-minute appointments to get the best combination of reception and other staff usage.

A second issue was Covid safety in a waiting room that could only accommodate 4 patients. Again, from modelling and other analysis, this was too few to manage the overall capacity planned for the centre, so a new process was developed whereby patients arriving in their cars would use their cars as their waiting room (and the receptionist would contact them to walk straight to their appointment), freeing up the waiting room for the exclusive use of those who arrived in other ways.

In the end…

Using a 4N framework as part of the management of an expansion of a health centre, an existing service was quickly upgraded for rapid access Covid patients, and tested robustly for capacity, throughput and safety.

Tools such as this are critical to the success of any agile or pop-up service. The good news is that the 4N approach is easy to understand, straightforward to implement and bridges the worlds of experience and clinical quality.

About the authors

Mr Simon Dodds, MA, MS, FRCS

Mr Simon Dodds is a general surgeon at University Hospitals Birmingham NHS Foundation Trust. He studied medicine and digital systems engineering before following a career in general and then vascular surgery. In 1999, he was appointed as a consultant surgeon at Good Hope Hospital in North Birmingham and applied his skills as an engineer and a clinician in the redesign of the vascular surgery clinic and the leg ulcer service.

In 2004, the project was awarded a national innovation award for service improvement. This experience led to the design, development, and delivery of the Health Care Systems Engineering (HCSE) programme.

Alan MacDonald, BSc

Alan studied at Nottingham Trent University and has a BSc (Hons) in Biomedical Science.

He worked for the Badger Group as an Out-Of-Hours primary care team leader and later became a data analyst. Since the start of the COVID-19 pandemic in March 2020, he became directly involved with the development of a multi-lane drive through Covid Referral Centre at the NEC.

He has been instrumental in the deployment of other temporary drive through clinics across Birmingham. He has also been actively part of the original team who were successful in applying this concept to the first purpose-built drive through clinic in the UK

He is frequently involved in new & novel projects within the out of hours primary care sector and is currently studying Health Care Systems Engineering.

Dr Fay Wilson, MBChB, FRCGP

Fay trained in Birmingham and has practiced there as a GP there since 1985. Her extensive national and local portfolio includes: NHS HA Non Exec, GMC fitness to practise chair, and associate postgraduate dean at Health Education West Midlands. She has served on the council of the BMA and other bodies. Fay brings people together to develop new models of care, a notable success being the Birmingham Multifund co-operative, a pioneering nurse-led walk-in centre and a prototype GP provider-at-scale ahead of its time in the mid-1990s.

Dr Wilson is medical director and co-founder of Badger, a GP social enterprise since 1996 providing out of hours and urgent primary care. COVID-19 introduced her to systems engineering, new people and new ways of thinking. Her ambition for the last decade has been to slow down.

Prof Terry Young, BSc, PhD, FBCS

After 16½ years as a research Engineer, Divisional Manager and Business Development Director, Terry became a professor at Brunel University London for 17 years.

He has a BSc in Electronic Engineering and Physics, a PhD in laser spectroscopy both from the University of Birmingham, UK.

His research has been in health technology, health services, and information systems. He has taught information system management, project management and e-Business.

His awards include the Operational Research Society’s Griffiths Medal, 2021, for analysing the return simulation methods offer when used to improve healthcare services.

Prof Young set up Datchet Consulting in 2018 to support innovation on the borders of academia, health and industry, of which the project reported here is an excellent example.

Health-tech sector can prosper from UK’s commitment to unleash potential of data

UK Healthcare

The role of digital data in the UK’s healthcare systems is set to gain newfound recognition and clarity when the government unveils its Data Saves Lives strategy this spring. If it lives up to its promise, the plan will help to drive the efficiency and effectiveness of data infrastructure and promote interoperability, while establishing clear and open standards for safely sharing data.

The backdrop to the new strategy is the tumult caused by the pandemic, and the ensuing acceleration of digital trends. The government now wants to build on the momentum which has been established in the push towards digital transformation. Similar exercises can be seen elsewhere in Europe, such as in Germany, which is set to invest €59 billion into healthcare technology and digitalisation in the rush to improve services.

While the UK’s strategy is primarily focused on the internal workings of the national healthcare system, the implications are positive for all healthcare technology organisations which have demonstrated a commitment to data safety and security. It means they are well-placed, both technically and culturally, to support the NHS on its journey.

Encouraging innovation

On reading the draft document, what is most encouraging is the focus on supporting innovators – those most likely to be responsible for developing and delivering new solutions to benefit both healthcare professionals and patients. The new strategy is set to provide a clear set of standards for those creating or deploying new data-driven technology.

“We find ourselves in the middle of a very exciting time in the digital development of healthcare in the UK.” Joost Bruggeman, Siilo messenger co-founder

This commitment to creating an innovation-friendly environment, with a framework for testing, approval and deployment, can be the catalyst for continuous improvement in the technologies used by healthcare professionals. It will provide the confidence to support investment, rather than the hit-and-miss, rather opportunistic nature of the current environment.

Joost Bruggeman, CEO of co-founder of Siilo

As CEO and co-founder of Siilo, a healthcare specific digital communications tool, I understand the fine line that the Government needs to walk.  On the one hand, it needs to build on the huge opportunities that new technologies present by keeping its doors open to innovation – doors which opened because of the challenges brought by the pandemic. But on the other hand, the Government needs to regulate and manage the relentless growth of new technologies.

Covid-19 played a part in Siilo’s own pathway into the UK healthcare market, due to the urgent need for rapid, reliable communication and information sharing. The other issue which facilitated Siilo’s entry was a series of daunting ransomware attacks in the UK, which prompted hospital boards to take preventive measures on all digital aspects of healthcare, pushing data security to the forefront, and seeing hospitals reject unsafe commercial messenger apps that posed a threat to data safety.

Siilo’s image ‘edit’ function allows users to blur and anonymise information and point out specific details on an image using the ‘Arrow’ tool

Without these driving factors, there is no doubt that Siilo’s route into the UK healthcare sector would have been far more difficult, especially as a tech company from outside the UK. So now that the panic of the pandemic is subsiding, the Data Saves Lives strategy is aiming to create an environment which is conducive to technological innovation, at a level which is appropriate for the NHS.

This is a significant challenge because oversight boards have to make decisions on topics and technologies that they may not be familiar with. Conversely, technology often develops so quickly that in vast structures such as the NHS, conducting a swift quality assurance and compliance strategy, as well as putting new regulations in place, is far more easily said than done.

Siilo’s Messenger App allows patients and healthcare professionals to communicate instantly

Siilo looks at the proposed strategy with great anticipation, while at the same time. understanding how things work in the real world. There’s unlikely to be a perfect solution, but that doesn’t mean that innovators should sit and wait until everything becomes more crystalised. It is the responsibility of the technology sector to interact with healthcare providers and the NHS, so we can hold up our side of any mutual agreement.

In short, it is also our job to provide clear data on our services so that decision makers have a good understanding of what we bring to the table, how we work, and how we can contribute to the NHS’s future aspirations and security regulations. And the sector should welcome any opportunities for dialogue, for we find ourselves in the middle of a very exciting time in the digital development of healthcare in the UK.

Joost Bruggeman is a former surgery resident at Amsterdam University Medical Centre and now CEO and co-founder of Siilo – Europe’s largest medical messenger app. For more information, please visit www.siilo.com.

New digital maternity pathway goes live in Devon

TPP's maternity software in action

TPP SystmOne Maternity technology goes live at Torbay and South Devon NHS Foundation, digitising the entire maternity pathway, from ante to postnatal care.

This week, Torbay and South Devon NHS Foundation Trust have gone live with TPP SystmOne Maternity. The system has enabled the Trust to digitise their entire maternity pathway, from antenatal through to postnatal care. It is being used by all midwives in the region, including those based at the hospital and those working in the community. More than 2,500 women will benefit from the new system every year, with their maternity care now centred on a complete, integrated digital care record.

Following the go-live, midwives now have instant access to all of the maternity data they need. For example, midwives working in postnatal care can easily view all antenatal care and delivery details. All medical and nursing notes are captured in a single record. This provides staff with the information required to make the best clinical decisions and improve safety for mothers and babies. Advanced functionality in the system is also supporting staff with the management of more complex pregnancies, through enhanced clinical decision support, alerts, and a complete maternity timeline.

TPP maternity
TPP SystmOne Maternity in use at Torbay Hospital

There has been strong clinical engagement throughout the project, from midwives, doctors and nurses. The teams have used TPP’s powerful Clinical Development Kit (CDK) functionality to develop exactly the data entry templates and visualisations they wanted. All staff members can quickly capture the information they need for a complete antenatal, labour, delivery and postnatal record. The Trust have also used CDK functionality to create customised safeguarding content, helping to support and protect the most vulnerable families. Staff are also benefiting from interactive inpatient screens in the system, allowing them to manage bed capacity and perform safe, efficient handovers.

The go-live has also included providing TPP’s smartphone application, Airmid, to all women under the maternity service. This is putting women at the very centre of their pregnancy journey. Airmid allows women to access their maternity records, manage their upcoming appointments, complete questionnaires at home, and receive personalised advice and education material. Airmid supports better engagement and seamless communication between women and their maternity care team.

SystmOne also provides significant improvements to integrated care across the region and to multidisciplinary working. For example, maternity staff can immediately access any important information entered by GPs. This is significantly improving patient experience. Women only have to tell their story once, without having to repeat themselves. GPs can directly refer into the maternity unit, improving efficiency across both services. Additionally, all new births are now automatically registered with regional Child Health services, with no extra burden placed on NHS staff.

Tracy Moss, Head of Strategic Systems’ Software Development at the Trust, said: “We are excited to be working with TPP to introduce a new maternity IT system here at Torbay and South Devon NHS Foundation Trust. The new system is expected to bring a wealth of clinical as well as efficiency benefits for our maternity teams and the wider organisation. The families we care for will also benefit from the system, as the new associated Airmid patient app will allow them to view their records, access information and be more involved in their care. Moving forward, we would like to continue to work with TPP to deploy other SystmOne products, both within our maternity unit and across our wider Torbay and South Devon organisation.”

Charlotte Knowles, Managing Director at TPP, said that “maternity services will always hold a particular place in my heart. Having had three babies, I know, from personal experience, what a superb job they do. We are delighted that the Trust are already seeing significant benefits for staff and patients from TPP Maternity. The dedication of the staff here has been truly inspiring. We are looking forward to working together to continue to make better use of technology to improve the experience and outcomes for pregnant women and their families.”

Addressing the increased demand in healthcare

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/

Clarifying the metrics: A true picture of system wide activity


Maria Kane, Chief Executive of North Bristol NHS Trust, addresses the need for defined and aligned metrics to provide one overall picture of system wide activity and reveal where improvements can be made.

Every acute trust is facing three challenges: the elective care debt, urgent care recovery and an exhausted and depleted workforce. With Integrated Care Systems (ICSs) on the horizon, we have an opportunity to step back and look at the bigger picture to see where we can make system improvements to meet these challenges and add value to the patient, public and taxpayer.

However, it is difficult to understand what is going on in any given health and care system. This is because the finance framework and metrics currently available are not defined or aligned enough to help determine the exact value (cost and outcome) of activity the funding is producing.

A clear picture of each health system

Each ICS will be responsible for allocation of funding at system level. The aim is to distribute resources according to population need and to help reduce health inequalities. However, all payment systems are complex and to ensure the right calculations for payment of care and enable health systems to provide the right care in the right places, it is vital to have access to the right sources of data. Where patient-level data is limited, this can impact on how system budgets are allocated.

Currently, trusts are operating with a mixed economy of block and activity contracts. Most of these are now block contracts since Covid-19 began, but there are also have large numbers of individual providers on specialist and general contracts, which makes it difficult to see the big picture. Specialist contracts, for example, can cover wide areas which makes it harder to pin down what is happening in each ICS. Operating with a variety of contracts like this can create significant challenges when trying to set out a whole system budget.

A greater understanding of each system

ICSs provide the health system with an opportunity to clarify and get on top of the metrics and to have a single interpretation within each system. This will allow the scope to broaden and incorporate areas such as mental health.

Giving full responsibility of finances to ICSs and enabling them to operate the whole budget will bring many benefits and allow good population health management. However, there needs to be a shared understanding of how local services are run to ensure all areas of the system are given adequate funding. All members of the ICS need to understand how each part of the system works and it is crucial that financial decisions are based on a sound knowledge of the challenges across the whole system.

Bringing together sources of data from across community, primary and acute care can help to provide one overall picture of how the system is performing. Data can highlight where funding needs to be focused to help create change, improvement and the best patient care, as well as being able to highlight areas where proactive care can start to make a difference, but  the finance framework and metrics need to be tackled first.

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/

Digital Health Academy to provide free digital skills training

Digital Health Academy

The Digital Health Academy opens today and aims to provide free digital skills training to all NHS staff by 2031.

From today, the Digital Health Academy, a free, digital training tool for NHS frontline staff, is in operation. Aimed at providing digital skills training to all NHS staff by 2031, the modules are now freely available on the Health Education England NHS Learning Hub. As highlighted by Health and Social Care Secretary, Sajid Javid, in a recent speech, it’s crucial that the NHS improves digital provision across all health and care services and the Digital Health Academy aims to address this by building on the digital skills of all NHS staff.

A survey from the Organisation for the Review of Care and Health Apps (ORCHA), reveals that although 65 per cent of the public are open to trying digital health technologies, only a fraction of tools are recommended by health or care professionals.

In total, amongst those using digital health, only a small proportion of recommendations came from healthcare professionals, with 17 per cent of recommendations coming from GPs, eight per cent from hospital doctors, and two per cent from nurses.

The need to support a digitally ready workforce has been highlighted by the NHSX Readiness Plan and the CPD-accredited Digital Health Academy responds to the critical requirement to invest in developing front-line skills for digital health through professional development.

Currently, there is still no mandatory digital health training for health and care professionals, and the courses that frontline workers can attend are often scarcely available. In response to this need, ORCHA, with the support of universities and healthcare professionals, and with financial support from Boehringer Ingelheim, developed the Digital Health Academy, the foundation level modules of which will be freely available at orcha-academy.com and on the Health Education England NHS Learning Hub.

The academy’s online training modules are designed specifically for frontline health and care professionals who want to use and recommend digital health tools but have been struggling to access the knowledge to do so safely.

ORCHA has created the infrastructure of the online training portal and designed courses, drawing on experience gained reviewing more than 17,000 health apps and operating health app libraries in 70 per cent of NHS regions.

The Digital Health Academy’s aims include:

  • Free access for all NHS and social care staff
  • Availability on Health Education England NHS Learning Hub
  • Enabling staff to gain Continuing Professional Development (CPD) points in a vital new area of professional development

The CPD-accredited Digital Health Academy programme includes:

  • Short, bite-sized learning modules to suit busy schedules, which can be accessed at any time
  • Two foundation modules which explain the function of health apps, the current digital health landscape, the barriers to using and adopting digital health and the importance of prescribing good quality digital health products
  • Coming soon, a series of specialist modules including topics such as digital health for mental health, diabetes, physiotherapy, long Covid and winter pressures

Commenting on the academy’s resources, Dr Neil Ralph, Head of Health Education England Technology Enhanced Learning (who has previously written about the need to prepare the NHS for digitally-driven healthcare), said: “COVID-19 accelerated the rapid adoption of digital health across health and care services and the need to embed digital health in the long term. We are delighted that ORCHA has contributed its Digital Health Academy foundation content to the Learning Hub and look forward to hosting new content in the future, further supporting health and care professionals in their roles.”

Learning about the value the Academy offers frontline staff, Boehringer Ingelheim committed to sponsor the foundation modules. This has enabled it to be opened up at no cost to health and care professionals. Commenting on this, Uday Bose, Managing Director at Boehringer Ingelheim UK & Ireland, said: “There’s widespread recognition of the need for digital health training for frontline workers, with organisations from the King’s Fund to the Royal College of General Practitioners calling for it. With six million people now waiting for elective care, and with first-class digital tools available which could support healthcare workers with many of the high volume and low complexity cases, the need to improve digital skills and digital confidence in the NHS has become critical. We felt the academy was a perfect way to address this very real need amongst frontline staff.”

Ahead of the launch, the academy has been introduced to professionals using the ORCHA digital health libraries to a positive reception:

Dr Michelle Webster, Chief Clinical Information Officer & Consultant Clinical Psychologist at Coventry and Warwickshire NHS Partnership Trust, said: “The ORCHA Digital Health Academy has helped to demystify digital health, strengthen our clinicians’ digital skills and boost their confidence in using healthcare apps. The bite-sized modules are easy to follow, interesting and relevant and designed to flexibly fit around their busy jobs. I would highly recommend.”

Najia Qureshi, Director of Education and Professional Practice, British Dietetic Association, said: “This is a really welcome resource for our members, who work across the NHS supporting patients with a wide range of health conditions. Innovation in healthcare is introducing new ways of working and is transforming patient care. This programme will help dietitians and other health and care professionals to develop the professional skills needed to confidently use and recommend the right digital health products – helping patients to benefit from digital healthcare.”

Reviewing a foundation module course, Dr Joel Brown said: “It takes quite a paradigm shift to move physicians away from seeing prescribing as an exclusively pharmaceutical enterprise. As medicine is increasingly digitised, clinicians need to take seriously the opportunity to prescribe digital health. The course by ORCHA, as part of their Digital Health Academy, makes this point brilliantly.”

How integrated care systems can improve digital inclusion

digital inclusion

Sarah Boyd, Head of Digital Experience and Transformation at Norfolk & Waveney Health and Social Care Partnership (NWHSCP), explores how her integrated care system (ICS) is using digital health to improve patient inclusion and help reduce health inequalities.

Health inequality is a growing problem but is still too often discussed separately from the core business of the NHS. Patients are treated through siloed care pathways, with conversations about why some populations have poorer health outcomes often treated as an aside.

The pandemic brought this into greater focus, especially around digital inclusion. Technology rolled out across the NHS in response to Covid-19 often widened the gap between those who could access online services and those who couldn’t.

The benefits of ICSs

When it comes to digital inclusion, there is little doubt that ICSs offer a huge opportunity to deliver more equitable access to healthcare and improved health outcomes for those previously underserved by the health system.

NWHSCP is a new type of organisation, working as a system across the Norfolk and Waveney region. Operating across the public sector, along with health and social care, councils and with voluntary organisations, presents an opportunity tackle health inequality and exclusion in a person-centred way.

The ICS allows health leaders to work across organisational boundaries, to test assumptions about exclusion, and to leverage the work that happens at the level of individual places.

Fixing existing digital inequalities

At every stage, NWHSCP are ensuring that their digital projects address digital inequalities. By implementing a pan-public sector hub-and-spoke model that provides personalised support to excluded groups, their plan is to gain the wider benefits of digital inclusion by engaging people – not only in health services – but more broadly in society.

For example, if a GP detects that an elderly person in their care is socially isolated, they can refer them to a central digital inclusion service. From there, they may be passed to a library or volunteer service who are able to provide connectivity or a 5G-enabled device, along with the ongoing support to use it. This allows the patient to order repeat prescriptions, but also to food shop online or video call family and friends, with positive benefits for their wider health and wellbeing.

“Creating an environment in which every service is digitally inclusive offers benefits not just to individuals, but also to wider society”

Asking people to go to an appointment at an unfamiliar location can create unnecessary barriers. As it proceeds, the ambition of NWHSCP is to work towards using services that people already access to provide a trusted contact point. If patients are already known to a church group or domestic violence shelter, for example, they might receive support there.

Through community partnerships, ICSs can build a network of digital tools and skill provision. For example, if a partially-sighted person, or family member, needs a speech-to-text reader, NWHSCP can point them towards their trusted toolkit. Once a person has access to this network, they can then download tools freely, ahead of their health needs.

Building an inclusive service

Creating an environment in which every service is digitally inclusive offers benefits not just to individuals, but also to wider society. As the Good Things Foundation’s Widening Digital Participation report found in March 2020, digital inclusion pays for itself in better mental and physical health, and stronger participation in the economy. For every pound spent, £6.20 is made back.

With this in mind, ICSs can leverage skills found in the private sector to identify new ways to increase inclusivity. Companies in the space include ThriveByDesign and CardMedic, an award-winning digital tool that provides instant access to communications options to improve engagement with healthcare professionals.

CardMedic is designed to help patients with a language barrier, visual, hearing or cognitive impairment, or to communicate through PPE and is unique in its space.

One issue with digital inclusivity tools is that they’re often seen as only affecting excluded communities, but digital inclusivity applies to everyone. Many people often struggle to retain emotionally-sensitive medical information, such as details about a cancer diagnosis. Tools like CardMedic allow any patient to review the basics of a hospital procedure or consultation – helping them to feel more secure in their care.

Applying innovation

Through pulling together with public sector and voluntary organisations, NWHSCP has built a strong, interconnected and multi-disciplinary team to implement their digital transformation agenda. As ICSs move towards statutory footing, the hope is to build on their initial successes though good recruitment and the implementation of innovative technology.

But there is only so much one system organisation can achieve on its own. To maximise the potential of integrated care systems, the NHS will require a national system for picking up on digital innovation. It should not be up to individual ICSs to find products, such as CardMedic, themselves. Digital inclusivity should be available to all.

Cheshire & Merseyside ICS teledermatology innovation helps relieve system pressure


Cheshire and Merseyside ICS have launched a suite of new teledermatology technology as part of an initiative to streamline the triaging and referral of dermatology patients.

The initiative has been rolled out across four Acute Trusts in Liverpool, Wirral, and Cheshire, including Liverpool University Hospital NHS Foundation Trust. The regions primary and secondary care services have been under extreme pressure with backlogs and record service demand. The aim of the technology is to support 228 GP practices in the delivery of timely, effective and collaborative dermatology care.

The solution consists of a smartphone-compatible Dermatoscope, a connected app and an integrated digital platform, funded by the National Teledermatology Investment Programme (NTIP). Cheshire and Merseyside ICS also partnered with Cinapsis SmartReferrals to make the initiative possible.

The 228 participating GP practices have all been provided with Heine dermatoscopes, with a universal adaptor that attaches to any smartphone camera. GPs are able to use their own phones to capture high-quality clinical images of moles and other skin lesions in a data-compliant manner.

The clinical images can be attached to dermatology referrals or Advice and Guidance requests made through the Cinapsis SmartReferrals app. A secondary care specialist is able to review the case and suggest the best next steps for the patient. The images, and the outcomes of the referral or advice and guidance, are automatically updated in the patient record via an NHS ERS and EMIS integration.

Paul McGovern, Elective Care Programme Manager at Cheshire and Merseyside Health and Care Partnership said: “This technology roll-out is the product of two years’ worth of planning and trials; several solutions were rigorously tested before the ICS team settled on Cinapsis SmartReferrals as selected as the most impactful teledermatology solution.

“The resource commitment and genuine partnership approach taken by Cinapsis has been first-class, enabling us to build a proof-of-concept model within the Liverpool area, secure further investment, then take the project forward across the city and into neighbouring Clinical Commissioning Groups (CCGs) within the ICS model.”

One important benefit of the initiative is that it is reducing the high number of benign moles and skin lesions being referred into secondary care via the Two Week Wait (2WW) cancer pathway. This has previously been a drain on resources and also caused needless concern for thousands of patients.

Prior to the technology roll-out 30 per cent of dermatology 2WW referrals in the region were being referred unnecessarily. This was amounting to approximately 7,000 unnecessary referrals a year, costing over £1 million. Since the Cinapsis technology was launched, 49 per cent of cases submitted on the platform are successfully managed with advice and guidance alone. Clinicians resources have been freed up to tackle wait times for other dermatological conditions, such as inflammatory dermatoses.

Dr Stephanie Gallard, GP & Primary Care Lead for Elective Dermatology within Cheshire and Merseyside Health & Care Partnership, said: “Historically, my GP colleagues and I had to waste hours wrestling with clunky, poorly-integrated photo-sharing technologies if we were able to attach photos at all in a data compliant manner. Aside from the heavy burden it was placing on our time, this was leading too many dermatology referrals to be made without high-quality images. This meant that patients were often called in for a face-to-face specialist appointment when they did not need special treatment, or when they could have been more appropriately managed in primary care.

“Now that I can use the Cinapsis SmartReferrals platform to manage patient referrals and access specialist second-opinions within days, I’ve been able to work more efficiently and treat patients more effectively.”

Dr Owain Rhys Hughes, founder & CEO of Cinapsis, said: “As a surgeon with over 20 years of experience, I know exactly how important streamlined communication is to the delivery of the NHS’s world-class patient care. That’s why the Cinapsis team has worked very closely with the Clinical Leads and the Teledermatology Programme team in Cheshire and Merseyside to build this bespoke, tailored solution.

“We’re passionate about delivering technologies that save time for clinicians, save money for the NHS, and ultimately could save patients’ lives. This partnership will make collaborative working between primary and secondary care teams a reality, and Cinapsis is proud to be playing a part in that.”

Experts call for ICSs to embrace industry and harness the “patient voice” to drive innovation

life sciences

During a crucial period for UK health and care policy reform, Public Policy Projects and IQVIA convened over 500 healthcare stakeholders for a special online discussion to identify the challenges and opportunities for UK life sciences within a new future of integrated care.

The topic was more than timely. Only hours prior to the event, the government published its eagerly anticipated Integration white paper, seeking to clarify exactly how integrated care will improve the patient experience and bring better value to the taxpayer. The white paper follows the publication of the Elective Care Recovery Plan published on Tuesday, which sets out the NHS plan for bringing down the elective care backlog and addressing the longstanding issue of waiting times, both of which have been exacerbated following Covid-19.

In the context of these flagship health policy proposals from government, this session was quickly brought into sharp political focus. “What we need to do through integrated care systems (ICSs) is learn lessons of recent history and apply them to develop more joined up integrated care – this is as important for UK life sciences as it is for health providers,” reflected PPP Executive Chair, Stephen Dorrell.

While this end goal has never been in question, the exact role of ICSs, and by extension ICS leadership, in delivering this joined approach has often been subject to debate. Dr Penny Dash, Chair of NW London ICS and Co-Chair of the Cambridge Health Network, likened the role of an ICS to one of the key facilitator of joined up care rather than a direct provider of it. “While we [ICS leadership] have control over funding, we do not have direct control over the health service provider portfolio, nor do we have commissioning control and we cannot simply move contracts around the system,” she said. The key benefit of ICS frameworks, she insisted, was to convene key parts of the system and build a robust population health strategy.

“We are rapidly moving towards borough-based partnerships (accounting for some 300,000 people in a locality). We want to see those services delivered much more at scale, with much better ability to coordinate and deliver a population health approach.”

Matthias Winker, Head of Strategy at Oxfordshire and Berkshire West ICS, also stressed the importance of ICSs acting as conveners of care transformation. “Our function as a facilitator is crucial, we are introducing a ‘learning culture’ by bringing different capabilities from different organisations to the table. This is particularly relevant when discussing commissioning skills, provider capabilities and local authority expertise.”

A new model of coordinating care also signals profound changes to the relationship between pharmacy and the wider healthcare sector. Brian Smith, Chief Pharmacist, Applied Insights, Access & Value, UK at IQVIA, stressed that ICSs have the potential to alter focus from measuring inputs to focusing on outputs. “Community pharmacists, for example, are remunerated on the number of prescriptions they dispense rather the value they provide – this dynamic has to change to bring community pharmacy further into system wide healthcare provision.”

Life sciences: “Seizing the opportunity”

Industry should be and will be round the same table as colleagues in the ICS landscape – playing an important part in delivering innovation

The agenda to join up health and care service provision wherever possible runs parallel to developing the UK into a life science powerhouse. ICS frameworks present new opportunities to enhance access to care, develop transparency and choice, and ensure that innovative treatments reach the people who need them – the patients.

Also speaking was Dr Ben Bridgewater, a former Professor of Cardiac Surgery at South Manchester NHS and now CEO of Health Innovation Manchester – an academic health science and innovation system, at the forefront of transforming the health and wellbeing of Greater Manchester’s 2.8 million citizens.

Reflecting on the opportunities for advancing health and care innovation, Dr Bridgewater said, “There is an extraordinary and exciting opportunity in ICS development to build momentum for those innovations and exciting projects and move as quickly as we can from the same old statutory functions. We must seize the opportunity.”

Building on this positive tone was Russell Abberley, General Manager, UK & Ireland for Amgen and Chair of the American Pharmaceutical Group (APG). Insisting that the pint glass was “half full” when it comes to UK life sciences innovation, Mr Abberley outlined his excitement over the prospect of industry, “building a stronger partnership” with the health and care sectors. “Industry should be and will be round the same table as colleagues in the ICS landscape – playing an important part in delivering innovation and data to solve issues around workforce and diagnostics and moving patients through the systems.

“I think we [industry] can play a really important part in communicating the value proposition of the solutions: the data, the technology, the medicines, the diagnostics, whether it be to solve some of the challenges around workforce and diagnostics and moving patients out into primary care or out back into the community.”

Mr Abberley went on to stress that the longer-term challenges are around health inequalities, driving uptake and access to treatments, as well as delivering treatments for patients in locality.

The voice of the patient

It is not about having the patient directly in the room, it’s about ensuring the system represents their voice

An increasingly important part of the integrated care debate has been the concept of building care around the patient – putting the patient in control of their own care and ensuring the system works for them. These themes were affirmed in the recent Integration White Paper, which placed particular emphasis on the value of “personalised medicine”. However, if providers truly want to develop personalised medicine, then they will need to take opportunities to better understand the people receiving it.

The extent to which patients should be included as an active participant in system transformation has proven to be a challenging and interesting debate and speakers on the day did not shy away from this discussion. Dr Bridgewater pointed to the inclusion of the voluntary sector as an important and necessary step to securing the patient voice in system transformation.

While certainly conscious of the fact that the people sitting at an ICB meeting may not be best placed to help patients understand how to live a healthier life, Dr Penny Dash played down the idea of direct patient involvement in transformation processes. She argued that if providers consider the idea of the patient ‘voice’ too literally, it could end up encompassing an entire ICS population (in Ms Dash’s case that would include the 2.2 million residents of NW London ICS).

“It is not about having the patient directly in the room, it’s about ensuring the system represents their voice, understands their needs and challenges and [about] tackling population health and…addressing health inequalities.”

Addressing health inequality is as important for life sciences as it is wider health and care – treatments and innovations brought into the ecosystem must not inadvertently exacerbate disparities through unequal access. As Dr Dash explained, “ensuring equitable service uptake while addressing the perennial issues of obesity and smoking is the priority; this is a huge and complicated agenda but we can no longer have an environment where sections of the population are ‘hard to reach.’”

Dr Bridgewater argued that what is considered the concept of a patient ‘voice’ in healthcare might be referred to as ‘customer centricity’ in other sectors. “Software companies understand the importance of user-centric design, but this concept has not always fed through to healthcare. Achieving this will require some co-creation with people who have lived experience of this issue – as well as ensuring collaboration with industry colleagues.”

Delivering innovation

If you do not open yourself up to power of industry you are missing a trick

Industry has a huge role to play in guiding system transformation. Ahead of ICSs taking up statutory footing in July, this webinar was a timely opportunity to dissect the debate and ensure that industry has a ‘seat at the table’.

“There must be incentivisation for both sides of the equation,” said Mr Matthias Winker, “commercial innovation has yet to truly mature for ICSs, however this could rapidly develop over the next few years – but we are still a long way off from where the life sciences sector is in terms of utilising commercial opportunities to encourage innovation adoption.”

Where pharma was once considered the ‘dark side’, there is now acknowledgement that its capacity for harnessing innovation presents a powerful opportunity to deliver lifesaving treatments to patients. Evidence in recent years of this shift in mindset can be seen with the Cancer Drugs Fund, presenting a faster means of appraising new drugs and treatments – harnessing industry innovation earlier. The ICS framework presents a unique opportunity to expand such opportunities.

“If you do not open yourself up to power of industry you are missing a trick,” said Dr Bridgewater who outlined the importance of the concept of ‘agency’ in encouraging innovation adoption. This concept has allowed Health Innovation Manchester to shift the dynamic in favour of innovation, allowing organisations to craft relationships and drive technology within the ICS structures.

Life science innovation in an ICS future

Whatever happens over the next few years, the whole system must be engaged in this transformation process

“While specific roles and duties of ICS leadership will change over time, it should become, and remain, the place where strategy is developed before handing to local providers for delivery,” said Dr Dash, “and developing strategic visions for innovation, as well as measuring and assessing its impact, is absolutely the role of the ICS.”

What most refer to as a care pathway, some in other sectors would consider an ‘innovation supply chain’, and this mindset should help turn the dial in favour of quicker innovation adoption. Ensuring this supply chain works requires making priority calls about what to do next, managing the benefit of innovation against the complexity of implementing it across the system.

Whatever happens over the next few years, the whole system must be engaged in this transformation process. As Mr Dorrell concluded, “this process cannot simply be about which compound to use specifically while the rest of the system remains unchanged. Why even bother innovating if it is used in an unchanged health system?”

Evident from the outset of this webinar was that the principle of integration must extend far beyond linking service providers. ICSs have a special responsibility to ensure that the health and care ecosystem includes industry partners, harnessing their innovative potential while ensuring the ‘voice’ of the patient is a key consideration in the transformation process.

The digital journey of adult social care

Adult social care

In the face of unprecedented challenge for the sector, many adult social care providers are demonstrating their ability to deliver impressive tech systems. Louis Holmes, Senior Policy Officer for Care England writes for ICJ.

Digital transformation in social care is often overlooked, particularly by those outside the health and care sector; the perception is that care providers are not as technologically mature as their healthcare colleagues. Despite funding issues, the inability to invest in tech, and not having access to the same level of resources as their healthcare counterparts; adult social care providers have demonstrated that they have the capabilities to deliver impressive tech systems, even when facing a crisis.

Outlined below are three case studies from Care England members that demonstrate innovation in the sector. For more innovation to happen however, resolving the funding of new tech must be addressed. Each study shows the benefits of the independent care sector, but the challenges faced when trying to invest in care tech.

At Care England, England’s largest and most diverse representative body for independent adult social care providers, we have seen countless case studies from our membership where there is strong evidence of digital maturity and innovation. Through our Digital Special Interest Group (DSIG), Care England members can ask digital questions or share their experiences with other group members. This space allows organisations to learn about new software, or avoid, when browsing for what is on offer. Members have found this group incredibly useful, thus demonstrating communication and engagement as necessary when discussing digital transformation.


Blackadder is a family-owned and operated group of nursing and residential homes in the Midlands and can brilliantly demonstrate the power of remote monitoring.

At a recent Care England event on the subject, Finance Director Michael Butcher explained that, in 2018, Blackadder set themselves the objective of being able to monitor their care data remotely. The aim of this was to reduce time and administration work when gathering paper audits, and ensure that the right data was available to the right people at the right time.

Through Nourish’s Electronic Care Management System and Power BI, Blackadder can produce hourly, daily, weekly and monthly reports, efficiently and rapidly analysing core care data points within their homes. The next stage of their digital transformation is linking their current system further remote monitoring systems and eMARs.

Integration and interoperability are essential factors care providers need to consider as they expand their digital systems. It can be the case that a provider buys several different software solutions/pieces without realising that they are not compatible with one another, resulting in barriers being created between the different systems. However, it can also be the case where a regional CCG is rolling out a programme that is not yet compatible with the provider’s current system. Thankfully, more is being done to resolve interoperability issues, but it will remain a pertinent problem as we see more technologies become available.

Hallmark Care Homes

To help avoid such instances, Care England member Hallmark Care Homes are creating a business intelligence system through Yellow Fin that collects data from several different systems used by Hallmark. Building a data lake allows Hallmark to mine important information which can then be analysed effectively by the relevant employee.

Programme Delivery Manager Saad Baig has developed a visual traffic light system through intuitive thinking, enabling head office to monitor each care home. Using a traffic light system, Hallmark can identify which homes needs immediate support and which homes are starting to edge towards becoming a concern.

Sophisticated systems such as the one being developed by Hallmark provide further freedom when it comes to choosing the right tech and enables quicker response times and delivery of care. It buys the gift of time leaving health and care workers to focus on their core role of delivering high-quality care.

Canford Healthcare

Sophisticated systems such as the one being developed by Hallmark provide further freedom when it comes to choosing the right tech and enables quicker response times and delivery of care. It buys the gift of time leaving health and care workers to focus on their core role of delivering high-quality care.

Through Microsoft 365, Amanda Rae, Quality & Compliance Manager, has created a user-friendly system that brings together several data and compliance sources, minimising burden and time spent on administration work. Amanda can link and share important tasks and documents using SharePoint, Forms, Teams, Planner, and Power Bi. It allows Canford to create the correct compliance documents that can then be shared with the Care Quality Commission (CQC).

Although it may seem daunting for providers to build a similar system from scratch, Amanda, who led the project at Canford, does not come from an IT background, demonstrating how easy it would be for any provider to build. This sort of innovation needs to be applauded and the huge innovation in ASC recognised, learned from and built on.

Adult social care: going forward

With Integrated Care Systems (ICSs) introductions scheduled for the summer, we must continue these digital discussions and connect care providers to the right people within each new system.

NHSX, with the help of Digital Social Care, has already begun working with some systems and helping develop their digital capabilities. Tools such as the ‘Digital Social Care Records – Assured Supplier List’ helps care providers choose a supplier who has been rigorously selected, ensuring that they can meet and deliver against the national specification.

The Adult Social Care White Paper demonstrated The Department of Health and Social Care’s (DHSC) eagerness to digitise the sector and outlined some bold ambitions. £150 million shall be invested into the sector over the next three years to help drive care providers’ digital journey with the commitment to ensure that at least 80 per cent of social care providers have a digitised care record in place. This is welcoming news, and Care England looks forward to working with the DHSC in achieving these goals.

Through workspaces such as DSIG, we can actively promote and share successful digital stories that help show the digital maturity of the sector and bring care providers to the forefront of digital discussions.

Louis Holmes is Senior Policy Officer for Care England.

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