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.

Damaging NHS disputes hindering progress on productivity, finds survey

By Integrated Care Journal

Trusts making progress on NHS targets and taking steps to boost productivity but concern mounting about staff morale and burnout as operational pressures take their toll.

Ongoing industrial action presents a major operational and financial challenge for NHS trusts, and is hindering all trusts’ ability to recover productivity, according to a new survey carried out NHS Providers. It highlights the scale of the task ahead for the NHS, as it simultaneously grapples with increasing numbers of patients with complex conditions staying in hospital for longer, emergency care pressures and limited bed capacity, exacerbated by the crisis-hit social care sector.

Trusts across hospital, community, mental health and ambulance services have made significant early progress towards meeting care backlogs for urgent and emergency care, cancer tests, long waits and diagnostic services as they strive to deliver better outcomes for patients, say NHS Providers.

They have introduced a range of measures to boost productivity in the NHS – delivering more care with existing resources – including targeted initiatives to improve staff health, wellbeing and retention alongside efforts to help discharge patients faster and adapting their buildings to treat more patients.

But trusts are now warning that eight consecutive months of industrial action across the NHS are taking their toll on efforts to cut waiting lists, with more than 651,000 routine procedures and appointments rescheduled so far and many tens of thousands more likely to be delayed as the health service faces back-to-back walkouts by junior doctors, consultants and radiographers in the coming days.

“Increasingly hard to improve productivity”

The new survey by NHS Providers, Stretched to the limit: tackling the NHS productivity challenge, outlines the scale and complexity of the challenge ahead, particularly as trust leaders count the cost of industrial action given the disruption to planned care, and increasing costs due to agency spend and the impact of consultant rate cards.

The Chief Executive of NHS Providers, Sir Julian Hartley, said: “Leaders and staff are working flat-out to cut waiting lists and to see patients as quickly as possible in the face of major obstacles.

“With waiting lists at a record high, trusts are keenly aware of the need to carry out more operations, treatments and scans. They are doing everything they can to see more patients more quickly and to deliver better quality care, including introducing virtual wards and new initiatives to speed up hospital discharge and offer more care at home.

“However, it is increasingly hard to improve productivity because of staff burnout, high turnover, vacancies, a rising number of patients with more complex conditions, stretched community and social care capacity, and fewer hospital beds per person than comparable countries.

Trusts are also warning that it will be very difficult to deliver the government’s overall demands in terms of performance while delivering unprecedented efficiencies, seeking to protect quality of care for patients.

The survey finds that:

Almost nine in ten (89 per cent) trust leaders said the scale of the efficiency task is more challenging than it was last year.
Almost three in four (73 per cent) did not think they had access to sufficient capital funding over 2023/24 to cover the costs of vital repairs to buildings and equipment.
Nearly two thirds (61 per cent) were not confident that they and their system partners would hit targets to reduce long waits for mental health care.
Fewer than half (43 per cent) expect to meet an interim recovery target of 76 per cent of A&E attendances to be seen within four hours during 2023/24.

The findings reveal widespread worry among trusts about having to deliver more for less as budgets, staff and resources are stretched to the limit, leaving trust leaders facing increasingly difficult dilemmas about how to sustain services in the future.

Despite an overall increase in workforce numbers and the welcome promise of more staff in the future through the new long-term workforce plan, rising concerns about staff morale and burnout also continue to play heavily on trust leaders’ minds. They are contending with 112,000 vacancies across the health service in England with staffing numbers and skill mix failing to keep pace with growing and changing demand.

This is piling on the pressure, with trust leaders identifying discharge delays, relentless demand on emergency care, a lack of investment in social care and a dependency on agency staff as the biggest barriers to returning to pre-pandemic levels of productivity.

They are clear that capital investment in the NHS estate is also key to boosting productivity. This would allow trusts to expand bed capacity and community provision, deliver digital transformation, bear down on care backlogs and eliminate the persistent inefficiencies created by creaking buildings and equipment.

But with the NHS capital maintenance backlog now exceeding £10bn, and only a handful of trusts benefitting from much-needed investment through the New Hospital Programme, a great many more need urgent major capital investment to overhaul their ageing estates to achieve better – and safer – outcomes for patients.

Sir Julian Harley added: “Industrial action also poses a significant financial risk to trusts, given the disruption to planned care, and increasing costs due to agency spend and the impact of consultant rate cards.

“The new long-term workforce plan with its focus on recruitment, training and retention could finally put the NHS workforce on a sustainable footing if commitments are made to keep it updated and funded. But the benefits of that plan can only be reaped with a wider focus on productivity and its enablers, many of which we explore in this report, such as investment in management capacity and capital.

“If we are to ramp up productivity across the NHS, we need a step change in capital investment to provide more beds, more community care, a digital revolution, a safe and comfortable therapeutic environment, and appropriate support for social care.”

Digital appointments could save the NHS £167 million per year: report

By Integrated Care Journal

Opening new digital pathways could free up capacity and help reduce NHS elective care backlog

Giving patients greater digital control over their hospital appointments could avoid 1.6 million unnecessary appointments and create a national annual system saving of £167 million, according to a new report commissioned by, patient engagement platform supplier, DrDoctor.

The report, commissioned by DrDoctor, a patient engagement platform supplier, and conducted by health economics consultancy Edge Health, analysed NHS outpatient appointment data. It suggests that allowing patients to request appointments using Patient Initiated New Appointments (PINAs) and Patient Initiated Follow-Ups (PIFUs) could significantly help to reduce the backlog in NHS elective care.

Reducing outpatient follow-up appointments

The data reveals that putting patients on digitised PIFU pathways for both high-volume, low complexity conditions and smaller volume, higher-complexity conditions could lead to at least 1.18 fewer outpatient follow-up appointments per patient. If implemented nationally, this could free up the waiting list for 1.4 million hospital appointments, creating capacity for more patients to be seen, and saving the NHS £167.2 million per year.

The report finds that the average time between the first appointment and follow-up appointments is also longer when patients are on a digital PIFU pathway. This indicates that when patients can initiate follow-up appointments themselves, they are likely to wait longer, which in turn creates more capacity for new patients to be seen, reducing waiting times further.

Supporting the elective backlog recovery

Edge Health examined the use of DrDoctor’s solutions at two of its customer sites, including PIFU and PINA tools at Guy’s and St Thomas’ NHS Foundation Trust (GSTT) in their physiotherapy services. The time and cost savings from more than 50 million outpatient appointments were applied to a national rollout to calculate the overall impact in the NHS.

The report finds that patients with mild symptoms for low complexity conditions may not need a first appointment at all. Using a digital PINA pathway to address this could reduce the number of people waiting for hospital appointments by more than 210,000, freeing up appointments for patients who need clinical care.

Tom Whicher, CEO at DrDoctor, welcomed the research findings and said: “This report demonstrates much-needed real-world evidence on the benefits of PINA and PIFU at scale. Given that the national target for 5 per cent of outpatient attendances using digital PIFU was recently dropped, the report should give confidence to providers on how these processes, enabled by digital tools, play a vital role in tackling the backlog and creating efficiency savings.”

GSTT has been using DrDoctor’s PIFU tool for musculoskeletal and hand therapy services since January 2022. The report found that more than 70 per cent of physiotherapy patients on a PIFU pathway chose not to return for a second appointment, compared to 44 per cent of non-PIFU patients. A greater number of PIFU patients also chose to request follow-up appointments later than those not on the PIFU pathway (84 per cent had it in 120 days or under vs 88 per cent in 90 days or under).

The report also finds that PIFU led to many patients requiring fewer outpatient appointments, creating capacity to reallocate these appointments to patients with more complex care needs who need to be seen more frequently. The ability to reallocate these appointments has created capacity for an additional 9,268 patients, at the value of £719,476 per year.

Rashida Pickford, Consultant Physiotherapist, GSTT, was involved in the research and said: “The analysis shows the benefits of using technology to give patients more control over their appointments. Avoiding clinically unnecessary appointments means we can provide a better patient experience and free up much-needed time for clinical and administrative staff.”

The report also concluded that from the patient’s perspective, demographic factors such as age, do not limit engagement with digital PIFU pathways. Tom Whicher added: “Often there are concerns about digitisation because it isn’t accessible for everyone. And whilst that can be true, this report confirms that it’s often an exception rather than the rule.”

DrDoctor helps manage around 25 per cent of NHS outpatient booking activity and provides digital PIFU, PINA and patient engagement services in over 45 healthcare organisations.

PPP’s Population Health Management Collaboration Framework

By Mary Brown

A new framework from PPP enables ICSs and business to assess and measure the progress of their collaboration on population health management.

Over the first half of 2023, PPP ran a series of roundtables for our Population Health in Business series, to analyse and explore the impact of business on the health of local populations, and explore how this impact can be leveraged to deliver benefits to businesses, workforces and communities. As the report highlights, ensuring that local business activity is sensitive and responsive to local health challenges requires close collaboration between business and local authority leaders. This collaboration, ideally, should occur within the framework of the integrated care partnership (ICP).

ICPs are intended to allow ICS leaders to “bring together a broad alliance of partners concerned with improving the care, health and wellbeing of the population”, as well as spearheading the integrated care strategy for a given system. Each ICS can decide which partners are included in the ICP, however suggested partners include local Health and Wellbeing Boards (HWBs), social care providers and members of the VCSE sector.

As conveners of local health-relevant organisations beyond the NHS, ICPs have the potential to rebalance the focus of health and care away from acute hospital settings and towards the broader health needs and goals of communities. This will empower organisations not traditionally involved in health-related decisions to make more active contributions to public health outcomes. Businesses have the potential to serve as partners in the delivery of a health inequalities strategy given their impact on their workforce and surrounding communities, and grow the impact of assessments such as the JSNAs already produced by HWBs.

The PPP PHM Collaboration Framework – part 1 of 2 (click to enlarge)

Joining up business and public health

By bridging the gap between public services and local industry, ICPs can support and monitor actions taken by businesses to create healthy workplaces and support employee health, assisting in setting priorities and objectives and advising on health and wellbeing issues. ICPs can also serve as forums of communication and alignment between ICSs, businesses and local health-relevant organisations, enabling businesses to contribute more effectively to community health.

ICPs could also play a central role in enabling better public-private data exchange, which will be crucial in determining the quality and impact of PHM insights. As a broad alliance of partners, ICPs can provide a forum through which businesses and local authorities can improve the accessibility and availability of data. While the needs and capabilities of businesses with regards to data usage vary significantly within an ICS region, the development of PHM strategies is ultimately a process that caters to the needs of a specific population reflected in health-relevant data collected and held by businesses.

The full Population Health in Business report can be accessed here.

Where businesses are able to share insights and collaborate to improve health outcomes within the same population (both with one another and with local authorities), there is a significantly greater opportunity for mutual needs to avail themselves – thereby laying the groundwork for more effective collaboration. The blueprints for such a collaboration can then be shared between ICSs and with central authorities such as DHSC, and local government including the Local Government Association and the Department for Levelling Up, Housing and Communities, to facilitate their development of data standards as recommended by the Hewitt Review.

However, though the report suggests that businesses should collaborate with one another and local authorities, using the ICP as a connecting forum, it must be recognised that many of these partnerships remain underdeveloped and that their progress is likely to be asymmetric. It is therefore necessary that businesses take an active role in assessing the strength of their own actions on health inequalities and their collaborations with local authorities.

PPP’s PHM Collaboration Framework – part 2 of 2 (click to enlarge)

A framework for collaboration

There are ongoing concerns within ICSs around the challenges of balancing the unique local needs and priorities of regions with national standards. In order for all ICPs to partner with local businesses in achieving improved regional health, collaboration and data sharing frameworks should be utilised to ensure consistent goals and progress across regions with different priorities, while avoiding duplication and so as not to discourage inter-ICS collaboration.

In order to support businesses and ICPs to implement the findings and recommendations from the series, PPP has crafted a suggested framework for ICS and businesses to collaborate and measure progress.

The framework is intended to compliment other matrices, such as the Leeds City Council Business Progression Framework, the JRF Business Progression Framework (both assembled by Les Newby and Nicky Denison), and the ICS Maturity Matrix (created by Cathy Elliott). These matrices provide examples of best practice and rough guides for organisations to evaluate their own progress as health-enhancing institutions. As such, the PPP PHM Collaboration Framework is intended to guide businesses to evaluate their own progress towards partnering with local authorities and interacting against local health systems to develop robust preventative healthcare and target causes of ill health.

The full Population Health in Business report can be accessed here.

Edge Health, News, Thought Leadership July 11, 2023

Rethinking cancer care: a system strategy for improved outcomes

By Lucia De Santis and George Batchelor

Boosting early detection and reducing backlogs through data-backed, collaborative initiatives will be crucial to addressing the deteriorating state of cancer care in the UK, write Edge Health’s Lucia De Santis and George Batchelor.

In the battle against cancer, the UK is grappling with alarming statistics, with outcomes for colon, lung and pancreatic cancers being particularly sobering. According to the Comparator report on cancer in Europe 2019, the UK was last out of all Western European nations for 5-year survival of colon cancer, as well as among International Cancer Benchmarking Partnership (ICBP) jurisdiction countries (Figure 1).

Figure 1: Age-standardised incidence, mortality rates and 5-year net survival for Colon cancer. Arnold M, Rutherford M, Lam F, Bray F, Ervik M, Soerjomataram I (2019). ICBP SURVMARK-2 online tool: International Cancer Survival Benchmarking. Lyon, France: International Agency for Research on Cancer. Available from: http://gco.iarc.fr/survival/survmark, accessed [08/06/2023]. (Click to enlarge)

The complex factors behind the UK’s cancer outcomes

Understanding the root of this crisis is not straightforward, as many intertwined factors play roles, from cultural attitudes affecting help-seeking behaviours to underinvestment in critical medical resources. As a doctor in a busy acute trust, I could not grasp why one of my patients only presented to hospital long after his skin tone had turned an unmistakable dark shade of yellow, a tale-telling sign of his late-stage lymphoma. On the other hand, as of 2021, the NHS operated with around 63 decade-old LINACs (essential cancer treatment machines), and the UK has the lowest number of PET-CT scanners per 100,000 people among International Cancer Benchmarking Partnership countries.

The UK’s uphill struggle is deep-seated, with it having the worst cancer survival rates in the EU as far back as 1995. NHS’s low spending on cancer treatments and restricted access to cancer medicines for patients have been contributing factors.

Turning the tide: a dual-pronged strategy

Despite the complexity, there are attainable starting points for improvements: boosting early detection through the two-week-wait (2WW) referral pathway and ensuring prompt diagnosis and treatment through collaborative approaches that have proven successful in other countries.

Front one: boosting early detection

Data shows that cancers identified via a 2WW referral are often diagnosed earlier, and result in fewer diagnoses during emergency admissions, with implications for survival.

Analysis on stage at diagnosis performed by Cancer Research UK (Figure 2) demonstrates this clearly, with 30 per cent of cancers detected via 2WW referral being at Stage 1, versus just 8 per cent of cancers detected through an emergency presentation to hospital.

Figure 2: Proportion of cancers by stage at diagnosis by route of detection. Source: Cancer Research UK Early Diagnosis data, accessed June 2023. (Click to enlarge)

However, across England, there is a glaring disparity in cancer detection rates – that is, the number of confirmed cancers that are detected via an urgent suspected cancer referral (2WW). This is intimately related to the overall volume of 2WW referrals (Figure 3), where higher figures are associated with a higher detection rate.

Patients whose practices have a lower threshold to refer under the 2WW programme fare much higher chances to have cancer detected via this route and as shown above, at an earlier stage. This, again, has implications for treatment and survival.

The national disparity between these practices not only means that average figures for cancer outcomes are affected by differing primary care strategies, but also that there are wide inequalities of care across the nation.

Cancer alliances and primary care networks can play an essential role in encouraging practices to revisit their referral behaviours. This effort can help reduce healthcare inequalities and potentially save lives by identifying and treating cancer earlier. Understanding what drives referral rates and promoting effective referral practices can make the difference between a life saved and one lost, and in the end spare the much higher healthcare and societal costs associated with late-stage cancer.

Front two: tackling backlogs through collaboration

Our second strategy is to reduce backlogs through collaboration. The NHS’s diagnostic capacity is currently strained, as the steady decline in patients diagnosed within the 28-Day target since its 2021 introduction suggests.

Figure 4: Proportion of patients referred for suspected cancer who meet the 28-Day faster diagnosis standard that was introduced in 2021. (Click to enlarge)

Taking cues from countries like Denmark, which successfully improved cancer survival rates by centralising specialised care and launching data-focused initiatives, the NHS can rethink its approach. By making comprehensive cancer patient data centrally available, we can make more informed decisions, improve workflow, and direct finances more effectively.

The NHS collects extensive data on cancer patients, encompassing their entire journey from referral to treatment. The key to better cancer care is ensuring the data is available centrally to key organisations and decision-makers, such as integrated care systems and Cancer Alliance leaders, to make evidence-backed financial, workflow and population health decisions and foster collaboration.

Sharing cancer data can help speed up diagnosis and treatment for patients. For instance, by sharing a cancer patient tracking list (PTL) across multiple trusts, patients who are at risk of breaching targets can be identified early and receive timely care. This strategy can also address the shortage of diagnostic appliances or services and specialised treatment.

Figure 5: Example of how cancer alliance PTL data could be pooled to estimate breach risk scores and inform waiting lists to either allow local prioritisation or highlight mutual aid opportunities. (Click to enlarge)

The road ahead: data-driven initiatives and collaboration

The current state of cancer care in the UK calls for an urgent, systemic response. By prioritising early detection and fostering data-driven collaboration, we can significantly enhance the prognosis for the UK’s cancer patients.

Expediting early detection efforts, particularly through increased 2WW referrals, is crucial to change the narrative. These efforts, when paired with the power of collaborative and data-driven care models, can revolutionise the cancer care landscape. It’s a potent combination that can help us ensure that no matter where patients live, they can access timely and high-quality cancer care. This system-wide approach presents an opportunity not just to catch up with our European neighbours, but to potentially lead the world in effective cancer care.

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Why personalised care must go beyond ‘patient-centricity’

By Dr Rob Simister

Dr Rob Simister, Clinical Director for Stroke and Acute Neurology, University College London Hospitals (UCLH) NHS Foundation Trust, writes about how digital platforms can help personalise stroke care, leading to better outcomes for patients and carers.

‘Personalised care’ is a term that has become ubiquitous, and something that the NHS has been striving to achieve for some time. As an NHS consultant, I understand the aim of personalised care to be the provision of a care programme that is tailored to the specific needs of each patient, and delivers better outcomes and a better life experience.

This ambition to create a personalised recovery pathway for survivors of medical emergencies, such as stroke, is critical. Such patients will have specific patterns of injury, risk factors, treatment programmes and rates of recovery. Each patient also brings with them a specific life history, expectations and hopes for the future. We can only help individuals to recover in the best way possible if we take all these elements into account. The challenge is the delivery of this personalised care across the wider patient group, and so far, we have struggled with this.

This is where technology can make a huge difference. By creating bespoke packages of support, we can equip patients, their families and carers with information pertinent to the event and help them understand what to expect throughout their recovery journey and how to manage their health and reduce the risk of secondary stroke in the future. Critically, this can be done at scale.

Personalised information is personalised care

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

Stroke occurrence is associated with a number of modifiable and unmodifiable risk factors. Lifestyle choices, weight, and compliance with medications and environment factors are all potentially modifiable. However, we need to ensure that everyone has access to the right information presented in an accessible way, something which remains challenging particularly for minority groups and people who are socially disadvantaged. We need to ensure that this information takes account of unique experiences, background, spoken language and life challenges. This is essential in helping more people to understand their stroke and improve their recovery outcomes.

Filling the gap

To try to bridge this gap, I have been involved in the development of a digital platform called My Stroke Companion. This technology offers patients a visual and interactive support package of information, which is specific to their type of stroke, risk factors and treatment plans. While the information provided is designed to be as accessible and as easy to understand as possible, it crucially helps the patient to answer: why did this stroke happen to me? What does my recovery look like? How do I prevent it from happening to me again?

Accessible content is especially important in conditions such as stroke, where patients can struggle to take in information due to tiredness or fatigue, or difficulties processing information. This is even more difficult for patients who also experience language barriers or have pre-existing communication needs.

We are currently piloting My Stroke Companion with 500 patients – the first pilot of its kind to take place. Each patient has been given a personalised information prescription, which they can share with family members and carers, helping them to manage their condition. We have been really pleased to learn that, particularly in the earliest phase of recovery, some of the main beneficiaries of the support packages have been carers, who have valued the dedicated content that helps them to provide better care. This develops the idea of personalised care further – so that it is not just patient-centred, but also relevant and useful for carers and family who are also often deeply affected.

This positive impact could easily be replicated across other health conditions, such as cardiovascular disease and respiratory conditions, with development of these resources following a similar process of co-creation with patients, carers and digital specialists.

Better for patients, better for the NHS

Personalised digital support packages can also help trusts to create system efficiencies, which is especially crucial now that staff and services are so stretched. By providing information that can be accessed in the comfort of a patient’s home, it is possible for patients to have time to understand more deeply what has happened – and what will happen next. We hope this will lead to improved medication adherence, participation in therapy and in better lifestyle choices – leading to fewer recurrent events, less time in hospitals and better outcomes.

We also hope that the platform will help overstretched NHS clinicians by acting as a trusted resource for patients and carers, and so release this highly pressurised group to be more available for direct care delivery.

Digital personalised support offers an opportunity for the NHS to channel the right information to the right patients and help patients to gain more control over their condition after a life-changing health event.