Government launches pilot pathway to accelerate access to innovative medical technologies
By Integrated Care Journal
The new Innovative Devices Access Pathway (IDAP) pilot is an initiative to bring new technologies and solutions to the NHS faster and will focus on addressing unmet needs.
The government has launched the pilot of IDAP, a new initiative aiming to accelerate the adoption of “innovative and transformative medical devices” within the NHS. Supported by £10m of government funding, the IDAP is a multi-partner pathway that offers product developers and manufacturers access to tailored support and scientific advice from a team of experts. The latter will in turn develop a bespoke Target Development Profile (TDP) roadmap for successful applicants to help bring their products to market more quickly.
The TDP roadmap will define the regulatory and access touchpoints pertaining to each product’s development, which can include:
Quality management system support
Advice on system navigation
A fast-tracked clinical investigation
Joint scientific advice with partners
Support with Health Technology Assessments (HTA) for product realisation and adoption
Safe-harbour meetings to discuss adoption within the NHS
Exceptional use authorisation granted by the Medicines and Healthcare products Regulatory Agency (MHRA), provided necessary safety standards are met
The IDAP is open to applications from UK and international commercial and non-commercial technology developers, subject to eligibility criteria. During the pilot phase, the IDAP partners, which include the Department of Health and Social Care, the MHRA, NICE and the Office of Life Sciences, will select eight products that best meet the eligibility criteria and that are most likely to benefit from the support and advice available. The pilot will see the main elements of the pathway tested and used to inform the future development of the IDAP.
Dr Marc Bailey, MHRA Chief Science and Innovation Officer, said: “The IDAP launch marks an exciting step in accelerating the delivery of cutting-edge medical technologies safely to patients across the UK. The insights gained during the pilot phase will be crucial in shaping the future direction of this new pathway.
“We encourage medical technology innovators in the UK and abroad to submit their applications and benefit from this combined support service. By working together, we can fast-track access to the most advanced technologies for those in urgent need.”
Mark Chapman, interim Director of Medical Technology and Digital Evaluations at NICE, commented: “We look forward to working with industry to continue the acceleration of our evaluations and with the MHRA to align our work for the benefit of patients.”
Why healthtech providers to the NHS have a responsibility to design interoperable solutions
By Dr Anas Nader
Boosting access to innovative technology has never been more important for the NHS. But providers have a duty to ensure interoperability is at the core of all solutions, writes Dr Anas Nader.
With the NHS facing increasing challenges, from extensive waiting lists to rising staff burn-out, boosting access to innovative technology across the industry is becoming a growing priority. The Health Secretary has promised to ringfence funding for health tech, highlighting it as a key investment for the future of the health service; and there is no shortage of emerging tech offering to step to the fore and build new solutions.
Many are already shaping up to deliver on this promise – from remote patient monitoring to increased surgical accuracy. But there is one thing that must not be overlooked: if these solutions are to have a long-term tangible impact, and support more joined-up care delivery across new integrated care systems (ICSs), they must be designed with interoperability in mind.
An interoperable solution is one that can connect with other systems, allowing for information to be easily and safely shared without the need for manual intervention. With hundreds of digital systems in use across the NHS – including databases such as the Electronic Staff Record – new tech must be able to ‘speak to’ these and share information directly if it is to have a viable long-term benefit. This is especially vital for facilitating cross-service collaboration within ICSs, enabling systems at different organisations to effectively and securely send information to each other.
For this reason, NHS England has identified interoperability as a key area of focus, to help boost the capabilities of ICSs, which were set up to drive the shift towards more joined-up care. This is a goal echoed by other recent reports, including the Hewitt Review, which highlights the importance of joined-up care and the effective interchange of information across organisational boundaries.
While new healthtech innovations are often built with the best of intentions, tech that cannot be successfully used in conjunction with other systems can inhibit this much-needed collaboration. Whether that’s by creating silos which slow down communication or increasing the admin burden on clinicians by requiring data to be manually re-entered; without interoperability, new technology can become difficult to use, and ultimately risks being abandoned by the clinicians it was built to support.
Indeed, a lack of interoperability between systems has been flagged as an ongoing problem in the NHS, with 76 per cent of doctors viewing this as a ‘significant barrier’ to digital transformation. According to the BMA, 13.5 million working hours are lost in England each year as a result of fragmented tech and IT systems.
To create a successful product that can make real change in the NHS, and facilitate genuine ICS-wide collaboration, healthtech companies must take into account the complex ecosystem of healthcare IT systems within the NHS. Providers have a responsibility to build in a way that ensures our solutions deliver genuine interoperability as standard.
How healthtech providers can deliver on interoperability
The biggest mistake that health innovators building tech for the NHS can make when approaching interoperability is viewing their product and the NHS as completely separate entities. Rather than being built for and with the NHS, solutions are often built in isolation, and then have to be retrofitted to meet the needs of each ICS. This is a surefire way to create a tech solution that is inherently incompatible with other NHS systems. To avoid this, companies must build in a way that prioritises interoperability from day one, with a close appreciation for the other systems tech must work alongside.
In the same vein, innovators must ensure their solution can be adapted to the many different healthcare contexts in which it could be used across each ICS. It may need to communicate with systems in primary care, hospitals, outpatient settings, or community and mental health care services. Ensuring full interoperability will allow for greater flexibility and mean it can be successfully adopted in different settings across ICSs, facilitating effective cross-service collaboration as a result.
Interoperability is not a ‘one and done’ exercise. Within systems as complex as the NHS, tech solutions must be flexible and able to continually evolve to meet the changing needs of the services using them. Healthtech companies should provide ongoing technical support and remain on-hand post-implementation to ensure that the solution continues to be a success. Parachuting in tech without this continued support may simply place a shelf life on the solution, especially if it is unable to integrate with future systems that are brought in across the ICS.
If technology is to fulfil the needs of the NHS’s staff and patients, interoperability must be prioritised at every step. This is vital for ensuring that the solution helps, rather than hinders, the healthcare service and offers a long-term solution which enables effective collaboration within the ICSs using it.
A failure to design interoperable software will result not only in an increased burden for NHS staff, but a lack of adoption and success. It’s a two-way street: working in partnership with the NHS to ensure systems are able to embrace new technologies is key. But innovators must actively take up the charge to prioritise interoperability and build solutions equipped to effectively support more ICS-wide, joined-up care.
Dr Anas Nader is the Co-founder and CEO of Patchwork Health: a digital solution that connects NHS organisations to a growing number of healthcare workers, reducing the reliance on locum agencies and improving the experience of flexible working in the NHS.
Winter is coming: how Doccla’s virtual ward pathways support Urgent and Emergency Care
By Tara Donnelly
Tara Donnelly, Founder of Digital Care Limited, explains how Doccla is supporting NHS Urgent and Emergency Care through an innovative suite of virtual ward and remote patient monitoring technologies.
Emergency Departments (EDs) across the NHS in England have experienced another record-breaking year, both in terms of increased volumes of patients attending – more than 24 million emergency attendances – and decreases in performance against waiting time standards. Pressures on EDs are no longer seasonal but exist all year round, leading to adverse patient experiences. It is imperative that all those involved reimagine how Urgent and Emergency Care (UEC) services are delivered to support NHS colleagues who are bracing for a challenging winter ahead.
There is increased recognition that digital solutions could help to alleviate some of this burden. NHS England’s latest guidance to deliver the UEC Recovery Plan spotlights the expansion of virtual wards as a high impact intervention this winter. Doccla, a leading provider of virtual wards and remote patient monitoring, is working closely with its NHS partners to provide alternatives to admission and to relieve bed congestion by supporting early discharge. The team works with more than a third of integrated care boards, providing:
A customised suite of technology to help clinicians and carers monitor patients at home.
Clinical dashboards that enhance caseload management through holistic views of patient cohorts and visualisations of patient data trends over time.
Integration with electronic patient records to enable flow of coded data from the Doccla dashboard to the patient’s medical record during their stay on the virtual ward.
Access to multi-disciplinary clinicians with specialist training in remote monitoring.
An end-to-end logistics service that task-shifts administrative and non-clinical activity from busy clinicians.
Access to a patient support team, which uses a variety of accessibility tools to ensure patients from all demographics are aptly supported on virtual wards, from onboarding through to discharge.
Doccla’s technology has been pivotal in enhancing various admission avoidance pathways within UEC settings.
Remote monitoring available to community urgent response teams
Doccla’s technology is integrated within Hertfordshire Community NHS Trust’s (HCT) virtual ward service. Under the guidance of HCT’s Medical Director, Dr. Elizabeth Kendrick, the service has enabled the rapid assessment, diagnosis, early treatment and discharge of over 4,000 patients – recently winning a Parliamentary Award for its work.
Most recently, the technology has been deployed to HCT’s urgent care and response teams tackling ambulance wait times. Rather alarmingly, one in 10 ambulances spend more than an hour waiting outside hospitals. Joining forces with the East of England Ambulance Service, HCT equipped its community urgent response service with Doccla remote monitoring boxes so they could have an additional tool to support people to stay at home. Early evaluation of the pilot showed promising results, including:
Reduced ambulance conveyance rate to 33 per cent (from an anticipated 100per cent conveyance rate).
Reduced ambulance attendances by 18 per cent at East and North Herts NHS Trust.
Increased time available for crew to respond to acute emergency calls.
Reduced handover delays outside hospital.
Tackling surges in respiratory admissions this winter
Seasonal variations in respiratory admissions are a major contributor to pressures within emergency care settings over winter. There are 80 per cent more lung disease admissions in the winter months of December, January and February than there are in the warmer spring months of March, April and May.
Virtual wards provide an alternative mechanism for services to manage patient flow and to cope with the surge in respiratory admissions. The Doccla-supported ARI pathway at Northampton General Hospital (NGH) has demonstrated considerable efficiencies for the delivery of care. By supporting early discharge, NGH’s virtual ward service achieved:
While additional UEC funding has been injected into integrated care systems, allocation of monies is challenging when there are competing needs across care settings. It is paramount that the additional funding is maximised. NGH’s virtual ward service demonstrates a £13,000 per month saving (associated with the reduction in bed days) and more broadly, has enabled workforce capacity savings. Analysis in 2021 showed on non-tech enabled wards, there is 1 nurse per 8.3 patients on average. Doccla’s tech efficiency gains have expanded this to 1 nurse per 10 patients.
Augmenting SDEC services
Bristol, North Somerset and South Gloucestershire (BNSSG) is another example of how effective partnership between clinical and operational teams, in conjunction with Doccla’s innovative technology, can reduce admission rates. Between February and May this year alone, BNSSG’s NHS@Home service:
Provided an alternative to admission or supported earlier discharge 487 times.
Enabled local people to be cared for at home for an additional 4442 days
Supported cost savings of £1,479,186.
Avoided readmission for 87 per cent of patients.
In collaboration with Doccla’s remote monitoring technology, BNSSG NHS@Home teams are pioneering the use of remote monitoring for same day emergency care (SDEC) patients to avoid inpatient stays within North Bristol Trust – with the SDEC model contributing approximately 20 per cent of NBT’s weekly referrals to the NHS@Home service.
An example of a presenting condition being cared for in this way is the bacterial infection Cellulitis, which results in more than 100,000 hospital admissions per year in England alone. The new pathway has the patient set up for remote monitoring while in the hospital; they are given a Doccla box to take home and asked to send in their readings over the next few days, to indicate to the clinical teams whether or not the infection is under control. Given that 1.6 per cent of all NHS hospital admissions are due to Cellulitis, enabling speedy discharge or reduction of inpatient stays for patients with the condition has the potential to shift the dial on bed pressures this winter.
It feels important both for patients and the sustainability of the NHS that we do everything in our power to rapidly scale innovative solutions that are demonstrating impact in tackling pressures in Urgent and Emergency Care pressures.
As a trusted partner to health systems and providers, Doccla’s technology is being flexed in agile and impactful ways to support urgent care pathways this winter.
Report finds doctors and nurses ready to embrace generative AI
By Integrated Care Journal
Elsevier Health’s landmark Clinician of the Future 2023 report highlights new opportunities technology will play in providing relief for healthcare workers and geographical differences in opinion
Global information and data analytics leader, Elsevier Health, has today released its Clinician of the Future 2023 report, offering a snapshot view on what doctors and nurses think about the changes and current challenges in healthcare, including the rapid rise of generative AI products and platforms.
The report finds that nearly half of all doctors and nurses surveyed are eager to make use of these new technologies to support their clinical decision-making. While only 11 per cent of today’s clinical decisions are assisted by generative AI tools, 48 per cent of respondents said that doctors using these tools to help make clinical decisions will be ‘desirable’ within two-three years’ time.
The current study comes one year after the launch of the inaugural Clinician of the Future report, which aimed to provide a voice for clinicians and a mandate for change to help ‘future-proof’ the global health industry. This new report canvassed the views and opinions of 2,607 doctors and nurses worldwide, building upon the understanding of healthcare workforce challenges highlighted in the original survey, but now putting an additional lens on the future of generative AI technologies across global healthcare.
Participants across both Clinician of the Future reports spotlight concerns around overwhelming resource issues for healthcare systems worldwide, even as they face substantial treatment backlogs. Clinician shortages remain the top concern in North America and Europe, with 54 per cent of clinicians surveyed for the 2023 report identifying nurse shortages as a pressing health priority.
“73 per cent of doctors surveyed believe they themselves will need to be experts in the use of digital health technologies…within the next two-three years.”
45 per cent similarly reported the need to tackle doctor shortages, reinforcing the urgent need for innovative solutions, such as generative AI, to address clinician shortages, as well as identifying opportunities for efficiencies and training to both enhance clinical readiness and provide much needed clinician support.
Additionally, doctors surveyed believe that they will themselves need to be experts in the use of digital health technologies, with 73 per cent of clinicians agreeing that these skills will be ‘desirable’ within the next two-three years. Accordingly, 55 per cent expressed as ‘desirable’ the transition towards ‘telehealth’, agreeing that remote routine checkups should form the majority of patient-clinician interactions within the next 2-3 years.
While more than half (51 per cent) of clinicians welcomed the prospect of medical students using generative AI-powered tools as part of their medical education in the next 2-3 years, clinicians from the UK and the US were found to be more reserved about generative AI technologies supporting medical students; only 33 per cent in the UK and 40 per cent in the US found this ‘desirable’.
Jan Herzhoff, President of Elsevier Health said: “As healthcare systems continue to face significant challenges, we must raise the voices of doctors and nurses worldwide to understand how we can best support them and the patients they care for. In this pursuit, advanced technology combined with trusted medical content emerges as a powerful ally, and generative AI, particularly, shows immense promise in helping clinicians.”
Mr. Herzhoff added: “By equipping clinicians with advanced tools and training to support their clinical decision-making, doctors and nurses will be empowered to allocate more time to the human aspect of patient care.”
As global healthcare systems progress towards a more digital-first approach, the findings in the Clinician of the Future 2023 report demonstrate that the workforce not only recognises the potential new technologies like generative AI can provide to innovate global healthcare, but also their beneficial impacts on patient care.
Josh Schoeller, President, Global Clinical Solutions at Elsevier and CEO, Healthcare at LexisNexis Risk Solutions said, “Elsevier is renowned for powerful point-of-care solutions that support clinicians throughout their workday. We have been at the forefront of developing clinical solutions tools, prioritising the responsible use of AI, while anticipating and staying ahead of the latest technology trends. We are deeply committed to listening to the needs of clinicians so we can continuously enhance our products to create efficiencies, enabling clinicians to prioritise delivering life-saving care.
For the full ‘Clinician of the Future 2023’ report, which includes robust data on global attitudes on the future of healthcare, important insights on training and development and more, click here.
Protecting the dignity of vulnerable people through technology
By Gavin Bashar
Gavin Bashar, Managing Director at Tunstall Healthcare, discusses why it’s important to protect the dignity of vulnerable people and how technology can be used to achieve this while improving health and care outcomes.
As the health and care needs of our population change, it’s important to uphold the dignity and rights of those who use health, housing and social care services. There are a number of strategies and innovations that providers can implement to help them deliver high quality services that support the dignity of vulnerable people.
Protecting the dignity of vulnerable people
As the health and care needs of our population change and the number of older people increases, it is important that service providers understand why and how care provision can play a crucial role in protecting the dignity of vulnerable people.
Dignity can be defined as the state of being worthy of honour and respect. When it comes to health, housing and social care services, this particularly focuses on being able to provide care that is tailored to meet the needs of each individual, their circumstances and wishes.
Robust and integrated systems can be well placed to deliver improved outcomes for citizens, reducing their need for emergency and more extensive care, such as hospital admission. The longer that people are able to remain independent without the need for acute services, the more their dignity and quality of life will be protected.
The role of technology
One of the prime objectives for technology-based solutions is to put people at the heart of their own health and care needs, protect their independence and dignity, and achieve citizen-focused outcomes. With the right digital frameworks in place, services can become focused on engaging each individual with their own health and care support.
When technology is embedded seamlessly into care and support services, it can be transformative, helping people to live happy, fulfilled lives in their homes and communities. Digital tools can also be used to ensure timely and appropriate responses to emergency events, encourage greater engagement from citizens, and provide more person-centred care.
Developments in the provision, scale and quality of digital technology can support improvements in how care providers are able to collaborate and provide person centred care. The UK’s transition to a digital communications network brings a once-in-a-generation opportunity to modernise, improve and shift the sector and its thinking from a reactive, to a proactive delivery model. This in turn can improve health outcomes for citizens, deliver efficiencies, and enable people to live independently for as long as possible.
Investment in digital solutions will support health and social care providers in reconfiguring services to make them more agile and integrated, leading to better outcomes. Utilising data and technology to create a connected approach can also provide actionable insights to deliver more informed, and more effective care.
Importance of collaboration
Last year saw the introduction of integrated care systems (ICSs) across the UK. ICSs should help us to integrate services effectively and drive collaboration between service providers, such as care homes, GPs and hospitals. Collaboration across sectors is essential to keep people healthy, reduce inequalities, enhance productivity and value, and support economic and social development. ICSs will play a key role in enabling us to remove silos between health and social care providers, while increased collaboration will reduce duplication and fragmentation, disseminate best practice and progress in technology.
Through collaboration we can create a truly joined up approach where we listen to citizens, understand their everyday needs and work together to bridge gaps in our services. Building on ongoing collaborations will see a system begin to emerge that is better connected and user focused. The latest generation of digital solutions broaden the circle of care to engage families, friends and communities, and promote services that are connected and data-driven.
Strong relationships between health and care providers and end users is vital to ensure users feel both respected and protected. This in turn can lead to clearer communication, giving care providers the opportunity to deliver care that is targeted to the requirements of individuals.
The workplace and a cultural shift
The digital transition is an opportunity to create a clearer and consistent approach to care delivery. Collaboration is essential but to encourage this, a cultural shift must take place. While technology has sometimes previously been viewed as an additional aspect of service delivery, embedding digital solutions into services will contribute to the successful transformation of existing care models, and provide more intelligent insight to improve health outcomes and protect the dignity of vulnerable people.
Increasing system capacity and capability, as well as providing a foundation for future technological advancement, will see health and care services more able to effectively meet the changing demands of the population. There are compelling benefits for all stakeholders when it comes to technology, particularly from an economic and operational perspective. By driving education within the health and care landscape and building on an already shifting culture, we’ll see more professionals become open to the idea of using technology and transfer their skills, knowledge and experience to the people they care for, to create a digitised world.
A dignified future for care users
As people live longer, increased pressure is put on our care services. Technology has the ability to aid the management of this and potentially reduce pressure points. If successful and integrated digital services for citizens can be realised, the benefits flow will through the health and care system. If we get our approach right, citizens can live independently for longer and have more choice and control.
As we look to a more digital future, we must consider how we can best harness the power of the connected world and the value that can come from technology solutions. By committing to investment in more technological solutions, we will reform our services, improve outcomes and place users at the centre of care to protect their dignity.
BEAMS banishes alarm fatigue at Sheffield Children’s
By Integrated Care Journal and Gabriel Blaazer
On a recent visit to Sheffield Children’s Hospital, ICJ found out about the benefits that BEAMS – the world’s first acoustic bedside equipment alarm monitoring system – has had on patient safety and staff workload.
Hospital staff are rightly keen to have all the tools at their disposal to be able to respond to urgent situations on wards and prioritise patient care effectively.
Bedside alarms are a case in point. They improve patient care, reduce stress for staff, and produce better outcomes for the wider health system. When Sheffield Children’s NHS Foundation Trust approached TBG Solutions in 2018, the trust was soon to be opening a new hospital wing, housing wards up to two times bigger than previously existed. The wing would also feature a higher percentage of single bedrooms than there were in the past.
While a boon to patient privacy and dignity, and better for infection control, the shift presented Sheffield Children’s then Medical Director, Professor Derek Burke, with a conundrum; how to preserve patient safety and ensure that alarms were heard and responded to when patients were behind closed doors?
Founded in 1876, Sheffield Children’s is one of only three stand-alone specialist children’s hospitals in the UK, primarily covering Sheffield and South Yorkshire but also offering specialist services to children from across the UK and internationally.
ICJ recently visited Sheffield Children’s to speak to the Matron for Medicine Care Group, Joanne Reid-Roberts, about the impact that BEAMS has had on nursing practice and patient safety in the new wing. We also asked Paul Rawlinson, Managing Director of TBG Solutions and sister company Tutum Medical, to speak to ICJ about the inception, design and roll-out of BEAMS, and about his vision for the future of BEAMS.
Although not a medical device company, TBG Solutions is no stranger to highly complex technology, operating as a provider of testing, measurement, and control solutions to the aerospace, automotive, defence, medical and energy sectors. As such, they were well placed to take up Sheffield Children’s challenge, which Paul Rawlinson explains: “Most monitoring systems require central monitoring, and every piece of equipment needs to be plugged in to power and ethernet. If you’ve got eight or nine different pieces from different manufacturers, your only option is to have eight or nine central monitoring systems.
“Alternatively, you can go to a third party who will give you one interface, but you need to have the software library to mimic the instrument or touchscreen. If you need to add a new piece of equipment and there’s no software library from these third parties, then there is no interface. These solutions are also expensive,” adds Paul.
After a period of close consultation between Sheffield Children’s and TBG Solutions, the latter “concluded that for the best possible benefit to patient safety, you need a nurse in each room – which of course, you’re not going to get – but putting the ear of a nurse in the room is the next best thing.”
From this brief, BEAMS – and Tutum Medical – were born. BEAMS works by picking up and identifying tonal noises emitted by alarms, routing alerts to a central monitoring system through its own Wi-Fi mesh network – removing the need to interface with existing hospital infrastructure.
“Not only can it do this in an environment that might have a radio or TV on,” maintains Paul, “it can also identify what the equipment is doing. It could be a ventilator’s high priority alarm, and BEAMS can provide this detailed data. And so, if a nurse has four or five alarms going off, such as a ventilator alarm and an end-of-infusion alarm for an IV drip, they are able to prioritise which one to address first.”
Fewer alarms, safer patients
Following a clinical trial, designed to make it possible to compare alarm response times before and after the installation of BEAMS, the system was found to produce an 84 per cent reduction in the maximum alarm response time, and a 74 per cent average alarm response time. The system was subsequently installed into 70 single-occupancy rooms, and it has fast become a vital fixture for the Matron, Joanne Reid-Roberts.
Joanne tells Hospital Times that she “couldn’t imagine being on the wards without it”. She credits BEAMS with inducing a “calmer, and more relaxed atmosphere” on the wing, and helping to address the harmful consequences of alarm fatigue.
Studies have shown that in paediatric wards, up to 99 per cent of clinical alarms are either false or clinically insignificant (such as a battery needing to be changed) and do not warrant clinical intervention. Research also shows the consequences of this dynamic – alarm fatigue – which arises when alarms are so numerous (and often inconsequential) that they blend into the background and are missed.
BEAMS addresses alarm fatigue by helping to reduce the number of alarms sounding at any one time, relaying alarm information in a details spoken notification and making it more likely that any one will be picked up. The statistics appear to back this up; alarm response times at Sheffield Children’s have been cut by an average of 90 per cent, down to just 40 seconds.
“We wouldn’t be able to function without it.”
These efficiency savings add up, bringing benefits to patient safety. “If a patient is on intravenous antibiotics,” Joanne illustrates, “BEAMS alerts us to say that the infusion has ended. If we missed that alert even for 30 minutes previously, what should have taken an hour would end up taking an hour and a half. It may sound small, but this can have a big impact on recovery.”
The second generation of BEAMS, currently in use at Sheffield Children’s and at Leeds Children’s Hospital, communicates the precise nature and severity of alarms, enabling the efficient delegation of tasks and saving precious clinical resource. It can now be instantly established whether an alarm requires the intervention of clinical staff or a support worker, “which has really improved the utilisation of our time,” Joanne adds.
Another important aspect of BEAMS is its reporting mechanism, which allows ward managers to see week-to-week reports detailing the number, location and nature of alarms, and response times, allowing them to pinpoint exactly where improvements are needed. Joanne is under no illusions that such comprehensive data reporting strengthened the impact of the BEAMS pilot, allowing them to demonstrate proof of concept and gain buy-in from the trust’s procurement and finance managers.
Importantly, and key for the workforce, Joanne is certain that BEAMS “has taken away many aspects of stress for staff. We no longer have to walk corridors just in case there is an alarm going off. It’s simple when you think about it, but we wouldn’t be able to function without it.”
Peace of mind for patients and carers
Having a loved one in hospital can be a troubling and anxious experience for anybody, not least when the patient is a child. In paediatrics, mere seconds can prove the difference between life and death – under certain conditions, children can reach an emergency condition faster than adults. This is often the case with respiratory conditions, where the smaller relative size of children’s airways can lead to greater difficulty with breathing than in adults.
While BEAMS has been successful in reducing average alarm response times, feedback from patients, parents and carers at Sheffield Children’s shows the reassuring effect it can also have. “It gives parents peace of mind,” Joanne relates. “It used to be normal that parents complained that alarms weren’t being addressed in a timely manner but that almost never happens anymore.”
She finds that most parents do not like to press the nurse call alarm for fear of wasting their time, yet are also fearful of what might happen if they are not at their child’s bedside. But, “BEAMS gives parents the confidence to know that the nurses will respond to their child’s needs if they are not there, and patients feel reassured because they know that somebody is coming,” a factor that can be important for recovery, explains Joanne.
Just the beginning for BEAMS
Joanne was full of praise for the manner in which Tutum Medical supported Sheffield Children’s throughout the trialling of BEAMS, recalling how easy it was to contact the company, and the fact that “they listened to our feedback and changed the product” according to need.
Why has BEAMS mostly been taken up in paediatric settings thus far? “It just so happened to be Sheffield Children’s who first wanted to trial BEAMS,” Paul says, “and Leeds like to look at what other children’s hospitals are doing.” Looking to the future, however, Paul hopes to see BEAMS deployed in other, non-paediatric settings (citing its particular utility for respiratory wards), and trials are indeed underway at a number of hospitals in England. According to Joanne, “there is no reason why BEAMS couldn’t go into adult services, as they will experience the same issues as us and will probably have less staff than we do.”
At Sheffield Children’s at least, the results are in; BEAMS is one of the tools that helps healthcare staff to provide the best possible care for their patients.
Pay increases alone won’t solve social care’s recruitment crisis
By Fiona Brown
Addressing the crisis in social care will take more than better pay, writes Fiona Brown, Chief Care Officer at Lilli. Efficiency savings made possible through implementing digital solutions will allow the sector to do more with less, and provide better care to those who need it most.
At the end of July, the Department for Health and Social Care (DHSC) announced they were giving a boost to adult social care by committing £600 million to support recruitment and retention in the sector over the next two years. With the myriad of winter pressures approaching and care-capacity-related hospital discharge delays back in the headlines, this should feel like the good news story both the health and care sectors have been waiting for. Yet many leaders will – and are – arguing that this cash injection will barely scratch the surface of an issue which needs a far more comprehensive and long-term solution.
Following years of neglect and Brexit, the reality across the country is that there simply are not enough physical resources to fill the deficit that exists between demand and capacity for adult social care in the UK. Vacancy rates for social care jobs hit 9.9 per cent in March this year, only a slight improvement from 2022’s record high. However, Skills for Care warn that this negatively correlates with trends in the wider economy: when there are more jobs available in other sectors, fewer adult social care posts get filled. This data makes it strikingly clear that unless the challenges faced in the ‘typical’ social worker role change, and are better supported, it’s going to be hard to attract enough people back to the sector, despite any better pay on offer.
While increasing pay is clearly important, the DHSC also urgently needs to look at how we can improve conditions for care workers, as well as efficiencies and processes throughout the sector, to drive meaningful, long-term change. Investing in these improvements, such as integrating digital tools to support care workers with time-consuming administrative tasks and taking records, will have a ripple effect and impact not just to those working in the sector, but bring significant benefits to the wider health and care ecosystem and those in need of care.
Greater efficiency through technology
One area where the potential for improved efficiencies within the sector is just starting to be realised is in technology that enables remote monitoring. By tracking and monitoring daily behaviours such as movement, home temperature, bathroom activity, falls, eating and drinking through discreet home sensors, the data can provide frontline social care practitioners with insights that help with their decision making. For the first time, care workers can have access to around-the-clock data to review the optimum level of care for each service user and rightsize their packages – perhaps reducing waking nights for elderly people who simply don’t require such a high level of care.
Importantly, the data can also support care providers to identify behavioural changes before conditions become acute, reducing hospital visits and ambulance call-outs, and can support individuals with self-limiting health conditions to maintain their independence at home for as long as possible.
“It is strikingly clear we need a framework for fixing the gap between capacity and demand.”
Pilot programmes across the UK have already demonstrated where this technology can increase efficiency to ensure resources are allocated where they are needed most. For instance, a recent pilot programme with the solution Lilli in North Tyneside found that more than 7,000 additional care hours could be generated over six months, allowing the council to redeploy the equivalent of 12 full-time care workers each day based on the hours saved. In addition to improving resource allocation, from a financial perspective they were able to save over £130,000 in costs through remote monitoring.
Likewise, a small-scale pilot with the same technology in Nottingham enabled the council to redeploy the equivalent of seven full-time care workers based on the hours saved, giving them the capacity to support an additional 12 adults – a significant gain in today’s environment. The pilot also found that with access to remote monitoring, they were able to accelerate hospital discharge for service users by an average of 16 days – demonstrating that these savings not only bring benefits at an organisational level but also significantly impact individuals in care and their loved ones.
Digital transformation may not be a silver bullet to all the sector’s pressures, and there are certainly procurement and adoption challenges to overcome to roll out new technologies like remote monitoring at scale. However, with the pressures the sector continues to face – and the direct impact this has across our health system – it is strikingly clear we need a framework for fixing the gap between capacity and demand. Better pay is of course one of these elements, but when vacancies remain high, implementing tools to help our stretched workforce dedicate their time where it’s needed most will also help drive meaningful improvements over the long-term. It’s time for the social care sector and the workers within it to get the support they so desperately need.
Fiona Brown was Executive Director for Neighbourhood for Sunderland City Council from 2013 to 2022 and is now Chief Care Officer at Lilli.
Digital health policy expert, Roger Greer, says that government action on its ‘digital-first’ plans must match its ambition.
The NHS has just turned 75, and across the country, parkruns, bake-offs and blue light-ups on buildings have taken place to celebrate this anniversary. The government celebrated the NHS’s 75th birthday with a present of its own: the NHS Long Term Workforce Plan, aimed at ensuring “an ambitious, sustainable and resilient NHS, there for patients now and for future generations”.
The NHS has felt more turbulence and change in the past five-to-10 years than at any point in the preceding 70. The Covid pandemic’s impact on the NHS has been severe, and the health service will suffer with the effects of long-Covid like many patients across the country. Its impact is still being felt by patients and services in every part of the UK. But as well as the negative impacts, Covid was also a catalysing event for the NHS in its use of data and digital technologies.
Prior to Covid, the NHS App had around 500,000 users. It now has over 30 million users, and is a key foundation of the government’s plan to digitise the NHS and make it more fit for the future. Could this have been the case prior to the pandemic and the mandated use of Covid passes? That’s up for debate; but the public health emergency provided the opportunity to seek solutions in innovation.
The Workforce Plan is not so much a big bang event; but it could have a significant impact on health and care policy over the next 10-15 years. The challenge is ensuring that it meets the data and digital needs of the NHS, and delivers the ambitions of a digital-first health service.
Despite this digital-first ambition, it is digital and data strategies that are often last to the funding table. As soon as there are frontline challenges, NHS England’s budget for data and digital is the first to be cut. This means that the advancements in key digital and data infrastructure, digital skills and implementing innovation fall even further behind where they should be.
That is not to say the NHS has not thought significantly about data and digital – there have been 21 documents that touch on data policy released by the government in the past 18 months (HT to Jess Morley for collating).
Priority 3 in the NHS’s 2023 mandate is: “Deliver recovery through the use of data and technology”. The Health and Social Care Committee’s report on digitisation of the NHS touched on the need to ensure a digitally-literate workforce. The Workforce Plan also has explicit aims around training in data and digital.
So, what does the Workforce Plan say about the future of digital and data skills in the NHS?
Nationally, the NHS Digital Academy has been established as the home for digital learning and development.
With NHS Providers, the Digital Boards Programme has delivered over 80 trust board development sessions to date.
The NHS Health Education England (HEE) framework for spread and adoption of workforce innovation sets out an approach for systems to follow.
NHS England, HEE and NHS Digital are now a single organisation and can develop tools, training and resources to support workforce redesign in practice, such as:
Skills mix blueprints for local adaptation and adoption.
Training programmes to build ICB capability in workforce transformation approaches such as the HEE Star and the six-step workforce planning approach.
The Government clearly recognises the potential positive impact that data and digital can play in making the NHS fit for the next 75 years; but also to solve some of its short term challenges. However, it is only a starting point, and is not nearly ambitious enough to deliver on the needs for the NHS right now.
More importantly, the challenge with policy is in the delivery. For every new plan or report which is published, there are 5 previous incarnations sitting on shelves of Departments in Victoria Street, and on the desks of consultants brought in to deliver them.
The conditions for delivery are in place. The Government has merged NHSX and NHS Digital into NHS England, alongside Health Education England, aligning digital, data and the training within one department, which “allows us to better align and co-ordinate planning and action, at every level of the service, so we can have the greatest possible impact for staff and, by extension, patients and citizens.”
The success or failure of the NHS to train for digital and data will be the scale of financial and technical support provided to deliver on the Government’s promises, and how far frontline challenges are allowed to overtake data and digital policy as priorities in the near term.
The delivery of this plan will also be impacted by the current political backdrop, the health backlog and the looming General Election, which will bring its own challenges, particularly in the event that Labour form the next Government.
Hope vs reality
Can digital and data be at the forefront of health policy in the next 10-15 years? It has to be. The NHS cannot move into 2024 and beyond with only a nod towards digital and data. It has the power to have such a huge and positive impact on the sector; on the way the NHS manages population health and individual care; how it plans services; how it conducts research into the latest treatments; how it interacts with patients on a day-to-day basis; and on how patients receive care and treatment.
The NHS needs not only a workforce plan fit for purpose, adaptable, and able to be delivered across the next 10-15 years; but wider support for those innovators who are delivering the tech and digital and data services. This means proper reimbursement and pathway to market for innovation.
The Workforce Plan is only one part of how the NHS becomes a modern, adaptable service. It requires all parts of the system to align around the power of data and digital. If it gets there, is the challenge, and one which it has failed to fully deliver on to date.
Roger Greer is Associate Director at PLMR Healthcomms and was previously Senior Stakeholder Engagement Officer at NHS Digital.
Digital appointments could save the NHS £167 million per year: report
By Integrated Care Journal
Opening new digital pathways could free up capacity and help reduce NHS elective care backlog
Giving patients greater digital control over their hospital appointments could avoid 1.6 million unnecessary appointments and create a national annual system saving of £167 million, according to a new report commissioned by, patient engagement platform supplier, DrDoctor.
The report, commissioned by DrDoctor, a patient engagement platform supplier, and conducted by health economics consultancy Edge Health, analysed NHS outpatient appointment data. It suggests that allowing patients to request appointments using Patient Initiated New Appointments (PINAs) and Patient Initiated Follow-Ups (PIFUs) could significantly help to reduce the backlog in NHS elective care.
Reducing outpatient follow-up appointments
The data reveals that putting patients on digitised PIFU pathways for both high-volume, low complexity conditions and smaller volume, higher-complexity conditions could lead to at least 1.18 fewer outpatient follow-up appointments per patient. If implemented nationally, this could free up the waiting list for 1.4 million hospital appointments, creating capacity for more patients to be seen, and saving the NHS £167.2 million per year.
The report finds that the average time between the first appointment and follow-up appointments is also longer when patients are on a digital PIFU pathway. This indicates that when patients can initiate follow-up appointments themselves, they are likely to wait longer, which in turn creates more capacity for new patients to be seen, reducing waiting times further.
Supporting the elective backlog recovery
Edge Health examined the use of DrDoctor’s solutions at two of its customer sites, including PIFU and PINA tools at Guy’s and St Thomas’ NHS Foundation Trust (GSTT) in their physiotherapy services. The time and cost savings from more than 50 million outpatient appointments were applied to a national rollout to calculate the overall impact in the NHS.
The report finds that patients with mild symptoms for low complexity conditions may not need a first appointment at all. Using a digital PINA pathway to address this could reduce the number of people waiting for hospital appointments by more than 210,000, freeing up appointments for patients who need clinical care.
Tom Whicher, CEO at DrDoctor, welcomed the research findings and said: “This report demonstrates much-needed real-world evidence on the benefits of PINA and PIFU at scale. Given that the national target for 5 per cent of outpatient attendances using digital PIFU was recently dropped, the report should give confidence to providers on how these processes, enabled by digital tools, play a vital role in tackling the backlog and creating efficiency savings.”
GSTT has been using DrDoctor’s PIFU tool for musculoskeletal and hand therapy services since January 2022. The report found that more than 70 per cent of physiotherapy patients on a PIFU pathway chose not to return for a second appointment, compared to 44 per cent of non-PIFU patients. A greater number of PIFU patients also chose to request follow-up appointments later than those not on the PIFU pathway (84 per cent had it in 120 days or under vs 88 per cent in 90 days or under).
The report also finds that PIFU led to many patients requiring fewer outpatient appointments, creating capacity to reallocate these appointments to patients with more complex care needs who need to be seen more frequently. The ability to reallocate these appointments has created capacity for an additional 9,268 patients, at the value of £719,476 per year.
Rashida Pickford, Consultant Physiotherapist, GSTT, was involved in the research and said: “The analysis shows the benefits of using technology to give patients more control over their appointments. Avoiding clinically unnecessary appointments means we can provide a better patient experience and free up much-needed time for clinical and administrative staff.”
The report also concluded that from the patient’s perspective, demographic factors such as age, do not limit engagement with digital PIFU pathways. Tom Whicher added: “Often there are concerns about digitisation because it isn’t accessible for everyone. And whilst that can be true, this report confirms that it’s often an exception rather than the rule.”
DrDoctor helps manage around 25 per cent of NHS outpatient booking activity and provides digital PIFU, PINA and patient engagement services in over 45 healthcare organisations.
Why personalised care must go beyond ‘patient-centricity’
By Dr Rob Simister
Dr Rob Simister, Clinical Director for Stroke and Acute Neurology, University College London Hospitals (UCLH) NHS Foundation Trust, writes about how digital platforms can help personalise stroke care, leading to better outcomes for patients and carers.
‘Personalised care’ is a term that has become ubiquitous, and something that the NHS has been striving to achieve for some time. As an NHS consultant, I understand the aim of personalised care to be the provision of a care programme that is tailored to the specific needs of each patient, and delivers better outcomes and a better life experience.
This ambition to create a personalised recovery pathway for survivors of medical emergencies, such as stroke, is critical. Such patients will have specific patterns of injury, risk factors, treatment programmes and rates of recovery. Each patient also brings with them a specific life history, expectations and hopes for the future. We can only help individuals to recover in the best way possible if we take all these elements into account. The challenge is the delivery of this personalised care across the wider patient group, and so far, we have struggled with this.
This is where technology can make a huge difference. By creating bespoke packages of support, we can equip patients, their families and carers with information pertinent to the event and help them understand what to expect throughout their recovery journey and how to manage their health and reduce the risk of secondary stroke in the future. Critically, this can be done at scale.
Stroke occurrence is associated with a number of modifiable and unmodifiable risk factors. Lifestyle choices, weight, and compliance with medications and environment factors are all potentially modifiable. However, we need to ensure that everyone has access to the right information presented in an accessible way, something which remains challenging particularly for minority groups and people who are socially disadvantaged. We need to ensure that this information takes account of unique experiences, background, spoken language and life challenges. This is essential in helping more people to understand their stroke and improve their recovery outcomes.
Filling the gap
To try to bridge this gap, I have been involved in the development of a digital platform called My Stroke Companion. This technology offers patients a visual and interactive support package of information, which is specific to their type of stroke, risk factors and treatment plans. While the information provided is designed to be as accessible and as easy to understand as possible, it crucially helps the patient to answer: why did this stroke happen to me? What does my recovery look like? How do I prevent it from happening to me again?
Accessible content is especially important in conditions such as stroke, where patients can struggle to take in information due to tiredness or fatigue, or difficulties processing information. This is even more difficult for patients who also experience language barriers or have pre-existing communication needs.
We are currently piloting My Stroke Companion with 500 patients – the first pilot of its kind to take place. Each patient has been given a personalised information prescription, which they can share with family members and carers, helping them to manage their condition. We have been really pleased to learn that, particularly in the earliest phase of recovery, some of the main beneficiaries of the support packages have been carers, who have valued the dedicated content that helps them to provide better care. This develops the idea of personalised care further – so that it is not just patient-centred, but also relevant and useful for carers and family who are also often deeply affected.
This positive impact could easily be replicated across other health conditions, such as cardiovascular disease and respiratory conditions, with development of these resources following a similar process of co-creation with patients, carers and digital specialists.
Better for patients, better for the NHS
Personalised digital support packages can also help trusts to create system efficiencies, which is especially crucial now that staff and services are so stretched. By providing information that can be accessed in the comfort of a patient’s home, it is possible for patients to have time to understand more deeply what has happened – and what will happen next. We hope this will lead to improved medication adherence, participation in therapy and in better lifestyle choices – leading to fewer recurrent events, less time in hospitals and better outcomes.
We also hope that the platform will help overstretched NHS clinicians by acting as a trusted resource for patients and carers, and so release this highly pressurised group to be more available for direct care delivery.
Digital personalised support offers an opportunity for the NHS to channel the right information to the right patients and help patients to gain more control over their condition after a life-changing health event.
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