Tackling the winter crisis and future-proofing the NHS

By Rob Shaw CBE

By Rob Shaw CBE, Mastek Adviser and former Deputy CEO of NHS Digital.

Digital infrastructure has the potential to transform the NHS’s response to additional winter pressures by delivering seamless routes of discharge, which accelerate patient flow and maximise available capacity.

For too long, digital infrastructure has been viewed by the NHS as discretionary spending rather than a core budget. If we are serious about protecting the NHS ahead of future winter pressures, digital infrastructure must be at the heart of winter planning and a key priority for NHS England and local NHS systems.

Last winter, 60 per cent of patients in NHS hospital beds were medically fit for discharge. Ahead of this winter, the NHS has invested £200 million and expanded its program of “traffic control centers” to provide an initial point of discharge to ease patient flow through the NHS. This additional capacity aims to free up NHS beds, but it fails to solve the problem of where patients go next.

NHS hospitals shouldn’t be used as traffic control centres; they should be equipped to act as digital command centres, empowered to unlock community care in their local area.

We need to look beyond the provision of extra beds as a solution, and move to a data-driven approach of managing patient flow through NHS hospitals and into community settings. Digital infrastructure in the NHS is key to reducing delayed discharge and maximising community capacity. Digital infrastructure has the potential to seamlessly match community care with a patient who needs it and to coordinate staff to deliver any step-down care that is required.

The Digital Command Centre model currently exists in pockets of the NHS, providing a comprehensive data taxonomy of capacity and staffing levels within a local health ecosystem. It allows NHS staff to quickly identify an appropriate point of discharge within their local area, coordinate urgent and elective care against available staffing numbers, and arrange discharge transport and medicine delivery for at-home care.

Digital Command Centre models can be found in the London Care Record, where patient records from across the capital can be accessed across acute and community settings and have been proven to accelerate discharge from the hospital to care homes.

A Digital Command Centre approach can also be found within the Leeds Care Record, which has created interoperable data sharing across acute hospitals, community services, GPs, social care, and hospices in the region. Nurses reported that the Leeds Care Record allowed them to “discharge and refer more quickly as information is more readily available, and we’re aware of what community care is in place.”

Currently, these examples of local best practice exist as islands of interoperability amid a wider NHS landscape where data on local NHS capacity is trapped within inadequate digital systems and is inaccessible to staff who are desperately trying to match a patient with a point of discharge.

The route to NHS Digital Command Centres: a three-step plan

Step 1: First, do no harm. The depth of winter is not the time to introduce a system-wide overhaul of digital interoperability. Digital solutions must empower staff at times of peak capacity and not act as a hindrance to the delivery of patient care. Before anything else, digital solutions must be resilient. At points of peak winter capacity, digital outages can be fatal, and autumn should be used to test digital systems and to rehearse for adverse events. The introduction of updated digital systems should also build upon existing infrastructure and should avoid forcing NHS staff to work with alien digital tools. Digital infrastructure should identify efficiency within existing patterns of work and empower staff to work effectively during peak winter pressures.

Step 2: Start with what you have. No single operating system will magically combine all the existing data sharing systems in the NHS. The NHS data landscape is messy and complex and requires tailored solutions that target fragility in local systems and maximise their strengths. March to September is a crucial window for the adoption of new digital solutions. It allows us to build on the experience of the winter past and provides an opportunity for staff to gain familiarity with new systems. Focus on data security and system resilience. These are the foundation stones of effective delivery during peak winter months. Digital systems should be dependable, accessible, and should promote confidence in data sharing between NHS services.

Step 3: A Call to Action for NHS England. Digital suppliers and local NHS services can’t promote system interoperability alone. There is a key role for NHS England to play in outlining national standards for interoperability which local NHS services can strive towards. National standard setting also puts suppliers on notice and holds them to account for the systems they provide and how they can support the delivery of joined-up care. Without these standards, we risk perpetuating a landscape of islands of interoperability, where mature systems neighbour immature ones, without any direction of travel towards wider dissemination and adoption of best practice.

To truly transform the NHS and prevent winter pressures becoming crises, the NHS must move to a more digital and data-driven approach, where data serves as an enabler for a system under constant pressure. The above three-point plan can serve as a framework for delivering real change, while recognising the challenges in the NHS.

About the author: Rob Shaw CBE is an Adviser to Mastek, having previously worked as Deputy CEO of NHS Digital.

About Mastek: Mastek is an enterprise digital & cloud transformation specialist that engineers excellence for customers across 40 countries, including the UK, Europe, US, Middle East, Asia Pacific and India. We help enterprises navigate the digital landscape and stay competitive by unlocking the power of data, modernising applications, and accelerating digital advantage for our customers.

NHS to begin roll-out of federated data platform in spring 2024

By Integrated Care Journal

The supply contract has been awarded to software company Palantir Technologies UK and will see up to £330 million in investment over the seven-year contract period.

The NHS will introduce a new platform in spring 2024 to enhance patient care, reduce waiting times, and expedite hospital discharge procedures. The Federated Data Platform (FDP) will consolidate existing NHS data, enabling healthcare professionals to access critical information more readily, resulting in improved and timelier patient care.

This new platform will integrate key data currently held in disparate NHS systems, addressing some of the healthcare system’s post-pandemic challenges. By aggregating real-time data, such as hospital bed availability, elective waiting list sizes, staff schedules, medical supply inventories, and social care placements, healthcare professionals can optimise resource allocation, including operating theatre and outpatient clinic utilisation, to ensure patients receive timely care.

Palantir Technologies UK, supported by Accenture, PwC, NECS, and Carnall Farrar, was awarded the software supply contract following an open and competitive tender process. The contract will entail a seven-year investment period as more trusts adopt the platform. The initial contract year is expected to see an investment of at least £25.6 million, with total investment over the seven-year contract period reaching up to £330 million for the FDP and associated services. Following the award of the contract for the FDP this week, there will be a six-month implementation period where products supported by the current platform will be transitioned across.

Data access within the FDP is strictly controlled by the NHS, requiring explicit permission for any company involved in the platform. Data usage within the platform is solely for direct care and planning purposes. It will not be utilised for research purposes, and GP data will not be incorporated into the national version of the software platform.

Pilot projects utilising the new data-sharing approach have demonstrated reduced waiting times for planned care and discharge delays, as well as faster diagnosis and treatment times. Since implementing the system, North Tees and Hartlepool Trust has reduced long-term stays (21 days or more) by 36 per cent despite increased demand, with a 7.7 per cent increase in hospital admissions.

NHS National Director for Transformation, Dr Vin Diwakar, said: “Better use of data is essential for the NHS to tackle waiting times, join up patient care and make the health service sustainable for the future. Patients come to the NHS at some of the most vulnerable points in their lives, and they want to know that our healthcare teams have access to the best possible information when it comes to their treatment and care.

“This new tool provides a safe and secure environment to bring together data, which enables us to develop and deliver more responsive services for patients and will help the health service drive the recovery in elective care.”

Palantir CEO Alex Karp said: “This award is the culmination of 20 years of developing software that enables complex, sensitive data to be integrated in a way that protects security, respects privacy and puts the customer in full control.

“There is no more important institution in the UK than the NHS and we are humbled to have now been chosen to provide that software across England to help bring down waiting lists, improve patient care and reduce health inequalities.

“It builds on our role supporting the delivery of the COVID-19 vaccine and, more recently, helping individual NHS Trusts to schedule more operations.”

Matthew Taylor, Chief Executive of the NHS Confederation, commented: “Health leaders will welcome the introduction of the Federated Data Platform as an important tool to help organisations across the NHS more rapidly connect and access data, free up vital clinical time and deliver more efficient, faster and safe care for patients.

“For the platform to succeed, it will also be crucial that the public continue to be engaged with, and that any concerns they have on the sharing of their data are addressed meaningfully. Likewise, Government and the wider NHS will need to ensure that there are adequate numbers of staff working in digital and patient data roles.

“We hope the new platform will offer much needed capacity for many Integrated Care Systems and for those systems that have already built their own effective platforms, we welcome both the assurance that they will be able to decide if and when to opt into it, and that they will continue to be supported.”

Can allied health professions catch up with NHS digitisation?

By Andy Soluk

As the UK healthcare landscape undergoes a radical digital transformation, can the independent sector adapt or will it be left behind?

This article was kindly supported by FormDr.

Thousands of independent practices and health-adjacent businesses are being left behind as the NHS moves towards digitisation. The extensive report on June 30th 2023 from Parliament’s Health and Social Care Committee recommends a plethora of changes to the NHS and integrated care systems (ICSs), with barely a mention of the tens of thousands of health and wellness professionals who work outside of the NHS.

Yet, private practices and allied health professionals around the country are interacting with tens, if not hundreds, of thousands of people who would equally benefit from digitisation. Many of these practices are still using pen and paper for their basic functions.

This is a mistake, and these health professionals cannot be left behind.

The process of an osteopath

Let us step into the shoes of an osteopath to explore the process that thousands of people face. While the NHS might cover osteopathy in some areas, most people pay for private treatment and are decoupled from NHS systems.

Upon registration, a patient would fill out a litany of paperwork, from medical history forms to informed consent. Perhaps an osteopath can email a copy of these forms to a patient before the first appointment. However, in our increasingly digital age, only 52 per cent of people living in the UK own a printer, so about half the population will need to complete paperwork in the office.

A patient likely arrives 20 minutes early to complete paperwork and review with the front desk staff. If his or her handwriting is illegible, then the process takes longer and creates additional delays.

Once this initial paperwork is sorted, staff must file it and ensure security. Practices have a false assumption that paper is safe, though we have seen fines under GDPR up to £275,000 for not handling paper health data properly. The Information Commissioner’s Office (ICO) is becoming more active and could strike at any time.

Returning patients might need to complete less paperwork, but the inefficiencies in paper still compound and take up valuable time and resources. One of our own surveys found that small practices saved an average of 21 minutes per patient when digitising.

This hypothetical osteopath is only one example, but it is not difficult to imagine how fitness centres, genetics testers, pharmacies, fertility clinics, anyone offering elective surgery, or small health-adjacent businesses are wasting hours each week on paperwork. For these practices, time spent on paperwork directly impacts client and patient care. These health and wellness professionals also need help digitising.

How practices are impeding their future progress

There is another, less obvious problem with paper processes. As the NHS moves towards digitisation and integration, practices and businesses without electronic records exclude themselves from future involvement. The NHS wants to streamline its processes and make data more accessible for GPs, but paper forms do not allow for this.

The foreseeable future of health care in the UK is built around ICSs. The wider NHS is also focusing more on preventative care, which, due to resource constraints, increasingly falls under the purview of the independent sector. The opportunities for growth in these practices and businesses will exponentially increase as they digitise and can more easily link with the NHS.

What can practices and small businesses do?

Fortunately, solutions to streamline paper processes exist and the rapid expansion of telehealth during Covid-19 shows that digitisation is possible and necessary. While the NHS is moving towards its goal, there are three steps that all practices and businesses, regardless of size, can take today to ensure they do not fall behind.

1) Examine your current process of sending and receiving paperwork.

Any good change management strategy starts with an assessment of current workflow. Do you only offer paper forms when a patient or client comes to the office? How many staff members are dedicated to intake? What do you do if someone is concerned about a Covid-19 resurgence and refuses to sit near strangers? Dive into your process.

2) Look for small, yet impactful changes you can make.

Perhaps you can put a copy of your forms on your website so that patients know what to expect. Emailing or text messaging forms can also be an easy step in streamlining your paperwork. Even a simple change such as highlighting required questions on your form could save hours each week.

3) Digitise where you can.

The more you can digitise your process, the easier it will be for everyone. While the goal should be to digitise everything, small steps are an improvement and worth celebrating. Building secure online forms and creating fillable documents might seem like a large hurdle to overcome, but the time and money savings will be astounding. Moving your paperwork online also allows you to keep electronic records and store information such as photographs in one place.

It is clear that the future of the health care sector will have digitisation at the heart. The unfortunate reality is that most of the focus is on the NHS. However, there are steps that small private practices and businesses can take to move towards a paperless existence and prepare for future benefits. Digitisation will soon be ubiquitous across health and care, so why not start saving time and money today?

Andy Soluk is the Director of European Operations for FormDr: a digital platform for health professionals to build, send, and receive custom forms. Get in touch to learn how we can help streamline and digitise your paper processes.

Inclusive innovation: using community co-innovation to tackle health inequalities and digital exclusion

By Fran Ward and Dr Paulina Ramirez

By Fran Ward, Project Manager, NHS Arden & GEM CSU and Dr Paulina Ramirez, Academic, Birmingham Business School.

Digitalisation of the NHS has the potential to enable more personalised care and improve health outcomes. But it can also widen health inequalities. Some people in communities facing social and economic deprivation, which are also those experiencing the poorest health, find accessing care increasingly difficult as the NHS becomes more digital.

If those most in need of health services become less able to access them, health outcomes for these communities will worsen and the overall cost of healthcare will increase. Integrated care systems (ICSs), therefore, need to maximise the value of their investment in digitalisation by making it work for all their communities, not just the ones they know and understand well.

The ‘Building Inclusive Digital Health Innovation Ecosystems’ research programme, led by University of Birmingham’s Business School and supported by NHS Arden & GEM’s digital transformation team and Walsall Housing Group (whg), explores how community co-innovation could be used to develop digital healthcare that works for diverse communities and reduces the risk of exclusion.

Co-innovation is about understanding and framing problems and taking a bottom-up approach to generating new ideas in response. Specifically, this programme of community co-innovation is socially inclusive by design, creating an opportunity for disadvantaged communities to share their knowledge and lived experience. It gives these communities an equal share of voice alongside commissioners, clinicians and other stakeholders in the development of new digital health technologies or design of new online services.

Peer research

To genuinely hear what more deprived communities need, it is important to rethink how we in the NHS structure engagement to make it easier and more comfortable for those we most want to hear from. Training peer researchers from whg and local voluntary organisations enabled us to build on existing skills, connections and relationships. As trusted members of the community, peer researchers were better able to have relevant conversations within people’s homes, and elicit more honest and open responses on how people access technology and the barriers they face.

The resulting insights challenged some assumptions around barriers to adoption of digital technologies. The main source of inequality was found to be the lack of skills and confidence to engage with online services, with an individual’s type of work or family support structure often having a greater influence on digital proficiency than age, for example. Concerns around data privacy and information sharing were high, causing some not to access potentially valuable support. Despite positive attitudes towards digital in general, many felt digital services such as online GP appointments were not an adequate replacement for face-to-face health services due to a combination of trust, complexity and importance of healthcare in people’s lives.

Simply developing more digital services without addressing these fundamental barriers is inevitably going to limit success.

Changing the nature of engagement

Although good examples of user engagement in digital health services exist, there are constraints too. In particular, technology companies often have little or no engagement with deprived communities so can’t be sure their technology will work for those most likely to have the highest health needs. Alongside peer research, we need to create spaces for co-innovation to happen, bringing together these stakeholders to share information and work together to come up with new ideas.

A locally hosted co-innovation event enabled system partners in the Black Country ICS and health technology companies to hear from and engage with peer researchers and other local community organisations to start putting theory into action. Based on health priorities identified through the peer research, table group discussions addressed challenges such as how to ensure that a mental health app was used by those who most needed it, and how to increase numbers of patients from areas of high deprivation attending diabetes reviews. Peer researchers were able to articulate the day-to-day challenges people in their communities face and why, for example, simplicity and ease of use is often preferable to feature-packed, complex apps.

The event has already resulted in a dedicated task and finish group being set up at NHS Black Country Integrated Care Board to explore how community co-innovation can be applied to issues such as digital GP access. Whg is also keen to continue building a space for co-innovation within its community. More broadly, however, there is a wealth of learning from this approach which can be applied to digital transformation across the country.

Developing best practice

It is clear from this work that input from communities facing social and economic deprivation is essential in finding solutions to some of the nation’s most complex health challenges – and that how we do that is as important as why.

Findings from the ‘Building Inclusive Digital Health Innovation Ecosystems’ research have been used to develop a What good looks like for our communities report to support the NHS Digitalisation Framework. This highlights the need for affordable, simple, safe and inclusive technology that is well integrated with in-person services, guarantees data privacy and is supported with local skills training and support.

We have also developed a playbook to guide ICSs in using community co-innovation to develop digital health services, drawing on the learning from this programme to encourage greater use of this approach across the NHS. After all, there is no point in developing digital services that aren’t going to work for the communities we most need to help.

Photo caption: Peer researchers interviewing community members in their own homes in Walsall.

To find out more about digital inclusion and health inequalities, see: The digital divide: Reducing inequalities for better, prepared by Public Policy Projects.

Digital Implementation, News October 27, 2023

How to improve patient and taxpayer outcomes with innovation

By Stuart Watkins

Stuart Watkins, Strategy Manager for Health at Crown Commercial Service (CCS), explains the 3 main stages of buying digital transformation solutions in the NHS, with a clear breakdown of programme stages and projects along the way.

Digital transformation solutions in the NHS can help health and care professionals communicate better and enable patients to access the care they need quickly and easily, when it suits them. It’s vital that our NHS health services, staff and patients are ready.

How, where, and when patient care is given is evolving towards smart healthcare services, where technology is embedded across clinical pathways and the digital patient is the new normal.

From websites and apps that make care and advice easy to access wherever you are, to connected computer systems that give staff the test results, history and evidence they need to make the best decisions for patients, technology can support improvements in patient care.

Innovative technology procurement

Technology procurement in the NHS touches on everything from network refreshes to artificial intelligence, virtual wards and patient self-referral. Health organisations, at whatever stage of their smart healthcare journey, require a robust technology procurement strategy that builds close collaboration between their procurement and ICT functions.

They also need to achieve value for money through their procurements, delivering against clear integrated care system requirements and cost improvement programmes – all while keeping social value and carbon net zero agendas front of mind.

A 3-step guide to digital transformation

To help the NHS meet these objectives for procurements, CCS has developed a step-by-step guide, setting out the three main stages of buying digital transformation solutions in the NHS, with a clear breakdown of programme stages and projects along the way.

Aimed at clinicians, ICT professionals, procurement professionals, CEOs and board executives, the guide supports NHS England’s ‘digital first’ guidance and makes a process that can all too easily go wrong more straightforward.

NHS trusts and ICS digital programmes that need to rationalise suppliers, save money, secure value, and ensure interoperability requirements are met will benefit from using the guide.

Covering a comprehensive programme of projects, the guide makes it straightforward for the NHS ICT functions to assimilate into their own ‘live’ digital programmes today. It is organised around the 3 key phrases of digital transformation (Prepare, Transform, Enhance).

Let’s take a brief look at these 3 phases:

1. Prepare

The first step is to develop a technology strategy that aligns with the trust’s organisational development plan and its intended outcomes. From here, you can develop your programme, create your design and delivery structure, prepare outline and full business cases, and allocate budgets.

Next, it is important to review existing assets with the aim of getting the “maximum value from what you already have”. Start by looking at where your core infrastructure and networks need refreshing. Then, explore how unified communications can bring together phone, email, and instant messaging to complement each other and encourage collaboration.

This is also the stage to consider how devices, applications, and databases will be rolled out and managed, and how cyber security requirements can be met.

2. Transform

The ‘transform’ stage invites users to consider how best to digitise patient records: these can be integrated into software and clinical systems, facilitating the delivery and receipt of patient data digitally at the point of service.

For example, if you need to scan historic paper records, consider what further processes and resources are required. You’ll need a validation process to check that scanned documents match the original paper versions and create new workflows to ensure they are available securely.

Smart technologies can also be deployed to enable patient participation and empowerment throughout their clinical pathways. You could integrate systems such as picture archiving and communication (PACS), radiology, pathology, pharmacy, and bedside monitoring, focusing on interconnection and sharing of data, using unified messaging standards such as Health Level Seven. This is also a good time to:

Review data warehousing, looking at how a central data store could improve reporting and analysis.
Build integration into your solutions.
Consider how to extend use securely to other organisations, such as primary, acute, mental health, and social services.

3. Enhance

In the ‘enhance’ stage of the digital transformation process, the focus should be on early intervention and prevention initiatives, in partnership with other healthcare providers in the integrated care system. Everyone involved in the technology procurement should be thinking about people, not tech. At this stage, you should be aiming to put the digital patient at the heart of everything you do.

Smart “champions” who take ownership of the process can help keep the focus on the people who are supposed to benefit from the transformation, while training providers can create bespoke training programmes that empower users and tackle change resistance.
You may even want to consider how apps could help improve the patient experience and provide easy access to clinical services.

The guide suggests that the “enthusiasm” of patients who are already using smart technologies to manage their health can be utilised to encourage widespread change. But it also emphasises the importance of ensuring that digital healthcare solutions are inclusive and accessible to the most vulnerable and disadvantaged people.

There is danger in assuming that all patients and their carers have the necessary digital skills to benefit from new digital healthcare services. This is not always the case and why you should consider how to provide support to anyone who cannot access digital services independently, helping them to find information and complete transactions.

Finally, it’s vital to ensure digital inclusion by helping patients and their carers gain basic digital skills so that they can access these digital services in order to benefit from better healthcare.

You can download the guide from the CCS website.

*Stuart Watkins, Strategy Manager for Health at Crown Commercial Service*

All news

12 questions that NHS IT buyers should ask communications technology vendors

By Dave O'Shaughnessy

While digital communications solutions are plentiful, budgetary constraints mean that asking the right questions of technology vendors is more important than ever, writes Dave O’Shaughnessy.

Today’s experience economy is not only applicable to customer-facing businesses. In the NHS, patients are the equivalent of customers and staff wellbeing is as important as in any other organisation. This means that putting experiences at the centre of NHS trusts and ICSs —for both patients and healthcare professionals—matters more than ever.

Because good communication and collaboration is at the heart of positive human experiences, every healthcare provider should aspire to an ICS-wide communications and collaboration layer. As NHS IT buyers look to realise the potential of transforming communications and collaboration efficiencies – not least improving their platforms’ ability to speak to one another and deliver service interoperability – what questions should they be asking their technology vendors? Here are some suggestions:

1. Innovation without disruption to day-to-day operations – it’s important to maximise the value and benefit from legacy investments by integrating modern communication solutions with existing technology. Ask technology vendors if they can layer on innovative and valuable features – that address real challenges and meet short-term objectives and long-term goals – without disruption to day-to-day operations.

2. Availability – check if a technology vendor is committed to delivering 99.999 per cent availability for communication services. This is important because, when it comes to hospitals, the availability of timely and dependable communications services can be seen as a matter of life and death. If systems drop or become unavailable because of cloud failure, lives are potentially at risk.

3. Security – the NHS needs the same security and reliability in its communications and collaboration solutions as those enjoyed by similarly sized government organisations worldwide, so a key question for vendors is: where will any cloud or hybrid cloud data reside?

4. Existing system interoperability – a new system must be able to push and pull data from the NHS trust’s current systems, including Patient CRMs or Electronic Health Records but if custom integrated work is needed, time-to-value can exacerbate project costs. This means that it’s important to ask if vendors have out-of-the-box connectors for current systems and how interoperability of digital systems and apps for previous clients has been ensured.

5. Single sign-on – ask if a vendor’s solutions are able to integrate with the current credentials system because single sign-on means staff can use their existing trust credentials to access new systems, minimising security-threats and vulnerabilities, while additionally reducing any complex technology-overhead on staff for accessing multiple applications and services.

6. Legacy device retirement – ask if a new system can take over functions presently performed by pagers, alarms, and notification systems. This matters because Trusts still using pagers and other legacy alerting and communication devices need modern solutions that enable legacy devices to be retired when ready and for modern communications and notifications technology to be rolled out.

7. Workflow automation – the NHS needs technology to help automate as many of its existing manual and time-consuming workflows and processes as is suitably possible. Therefore, a key question for vendors is: can you integrate with a hospital’s CRM or EHR systems so as to facilitate automated or self-service patient and staff services?

8. Remote/WFH capability – facilitating high-quality care even when employees aren’t onsite reduces the need for patients to travel to hospital, improving infection control. At the same time, suitable staff must be able to work remotely or from home without service disruption, so vendors should be asked how they would enable staff to communicate and collaborate remotely without hampering productivity.

9. Mobile experience – smart mobile devices that enable staff to access patient data while making a one-touch call to an on-call specialist accelerate traditionally disparate, time-consuming tasks, so be sure to ask vendors how they have integrated healthcare and communication systems using mobile solutions for previous clients.

10. Multilingual capability – the NHS needs healthcare applications that provide their complete set of features and services in as many languages as possible because it’s important to provide services to all who need them in a language they understand. This means that a key question for vendors is: how easy would it be for a patient to select their preferred language using your application?

11. Device and OS agnosticism – it’s important that digital services for staff and patients are available and deliverable across all access interfaces, so be sure to ask vendors if staff and patients will be able access services over various devices, browsers, and operating systems.

12. Video capability – integrated video calls improve engagement, enhance collaboration, and optimise services delivery, so ask vendors how staff and patients will be able to make video calls using their chosen device, and if the calls will be integrated with other digital applications.

Modern integrated unified communications can make the NHS more collaborative across all trusts, departments, and practice areas, enabling healthcare professionals to overcome frustrating pain points, by optimising every communication and collaboration experience for staff and patients alike.

Taking an Innovation Maturity Model assessment can help trusts and ICSs benchmark themselves against industry standards and visualise their readiness and capacity to maximise the use of existing technology and where holes need to be plugged. A great place to start a digitisation journey is to work with a trusted leader in customer experience. This helps leverage existing communications and collaboration investments and adds capabilities from advanced solutions that deliver enhanced experiences across a patient’s experience lifecycle.

Dave O’Shaughnessy, Healthcare Practice Leader, Avaya International

RIVIAM Digital Care’s Hospital Discharge: ready for NHSE’s Care Traffic Control Centre roll out

By Claire Hopkins, RIVIAM Digital Care

Delayed discharge cost the NHS an estimated £1.7 billion in 2022/23. RIVIAM’s Hospital Discharge service connects third sector partners and NHS trusts with the data they need, speeding up discharge, reducing readmission rates and supporting system-wide efficiency.

In 2023, RIVIAM introduced its Hospital Discharge service which is currently being piloted at the Royal United Hospitals Bath NHS Foundation Trust (RUH). Following the pilot, the service will be available on all wards to fast-track patient hospital discharge. The service enables RUH ward teams to make patient referrals simultaneously to multiple community, housing and voluntary sector services working together using RIVIAM at the Community Wellbeing Hub (CWH) in Bath and North East Somerset.¹

Staff at the RUH can then see the status of the care in real time via RIVIAM’s Care Control Dashboard. NHS England plans to expand such Care Traffic Control Centres across England to boostcapacity and improve patient flow^.2 RIVIAM’s Hospital Discharge service is a ready-made digital solution to support this ambition.

The challenge

According to NHS England, there are “more than 12,000 patients every day in hospital despite being medically fit for discharge.”³ Data from The King’s Fund also suggests that discharge delays in England increased throughout 2022 and that the cost of delays in 2022/2023 was at least £1.7 billion, at a time when the NHS is pushing to find cost savings.⁴ For patients, being stuck in hospital when they are fit enough to leave is also upsetting.

One of the challenges with reducing delayed discharges is how to access capacity in the care system provided by social care, community, housing and voluntary sector organisations. To make and coordinate discharge dependent referrals to these services often means multiple different referral routes and phone calls – this takes time that hinders patient flow and could be better spent delivering care.

For community, housing and voluntary sector services receiving referrals, it’s hard to access the latest patient information and to co-ordinate referrals for the best follow up care.

RIVIAM’s Solution

With RIVIAM’s Hospital Discharge service, ward teams at the RUH complete an Onward Admission Referral form giving them one place to refer a patient to a wide range of available community, housing and voluntary sector services at the CWH. This includes commissioned discharge dependent services which cross local authority boundaries.

Immediately reducing admin burden, the referral process is quick and seamless. RIVIAM also auto checks the patient’s details against the NHS Spine Mini service ensuring a high level of data accuracy is captured during the referral process.

Ward teams then use a Care Control Dashboard to see in real time what’s happening regarding the care they have requested for a person. Status updates and useful information are easily accessible. Online communication reduces the need for phone calls and emails which introduce time delays to a patient’s discharge.

A view of the dashboard is also available for the 20 different partners at the CWH so staff can easily see the person’s most recent ward, their expected discharge date and the different services requested.

Integration with the hospital’s Electronic Health Record (EHR), Cerner Millennium®, means that the dashboard data is seamlessly updated in near real time providing timely visibility of this critical information.

For CWH partners, RIVIAM makes it easy to co-ordinate care for a person with each other, reducing duplication, providing efficiencies, and improving the person’s experience.

Benefits of using RIVIAM’s Hospital Discharge service:

Improves patient care and prevents readmission. People leave hospital as soon as they are medically fit with the right support in place.
Frees up beds. Patient flow of those who are Clinically Ready for Discharge is improved, relieving pressure on hospital beds.
Utilises community and voluntary sector capacity. People can recover from a hospital visit at home, with access to local services.
Increases team productivity through data-driven decision making. There is one place for ward staff to see the latest information about the community care lined up for a person, communicate with them more easily and make quick decisions about discharge.
Delivers integrated care. Health, social care and voluntary sector providers can receive, manage and co-ordinate and care delivery and communicate with hospital ward teams.
Greater system-wide efficiency. Real time integration with electronic health records (EHR) provides seamless information flows and insights to reduce time delays, duplication and enable improved care.

“The impact of this digital transformation is plain to see. For ward staff, the ability to easily make referrals to multiple organisations at the click of a button is revolutionary. However, the ability for Discharge Co-ordinators to then easily see when support has been put in place gives much more assurance that a person can return home safely. This platform is not just a tool; it’s a conduit for change, enabling us to reach those who need us most,right when they need us.” – Simon Allen, CEO, Age UK Bath and North East Somerset

To find out how RIVIAM can support your organisation via hello@riviam.com or 01225 945020.

Visit www.riviam.com

¹ The CWH uses RIVIAM’s Multi-agency Referral Hub service to receive and manage referrals in Bath and North East Somerset for 20 social care, community, housing and voluntary sector organisations.

² https://www.england.nhs.uk/2023/07/nhs-sets-out-plans-for-winter-with-new-measures-to-help-speed-up-discharge-for-patients-and-improve-care

³ https://www.england.nhs.uk/2023/07/nhs-sets-out-plans-for-winter-with-new-measures-to-help-speed-up-discharge-for-patients-and-improve-care

⁴ https://www.kingsfund.org.uk/blog/2023/03/hidden-problems-behind-delayed-discharges#:~:text=That%20means%20that%20the%20direct,at%20least%20%C2%A31.7%20billion

Using digital across adult social care to enable independence for longer

By Integrated Care Journal

This content is supported by Access Group.

In January of this year, PPP published their report, A care system for the future: how digital development can transform adult social care. The report examined the status of the social care system, focusing on the use of technology to support services, and the steps that need to be taken to support the full digital transformation of the sector for improved care, increased efficiency, and workforce satisfaction.

Recommendations from the report covered enabling DHSC to ease the burden of social care providers operating in multiple ICS footprints who deal with a variety of Shared Care Record formats, the support of digital inclusion among people receiving adult social care by local authorities and mandatory basic digital training for adult social care professionals.

The government has recently announced that £600 million is to be allocated to the adult social care sector to boost winter capacity, fund a research programme to determine future policies for social care, and follow through on commitments made in the Next Steps to Put People at the Heart of Care white paper. In order to achieve these goals, DHSC should not undermine the importance of investing in digital technologies within the social care sector, which will increase efficiencies and reduce pressure on frontline staff.

Examples of this type of technology are provided by The Access Group and include Access Assure and Oysta Technology – part of their Technology Enabled Care (TEC) solutions. The Health, Support and Care division (HSC), of which Access TEC is a part, works with more than 10,000 registered care providers, more than 200 local authority departments, and 50 NHS trusts, providing technology that helps these organisations deliver more efficient and personalised care.

Access Assure is a key pioneering technology supporting the adult social care sector by allowing vulnerable individuals to live independently for as long as possible and giving their loved ones peace of mind that they are safe, even when alone in their homes.

Alex Nash founded Alcuris – now Access Assure – in 2015 following his grandfather’s diagnosis with dementia, after noticing a lack of sufficient updates on his wellbeing. He developed a digital care solution that learns the behaviours of individuals and supports their independent living, while also providing the necessary information to the relevant health and care professionals.

The platform uses insights from social alarm and smart sensor technology to enable caregivers to provide proactive care by seeing where anomalies in data could be caused by health complications. These can include notifying carers if someone hasn’t been mobile, which could be due to a potential fall, or if they haven’t been going to the toilet regularly, which may be a symptom of a urinary tract infection (UTI), which is one of the biggest causes of hospital admissions for older people in the UK.

NHS East Lothian has been using the product since 2019 to review patient data and make decisions about the care of each individual. The system has enabled them to change care packages by identifying issues such as UTIs, making their delivery of care preventive of larger issues. By connecting direct costs in care to the use of Access Assure at NHS Lothian, it can be seen that each UTI avoided, or detected early on, produces a cost avoidance of around £3,000 per event.

A 2020 white paper titled Next Generation Telecare: The evidence to date, focusing on 29 family members users using Access Assure, also showed that 83 per cent of families felt it provided increased reassurance because even when not with their loved ones, they can still support them remotely and check-in.

Across the Access Assure customer base, staff have reported significant improvements to their work experience since using the technology. Tools embedded within the system have streamlined administration processes, helping staff cut admin time from 4 hours to a few minutes per individual, releasing time to care. Local authorities can also access the data to intervene swiftly, reducing the need for emergency care and improving quality of life for individuals. When the average wait time for an ambulance is 56 minutes and each callout costs the NHS around £252, the ability to pinpoint potential health complications early with platforms like Access Assure can prove significant in alleviating current pressures on emergency care.

Plus, the Access Assure dashboard, which has been developed over the last year, allows all Access Assure devices and their data to be pulled together into a single resource. Considering the insights provided by Access Assure, the Next Generation Telecare white paper also highlighted that over 40 per cent of care plans were amended after close interrogation of the data, resulting in better care for individuals and a reduction in hospital visits. The dashboard highlights information which can be saved as a PDF so that local authorities can quickly recognise any anomalies and spot where intervention may be needed.

Using Access Assure, patients can be supported to live independently for longer, and care providers and staff are able to drive care management forward. And collectively, with Access’ other technology enabled care solution, Oysta Technology, and wider HSC portfolio of technology, health and care professionals can take a more proactive and preventative approac h to person-centred and participatory care. Access TEC supports NHS, local government and registered care organisation customers wishing to ensure service-users maintain and enhance their independence and confidence, while having dignity, security, and reassurance. These solutions also prevent, reduce or delay hospital admissions or the need to access care home settings and improve the quality of life for the cared for as well as family members and informal carers so that people are supported to stay safe, happy, and healthy in the communities they call home.

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.