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.

For more information, please visit www.tunstall.co.uk.

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.

Why 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.”

BEAMS utilises its own Wi-Fi mesh network, removing the need to interface with existing hospital infrastructure.

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.

Joanne Reid-Roberts, Matron for Medicine Care Group, Sheffield Children’s Hospital (L) and Paul Rawlinson, Managing Director, TBG Solutions and Tutum Medical (R)

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.

To find out more about BEAMS, visit www.tutummedical.com.

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 first – but digital eats last

By Roger Greer

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.

The challenge

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.

Personalised information is personalised care

Annually, 15 million people worldwide suffer a stroke and it is one of the most common causes of death. There are approximately 1.3 million stroke survivors in the UK and many more family members living with the sudden, unplanned and life-changing consequences of stroke.

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.

Majority of public would use health tech to avoid hospital, research finds

By Integrated Care Journal

Survey highlights increasing public acceptance of healthcare technology to self-manage care and take greater individual responsibility for health.

The majority of people would use health technology if it meant they could avoid going into hospital, new research carried out by Ipsos on behalf of the NHS Confederation, supported by Google Health, shows.

The same proportion – more than 7 in 10 people (72 per cent) – would also use technology including wearable and health monitoring devices to help better manage and monitor their health and would also be willing to share the information and data gathered with their doctors and other medical professionals.

The survey of 1,037 members of the public highlights people’s increasing appetite for using technology to self-manage their care, and more broadly, to take greater responsibility for their health and that of their families.

Nearly 4 in 5 people (78 per cent) also said they would be happy to use different types of health monitoring equipment to help manage their health if an NHS professional recommended it to them, with nearly 9 in 10 (89 per cent) people aged over 75 willing to do so.

The results have also found that just over half (53 per cent) of the 92 people included in the survey who have been diagnosed with a long-term condition resulting in them interacting with the health service four or more times a year, are already using the NHS App to access personal health information, compared with one third (33 per cent) of the general population.

The government recently announced a target for patients at more than 90 per cent of general practices across the country to be able to use the app to see their records, book appointments and order repeat prescriptions by March 2024.

Commenting on the findings, Matthew Taylor, chief executive of the NHS Confederation said: “This research shows the potential of technology in empowering patients to better manage and monitor their own health, especially if it means they can avoid being admitted to hospital.

“There is clearly an appetite amongst the public to use technology to self-manage their long-term conditions, and more broadly, to take greater responsibility for their health and that of their families.

“The government’s recent commitment to accelerate and widen the use of the NHS App should also help to strengthen the public’s understanding of the benefits of digital engagement.

“However, the decisions we make now as a society will determine whether technological change means we can make continuous improvement in the offer we make to everyone through the NHS, or whether it will divide ever more widely the ‘healthy haves’ from the ‘unhealthy have nots’. We must always deliver greater digitisation with equity in mind.”

Elsewhere, the survey findings showed that just over 8 in 10 (83 per cent) adults already use some form of technology to manage their health, and this increases to nearly 9 in 10 (89 per cent) people living with one or more long-term condition. However, only just over half of those surveyed were currently satisfied with the technologies and tools available for them at present.

The research also showed that that nearly three-quarters (73 per cent) of patients want their doctors to provide them with the “best technology available”, with three-fifths (58 per cent) wishing “their doctor provided them with technology to monitor their health”.

Ease of appointment booking and the ability to communicate via messaging services with healthcare teams are also high on the list of priorities. The research also found that more than two thirds (68 per cent) of people believe that healthcare in the future will include more technology and less reliance on healthcare professionals, although this comes with the concern that without access to the right technologies, access to healthcare could be limited.

Susan Thomas, UK Director, Google Health added: “Google Health has been privileged to partner with NHS Confederation and Ipsos to drive this piece of research; the findings have resonated with our mission to help everyone, everywhere be healthier through products and services that connect and bring meaning to health information.”

Number of repeat prescriptions ordered via NHS App up 92% in last year

By Integrated Care Journal

2.4 million repeat prescriptions were requested through the NHS App in April and more than 500,000 repeat prescriptions are now booked through the app every week.

New figures released by NHS England show that since the NHS App’s launch in December 2018, more than 42 million repeat prescriptions have been ordered through the app. In April 2023 alone, the NHS App enabled 2.4 million repeat prescriptions to be ordered, compared with 1.7 million in April 2022 and 393,000 in April 2021.

The latest figures represent a 92 per cent year-on-year increase in repeat prescriptions ordered via the app from 13 million in 2021/22 to 25 million in 2022/23. The increase comes ahead of the NHS’s milestone 75th birthday on 5 July, when the achievements and innovations of the NHS and its staff will be celebrated.

Patients across England were reminded of the benefits of using the NHS App to order repeat prescriptions, ahead of the upcoming bank holidays in May.

Chief Pharmaceutical Officer for England David Webb said “we are reminding people of the excellent benefits of the NHS App,” particularly in the context of May’s long bank holiday weekends limiting access to GPs.

Webb continued: “Patients can order repeat prescriptions through the app at a time and date convenient to them and access community pharmacy information about local healthcare advice and services available during the bank holidays.

“The NHS has always innovated and adapted to meet the needs of each generation and as we approach the NHS 75th birthday, the NHS App is yet another fantastic example of how we are doing this.

“The app offers a digital front door for interacting with the NHS with a host of new features launched in the last year– empowering patients to access services from the comfort of their homes. As ever, if you need care during the bank holiday weekend, come forward – using 999 in life threatening emergencies and NHS 111 online for other health concerns.”

Some of the features available on the NHS App enable patients to view their GP health record, nominate their preferred pharmacy, find local NHS services and get health advice via 111 online.

New and innovative features continue to be rolled out to help patients access convenient and high-quality care when and where they need it. Patients in many parts of the country are now able to view and manage their hospital appointments on the app, and many GP practices are now sending NHS App notifications to patients with appointment reminders and other messages relating to their care.

Health and Social Care Secretary Steve Barclay said: “Technology is transforming the way we deliver healthcare for patients, and I’m determined that the NHS App plays a vital role in this.

“Repeat prescription orders through the app have increased by 92 per cent in the last year – including 2.4 million in last month alone. This is freeing up valuable time for clinicians and helping people access services easily and conveniently from the comfort of their own homes.

“A host of new innovative features have also been rolled out– from viewing GP records to finding local health services – offering a digital front door to the NHS.”

The NHS App has now recorded more than 32 million sign-ups (as of April 2023).

More than 28 million of these have fully verified their identity through NHS login, which means they can now access a variety of digital healthcare services quickly and securely through the NHS App.

How the ICS can unify data and relieve elective care

By David Duffy

In taking decisive action to bring down elective care backlogs, Mid and South Essex Integrated Care System has demonstrated the value of industry collaboration – made possible by the new ICS construct.

With over seven million people on elective care waiting lists, unifying data strategies and enhancing visibility across health providers has never been more important. UK health and care transformation has long been hampered by historically fragmented approaches to data infrastructure and these complex vulnerabilities were laid bare nationally throughout the Covid-19 pandemic and the resulting aftermath.

With such vast numbers of people stranded on backlogs, providers need data infrastructure to illuminate patient waiting lists, to provide absolute clarity as to who is waiting for what and to ensure that those who are in most urgent need are prioritised.

“There are opportunities for a partnership-based approach to care reform, allowing innovators to innovate as part of a cross-sector team”

In many respects, the development of integrated care systems (ICSs) has been fortunately timed to deal with such an issue. Central to the population health mission of ICSs is integrating data strategies and overcoming the obstacles posed by legacy data systems. There is also an opportunity for a revitalised provider-supplier relationship – with the ICS onus on collaboration over competition, there are opportunities for a partnership-based approach to care reform, allowing innovators to innovate as part of a cross-sector team.

This is in part the mindset that has defined the approach from Mid and South Essex Integrated Care System (MSE) to deal with its own elective care backlogs. MSE is responsible for the care of 1.2 million people, across Basildon and Brentwood, Mid Essex, South East Essex and Thurrock. According to the latest referral to treatment data from NHS England, there were 153,000 people across MSE waiting for non-urgent surgery in August 2022. Like in many other systems, MSE’s backlog covers multiple disciplines and as such requires a multifaceted solution to aid with prioritising those in most urgent need while pushing for further optimisation wherever possible.

To meet this challenge, system leaders across MSE have harnessed the new ICS framework to lead a data led transformation. In May 2022, system leaders kickstarted a partnership with leading NHS data solution specialists, Insource Ltd, to combine data from three acute sites to optimise waiting list management across the MSE system.

Articulating the problem

The core objective of the project is one of visibility. Historically siloed approaches to health data infrastructure have left a fragmented data landscape across the NHS, and this is no different for MSE. Competing legacy Patient Administration Systems (PAS), used under the former CCG constructs, had made it more difficult for providers to develop holistic plans to deal with issues such as elective backlogs.

“You can’t address the backlog if you do not fundamentally understand the nature of the problem”

PAS systems support the automation of patient management across hospitals, allowing them to track patients and manage admissions, ward attendances and appointments and as such are crucial for managing waiting lists. “Tracking and managing patients along complex elective pathways is technically difficult even with one PAS. Today’s NHS needs to manage patients safely across several hospitals in one ICS, making that challenge even bigger,” says Dr Rob Findlay, Director of Strategic Solutions at Insource. MSE has three different PAS systems in use across its acute sites, as well as three different theatre systems.

Insource have begun implementing its data management platform to unify and enhance data visibility across these three hospitals, creating a unified data foundation for system wide recovery, and has now created a unified Patient Tracking List (PTL) across the MSE system. In layman’s terms, the PTL provides a single view for all clinicians and operational managers across the ICS, detailing exactly who is waiting for acute care, for how long, for which specialty and what their clinical priority is – allowing for those with the most urgent needs and those waiting longest to be treated first.

“You can’t address the backlog if you do not fundamentally understand the nature of the problem,” says Barry Frostick, Chief Digital and Information Officer for MSE, who has spearheaded the project alongside Dr Rob Findlay. Reflecting on MSE’s enhanced backlog visibility Rob says, “when the NHS approaches us with a problem, our goal is to help the system clearly think through the challenges and accurately articulate the nature of the challenges they are facing, this way, the potential solutions that could be applied start to become obvious.”

A strategic partnership approach

The size and scope of MSE’s backlog necessitates a truly collaborative approach that develops holistic solutions to reflect the needs of all stakeholders and voices. “The project so far has benefitted from a clear alignment between the provider and supplier. This relationship is far more of a partnership than your typical supplier-provider relationship,” says Barry.

“There is a rich level of intellectual engagement and respect for these challenges across MSE”

From an Insource perspective, this type of relationship allows for a much richer dialogue between provider and supplier – necessary to deal with complex data issues. As Rob explains, “from talking to consultants, medical staff, and managers, it is clear that there is a rich level of intellectual engagement and respect for these challenges across MSE – this engagement has been a hugely enjoyable and rewarding part of this project and has been central to its success so far.”

While Insource have decades of experience in unifying operational data, a system wide, automated PTL is new to the NHS and the fact that MSE have managed to implement such a solution after only being in official existence for a few months is a remarkable achievement. However, despite the initial success, neither Barry nor Rob are getting ahead of themselves – both insist that this is not “miracle working”, but rather harnessing the new ICS structure and laying strong groundwork though effective leadership to create a fruitful partnership.

How has the ICS enabled this change?

‘Partnership’ has become an oft-repeated term in the context of integrated care, so much so that it can at times become an abstract concept. But the relationship between MSE and Insource has already borne tangible, significant fruit in the form of a PTL that now acts as a “single source of truth” on waiting lists across the system. Progress has been down in part to the renewed ICS focus on collaboration over competition (the latter defined much of the approach taken by former CCGs toward industry partners).

“There’s a higher level of involvement and a much higher level of accountability than the commissioner function used to have”

The partnership ethos visible here is in part down to the new ICS structures. Previous provider/supplier relationships under the CCG structure were simply based on providing a service, “whereas today,” says Barry, “the ICS has allowed us to stand shoulder-to-shoulder with our industry partners.”

For this project, the new ICS structure for MSE has allowed system leaders to take a step back from the day-to-day operational grind of service delivery. “The ICS acts as a critical friend to NHS services on the ground, making more impartial decisions, taking a step back and seeing the impact that a potential solution would have across the system” explains Barry.

Rob argues that the ICS is much closer to the frontline than the old commissioners were within CCGs, giving them “more skin in the game”. He says, “there’s a higher level of involvement and a much higher level of accountability than the commissioner function used to have. This allows us to harness the huge potential that the ICB has to intelligently bring together the different sectors, including the mental health, social, community and primary care sectors, as well as the acute sector, which tends to get the attention and is the initial focus”

Ultimately, the initial success of this project will be judged upon how MSE’s elective care backlog figures change over the coming months and years. However, with the new sense of visibility offered by the PTL – few could argue that its impact will be anything but positive. In fact, those closely involved in the project are already looking ahead. There is serious expectation that this new bank of centralised data, accessible system wide, will enable revolutionary improvements across the MSE system.

Digital Implementation May 27, 2022

How ICSs can help uproot risk aversion and progress innovation

By David Duffy

Kathy Scott, Chief Operating Officer and Deputy Chief Executive of the Yorkshire & Humber Academic Health Science Network (AHSN) and Aejaz Zahid, Yorkshire & Humber AHSN’s Director for the South Yorkshire ICS Innovation Hub, spoke with Integrated Care Journal on how the implementation of a dedicated innovation hub within ICS frameworks has helped to streamline innovation and improve patient care.

Integration and innovation are two increasingly prominent principles that are, in part, designed to address the growing problems of unmet health needs. Each is intended to supplement and support the development of the other.

Integrated care systems (ICSs) offer new frameworks through which innovation can be adopted at scale, streamlining past previous bureaucratic and individualistic barriers to change and adopting a transformation led approach. Innovation is crucial to turning the core aspirations of integrated care into tangible realties, to use technology and sophisticated approaches to data to help address the root causes of ill-health and expand health service offerings.

“There is a vast range of unmet need across the whole health and care sector”

The above outlines the core principles of integration and innovation, which can be found reiterated from a wealth of sources if one is to engage in the sector for even a few days. Integrated care is not a new concept and neither is innovation, so how are these two principles coming together to improve patient outcomes in reality?

“There is a vast range of unmet need across the whole health and care sector,” says Aejaz Zahid, Yorkshire & Humber AHSN’s Director for the ICS Innovation Hub at South Yorkshire & Bassetlaw Integrated Care System (SYB ICS). “Much of this is of course clinical, but a huge part of this more operational, system level needs.

“The ICS needs intelligence on all of this, but then must ascertain how it can use innovation to leverage economies of scale in terms of investing and finding solutions to those problems and challenges. What we are trying to do within the innovation hub is create straightforward and easily accessible processes which enable busy staff working on the ground to regularly bring those challenges and problems to our attention, while enabling ICS leadership to ascertain and prioritize needs that could benefit from a systemwide innovative solution.”

The ICS Innovation Hub is a single point of contact for health and care innovators in the SYB region. The hub works, via the AHSN, to identify and validate market ready innovations and help drive improved health outcomes, clinical processes and patient experience across the SYB health economy. The idea to set up a dedicated innovation hub within an ICS was developed by the Yorkshire & Humber Academic Health Science Network (Yorkshire & Humber AHSN) and has proved a successful model to help spread and adopt innovations at pace and scale. Yorkshire & Humber AHSN also provides innovation support to three different ICSs in the region.

Fostering a culture of innovation

Explaining how the Hub and by extension Yorkshire & Humber AHSN are working to cultivate innovation in the region, its Chief Operating Officer and Deputy CEO, Kathy Scott says “it is as much about identifying good practice as it is implementing the ‘shiny stuff’.

“We can push out new ideas and innovations as much as we like, but if you don’t embed a culture of innovation and improvement, it’s not going to stick”

“As an AHSN we also have sight of a lot of potential solutions that can address those needs often identified by the innovation hub. So we are able to nudge the ICS leadership towards potential solutions.

“It’s about growing the capability and capacity for change within a locality and for improvement techniques and innovation adaptive solutions to be implemented. Not simply implementing new technology and essentially running away.

“We can push out new ideas and innovations as much as we like,” continues Kathy, “but if you don’t embed a culture of innovation and improvement, it’s not going to stick.”

The ICS’s digital focus has also enabled significant work on pre-emptive care. For example, through the Yorkshire & Humber AHSN’s digital accelerator programme Propel@YH, the AHSN has worked with innovator DigiBete to support the adoption of their ‘one stop shop’ app to help young people living with diabetes manage their treatment.

The app was clinically approved during the height of the pandemic with extra funding provided from NHS England and is now being used in 600 services across England. “This is an excellent example of how we can pre-emptively assess unmet need and streamline innovation into the system,” says Kathy.

Innovation as an antidote to health inequality

“Health inequalities is part of our design thinking from the get-go in any project,” says Aejaz, who points to the recent implementation of SkinVision, a tele dermatology app, as an example.

“The app was originally developed in the Netherlands, where predominantly you would have Caucasian skin that the AI would have been trained on,” he explains, “so, from the beginning, we have been mindful to capture more data on how well the app works on other skin types and feed that back to the company to improve their AI algorithms for wider populations.”

The Innovation Hub also works to ensure that implementing digital technology does not exacerbate inequality for less digitally mature users. “If somebody, for example, doesn’t have a smartphone that is able to run that app, there is always the non-digital pathway in parallel. So, it’s never either or.”

Risk appetite

“There is always a level of risk aversion when it comes to adopting something new in healthcare,” says Aejaz, “even with evidence backed solutions, we find there’s sometimes a level of reluctance. Staff want to know whether it’s going to work in their local context or not and whether introducing innovation would entail a significant ‘adoption’ curve. Overcoming hesitancy to innovation is, therefore, central to the role of organisations such as the AHSN and by extension ICS innovation hubs.

“We need to create systems which provide innovators with the necessary psychological safety that allows them to experiment”

“Building a culture of innovation is fundamentally about building a culture of increased risk appetite, where failure is most certainly an option. We need to create systems which provide innovators with the necessary psychological safety that allows them to experiment.”

To help shift the mindset of NHS staff in favour of innovation, the Innovation Hub established a series of ‘exemplar projects’, designed to erode the fear of failure and capture learnings in the process. For example, for Population Health Management exemplars, one of the priority themes for the ICS, the hub called for providers to submit ideas to the Hub, all framed under high priority population health challenges such as cardiovascular health. Successful applicants with promising ideas received funding in the region of £25,000 as well as co-ordination support from the Hub towards their project.

The programme has enabled frontline innovators and has led to the development of a host of new services incorporating novel technologies such as virtual wards and remote rehabilitation. The Hub is also working to transform dermatology pathways throughout the SYB region by introducing an app that allows patients to upload images of skin conditions and be processed more efficiently through the system. Funded by an NHSX Digital Partnerships award, this pilot project with Dermatology services in the Barnsley region will test out the use of this AI enabled app to ascertain how well it can successfully identify low risk skin lesions which can be addressed in primary care. Thereby reducing demand on secondary care and speeding up access for higher risk patients. Each of these projects demonstrates the capacity for transformation when on the ground staff are given the freedom to innovate.

“Introducing solutions outside of traditional domains will enable a culture of innovation and improvement”

Interestingly, many of the ideas that the Hub works with are non-tech solutions. For example, primary care providers working with local football teams via a 12 week health coaching programme to engage with fans who may be at risk of cardiovascular disease, or introducing Cognitive Behaviour Therapy techniques to patients with severe respiratory conditions to help reduce anxiety when experiencing an episode of breathlessness. To nurture a mentality more open to change, the Innovation Hub and AHSN teams have been reaching out to key leads from each of the provider organisations who are involved in innovation, improvement or research and invited them to become innovation ambassadors. “These ambassadors have become our eyes and ears on the ground across health providers, where they can start to introduce what we do and also help capture unmet needs from colleagues in their respective organisations.”

Following in the footsteps of the first innovation hub established by the Yorkshire & Humber AHSN in South Yorkshire, other AHSNs across the country are now looking at setting up innovation hubs within their ICS by bringing leadership together, getting them out of their ‘comfort zone’ and giving them the space to innovate, and hoping to chip away at risk aversion and fear of experimentation. Introducing solutions outside of traditional domains will enable a culture of innovation and improvement. To streamline past bureaucratic and individualistic hurdles, ICS frameworks are key to facilitating transformational change in every region of the country.

If you would like to find out more about the Yorkshire & Humber AHSN please contact info@yhahsn.com.

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