Report finds doctors and nurses ready to embrace generative AI

By Integrated Care Journal

Elsevier Health’s landmark Clinician of the Future 2023 report highlights new opportunities technology will play in providing relief for healthcare workers and geographical differences in opinion

Global information and data analytics leader, Elsevier Health, has today released its Clinician of the Future 2023 report, offering a snapshot view on what doctors and nurses think about the changes and current challenges in healthcare, including the rapid rise of generative AI products and platforms.

The report finds that nearly half of all doctors and nurses surveyed are eager to make use of these new technologies to support their clinical decision-making. While only 11 per cent of today’s clinical decisions are assisted by generative AI tools, 48 per cent of respondents said that doctors using these tools to help make clinical decisions will be ‘desirable’ within two-three years’ time.

The current study comes one year after the launch of the inaugural Clinician of the Future report, which aimed to provide a voice for clinicians and a mandate for change to help ‘future-proof’ the global health industry. This new report canvassed the views and opinions of 2,607 doctors and nurses worldwide, building upon the understanding of healthcare workforce challenges highlighted in the original survey, but now putting an additional lens on the future of generative AI technologies across global healthcare.

Participants across both Clinician of the Future reports spotlight concerns around overwhelming resource issues for healthcare systems worldwide, even as they face substantial treatment backlogs. Clinician shortages remain the top concern in North America and Europe, with 54 per cent of clinicians surveyed for the 2023 report identifying nurse shortages as a pressing health priority.

“73 per cent of doctors surveyed believe they themselves will need to be experts in the use of digital health technologies…within the next two-three years.”

45 per cent similarly reported the need to tackle doctor shortages, reinforcing the urgent need for innovative solutions, such as generative AI, to address clinician shortages, as well as identifying opportunities for efficiencies and training to both enhance clinical readiness and provide much needed clinician support.

Additionally, doctors surveyed believe that they will themselves need to be experts in the use of digital health technologies, with 73 per cent of clinicians agreeing that these skills will be ‘desirable’ within the next two-three years. Accordingly, 55 per cent expressed as ‘desirable’ the transition towards ‘telehealth’, agreeing that remote routine checkups should form the majority of patient-clinician interactions within the next 2-3 years.

While more than half (51 per cent) of clinicians welcomed the prospect of medical students using generative AI-powered tools as part of their medical education in the next 2-3 years, clinicians from the UK and the US were found to be more reserved about generative AI technologies supporting medical students; only 33 per cent in the UK and 40 per cent in the US found this ‘desirable’.

Jan Herzhoff, President of Elsevier Health said: “As healthcare systems continue to face significant challenges, we must raise the voices of doctors and nurses worldwide to understand how we can best support them and the patients they care for. In this pursuit, advanced technology combined with trusted medical content emerges as a powerful ally, and generative AI, particularly, shows immense promise in helping clinicians.”

Mr. Herzhoff added: “By equipping clinicians with advanced tools and training to support their clinical decision-making, doctors and nurses will be empowered to allocate more time to the human aspect of patient care.”

As global healthcare systems progress towards a more digital-first approach, the findings in the Clinician of the Future 2023 report demonstrate that the workforce not only recognises the potential new technologies like generative AI can provide to innovate global healthcare, but also their beneficial impacts on patient care.

Josh Schoeller, President, Global Clinical Solutions at Elsevier and CEO, Healthcare at LexisNexis Risk Solutions said, “Elsevier is renowned for powerful point-of-care solutions that support clinicians throughout their workday. We have been at the forefront of developing clinical solutions tools, prioritising the responsible use of AI, while anticipating and staying ahead of the latest technology trends. We are deeply committed to listening to the needs of clinicians so we can continuously enhance our products to create efficiencies, enabling clinicians to prioritise delivering life-saving care.

For the full ‘Clinician of the Future 2023’ report, which includes robust data on global attitudes on the future of healthcare, important insights on training and development and more, click here.

Addressing whistleblower concerns in the NHS

By Chancelle Blakey

Building a culture of transparency and accountability will be essential steps to encourage and protect whistleblowers in the speak-up system.

The NHS has been grappling with concerns surrounding its whistleblowing systems and cultural health. This has been highlighted repeatedly in the press over the last week with coverage of the Lucy Letby trial, within which there were shown to be multiple failures in internal reporting processes.

This demonstrates the need for an independent reporting line for employees across the organisation. NHS employees must have the opportunity to speak with an entirely impartial party who can process their concern and pass on the information to the appropriate team for further investigation.

Whistleblowers within the NHS have often faced challenges, making them hesitant to report wrongdoing due to fears of retaliation and detrimental treatment. Despite these obstacles, 2023-23 saw a significant increase in NHS whistleblowers coming forward compared to the previous year, highlighting the urgent need for reform in the whistleblowing process.

In fact, a record 25,000 plus NHS whistleblowers came forward last year. Of these cases, as has been reported by Freedom to Speak Up Guardians office, the most common reports were of inappropriate behaviours and attitudes (30 per cent), followed by worker safety and wellbeing (27 per cent) and bullying and harassment (22 per cent).

Reports indicate that NHS employees are lacking confidence in the current speak -up system, with many feeling labelled as troublemakers when they raise concerns. This detrimental culture not only deters individuals from speaking up but also hinders the NHS’s ability to identify and address wrongdoing, potentially endangering both patients and employees. And that’s before the damage to the NHS’s reputation is considered.

Improving the speak-up system

For optimal trust and confidence in a speak-up system, employees must feel that their concerns will be taken seriously and investigated appropriately.

Unfortunately, this most recent case is the most extreme example of that not happening, with Dr Stephen Brearey stating that if hospital executives had acted on concerns about nurse Lucy Letby earlier, lives may have been saved.

To address these pressing issues, steps need to be taken to: improve employee confidence; identify and combat wrongdoing; and protect those who come forward to report concerns.

One crucial measure is to review and audit the NHS’s whistleblowing policy, processes, and operations to understand the reasons for the breakdown of trust. Identifying and holding accountable those responsible for retaliating against whistleblowers is essential to foster a culture of transparency and accountability.

Providing whistleblowing training to both employees and managers is another critical step to improve the speak-up culture. When employees are aware of how to raise concerns, and the legal protections they have under the Public Interest Disclosure Act (PIDA), they are more likely to come forward without fear of retribution. Additionally, providing training to managers on how to receive and handle disclosures appropriately can help deter misconduct.

The current Freedom to Speak Up (FTSU) Guardian scheme, while a positive step towards improving whistleblowing culture, appears to lack confidence among NHS employees, with many remaining hesitant to report serious concerns through an internal system due to doubts about confidentiality and impartiality. One worker told the FTSU Guardians that “the Guardian was excellent, but nothing has been resolved”. The Guardians themselves have said that managers need to be trained about their obligations once they receive a report.

Taking affirmative action to instil trust

To build trust, the NHS can consider offering an alternative means of disclosure, such as a dedicated, outsourced whistleblowing hotline provider, ensuring true anonymity and independence in the reporting process. Safecall already works alongside several NHS Trusts helping make their processes more robust and transparent. Employees are much more confident speaking to, and reporting through, a third party.

It is vital that the investigation procedure is handled in a fair and balanced fashion, and not conducted in a way that undermines the whistleblowers’ concerns. To instil confidence in the reporting process, investigations should be conducted in an independent and confidential manner. Outsourcing the investigation process or ensuring that internal investigators undergo proper training and possess the necessary experience can help safeguard employees’ wellbeing and protect the NHS’s reputation.

It is paramount for the NHS to take affirmative action in protecting whistleblowers and fostering a culture of transparency and accountability. No healthcare professional should face detrimental treatment for raising concerns that may impact patient safety. To achieve this, the NHS must review its systems, provide comprehensive training, and offer reliable and independent reporting avenues.

The NHS must strive to offer confidentiality, impartiality, and independence when receiving and investigating concerns. These efforts should be continuous and consistent to create effective and sustainable change within the organisation.

In conclusion, addressing whistleblowing concerns in the NHS is crucial for promoting a culture of transparency and accountability. By taking proactive steps, such as reviewing policies, providing comprehensive training, and ensuring independent investigations, the NHS can create an environment where employees feel confident and protected when speaking up against wrongdoing.

Fostering a culture that values whistleblowers and their contributions will not only strengthen the NHS internally but also enhance its reputation and commitment to patient care.

*Chancelle Blakey, Business Development Manager, Safecall*

NHS Workforce Plan will need a change in mindset from clinicians, patients and systems

By Amanda Grantham

Enacting reforms through a clinically-led, multi-disciplinary lens will be critical to achieving the ambitions of the NHS Long Term Workforce Plan.

The NHS Long Term Workforce Plan centres on the need to train, reform and retain its employees to meet future demand, leading to an increase of up to 360,000 new staff across integrated care systems (ICSs). Increasing the number of formal training places available through more diverse points of entry and improving retention through rewarding career and development are at the heart of what needs to be done to deliver this plan.

The introduction of new roles, reforming the way care is delivered and by whom, will be critical to meeting anticipated demand in 2036/37. But these roles will need to be designed, clinically-led, and committed to driving productivity to create the capacity needed.

Determining which roles will be needed to meet demand

It is important to recognise that more staff will not increase capacity unless clinical pathways can be redesigned to be more efficient and effective. During COVID-19, there was about a 10 per cent increase in headcount within NHS acute trusts. However, at the beginning of 2023/24, providers were at 97 per cent of pre-pandemic productivity levels. Delivery of the NHS Workforce Plan means broadening the skill mix of multidisciplinary teams, creating new and diverse roles across systems. In designing the new workforce, the roles need to create new capacity to meet demand, either through new services to meet future need or by increasing provision in existing services.

Creating a new role requires the redesign of the way that multidisciplinary teams work together. The starting point for this workforce design should be the optimal clinical pathways, rather than what is being done today. That means setting out the clinical red lines (what can only be done by a registered healthcare professional), looking at the skills and roles needed, and the most efficient use of capacity.

The design of the COVID-19 vaccination workforce demonstrated how new roles could be created to meet increased demand. The drive to create this workforce led over 145,000 people to join the NHS working as unregistered vaccinators who came from diverse backgrounds, including retired medical staff, airline workers, volunteers and students.

Systems will also need to be more focused on the competency of the workforce, training employees in the skills needed to deliver their role safely and efficiently. The aim from the offset should be designing broad and rewarding recruitment, training and career pathways that will attract and retain the right talent. This could include consideration of how these roles can be steppingstones into future training or careers, as well as how apprenticeships could open doors for eligible people to take on these new roles.

To meet growing demand in the national breast screening programme, two unregistered roles have been created in collaboration with the College of Radiographers, along with redefined roles and clinical career frameworks. Approximately 30 percent of the breast screening workforce is now in these new roles. – mammography associates and assistant practitioners – with defined scopes of practice and accreditation to undertake mammography.

Clinical leadership is required

Creating new roles in healthcare is about shifting care, or elements of decision making, to another trained and competent healthcare professional. This requires a change in approach from the provision of clinically delivered care to a position where healthcare is clinically-led but can be provided by a diverse multidisciplinary team. Clinicians should be at the centre of the redesign of the workforce, but their input will need to be coupled with that from those with the skills and expertise in increasing capacity.

The NHS has had mixed success in integrating new roles into healthcare teams. The COVID-19 vaccination programme was a nationally designed workforce model which used simulation to provide an evidence base and was clinically-led.

Another approach, the Additional Roles Reimbursement Scheme (ARRS), was established in 2019 and produced more variable results. The scheme provided an automatic funding stream to Primary Care Networks to recruit 26,000 alternative roles to expand service provision and reduce patient waits.

This was part of the government commitment to improve access to general practice and included roles such as clinical pharmacists and technicians. Not all practices have seen the anticipated benefits of these roles, with the Kings Fund highlighting that the roles were not being implemented or integrated into primary care teams effectively.

It will also be important to manage the expectations of patients, in particular that they will always see a medical professional. The government and NHS leaders need to consider how to secure public acceptance of self-management for those with long term conditions, more care being provided in the home and community rather than hospital, and from trained staff who are not medically qualified. However, there will need to be a visible improvement in access to healthcare services if the public are to support these changes.

The NHS is aiming to have 10,000 virtual ward beds in place to support growing demand this winter. A clinically-led redesign of the workforce means that care will continue to be overseen by a medical team, but the delivery of healthcare will predominantly be through a multidisciplinary team of healthcare support workers and allied healthcare professionals.

New capacity will be needed to meet training demands

The Workforce Plan contains a commitment to grow the number of training places across all professions. Capacity to provide this training will need to be created from existing workforces and services. This creates a risk that waiting times may increase.

The plan commits to growing the number of medical school training places from 10,000 in 2028/29 to 15,000 by 2031/32. Each of these training place will require support from existing clinicians. The British Medical Association (BMA) recommends additional non-patient facing time to support trainees, of only an hour a week, per trainee, for each consultant.

To meet this standard will require more than 125 full time consultants/GPs to be released each year from NHS services. By 2036/37 this will see more than 625 full time consultants/GPs supporting additional trainees, rather than delivering care. That makes it critical that productivity and efficiency are at the heart of service redesign to minimise the impact on waiting times.

This underlines that the plan’s ambitions on training and retaining staff will not be achieved without fundamental reform. That will require a careful analysis of the right size and shape of the workforce that will be needed to meet future demand for local populations. Now more than ever, diverse, multidisciplinary, efficient, and clinically-led approaches will be the key principles that systems should be adopting when driving the reform of their workforce.

Written by Amanda Grantham, healthcare expert and Partner at PA Consulting.

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.

Digital Implementation, News August 21, 2023

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.

All news

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.

Creating a consistent and transparent approach to NHS procurement

By Andy Smallwood

By Andy Smallwood, Assistant Director of Procurement, NHS Wales Shared Services Partnership.

NHS procurement teams face a wide range of challenges, which have been amplified in recent years due to the far-reaching impacts of the COVID-19 pandemic, rising levels of inflation, and ongoing workforce pressures.

From identifying cost-saving opportunities to reducing the NHS’ environmental impact through better purchasing decisions, the only way to can enhance the NHS’ procurement processes is by using data effectively and implementing innovative technology solutions to support us.

Identifying challenges in procurement

Having worked in NHS procurement for over 25 years, one of the biggest challenges I’ve repeatedly faced is the lack of access to consistent and transparent data within complicated procurement systems. Data visibility hinders our ability to identify cost-saving opportunities – an essential part of procurement in all walks of life. The challenge is even greater when data is spread across multiple systems and teams, which many procurement teams in England will be aware of, given the ongoing transition to integrated care.

The move to integrated care has left some regional procurement leads with less visibility and control over procurement spend data and analytics, with more data to manage across multiple sites within a region. In Wales, the NHS has been operating in an integrated way for a while through the NHS Wales Shared Services Partnership, which ensures that the right products, provisions and services are sourced and supplied efficiently and at the right price across the country.

This has only been made possible through the emergence of advanced analytics and solutions which have improved the quality and visibility of data considerably.

Enabling better decision making

To help our procurement team deal with the vast amounts of data being collected and managed across each care setting in Wales, we implemented AdviseInc’s Procurement Dashboard, now known as the AdviseInc Platform. The platform provides us with complete oversight of catalogues and procurement data across the country, while also enabling us to add more detailed classification to spend, including all the major clinical categories.

By working with AdviseInc, who act as an extension of our team, we now have the ability to cleanse our data, compare this data with areas outside of Wales, and have visibility of greater savings and richer information as a result.

AdviseInc also provides us with valuable analytical support, meaning that instead of analysing rafts of procurement data and manually searching for cost-saving opportunities, our team has more time to focus on other key areas of procurement.

For example, we can now dedicate more time to consider how our procurement decisions align with objectives set out in the Future Generations Act. This was introduced in 2015 to make sure public bodies in Wales think about the long-term impact of their decisions and work collaboratively to prevent persistent problems such as poverty, health inequalities and climate change.

Using data analytics to improve safety and accuracy

For NHS procurement teams, environmental considerations should be made with every purchasing decision. Along with buying fewer overseas products and reducing the number of single-use plastics across the NHS, procurement teams need to spend more time innovating and contributing towards green initiatives, which is where companies like AdviseInc can make a tremendous impact. The solution is helping us meet national and local targets and gives us the ability to clearly target actions and deliver against carbon reduction targets.

It goes without saying that safety is a top priority for all NHS staff, from clinical staff to administration to procurement. In 2016, the Scan4Safety programme was introduced across England and Wales, with the aim of ensuring all products are labelled according to GS1 standards with a Global Trade Item Number (GTIN). This safety system is being implemented across the country, contributing to improved patient safety, product traceability, operational productivity and supply chain efficiency.

Across Wales, we’re now identifying hundreds of thousands of product barcodes and collecting as much information on these products as possible. So far, we’ve identified more than 170,000 products with barcode information and shared these with AdviseInc who can validate these barcodes, resulting in richer data. The AdviseInc team can then give a confidence rating for these codes to indicate if the data is reliable, as sometimes suppliers provide inaccurate product codes.

Additionally, AdviseInc has helped to identify more than 230,000 barcodes. The added benefit of being able to check these codes against existing data adds another level of safety for patients as stock can be recalled through the GTIN number which is also linked to patient records.

As always in procurement, our goal is to ensure products are coming from the correct supplier. Through the AdviseInc Platform we can check GTIN numbers, further adding another layer of accuracy. Looking to the future, our teams are working with AdviseInc on an inventory model which will act as a ‘one-stop shop’ for data analytics. This model will give users the ability to see what stock is available, who bought it and when.

The use of data to make informed decisions

Thanks to these new capabilities, we now have more time to collaborate with our clinical staff, using our data to inform and guide procurement decisions. By bringing our procurement team and clinicians together, we can find solutions that work for everyone.

Procurement teams face many challenges, but then use of technology can make workflows easier and more efficient. Better use of technology allows us to identify cost-savings, support green initiatives, and generate genuine value through procurement decision-making for both patients and staff. The future of procurement is transparent, and data-driven.

How industry can help deliver the ambitions of the NHS Workforce Plan

By Stephen Jowett

The long-awaited NHS Long Term Workforce Plan (NHS LTWP) was published at the end of June and has been broadly welcomed across the healthcare system.

The NHS in England is under increasing pressure. By 2037, the number of people aged over-85 is estimated to grow by 55 per cent, which means there will be an ageing population who will require more healthcare interventions and more care for long-term conditions and co-morbidities. The NHS currently has the longest waiting times and lowest satisfaction rates ever recorded which has been demotivating for employees and frustrating for patients.

The current NHS workforce challenges have impacted the whole of the healthcare system and can delay people receiving the best treatments available. Once a treatment is approved by the National Institute for Health and Care Excellence (NICE) there needs to be the capacity for it to be rolled out, including any additional training requirements and this will have an impact on industry partners if new treatments are not utilised.

There are examples of fast-paced innovation within cancer treatments, but the adoption is slowed by a stretched and understaffed system – following the long-term impacts of the pandemic – that does not have protected time to embed new approaches. Collaboration between sectors is also crucial to support adoption at scale. If these workforce challenges are not addressed, patients will not be able to access the right healthcare when they need it.

There are three big ambitions laid out in the NHS LTWP:

Recruitment – there is a focus on a big recruitment drive into roles in the NHS and into training places. As there are currently shortfalls in almost every area of the NHS, particularly in frontline care, this needs to be a priority.
Retention – a large number of professionals leave the NHS every year, so focusing on how the NHS keeps the people who are already employed is essential if they are going to meet the increasing demand on the system.
Retraining – there is more to training than getting new people into the workforce – it is also recognising that to make the NHS future proof, more needs to be done to support the current and future workforce to embrace new technology. This needs to address how the whole health system embraces new ways of working and developments in technology. There can’t be fast adoption of new technologies if the training and skills aren’t quickly put into place for the workforce and patients.

Although the NHS LTWP has been broadly welcomed by the healthcare system, there are some very clear omissions that will make it hard to deliver. There is no mention of infrastructure, meaning that capital investment isn’t aligned to the planned workforce investment. Many of the current hospital buildings in use are not fit for purpose and it was recently announced that the target to build 40 new hospitals by 2030 is likely to be missed.

“There is an opportunity for industry to think about how new technologies can address some of these pressures in the system.”

This NHS LTWP does not include social care and is not aligned to a similar reform of our social care system, which is currently suffering from many of the same challenges as the NHS in terms of increased demand on services with a reduced workforce. If the healthcare and social care systems do not receive investment simultaneously, then one will take on the burden of the other, as they are intrinsically linked.

The NHS LTWP talks about innovation in robotics which has dramatically reduced how long patients need to stay in hospital; for example, heart surgery often now requires a shorter stay in hospital due to technological advances. However, these technologies often need to be accommodated in modern facilities, which means new capital investment. Furthermore, without appropriately resourcing the social care system, many patients are not able to move out of hospital when they are ready to.

Many of the ambitions laid out in the NHS LTWP will take time to deliver, so there is an opportunity for industry to think about how new technologies can address some of these pressures in the system. Those in industry can position themselves to make relevant value propositions and be part of the discussions over the coming years.

The education piece in the NHS LTWP is also interesting for industry, as there are plans to accelerate how people are trained, meaning that there could potentially be a role for life sciences to support with this. IQVIA’s work in population health management and service redesign will also continue to help address workforce challenges, especially when aligned and augmented with IQVIA’s clinical services.

This NHS LTWP is highly innovative, but there is no mention about how it is going to be funded, which raises questions around whether it will actually deliver what is needed for the NHS. This is especially true given the current issues within social care, but by working collaboratively with industry, there is an opportunity to bring in experts to look into niche, innovative solutions.

Stephen Jowett is Senior Director and Head of Healthcare Consulting at IQVIA.

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 innovation will be key to realising ambitions of the Workforce Plan – Richard Stubbs

By Richard Stubbs

Responding to the NHS Workforce Plan, CEO of the Yorkshire & Humber AHSN, Richard Stubbs, argues that plan’s success will depend on the adoption of digital innovation and the creation of a digitally-capable workforce.

Workforce pressures remain one of the greatest challenges facing the health and care system, with ever-increasing and diversifying demands of the population driving the need for greater system capacity. It is implausible to imagine that we will continue to expand our workforce to meet future demand in a sustainable way. As well as supporting and championing our workforce, we need to also explore new ways of working by unlocking the power of digital, introducing new models for delivering services which will enable our staff to spend more time on activities that directly benefit patient care.

These ambitions are reinforced by the recently published NHS Long Term Workforce Plan, majoring on training and retaining our healthcare workforce, alongside the need to reform our ways of working and workforce training offer.

Digital technology, data, AI, and robotics offer numerous opportunities to address system capacity challenges and enable patients to receive timely, high-quality care. For example, the PinPoint blood test optimises NHS urgent cancer referral pathways so patients in greatest need are seen first, whereas the Digibete online platform supports better management of young people with diabetes and helps prevent unplanned hospital admissions.

These innovations will never replace care delivered by people and the specialist skills of our health and care workforce, nor is it an alternative to safe levels of staffing. Instead, it should be an integral part of a modern health and care system’s approach to coping with increasing demand. However, as around 22 per cent of the UK population lack basic digital skills, digital technology needs to be introduced in a way which doesn’t exacerbate existing inequalities. As the Digital Divide report I supported in conjunction with Public Policy Projects recommended, we need to avoid a ‘digital-by-default’ approach, and instead, ensure that adoption of digital technology is sensitive to the needs and challenges of different population groups.

As the Long Term Workforce Plan acknowledges, adoption of digital technology needs to take place alongside digital skills training for the workforce, enabling them to continue providing high quality care aided by digital technology. The linkages between digital technology and health inequalities should also be further highlighted within the workforce, helping mitigate inequalities caused by future introduction of ‘digital by default’ services.

“ICSs’ intrinsic knowledge of the populations they serve will also help to ensure that digitally enabled services don’t exacerbate existing health inequalities.”

ICSs have a critical role in delivering the Long Term Workforce Plan and mitigating current workforce challenges by bringing together workforce, clinical, and service planning and implementing digital solutions which unlock system capacity and deliver patient and system benefits. ICSs’ intrinsic knowledge of the populations they serve will also help to ensure that digitally enabled services don’t exacerbate existing health inequalities. The fifteen Academic Health Science Networks also have a role to play in supporting ICSs to match local need with evidence-backed innovations and supporting equitable adoption and spread of innovation across services.

We can only fundamentally address our current workforce challenges by reimagining the way we deliver health and care. Digital and tech transformation has been the journey for almost all non-health sectors over the last few decades. ICSs and AHSNs will be fundamental in driving this transformation, ensuring digital technology is adopted in a way which supports our workforce, meets local demand and reduces inequalities in access to services.

Richard Stubbs is CEO of the Yorkshire & Humber AHSN, an organisation that connects NHS and academic organisations, local authorities, the third sector and industry to facilitate change across health and social care economies. Prior to becoming CEO, Richard was AHSN’s Commercial Director.