News, Thought Leadership November 6, 2023

PPP South West ICS Delivery Forum – key insights

By Gabriel Blaazer

On 4th October 2023, Public Policy Projects welcomed health and care leaders from across the south west for the South West ICS Delivery Forum to debate and discuss the key challenges the region is facing in the delivery of integrated care.

With an ageing and largely rural population, and the close juxtaposition of affluent and highly deprived areas, the South West of England faces some unique challenges in the delivery of integrated care. Introducing the day’s discussions, Public Policy Projects’ (PPP) Chair, Stephen Dorrell, remarked that the introduction of ICSs represents the biggest opportunity to transform healthcare delivery in living memory. The consensus around ICSs is somewhat unique, as for the first time possibly ever, a major NHS reform is not the subject of intense party-political argument. How ICSs make use of this opportunity will shape health outcomes for generations to come.

To discuss the unique challenges the South West faces, and share examples of meaningful work that are shaping better outcomes for the region’s population, PPP’s South West ICS Delivery Forum brought together health and care leaders from across the region. Central to these discussions were the importance of collaboration, the need for system-level data strategies, and how ICSs can harness all assets at their disposal to improve population health and reduce health inequalities.

Keynote address

By virtue of his decades’ experience in the police service, Stephen Dorrell introduced Dr Jeff Farrar as “the embodiment of the principle that if we want to deliver better health outcomes, we need to begin by bringing together the different elements of local public services.” The former Chief Constable of Gwent Police invoked this experience during his keynote speech, explaining that despite the long-standing consensus that “collaborative services are the way to proceed,” public sector organisations have historically reverted to their old ways. Farrar, who now chairs Bristol, North Somerset and South Gloucestershire (BNSSG), identified a lack of visibility between different parts of the system as a key reason for this.

“The opportunity to get things done in the locality will give huge rewards.”

Dr Jeff Farrar, Chair, Bristol, North Somerset and South Gloucestershire ICB

In an effort to improve communication and collaboration across the system, BNSSG ICB has recently launched a review of its governance structures. The goal of this review is to ensure that the different elements of the system, such as the integrated care partnership (ICP), the ICB, and locality partnerships, have oversight of each other’s work and can align their services to enhance their value and reduce duplication of efforts. Farrar added that the majority of lean continuous improvement and systems thinking has historically taken place within, not across, organisations, and stated his conviction “that if we do that more scientifically this year, we will improve our services and stop duplication of effort in the system.”

Farrar also praised what he referred to as “the jewel in the crown” of integrated care – the possibility to think about and enact reform from the bottom-up, rather than imposing it from the top. “The opportunity to get things done in the locality will give huge rewards,” argued Farrar, “but it needs a little bit of time.”

Developing partnerships – don’t shirk the hard conversations

When discussing partnerships or collaboration, it can be tempting to think in terms of agreement; if organisations are collaborating, they probably have areas of common agreement. Earlier, Jeff Farrar alluded to sitting in rooms in which there is “violent agreement” that integrated services are a good thing, but subsequently, nothing has meaningfully changed. These are the easier conversations that do not tend to include agreement over the more difficult, controversial or intractable problems. They also do not account for what happens when things go wrong.

And as multiple participants remarked, ICSs are hardly operating in an environment that can be described as optimal. While the 30 per cent reduction in operating costs that ICBs must deliver by 2025/26 limits the scope of transformation, it simultaneously makes such efforts – and effective collaboration – all the more important.¹ “Obviously, funding is a major factor,” confirmed Mills & Reeve Partner, Rhian Vandrill, “but over time we’ve come to see a genuine realisation that some of the benefits of being able to share workforce and resource over a collaboration can bring benefits to the individual organisations as well as the collaborative.”

If ICSs are to achieve their goals in a straightened economic environment, effective partnerships with the voluntary, charitable and independent sectors will be especially crucial. Although upending long-held consensus about how and where money should be spent will be a difficult process, as Chief Commercial Officer at Nuffield Health, James Murray, noted, “partnerships should be hard. Sometimes you have to fall out and have these conversations and take a leap of faith about what you do and don’t do in the system. With the independent and third sectors, there are massive resources that could add huge weight to what we do and don’t do. It’s going to require leadership and being brave, but I hope that there’s the opportunity within the new ICBs do be able to do that.

“The lessons learnt at the locality level have to have a clear route to the strategic level.”

Cllr Helen Holland, Chair, Bristol, South North Somerset and and South Gloucester Integrated Care Partnership

Vandrill summarised the position succinctly, saying “don’t make an agreement that’s going to be broken. Sometimes you need to air difficult subjects to create an agreement that you all buy in to.

Despite Bristol City Council losing 60 per cent of its funding since 2010, Bristol Health and Wellbeing Board’s Chair Cllr Helen Holland, who also chairs the BNSSG Integrated Care Partnership, remarked that “there is a lot of money in the system. But we’ve been spending a lot of money doing the wrong thing.” Leveraging what Cllr Holland referred to as one of the “jewels in the crown” of ICSs – the role of the voluntary sector – will enable ICSs to develop more cost-effective, bottom-up strategies that take into account population needs, as well as the plethora of resources at the disposal of each system. Holland explained that she regularly produces the BNSSG ICP strategy at meetings, saying that “any organisation doing anything, even the bus company, can look at this and see that they have a role” in the delivering the aims of the system.

Ros Cox, Associate Director of Partnerships at BNSSG ICB, stressed that the presence of the voluntary sector in the ICSs locality partnerships has enabled these places a greater on-the-ground visibility of gaps in the system when it comes to community mental health provision. The integrated care teams that were created thanks to this insight include voluntary sector providers and “have been a huge success in each of our locality partnerships,” said Cox. Not only are these partnerships enabling services now, they are key to informing future policy; “The lessons learnt at the locality level have to have a clear route to the strategic level,” said Holland. As such, “the next iteration of the strategy should look different because it will have been informed by the work of locality partnerships now.

Harnessing pharmacy to revamp patient pathways

It is increasingly being recognised that pharmacy as an asset has been underutilised in healthcare delivery. A slew of recent policy recommendations from both government and the sector itself have focused on the need to expand the role of pharmacy to relieve pressure on general practice and secondary care.^2,3,4,5 As ICSs mature and the scale of their challenge comes into focus, it is becoming ever clearer that they will need to harness all of the tools at their disposal if they are to achieve their ambitions. One of the biggest assets that ICSs have is pharmacy. The expanded role the sector assumed during the Covid-19 pandemic is testament to pharmacy’s ability to reach parts of the population that other sectors cannot. However, during this panel, speakers identified a number of barriers holding back the potential of pharmacy and preventing it from become a true partner in the delivery of integrated care.

For pharmacy to be an effectively integrated, it must be integrated digitally with the rest of the system. Peter Fee, Lead Clinical Pharmacist at Taunton Central PCN, remarked that generally, “community pharmacy is quite isolated in its access to the clinical systems”. Pharmacies that do have access to patient records (usually as a result of being owned by the GP practices to which they are attached), “can have a huge impact on patient care”, so establishing a means of granting this access securely should be a priority for all ICSs. Aside from the implications on patient care, this will help to lubricate the joints between pharmacy and general practice in particular, saving the time of GPs and pharmacists and enabling them to focus on better patient care.

Only by granting this visibility can pharmacy then be empowered to act on its findings and physically provide patient care. An example of this is hypertension case-finding, which was commissioned in 2021 as a means of identifying and preventing cardiovascular disease (CVD).⁶ CVD is a major driver of health inequalities, comprising around 25 per cent of the life expectancy gap between rich and poor populations in England. As such, the hypertension case-finding service could be a tangible and impactful way for ICSs to target and reduce health inequalities, in line with the CORE20Plus5 approach.⁷

“National contracts are starting to move towards helping those different players work together better.”

Kyle Hepburn, Clinical Director and Lead Clinical Pharmacist, North Sedgemoor PCN

Kyle Hepburn, Clinical Director and Lead Clinical Pharmacist at North Sedgemoor PCN said, however, that all the service presently does “is highlight that a person has hypertension – we can’t complete the episode of care because we can’t currently prescribe in community pharmacy. There are 50,000 people in Somerset alone walking around with undiagnosed hypertension, and current primary care capacity can’t handle that. We’re finding more hypertension cases, but who’s going to pick that up?”

Asking community pharmacy to undertake hypertension case-finding is undoubtedly a positive step towards better prevention of CVD, but if a pharmacist is unable to complete the episode of care, this does little to reduce pressure on primary care – although it may do for secondary care further down the line. Pharmacy needs to be empowered to act on its findings, and the drive towards increasing the numbers of independent prescribers is a good step in this direction.

Interface Clinical Services’ Associate Director, Service Development, Laura Siepker, gave an insight into how pharmacy can support prevention when properly resourced and empowered to manage long-term conditions. Chronic pulmonary obstructive disease (COPD) often interacts with CVD and accounts for more than one million NHS bed days and 140,000 admissions per year, and is projected to cost the health service £2.3 billion per year by 2030. Interface Clinical Services delivers 23,000 days of clinical support into primary care each year, said Siepker, and in the last year, “has delivered over 9,000 COPD clinics over the country to more than 110,000 high-risk patients. Many of those patients will not progress into secondary care, and we’re proud to say that we’ve hopefully avoided around 150 deaths doing this.”

On a positive note, Fee remarked that a recent ICS key stakeholder event attended by representatives from all four pillars of primary care, as well as other members of the ICS, was the first time he had seen so many senior stakeholders in one room “to discuss aligning how they work for the betterment of patients and getting away from the combative mindset that has always been prevalent in primary care”. Kyle Hepburn added that “now, national contracts are starting to move towards helping those different players work together better”, all of which suggests that the dial is shifting in the right direction as ICSs continue their development.

Developing system-level approaches to data

ICSs are bringing with them new appreciation of harnessing data assets to drive not just technology strategies, but to inform all parts of healthcare delivery. A crucial aspect of this new environment is the greater emphasis on population health management (PHM). As Deborah El-Sayed, who is Chief Digital Information Officer at BNSSG ICB, explained, technological advances have created the ability to “address the entirety of the health and wellbeing of people, communities, populations or system,” but enabling this shift requires changes in how data is used at the system level.

This means data providing intelligence, “helping us to understand if we are making the right decisions and spending money in the right place”. El-Sayed continued: “It’s less about activity levels or how many beds we’ve got. Those things remain important, as there’s still a need for the Treasury to know where the money’s gone. But it’s now more about the interconnectedness of the data, what’s happening between organisations and what’s happening in the PHM space. We’re now starting to look at different areas like people’s behaviour, adherence to prevention, approaches to healthy lifestyles, etc.”

“We should have a more MDT approach because then the data people are in the room earlier on in discussions.”

Sarah Blundell. Analytical Development Lead, Analytics Unit, NHSX

However, there are still barriers preventing ICSs from truly developing system-level approaches to data. For Sarah Blundell, Analytical Development Lead, Analytics Unit at NHSX, “the biggest challenge is now around the workforce, not necessarily technology. We may have to pay for it and integrate it, but it is no longer the blocker it used to be. The challenge we now have in data and analytics is there aren’t enough of us who have skills in using, understanding and analysing data. We have a supply and demand problem across all of our data and technology areas in the NHS.”

To make the most of data at the system level, data literacy needs to be improved and embedded at virtually every level of the NHS. This is because data only paints part of the picture and will only enhance services if it is paired with the right understanding of how to use this data to inform strategy and decision-making. “This means not only employing more data and analytics staff, but also improving the data literacy of everybody in our workforce, including the people that are inputting information into the systems.”

Improving data literacy throughout the NHS must also include embedding these skills within multidisciplinary teams (MDTs). Blundell added: “We should have a more MDT approach because then the data people are in the room earlier on in discussions. Through that closer joint working, you then have a better transfer of data skills to people that are making these decisions. We need to stop divorcing [data] and embed data staff into actual programmes. At the moment, clinicians and managers might not be asking the right questions.”

Until data input automation becomes the norm, embedding this expertise will also help to improve data quality, as “I could build you the most sophisticated neural network you’ve ever seen, but if the data coming in is rubbish, the decision making just won’t be there,” Blundell remarked. Similarly, automation will reduce the burden on clinicians. El-Sayed added that “we need systems that, almost as a by-product of delivering a service to a patient, can actually capture data in sophisticated ways that mean we haven’t got this human burden.”

An example of how comprehensive, longitudinal data analysis is enhancing ICSs’ system-level understanding was provided by Oracle Health’s Director of Consulting Services, Charlie Evans. Evans is responsible for delivering Oracle data platforms into ICSs, including PHM platforms that integrate real-time data from acute, primary and community health settings, and increasingly, housing data. In North Central London ICS, data from these sources is combined with elective recovery waiting lists, using MDTs to “look across all of the pathways and establish how they can work better with these patients.” This includes some innovative work, including “looking at if there are any carers waiting for surgery and asking if we can bring their care forward, so that they can look after the person they care for in a better way.” Evans confirmed that in South London ICS, this and similar approaches have led to a “reduction in waiting times of around 11 per cent, which is a really massive reduction there.”

Addressing health inequalities in the South West

ICSs are well-positioned to identify and address the root causes of health inequalities, in that these causes often stem from factors outside of the health system’s control. As such, ICS’s ability to mobilise, engage and coordinate a wide range of public services makes it possible to develop holistic strategies that can address these wider determinants of health.

They are also well-equipped to take on health inequalities due to their intrinsically local focus. “You can’t think about health inequalities without thinking about ‘place’”, began Andrea Beacham, who is Senior Programmes Manager for Health Inequalities at Northern Devon Healthcare NHS Trust. “That’s because the characteristics of the populations we serve are so heavily influenced by the places they live,” that developing a meaningful understanding of the causes of health inequalities is almost impossible without first understanding the specific interplay of “independent and mutually reinforcing” factors that is unique to each ‘place’ in each system.

“We’ve been working at solutions that have actually been identified in the community.”

Jonathan Higman, Chief Executive, Somerset ICB

Specifically in Northern Devon, there are “huge disparities between the affluent and non-affluent areas which, because we work in averages, can obscure the depths of the deprivation we’ve got. So we often don’t quality for things like the levelling up fund, because our whole area on average isn’t too bad.” This provides another reason why data alone cannot be relied upon, and must be supplemented with local insight.

Local networks, such as PCNs, make for an ideal means of gathering this insight, “not because of PCNs themselves,” said the Chief Executive of Somerset ICB, Jonathan Higman, “but because of the footprint that PCNs service and the ability to have neighbourhoods with integrated teams from primary care, the voluntary sector, education and transport, all coming together to solve local issues.” This capability has enabled the Somerset ICS to understand and begin to address inequalities that previously were more opaque and intractable, such as among the farming community. “We’ve been working at solutions that have actually been identified by the community,” Higman explained, “and we now do things like taking health checks out to farmers’ markets, targeting that community with lots of preventative work.”

This example demonstrates that, to be effective, action on health inequalities needs to be proactive, targeted and rooted in local insight, which means listening to people and understanding their unique circumstances. Dr Jim Forrer, a GP and Director of Population Health at Optum offered another example as he related the story of a woman with learning disabilities who had missed three ophthalmology appointments and, in line with procedure, was about to be struck off the waiting list. “A quick phone call revealed that her husband also had learning disabilities and they both found the thought of going to hospital too overwhelming,” Forrer explained. “And so, we arranged voluntary transport, had somebody meet them at the hospital entrance, take them to the outpatients’ department and stay with them. Ultimately, this woman got the care she deserved with a bit of support and outreach, and a different approach.”

Although noting that volunteering services “can be very clearly linked to a reduction in health inequalities,” the Royal Voluntary Service’s Head of Business Development, Duncan MacLeod, used his address to touch on the benefits that volunteering can offer to volunteers themselves. Alongside keeping service users connected to health, community and social prescribing services, McLeod cited a London School of Commerce evaluation of the Volunteer Responders programme, which identified that volunteering provides the “double bonus” of fostering feelings of greater wellbeing and social connectedness among the volunteers themselves. The Volunteer Responders programme was established in March 2020 to support clinically vulnerable people who were shielding from Covid-19. The same report also highlighted the cost-effectiveness of volunteering, finding that each volunteer/client interaction in the programme generated social value of approximately £500.

Conclusion

If ICSs are to achieve their objectives while simultaneously managing significant real-terms cuts to their operating costs, they will need to mobilise all assets at their disposal. Over the course of the South West ICS Delivery Forum, the following insights were identified:

Workforce constraints, rather than technology, are now the main barrier to the development of systems-level data strategies.
Pharmacy must be empowered to take on a greater role in the treatment of minor illnesses and conditions to relieve pressure from primary and secondary care and enhance prevention.
The specific interplay of factors contributing to health inequalities are unique to each local context – action on health inequalities must be proactive, targeted and predicated on local insight.
Complex networks of place-based statutory and non-statutory organisations play a key role in mitigating the worst impacts of health inequalities. ICSs must ensure that the vital contributions of voluntary organisations in particular are recognised, and their local insights used to improve service provision, reduce health inequalities, and improve health outcomes.

References

¹ NHS England (2023) Integrated care board running cost allowances: efficiency requirements [online] Available at: https://www.england.nhs.uk/long-read/integrated-care-board-running-cost-allowances-efficiency-requirements/ [Accessed 16/10/2023]

² Company Chemist’ Association (2023) Transforming pharmacy practice in England through Pharmacy First and independent prescribing [online] Available at: https://thecca.org.uk/wp-content/uploads/2023/06/Developing-pharmacy-practice-through-Pharmacy-First.pdf [Accessed 16/10/2023]

³ Royal Pharmaceutical Society (2023) RPS Recommendations for Integrated Care Systems [online] Available at: https://www.rpharms.com/england/nhs-transformation/ics-recommendations [Accessed: 16/10/2023]

⁴ NHS England (2023) NHS Community Pharmacist Consultation Service (CPCS) – integrating pharmacy into urgent care [online] Available at: https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-integration-fund/community-pharmacist-consultation-service/ [Accessed: 16/10/2023]

⁵ NHS England (2023) Delivery plan for recovering access to primary care [online] Available at: https://www.england.nhs.uk/long-read/delivery-plan-for-recovering-access-to-primary-care-2/ [Accessed:17/10/23]

⁶ Community Pharmacy England (2023) Hypertension case-finding service [online] Available at: https://cpe.org.uk/national-pharmacy-services/advanced-services/hypertension-case-finding-service/ [Accessed: 18/10/2023]

⁷ NHS England (2021) CORE20Plus5 (adults) – an approach for reducing health inequalities [online] Available at: https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/ [Accessed: 18/10/2023]

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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*

Transforming rehabilitation services in England: A new model for community rehab

By Sara Hazzard

By Sara Hazzard, Assistant Director Strategic Communications at The Chartered Society of Physiotherapy (CSP) and Co-Chair Community Rehabilitation Alliance

Change is in the air when it comes to rehabilitation in NHS England.

And while the word ‘change’ may send shivers up the spines of many, the change that is underway in the rehab space must be seen as positive, if we are to safeguard the future of the service for current and future generations.

At the Chartered Society of Physiotherapy, we have long been calling for change and transformation when it comes to rehabilitation. Our Right To Rehab campaigning has made significant progress in pushing this issue up the agenda. And we are not alone. As part of the Community Rehabilitation Alliance (CRA), which we are proud to convene and co-chair, 60 health and care charities and professional bodies are also united in seeing rehabilitation become a central part of NHS thinking and future planning.

So, what does the most recent change, when it comes to rehab, mean?

For the answer, we need to look at two landmark publications from NHS England: the Integrated Care Framework and a new model for community rehabilitation.

Issued in September this year, this framework and model, read together, signal a step-change in the way community rehabilitation is regarded at a system-level within the NHS. While rehab has been steadily growing in prominence over the last few years, to have tangible, clear policy setting out the expectations for what good rehab looks like is a seminal moment.

What is hugely encouraging is that the ICF and new model for rehabilitation reflect strongly the rehab best practice standards, which were developed and endorsed by the CRA. This again shows that there are many voices all calling for the same thing, and for everyone’s right to rehabilitation to be realised.

Significant, too, is that before looking at the detail of the ICF and new rehab model, their very existence is an acknowledgement from the top of the service in England that rehabilitation must be taken seriously and delivered comprehensively to improve patient and population health outcomes. It is a pillar of health care as important as medicines and surgery.

The evidence for needing this shift is clear to see.

Stroke rehabilitation for example, delivered at the optimum time, reduces the risk of a further stroke by 35 per cent. It enables people to regain function and independence yet only 32 per cent get the recommended amount of rehab.

Updated guidance from NICE in October 2023 (the month of this publication) has further bolstered the importance of rehab, by advising that the level of rehab offered is increased to at least three hours a day at least five days a week. This is significant because NICE are guided by effectiveness and cost.

Roughly one in four emergency hospital admissions and ambulance call outs are due to a fall.

Falls prevention saves the NHS £3.26 for every £1 invested because it reduces admissions and bed days. Preventive rehab such as Fracture Liaison Services (FLS) are therefore a cost-effective intervention.

COPD exacerbations are the 2nd largest cause of emergency hospital admissions. Rehab is vital and can reduce admissions by 14 per cent and hospital bed days by 50 per cent yet less than 40 per cent of eligible people are offered rehab.

It is the same with cardiovascular disease and heart attacks. Only 50 per cent of eligible patients receive cardiac rehab. There would be 50,000 fewer hospital admissions if access was 85 per cent.

The release of the ICF and new model for community rehabilitation could therefore not come soon enough.

But with publication, all efforts must now ensure that the actions set out in them, including an adequate rehab workforce, are delivered at pace. We need roles created in the community. It is where people need the help and support. The Chartered Society of Physiotherapy stands ready, alongside our partners in the Community Rehabilitation Alliance, to work with the NHS to make this happen.

The good news is that maximising the rehabilitation workforce is a key feature of the ICF and rehab model, as it highlights AHP leadership at system level to lead implementation. This focus to make the best use of the workforce ensures that individual expertise is used to best effect and has a potential valuable knock-on impact when it comes to the progression and retention of staff.

Also of key importance is the use of data to make the best decisions about service delivery. While there is some data available, much of it is condition specific and/or held in just one place. Now work must develop to ensure that information is shared, and silos broken down.

We must at minimum collect information to identify who needs rehab, who gets rehab and the outcomes.

We therefore have an opportunity, with the momentum and appetite for rehabilitation firmly behind us from the top of the NHS. We must not waste this moment and instead work together, understand what this new approach to rehab means for us in practical terms and then forge a way forward. We owe this effort to the more than one million people waiting for NHS community services, of which rehabilitation makes up a large part.

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

The Diabetic Foot Valley Project: A model for implementing Diabetic Foot Syndrome management

By Dr Alberto Piaggesi

Following the Covid-19 pandemic, the Diabetic Foot Valley Project was launched in Tuscany as a bottom-up initiative and is now a model for diabetic foot syndrome management.

Diabetic foot syndrome (DFS) has a mortality rate of 60 per cent within five years, comparable to the most aggressive forms of cancer. In the Tuscany region of Italy, 24,000 of a total 250,000 diabetic patients are estimated to be affected by DFS. Although Tuscany released guidelines for the management of DFS in 2003, their implementation has not been successful, and disparities in treatment and outcomes between different treatment centres remained significant.

This was further exacerbated by the Covid-19 pandemic, where other pathologies were left largely under-resourced. For DFS, comparing 2021 to 2019 this meant an excess of lower limb amputations of 47 per cent and deaths of 62 per cent. To react to the situation and implement the Regional Guidelines into clinical practice, the “Diabetic Foot Valley Project” was launched in July 2022.

The project aims to create a community of healthcare units offering diabetic foot ulcer (DFU) management. A community should include three diabetic foot (DF) centres of excellence, each with sufficient capacity and all necessary competencies, and should be surrounded by a network of inter-related centres. Diabetic Foot Valley – Tuscany is a bottom-up initiative with participation from all healthcare professionals working in the public diabetic services. The base strategy, applied at various levels of patient care, is to improve patient outcomes by:

Implementing the International Guidelines for DF Management into clinical practice.
Implementing the existing Tuscany organisational guideline for DF management into clinical practice.
Establishing a regional network for DF, involving all the professionals engaged in the management of DF, in hospitals and in the community.
Homogenising the approach to the cases by sharing diagnosis, treatments, and management in a three-level model of care.
Collecting data in relation to the pathology, both with regards to clinical, organisational, and economical aspects, to improve the knowledge base and evidence supporting optimal management of DF.
Promoting the quality of DF management by organising courses, workshops, audits, and scientific meetings for the members of the community of care established in connection with the Diabetic Foot Valley (DFV) – Tuscany.

The initiative is intended to be model for improvement of DF management and is currently being spread to other regions of Europe, supported by the European Wound Management Association (EWMA) Diabetic Foot Committee, established by EWMA. Access to key opinion leaders in the various EU regions is crucial to move the initiative forward, which is ensured via the EWMA network.

Evidence of the Tuscany project’s success:

14 regional clinics have joined.
Three regional funded sub-projects target disparities in regional DF care and work towards improving the integrated DF patient’s pathway.
A regional patient data registry is under preparation funded by the regional authorities.
A one-stop-entry for industry to facilitate clinical trials has been established, assisted by a regional regulatory expert.
Regional investment agencies have expressed interest.
Three industrial clinical trials are being initiated.
Visibility is quickly rising regionally, nationally and at an EU-level including presentations at the EWMA conference 3-5 May 2023 in Milan, Italy.
Diabetic Foot Valley Tuscany is trademark protected in Europe.

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.

Gypsy, Roma and Traveller communities subject to stark access and mental health outcome inequalities, report finds

By Integrated Care Journal and Gabriel Blaazer

Suicide rate among Gypsy, Roma and Traveller community is up to seven times higher than for all other communities in England, with poor service provision identified as major factor.

A report published last week says that Gypsy, Roma and Traveller communities experience among the starkest inequalities in access to healthcare of any community in England. The report was commissioned by the NHS Race and Health Observatory and was led by The University of Worcester.

It addresses a marked lack of mental health care provision and captures first-hand insights from service users and providers, as well as examples of good practice from six effective services. Most of these services are run by voluntary organisations from within the Gypsy, Roma, and Traveller community themselves.

Inequalities in Mental Health Care for Gypsy, Roma, and Traveller Communities estimates that the suicide rate among this group is up to seven times higher for this community than for others, and that life expectancy among the Gypsy, Roma and Traveller community is up to 10 years lower than the national average.

It further identifies a lack of access to digital services, low literacy levels, shortage of local and national data collection, and limited financial investment as presenting significant barriers to accessing to local health services and preventing the development of customised services.

Considerable stigma is still attached to mental health concerns within many communities, and a lack of granular data to support tailored services is contributing to the problem of poor access for Gypsy, Roma and Traveller communities.

Data was difficult to fully assess regarding the uptake and impact of services, due in part to the organisations studied not having the resources to collect and analyse such data and also to non-reporting of ethnicity (for fear of discrimination).

In response, Joan Saddler, who is Director of Partnerships and Equality at the NHS Confederation, said: “Leaders will be increasingly concerned about the troubling findings this report has illustrated which show a huge disparity in access, experiences and outcomes for gyspy, roma and traveller communities. These are people’s lives – impacted and in some cases shortened by preventable inequalities.

“We have known for some time that Gypsy, Roma and Traveller communities experience poorer care access, experience, and outcomes as a result of discrimination. The Race and Health Observatory report helpfully builds on this, but we must now focus on action. We would welcome the opportunity to be part of a coalition working with NHS England to reduce such inequalities particularly with Gypsy, Roma and Traveller communities at the heart of creating solutions, so we can take the first step to finally eradicating discrimination.”

National strategy lacking

Professionals’ lack of expertise and knowledge about Gypsy, Roma, and Traveller cultures was further identified as a significant deterrent to take-up of mainstream services. In 2022, Friends, Families and Travellers noted that out of 89 suicide prevention plans in England, only five mentioned Gypsy, Roma, and Traveller communities and only two listed any action plan strategy.

The government’s latest England Suicide Strategy (2023-2028) mentions the Gypsy, Roma and Traveller community twice, but does not afford these communities priority status nor mention them in its associated Action Plan.

Despite the lack of national investment in national mental health care provision, there are many examples of locally organised services doing targeted work with these communities. Researchers visited effective services run in Hertfordshire, Leeds, Lincolnshire, York, Cambridgeshire, and Ireland (the latter due to its provision for young people). Each site represents an example of novel, progressive initiatives which have broken down barriers for Gypsy, Roma, and Traveller communities in need of mental health support.

These, and more findings, were presented at an online report launch of Inequalities in Mental Health Care for Gypsy, Roma, and Traveller Communities, Identifying Best Practice, on Thursday September 28.

The launch included a presentation of the research around the significant mental health needs of these communities; first-hand experience and insight from those involved in the case study sites; a Q&A and practical recommendations for health and mental health providers to action around the country.

Panellists included representatives of the Observatory’s Mental Health working group, the Gypsy, Roma and Traveller Social Work Association and the University of Worcester. Insight gathered over 12 months of research was undertaken in collaboration with research co-authors, Gypsy and Traveller Empowerment Hertfordshire UK (GATE Herts), and the Gypsy, Roma, Traveller Social Work Association (GRTSWA) and involved 70 community and 21 staff members.

“Deeply concerning”

Speaking ahead of the launch, Dr Habib Naqvi, Chief Executive of the NHS Race and Health Observatory said: “We know that Gypsy, Roma, and Traveller communities face stark challenges in accessing psychological therapies and other mental health services. This report lays bare the mental health issues and stigma faced by these communities first hand. We are pleased to have co-produced with these communities, a clear set of practical, tangible actions and recommendations for more equitable mental healthcare provision.”

Dr Peter Unwin, Principal Lecturer in Social Work, University of Worcester, said: “It has been a pleasure to carry out this research in co- production with community members and to have met so many inspiring people who have developed mental health services against the odds. We should all now work together to ensure that this report on the health inequalities in Gypsy, Roma and Traveller communities leads to real change and equality of opportunity.”

Responding to the Race and Health Observatory report, Saffron Cordery, Deputy Chief Executive at NHS Providers, said: “Gypsy, Roma and Traveller (GRT) people’s experiences of health services are dented severely by discrimination. It is deeply concerning to see how GRT communities struggle to access mental health services they need.

“There should be no ‘winners and losers’ when it comes to physical and mental health provision. NHS trusts work hard to reduce health inequalities but years of funding cuts to councils’ public health and preventative services mean that already stretched NHS services face more strain.

“Government must tackle the root causes of why some minorities are more likely to have worse physical and mental health outcomes and address barriers and discrimination facing too many groups of people including GRT communities.”

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.”

Tackle microaggressions to transform services

By Ishmael Beckford

Ishmael Beckford is the Chair of Council at the Chartered Society of Physiotherapy. Here, he writes about the impact of microaggressions on both staff and patients, and says that tackling the issue should be a priority for the NHS.

“But where are you really from?”

I doubt there can be many NHS staff of colour who have not been asked this question at some point.

The insinuation – whether conscious or not – is that our ethnicity means we cannot be from the UK, an alienating statement that tells us we don’t belong. It’s an example of what’s known as a microaggression, an often-overlooked form of discrimination and one that NHS system leaders could deliver a transformative effect on by tackling.

It won’t be easy.

The professional body and trade union that I chair, the Chartered Society of Physiotherapy, sought testimony from its members with marginalised protected characteristics, such as ethnicity, disability and sexual orientation, about their experiences of microaggressions – and the findings were stark, yet unsurprising.

Members spoke of regular incidents where they felt belittled, othered or insulted through the words or actions of someone in their workplace. Examples given by minority ethnic physiotherapy staff included repeatedly mispronounced names and being asked who the decision-maker was, despite it clearly being them – something I experience myself.

Members of our LGBTQIA+ community said they often heard the pejorative phrase, “that’s so gay”, and were told they “didn’t look gay”, while trans physio staff were asked for their “real name”. Physio staff with disabilities, meanwhile, spoke of being excluded from everyday activities and having their status questioned.

It seems highly unlikely that the experiences of physiotherapy staff differ from those of any other profession working in the NHS. And while this is, of course, a societal issue and not one exclusive to the NHS, the UK’s biggest employer has a responsibility to protect its staff – and its patients – from experiencing these behaviours in its settings.

More than a quarter of NHS workers are from an ethnic minority, while nearly 5 per cent have a disability and at least the same number identify as LGBTQIA+. Obviously there will be intersectionality across those numbers but that’s a hugely significant part of the workforce facing painful, damaging experiences in the workplace on a regular basis.

We also need to be honest and acknowledge that patients experience these behaviours when receiving NHS care. The evidence base demonstrating the poorer health outcomes among marginalised groups is well established. Those outcomes are shown to be made worse by communities experiencing poorer care due to racism, ableism, homophobia and transphobia.

Microaggressions form part of those experiences and will undoubtably deter some patients from seeking the care they need.

So, this is an issue facing staff and patients alike, and during a workforce crisis when retention is of such importance – and with record numbers of people waiting for care – the case for action on microaggressions is overwhelming.

But what should that action involve?

Education for staff and patients is important, clearly. There remains low awareness of the term microaggressions and, from the regularity that they occur, a limited understanding of their impact.

Our campaign includes posters and an animation that services may find helpful to display in public spaces and staffrooms. But crucially, our members also reported significant concerns about reporting microaggressions, fearing they wouldn’t be taken seriously and no action would be taken. There were also concerns about consequences for them of making a complaint and, dispiritingly, the idea that they happen so regularly that they aren’t worth reporting.

So, it is essential that systems, and specifically managers, create environments where people feel supported, heard and confident to report. These workplaces must be inclusive, culturally sensitive, and no longer somewhere microaggressions can go unchallenged. Our campaign includes training, guides and resources for managers to deliver that and encouragingly, after the first phase of the CSP’s campaign, members reported increased confidence to report microaggressions.

So change is possible. It just needs to be a priority.

Because don’t let the name fool you – microaggressions can have an enormous impact on the physical and mental health of those on the receiving end.

They chip away at you, bit by bit, day by day.

The constant challenge is how to navigate these experiences but still be yourself, because often a response to being exposed to these forms of prejudice is to dilute yourself, not be authentic and to conform to reduce the opportunity for people to point out that you’re different.

You start to see the world in a different light which can result in you feeling like you have to put armour on to go to work and this is a heavy weight to carry every day. Many people will never know that invisible armour exists for a lot of people.

That’s why it’s so important to bring the issue into the light and the enormous pressures facing the NHS cannot be used as an excuse for inaction.

Tackling microaggressions is not an add-on to easing those pressures.

It’s essential for delivering a workplace where staff feel valued and want to remain and where patients can feel confident they will receive equitable, quality care.

Access guides, resources and training for managers and staff at www.csp.org.uk/microaggressions.

Ishmael is the Chair of Council at the Chartered Society of Physiotherapy, the trade union and professional body representing 64,000 physiotherapists, support staff and students across the UK. He is also a director at Vita Health Group, an independent provider of physical and mental health services, where his current remit covers Equality, Diversity and Inclusion and Sustainability. His clinical background is in MSK physiotherapy, primarily within private practice and occupational health settings. Ishmael has undertaken leadership roles including as a clinical manager and operations lead and has worked away from physiotherapy as a Talking Therapies service lead.