Support through the menopause is a necessity, not a luxury

By Professor Dame Jane Dacre

‘The only matter where a woman can take time off for her reproductive health that is widely accepted is pregnancy – that’s the reality’.

These are not my words but those of one of the doctors in the UK that responded to a recent survey by the Medical Protection Society (MPS).

It is a sentiment that many women will recognise. But the medical community surely can, and must, do better than this in 2022.

Every day initiatives are announced to support healthcare professionals’ wellbeing and to enable those of us further along in our careers to continue working. I would argue that support for healthcare professionals experiencing menopause has to be a top consideration as part of this work.

NHS Digital data tells us that women make up more than 75 per cent of the NHS workforce, and that there are more women in medicine than ever before. However, looking at the split of doctors on the GMC register, there is quite a dramatic reduction in the number of women over 45. Under the age of 45, female doctors form the majority of the profession. There will be many reasons for this, including the extent to which women entering medical schools have outnumbered men in recent years.

However, the lack of support for those going through the menopause could be a factor in the reduction of female doctors over the age of 45 on the register. Better recognition of the impact of the menopause on some women’s medical careers could help to keep them in practice for longer.

Some of the most common physical menopause symptoms include hot flushes, night sweats, menorrhagia or a change to the menstrual cycle. Migraines and other headaches are also frequently reported, as well as joint and muscle pain, heart palpitations, urinary incontinence, vaginal dryness, genitourinary infections, and an adverse effect on an individual’s sex life, which can affect relationships and overall wellbeing.

Mental health symptoms reported include anxiety, mood swings, panic attacks and depression. Other reported symptoms include fatigue, poor concentration, brain fog, dizziness and insomnia.

These symptoms can of course have a negative effect on a person’s work performance. The UK’s Faculty of Occupational Medicine and the Chartered Institute for Personnel and Development state that 25 per cent of women say they have considered leaving their job and 1 in 10 do end up quitting as a result of menopause and a lack of available support.

Healthcare professionals will know more about the menopause than others, but this does not mean we are immune from these pressures or that we get the support we need.

A recent survey of 261 doctors in the UK conducted by MPS found that just 14 per cent of female doctors who have experienced the menopause report feeling supported by their employer/workplace and only 7 per cent feel supported by their line manager, with most (76 per cent) feeling supported by their family and friends. 28 per cent feel supported by colleagues, yet 17 per cent say colleagues have been dismissive of their menopause symptoms. 19 per cent said they have considered early retirement due to the menopause.

While the sample size is small, these findings suggest more needs to be done to help doctors experiencing menopause continue to perform at their best and stay in the workforce for longer. A work culture that destigmatises menopause and other factors that impact on a doctor’s wellbeing is much needed to reduce the continued exodus of doctors. Creating an environment that promotes wellbeing is a necessity, rather than a luxury, as the impact of engaged and content clinical staff on patient safety should not be underestimated.

There is a crisis in the medical workforce, due to understaffing, which needs to be addressed urgently, so that we can continue to provide the highest quality of care to our patients. Recognising the potential difficulties faced specifically by women doctors, and addressing them compassionately will help reduce attrition, and will benefit the medical workforce overall, and ultimately, patients too.

MPS, of which I am President, offers support to members including making our 24/7 confidential counselling service available for those struggling with the menopause and other wellbeing concerns.

A much broader approach is needed by the wider system however to ensure better mental wellbeing support and greater awareness from leaders. This is why MPS, in its paper Supporting doctors through menopause, is calling for better training and education around the menopause and its symptoms for managers and senior leaders, and asking healthcare organisations to consider flexible working arrangements to support female doctors to stay in the workforce for longer.

How the ICS can unify data and relieve elective care

By David Duffy

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

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

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

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

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

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

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

Articulating the problem

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

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

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

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

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

A strategic partnership approach

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

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

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

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

How has the ICS enabled this change?

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

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

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

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

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

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

How ICSs can help uproot risk aversion and progress innovation

By David Duffy

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

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

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

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

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

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

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

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

Fostering a culture of innovation

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

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

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

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

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

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

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

Innovation as an antidote to health inequality

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

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

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

Risk appetite

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

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

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

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

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

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

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

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

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

GMC urges removal of barriers to help tackle NHS workforce crisis

By Gabriel Blaazer

The rules preventing thousands of doctors from being deploying deployed to areas of high patient demand must be removed to help tackle NHS challenges, the General Medical Council has said.

The regulator of doctors in the UK is urging the government to relax rules which dictate the roles that specialty and associate specialist (SAS) and locally employed (LE) doctors can undertake.

Published yesterday, the GMC’s The state of medical education and practice in the UK: workforce report 2022, identifies SAS and LE doctors – who are skilled doctors in non-training roles – as the fastest growing part of the medical workforce and a cohort which may become the largest group in the medical workforce by 2030.

The report argues for a relaxation of current rules to allow these doctors to be deployed to areas of high patient demand, including primary care. Rules such as the Performers List, which details those practitioners approved to work in primary care, can restrict the roles that doctors fulfil.

The number of licensed SAS and LE doctors rose from 45,587 to 63,740 between 2017-2021 – a 40 per cent rise. During the same period, the number of licensed GPs rose from 60,6090 to 65,160 – a 7 per cent rise. It is hoped that allowing more flexibility in the roles that doctors are permitted to undertake will help plug staffing gaps where demand is higher than workforce constraints can accommodate.

According to the Chief Executive of the GMC, Charlie Massey, a change to the rules would also help in the recruitment and retention of doctors, as it would allow for greater flexibility over when and where doctors can work. “Lots of these doctors tell us they want better career development and progression, and to have more flexibility in the positions open to them. But there are barriers that hinder their development, and rules that prevent them fulfilling some important roles,” he said.

The report also shows that many SAS and LE doctors come to the UK after qualifying abroad and are more likely to work for in the NHS for relatively short spells. It is hoped that offering more flexibility and career opportunities to these doctors will persuade more to stay in the UK “make the most of these talented and able doctors”.

Mr Massey added: “These are skilled doctors who do hands on work but are not in training to become a consultant or a GP. Many have made a positive choice to work in non-training and non-specialist roles in secondary care, where they do hugely valuable work.”

“But we know there are significant numbers who want wider opportunities. Systems must adapt to make the most of their talents. We need fresh thinking about how these doctors are deployed, and how they can be best used to benefit patients.”

“Now is the time to discard dated ideas and tap into the skills and experience these doctors provide.”

Building sustainable ICS staffing to weather the workforce crisis

By Dr Anas Nader

The advent of integrated care systems (ICSs) across the NHS marks an invaluable opportunity to facilitate greater collaboration, efficiency and more joined-up care for patients.

To be successful, this period of transformation needs to be underpinned by a strong, comprehensive workforce strategy that enables staff to be flexibly and safely deployed in line with fluctuating demand.

Amid present staff shortages and rising waiting lists, and with pressures set to grow over winter, this is, unsurprisingly, no easy task for organisations. As managers rightly address these immediate challenges, it’s understandable that little time or capacity is left to support broader workforce transformation. Yet the benefits of a transition to more collaborative ICS-wide staffing have the power to tackle these same challenges in the long-term.

While it may seem like another hurdle for teams who are already facing extreme pressure, there are a number of ways that ICSs can reap these benefits, without compounding workloads or piling additional pressure on staff. Throughout my time working closely with NHS organisations to tackle various workforce challenges, I have found the following steps essential to successfully enabling truly collaborative staffing. I believe they are also the key to unlocking a more sustainable, long-term workforce strategy.

Harnessing the power of collaborative temporary staffing

Temporary staff are crucial to the successful running of an ICS, helping to plug any gaps in rotas across the region. However, currently, when organisations are unable to source clinicians from their own internal staff bank, they must often turn to more costly external agencies to fill vacant shifts. Instead, by building a collaborative network of approved temporary clinicians, organisations can seamlessly tap into a much larger and more flexible contingent workforce from which to reliably fill shifts.

The key to effectively leveraging a collaborative staff bank is enabling compliant digital passporting for all participating clinicians. This means approved workers can passport their credentials across different participating organisations, without having to repeat compliance or background checks. As a result, they can more easily work across a number of different sites and locations and be deployed effectively in line with demand throughout the ICS.

Increasing data oversight

In order to reliably plan ahead, identify staffing gaps and deploy staff where most needed, access to comprehensive data insights is crucial. This means not only enabling managers to view data from within their own organisation, but granting access to pan-regional workforce data from across the entire ICS.

Dynamic data reporting, which provides timely, granular insights into organisational performance, can help measure the success of workforce planning, enable targets to be reliably met and pinpoint areas where improvements can be made. Individual organisations should be able to assess their own performance data and compare this with others in their region. With clear visibility over regional shift fill rates, workforce spend and staffing trends, it becomes easier to identify areas for improvement, while harmonising pay rates and maintaining safe staffing levels in a truly collaborative manner.

Introducing more flexible rostering

When it comes to rostering, the current systems at managers’ disposal are often slow, outdated and require large amounts of manual input. Introducing more streamlined, digital systems which can safely provide staff with greater flexibility and predictability, while reducing the admin burden on managers, can help open the door to more effective ICS-wide rostering in the future.

Rostering clinicians based on skillset rather than title or grade will allow managers to deploy staff more effectively, in line with patient need. This will also give staff the flexibility to safely work in a wider range of roles, in different locations across the ICS, and to access wider professional development opportunities. These are all essential to helping boost retention.

Meanwhile, multi-organisational rostering could begin to allow more efficient deployment of staff to areas of highest need across the ICS. This makes it easier for managers to reliably plan ahead and gives staff greater control over where they work, in line with their personal and other professional commitments.

Prioritising system integration

System integration is a fundamental prerequisite to the success of every single one of these steps. If the systems being used to organise staffing within different organisations are unable to communicate or share data with each other, genuine collaboration will remain out of reach.

When introducing new workforce management systems, organisations should prioritise those which are fully integrated or interoperable, enabling managers to directly share workforce data, rota planning and temporary staffing networks with other organisations throughout the ICS. This reduces the need for manual data input, minimising admin for managers and speeding up the transfer of vital data and information.

As a result, organisations will be able to collaborate in real-time and deploy staff to the most appropriate services in line with evolving ICS-wide demand.

To reap the full rewards of ICS working, facilitating a collaborative, flexible workforce is vital. This transition does not have to be costly, nor add additional burden to managers or organisations. By working together and implementing these four key areas of change, we can lay the foundations for strong, collaborative ICS-wide working, built to weather the challenges which lie ahead.

Billions needed to plug growing NHS maintenance backlog

By Integrated Care Journal

New figures from NHS Digital show sharp rise in funding needed to undertake upkeep and repair on NHS buildings, as trust leaders say delays hurting patients.

The NHS maintenance backlog – the measure of how much would need to be invested to restore facilities through work that should have already taken place – has risen to an estimated £10.2 billion according to new figures from NHS Digital – an 11 per cent rise since 2020-21.

More than half of the total backlog (52 per cent) represents a “high and significant risk” to staff and the public according to NHS Providers, as 62 per cent of trust leaders responding to a recent survey said that delays to the new hospitals programme were affecting their ability to deliver safe and effective patient care.

Saffron Cordery, Interim Chief Executive of NHS Providers, said: “Far too many NHS buildings and facilities are in very poor condition and the latest figures show the situation is getting worse. The costs of trying to patch up creaking infrastructure and out-of-date facilities are piling up.

“We need a step change in capital investment by the government as well as urgent clarity and commitment about its delayed new hospitals programme.”

According to NHS Digital’s figures, the total cost of running the NHS estate rose 8.8 per cent from 2020-21 and now stands at £11.1 billion. Also increasing was total energy usage across the estate, rising 2.6 per cent during the same period to reach 11.7 billion kWh. The total cost for cleaning services has also risen to £1.2 billion – a 7.5 per cent increase since 2020-21.

From 2020-21 to 2021-22, the value of investments made to cut the maintenance backlog increased to £1.4 billion, a rise of 57 per cent. Despite this, trusts are currently shouldering £5.3 billion of the total backlog risk, £700 million more than in 2020-21.

Saffron Cordery added: “The maintenance backlog across the NHS continues to grow at an alarming rate. It’s not just about old boilers and bricks and mortar. Safety of patients and staff is at the heart of everything the NHS does.”

The figures from NHS Digital come as concern mounts among trust leaders regarding the ability of the current capital budget to meet cost pressures; half (50 per cent) of all trusts surveyed by NHS Providers were ‘not confident’ or ‘not at all confident’ that their funding allocations are enough to deliver projects currently included under the new hospital programme – one of the headline manifesto pledges of the Conservatives under Boris Johnson.

In signs that trust leaders have concerns over funding allocations, almost 96 per cent of trusts surveyed agreed that the government should ‘confirm the funding envelope for the new hospital programme beyond the current spending review period (2022-23 – 2024-25)’. Less than half of trusts (46 per cent) in the new hospitals programme are running on time, and of these, 100 per cent reported that costs would increase because of delays.

How any budgetary shortfalls are to be met remains unclear, but with 62 per cent of respondents saying that delays would ‘somewhat effect their trust’s ability to deliver safe and effective patient care’, the latest figures will add more fuel to concerns over the NHS’s ability to cope this winter.

Ethicon showcases product portfolio in UK & Ireland hospital tour

By Ethicon

Ethicon, the Surgical Technologies Company of Johnson & Johnson MedTech, has launched its first-ever roadshow across the UK & Ireland, including a showcase that demonstrates the role of digital innovation in supporting the NHS to tackle the backlog of patients waiting for treatment.

Ethicon is committed in its mission to support healthcare systems to treat more patients and provide better experiences and outcomes, especially as recent announcements from the Department for Health and Social Care show how important digital transformation of the healthcare system is, with £2 billion earmarked from the spending review to help digitise the NHS and social care sector.

The Ethicon roadshow began in September and runs until early December. It is a unique opportunity for clinical and non-clinical healthcare professionals to speak to representatives and industry experts about how driving digital transformation is pivotal in this mission, outlining the importance of Ethicon’s Surgical Simulation Strategy and Services & Solutions offering which gives surgeons additional information to support their clinical decision-making.

The products being showcased on the tour bus cover specialties including Colorectal, Gynaecology, Thoracic, and Bariatric. Ethicon’s digital offering has the potential to drive the next surgical revolution, bringing together the value of Next Generation Robotics and Instrumentation, Advanced Imaging, and AI-powered Digital Solutions.

Learn more about Ethicon and its product portfolio here.

“We’re focused on creating a differentiated digital ecosystem including working in partnership with our dedicated account management team to support a successful implementation, data insights, and best practice sharing,” said Jenny Nagy, Ethicon’s General Manager in Great Britain. She continued to highlight the value the company sees in this collaboration:

“Our Ethicon roadshow will give customers the opportunity to discuss innovation in healthcare and witness our innovations first-hand with our product demos hosted on the bus. Our mission may have been accelerated by the pandemic, but we’re keen to connect with our customers in-person to demonstrate the value we place on working together to advance the use of technology in tackling the biggest healthcare challenges.”

The Ethicon tour bus is also hosting:

Science of Energy Training
Surgical Simulation Suite
Product Training Innovation Workshops
New Product Innovations

Clinical and non-clinical healthcare professionals can register their interest in attending and booking a slot at their chosen hospital location here.

This is a sponsored article.

NHS community pharmacies sound alarm as inflation bites

By Gabriel Blaazer

The National Pharmacy Association (NPA) has raised concerns about the future of the community pharmacy sector, with a new report highlighting the impacts of inflationary pressures

The NPA commissioned the investigation into the implications of inflation on community pharmacy commissioned in June 2022 following large spikes in inflationary pressures this year. Professors David Taylor of University College London and Panos Kanavos from the London School of Economics and Political Science were asked to investigate the capability of community pharmacy across the UK to purchase and dispense NHS and other medicines and to become more focused on the provision of clinical services.

The report, Protecting the UK Public Interests in NHS Community Pharmacy, was published in September 2022 and warns of several thousand community pharmacies in the UK having to close thanks to rising costs and ‘flat’ NHS pharmacy funding.

The overall number of community pharmacies in England has fallen by 600 since 2018, about 5 per cent of the total. This number was likely kept artificially low thanks to temporary additional payments that were made to pharmacies during the Covid-19 pandemic, while many pharmacies that remain open have only done so by accepting reduced incomes and incurring more debt.

Many have also reduced the services they offer, cutting loss-making discretionary services and reducing opening hours. A FOI request has revealed that between December 2020 and July 2022, 1600 pharmacies in England reduced their opening times by an average of six hours per week in a bid to cut costs.

Many of the pharmacies that remain under threat are located in more deprived areas, where further closures of pharmacies risks widening existing health inequalities. The report warns that serious damage could be done to the NHS’ medicine supply without urgent government action to help community pharmacies remain as viable going concerns.

However, the picture looks less grim outside of England, with initiatives in Scotland and Wales producing a more stable outlook for community pharmacies there. In Wales, shifts in the balance of NHS pharmacy fees towards providing clinical services, as opposed to dispensing medicines, are being introduced, while in Scotland, prescribing pharmacists are now able to diagnose and treat a variety of conditions that previously would have required GP intervention thanks to the Pharmacy First Plus scheme.

Inflation, inflation, inflation

The report comes after Ernst & Young (EY) were commissioned by the NPA to conduct a study of the funding, policy and economic environment for independent community pharmacies in England. This study was concluded in September 2020 and predicted a deficit of £500 million in community pharmacy funding by 2024. It also asserted that the current financial framework for the NHS pharmacy network was unsustainable.

According to figures from the NPA, the inflation adjusted value of NHS community pharmacy ‘global renumeration sum’ fell by 10 per cent between 2015 and 2017 (see Figure 1 below). It has remained at £2,592 million since then, with no annual allowance for inflation. As things stand, the proportion of English NHS funding allocated to pharmacies will have fallen in real terms by over one third in the period 2015-2024, falling from 2.4 per cent to 1.6 per cent. However, higher inflation rates and increased NHS outlays mean that the drop is likely to be larger.

Figure 1 (click to enlarge): The Community Pharmacy Global Sum in England to (projected) 2024 in current prices and at 2015 prices, CPI adjusted. Source: Professor David Taylor, Professor Panos Kanavos. Authors’ estimates based on ONS and NHS data.

The current Community Pharmacy Contract Framework for England was agreed upon for the period 2019-2024, before the pandemic and the recent inflation crisis. It would have been appropriate to expect a 2 per cent annual inflation rate when the ‘flat NHS funding’ contract sum was agreed upon. However, with inflation sitting at over 10 per cent, and expected to remain there for potentially one or two years, community pharmacies in England are now facing up to net funding shortfalls of 15 per cent in 2023 and 20-25 per cent in 2024, against what could have reasonably been expected in 2019.

Following the steep rise in inflationary pressures in 2022, the new report, Protecting the UK Public Interests in NHS Community Pharmacy, was commissioned by the NPA. It urges the new government to intervene to prevent further pharmacy closures and ensure the viability of the sector throughout the current period of economic turbulence.

The report does, however, point to some signs for long-term optimism, notably the fact that all new pharmacy graduates will qualify as prescribers by 2026. The government has recently announced its ambition for community pharmacy to assume some of the clinical services burden, thus relieving pressures on GP practices and A&E departments.

Such measures were also recommended by a recent Public Policy Projects report, ICS Futures, and the NPA say that that under the new integrated care systems, a transformation of community pharmacy’s role can be achieved, “given sufficient political, managerial and professional will to pursue the public’s best interests.”

Health Inequality, Population Health, Primary Care, Thought Leadership September 30, 2022

Has the government given up on its health ambitions?

By David Duffy

David Duffy analyses Theresa's Coffey's start as health secretary.

Despite the already catastrophic impact of the government’s mini-budget, the first casualty of the government’s short-termist approach to governing was health and care.

Amid the ongoing response to the government’s remarkably misguided mini-budget, recent announcements from DHSC have flown somewhat under the radar of national media. But last Friday’s postponement of the health inequalities white paper is a reflection of a 12-year-old government who have become devoid of long-term strategic thinking in health and care.

Much like how Mr Kwarteng’s budget is being criticised for seeking a short-term growth boost while sacrificing economic stability, Ms Coffey’s health announcements so far seem to be aimed at garnering public support in the short term, and fail to into account the long-term causes of ill health and the enduring challenges facing the sector. Our Plan for Patients, Thérèse Coffey’s first stab at a plan for health and care, is receiving as much attention for what it misses as what it includes, with glaring omissions around workforce strategy and health inequality.

Last week it was reported that new Health and Care Secretary intends to postpone, and potentially scrap, the publication of the long-awaited government health inequalities white paper. It is estimated that health inequalities cost the UK £31 billion to £33 billion per annum before Covid-19 and the paper was a key part of Boris Johnson’s leveling up initiative. When first announced by then Health Secretary Sajid Javid back in February, the intention was to set out “bold action” to deal with disparities in health outcomes based on race, gender and income.

In response, over 155 members of the Inequalities in Health Alliance (IHA) last week wrote to Coffey urging her to maintain the commitment to publishing a Health Disparities White Paper (HDWP) by the end of this year.

The Alliance said: “The DHSC and NHS will be left in the ultimately unsustainable position of trying to treat illness created by the environments people live in”.

The IHA have urged for the government to restate its commitment to health inequalities, warning that “focusing on individual behaviors and access to services alone will not be enough to close the almost 20-year gap in healthy life expectancy that exists in England between those from the least and most deprived communities.”

“that the Secretary of State has so far chosen to ignore the issue almost entirely poses ominous signs for the future health of the nation”

Whether or not you agreed that Johnson’s levelling up initiative was ever truly going to become a reality, it did help kickstart hugely beneficial discourse around health inequality, further prompted by the uneven impact of Covid-19. It was clear from recent Public Policy Projects meetings between system leaders that there is a growing consensus that tackling health inequality is the central objective of integrated care systems (ICSs). With ICS leaders in agreement on the need for action, what has happened to the government’s desire for “bold action” on health inequality?

The obvious answer is that while the economy is rapidly deteriorating and every government department is being asked to find ‘efficiency savings’, long term social and economic rejuvenation is taking a back seat. But in the context of a deepening cost of living crisis, the fact that the new Secretary of State has so far chosen to ignore the issue almost entirely poses ominous signs for the future health of the nation.

Cost of living

Recent polling from the Roya College of Physicians has found that even by May 2022, 55 per cent of people felt their health had been negatively affected by the rising cost of living, with the increasing costs of heating (84 per cent), food (78 per cent) and transport (46 per cent) reported as the top three factors.

Rising costs are creating environments for preventable ill health to manifest in deprived areas across the nation, ultimately impacting health services – but of course, the crisis directly impacts health providers, as well as those delivering care.

NHS Providers have published a shocking new survey from its membership, revealing that some staff are electing to not eat during work hours in order to provide for their children, with some quitting altogether to find better paid work in pubs and bars. Other key findings from the survey include:

71 per cent of trust leaders reported that many staff are struggling to afford to travel to work;
69 per cent said the cost of living is having a ‘significant or severe’ impact on their ability to recruit lower-paid roles such as porters and healthcare assistants;
61 per cent reported a rise in mental health sickness absence;
81 per cent are ‘moderately or extremely’ concerned about staff’s physical health;
95 per cent said that cost of living increases had significantly or severely worsened local health inequalities;
72 per cent said they have seen more people coming to mental health services due to stress, debt and poverty;
51 per cent said they have seen an increase in safeguarding concerns as a result of people’s living conditions.

The health and care community is united in its concern for the wellbeing of its staff and for their capability to respond to the underlying causes of the nation’s health challenges. Unfortunately, the government is failing to match this concern with sound, long-term policy – this epitomised by Our Plan for Patients.

In some ways, it can hardly be a shock that the government is losing its desire to implement long-term health policy; Coffey is the country’s fifth Secretary of State for Health in as many years and must also balance this role with the position of Deputy Prime Minister. Even still, much of the sector has been taken back by some of Our Plan for Patients’ glaring omissions, as well as questioning some of the key commitments within it.

In setting out her key priorities as Health Secretary, the threadbare document published last week attempts to establish Coffey as a “champion” for patients. So far, the plan has achieved little more than alienating much of the health and care community, while simultaneously discrediting the last 12 years of government health policy.

Primary care

“Ministers are quick use the pandemic to excuse ominous backlogs in elective care, yet they do not offer the same leeway for the primary care sector”

One of the central aims of Our Plan for Patients is the expectation for all patients to receive a GP appointment within two weeks of request. In setting this wholly unrealistic, arbitrary national target, without providing additional support for GPs to achieve it, Coffey is seeking to create a doctors vs patients dynamic.

It’s a cheap tactic, designed to pick up votes, and the right wing press immediately came out in support of it. The Daily Mail blamed ‘soulless megapractices’ for ‘Glastonbury style 8am ticket rushes’ – the simple and highly flawed suggestion is that GPs must ‘do more’ and ‘care more’ to improve access to services.

“Targets don’t create doctors,” said Helen Buckingham from the Nuffield Trust, one of many organisations and figures who criticised the target. Former Health Secretary Jeremy Hunt insisted in the Commons that “adding a 73rd national” target for GPs would not address the challenges in the sector. Matthew Taylor Chief Executive of the NHS Confederation simply said the plans “do not go far enough”.

Fundamentally, the UK has a rapidly ageing population with increasingly complex conditions and comorbidities to manage – and it does not have the staff to deal with it. The Health Foundation recently revealed a shortage of full-time 4,200 GPs, with that number projected to rise to about 8,900 by 2030/31. Further, there are 132,000 vacant posts across the NHS. This number includes 47,000 nurses and more than 10,000 doctors.

In the face of these challenges, primary care teams continue to perform remarkably. The latest figures show that GPs carried out 26.6 million appointments in August, up from the previous month and over three million more than in August 2019 – before the pandemic. Nearly half of appointments in August took place on the same day that they were booked and over 80 per cent within two weeks of booking. Almost 70 per cent of these appointments were delivered face-to-face.

Ministers are quick use the pandemic to excuse ominous backlogs in elective care (despite the fact that there were already four million people on waiting lists before Covid-19 hit), and yet they do not offer the same leeway for the primary care sector and continuously fail to acknowledge its achievements.

Primary care was at the centre of the UK’s highly successful Covid vaccine rollout, one of the few genuine achievements of Boris Johnson’s government. All the while the sector maintained impressive rates of service delivery in other areas and managed to rapidly adapt to digital consultations, ensuring that as many patients as possible received care with little to no infection risk.

Rather than support and celebrate a sector that delivered when we most needed it, the government has decided to point the finger at primary care – demanding more from GPs without providing them with the means to deliver.

Unfortunately, initial noises from the current ‘government in waiting’ will have done little to reassure primary care professionals. Shadow Health Secretary Wes Streeting has not only reaffirmed the gas lighting of GPs but has gone a step further, promising same day face-to-face GP appointments to anyone who wants them if Labour were to win power – an announcement already dismissed by the British Medical Association as “not being grounded in reality”.

Even in a political sense, this seems a needless promise to make while the Tories continue to haemorrhage support in all policy areas. A recent YouGov poll suggests that Labour are four times more trusted by the public to manage healthcare – the party should use this political capital to outline long-term health policy that addresses fundamental workforce shortages.

We need our leaders to be realistic and honest with the public about what is possible, and not automatically assume “meeting public expectations” is best for primary care without seeking to manage those expectations.

In the absence of a bona fide, long-term workforce strategy from Westminster, perhaps it is time that we had a government that faced a hard truth: that not every patient should get to see their GP upon request. Patients and end-users should be better engaged with system reform so that they are more aware of the options available to them within health and care and not resort to using GPs for every request – there are simply not enough doctors to see everyone.

Where is the integration agenda?

“This is ‘sugar rush’ politics at its worst. A short-termist approach to governing that is designed to garner a quick dose of public support while the long-term needs of the sector go ignored.”

Political leaders must reaffirm the aims and objectives in the NHS Long Term Plan and indeed the recent Health and Care Bill. In integrated care, there is a principle for care delivery which is designed to segment patients to different parts of the system – delivering them the care that most appropriately addresses their needs while protecting the precious capacity of seriously understaffed and under-resourced parts of the sector.

It is concerning that supporting the development of ICSs, and their focus on addressing health inequality through population health strategies relevant to specific regions, received so little attention in last week’s announcements. If properly supported, ICSs can act as conveners of public services beyond health and care, and so have a huge role to play in revitalising communities and addressing broader inequalities.

The term ‘ICS’ does not appear once in Our Plan for Patients, and the only references to ‘integrated care’ are made in the context of describing integrated care boards as ‘local NHS services’. The whole point of integrated care, i.e., the heart of the government’s flagship health legislation only published two months ago, is to unite a disparate health and care system under a common purpose to improve health outcomes. This of course includes providers within the NHS, but it also includes social care, primary care and wider local government and community care.

As Richard Vize outlined recently in the British Medical Journal, the government has repeated the age-old trope of essentially treating social care as a discharge service for NHS hospitals. Yes, it is true that that a healthy social care sector would alleviate pressure on the NHS, but social care should be so much more than a pressure valve for hospitals.

For many with serious and lifelong conditions, social care is the lifeline that enables them to interact with the world and live with dignity and independence. Politicians who treat social care as a mere afterthought would do well to remember this.

As well as this, the care sector harbours unique insight and intelligence into local health challenges and could provide a hugely meaningful career option for thousands of new recruits. The government should be looking to professionalise the social care sector while helping ICSs to harness the expertise that already exists within it to improve population health outcomes.

There should always be a dual purpose to health reform: addressing immediate challenges while moving towards common, long-term objectives. Immediate problem solving is essential – patients deserve the best possible care that the system is able to give them and right now they are having to wait too long to get it or not receiving it at all. But in purely focusing on the immediate, more visible issues, such as GP waiting times, the government fails to address the root of the problems. The sector needs more staff, better equipment and more resource.

To make matters worse, there are already worrying rumours that the government plans to scrap its obesity targets. Alongside smoking, obesity is one the largest preventable causes of ill health and contributes significantly to cancer rates. Scrapping targets before they have barely had a chance to have an impact makes the promise in this plan to “support people to live healthier lives” ring rather hollow.

This is ‘sugar rush’ politics at its worst. A short-termist approach to governing that is designed to garner a quick dose of public support while the long-term needs of the sector (and ultimately the public) go ignored. It seems that finally the Conservatives have now stopped pretending they have any intention of fixing this very broken health and care system.

It will be of little reassurance that DHSC has already begun rolling back some of these expectations, with the two-week GP appointment target pushed back to the Spring of 2023. The damage has been done, Coffey has drawn her ‘battle lines’, and seeds for a crisis winter like no other for health and care have already been sown. Compounding this is the fact that the government seems incapable or unwilling to provide light at the end of the tunnel in the form of a long-term plan for health and care.

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35,000 patients diverted from primary care through social prescribing hubs

By Rusheen Bansal

NHS Property Services announces the successful delivery of more than 50 buildings and outdoor spaces converted into social prescribing hubs to ease burden on primary care ahead of a winter crisis.

NHS Property Services (NHSPS) has announced the successful delivery of more than 50 buildings and outdoor spaces being used as social prescribing hubs by members of local communities across the country.

The government-owned company has helped local communities up and down the UK over the last three years by identifying, converting, and handing over 54 tailor-made hubs where people can access non-clinical services such as outdoor gyms, sensory gardens, suicide prevention counselling, breastfeeding advisory sessions and ‘toy libraries’ for families to engage in social interaction.

Patients are encouraged to take greater control of their own health and improve their wellbeing in a bid to help reduce mounting pressures on clinical and acute services. Rhea Horlock, Head of Corporate and Social Responsibility for NHSPS comments: “Passing the 50-hub milestone is important progress in our efforts to support NHSE in meeting its targets for 900,000 people to be referred to social prescribing by 2023/24. We are committed to continue to grow our social prescribing programme to bring this valuable support to more local communities”.

It is estimated that about 35,000 people have been able to access services and spaces located at the converted sites since the project began in 2019. This includes patients experiencing a range of physical and mental health issues, including people with special educational needs/learning difficulties and disabilities, people with physical and mental health issues, young carers, asylum seekers and refugees, expectant parents, and adult offenders

This supports NHS England’s announcement earlier this summer to recruit 2,000 link workers to ease the demand on primary care this winter. Hubs like the ones successfully delivered by NHSPS will be a vital component in ensuring the NHS remains resilient as winter pressures are expected to be the worst to date.

One example of this kind of space delivered by NHSPS is The Listening Space in London, set up to provide ongoing face-to-face support available for many people with chronic suicidal feelings, given by well trained and professionally supervised volunteers.

CEO Sarah Anderson CBE shared: “Although The Listening Place was only established five and a half years ago, with a second full time premises opened in partnership with NHSP, and even more Volunteers trained, we are now receiving and responding to more than 500 referrals a month.”

With the NHS Long Term Plan expecting to be refreshed over the coming months, non-clinical interventions such as social prescribing are expected to feature as a core focus for innovation given their proven results to reduce the pressures on primary and acute care. NHS Property Services will continue to support the development of hubs across the NHS estate to support this growing ambition.