A person-centred, digital first approach to recovery

By Patricia Wynn

Ensuring that patient pathways are digitally enabled and person-centred is critical to tackling the elective backlog, writes Patricia Wynn, Director and Sales Leader, International Public Sector Health, Cerner Corporation

NHSE guidance states that “our ambition is to improve core digital and data services in hospitals to ensure we have the basics right.” A leading EPR provider in the UK and globally, Cerner supports systems to reach the minimum digital foundation and strive for HIMSS Stage 7 and beyond.

Cerner work across provider collaboratives to enable shared instances of the EPR. ICS-level collaboration reduces total cost of ownership and enables sharing of resources, such as PMO, training, back office and support. For example, a shared instance of Cerner accelerated provider collaboration across North West London ICS.

Imperial and ChelWest began sharing a domain in 2019 and now London North West and Hillingdon are set to join. According to Kevin Jarrold, ICS data and digital lead, “we have a growing agenda around collaboration across care pathways and the shared domain is absolutely fundamental.”

A shared domain has enabled NWL to gain efficiencies and generate much-needed capacity. Leaders can see across the system and transfer patients more effectively from one site to another. Virtual ward capacity is also managed centrally and embedded into the core EPR. Remote patient monitoring is leveraged from a variety of vendors, with all data feeding centrally into virtual wards created within the core EPR, enabling more efficient workflows and the sharing of virtual care staff.

Prioritising care

The national guidance outlines care must be prioritised based on clinical urgency, the impact of waiting on individuals and potential inequalities. To achieve this, North Central London (NCL) ICS uses Cerner HealtheIntent^®, a data and analytics platform that provides a single longitudinal record for every citizen, comprising data from all health and care organisations across the ICS.

According to Amy Bowen, director of system improvement, “[We built] an elective waiting list dashboard in HealtheIntent. Now we can show GPs for the first time ever what their waiting list looks like. We can cut that data by all the demographic factors, e.g. how many people have long-term conditions and how many? We can look and see by ethnicity, by deprivation – we can combine several factors. And we can actually understand that population at a practice level, at primary care network (PCN) level; by specialty, by borough.”

Transforming care

NHS guidance outlines transformation should focus on flexibility, ease of access and citizen control. Re-envisioning patient pathways – and ensuring they are digitally enabled and person-centred – will be critical. Royal Free London (RFL) has standardised and digitised 40 pathways.

Cerner experts are involved from the beginning of pathway design. Dr John Connolly, CEO of the Royal Free Hospital and group director of clinical pathways shares, “The goal of this ambitious programme is to ensure every patient can get the same high-quality treatment in any of the Trust’s three hospitals… and to create value for the entire healthcare system in the locality – not just our hospitals, but also primary care and public health services in an area that has high levels of deprivation.”

Supporting patients

Ultimately, a person-centred, digital first approach must include the person at the centre. Cerner Patient Portal UK, delivered in collaboration with Induction Healthcare, enables interaction and engagement between caregivers and their populations. A prostate cancer survivor in the Wirral explained, “I cannot emphasise how much the patient portal has improved the quality of my life. Those two weeks of waiting – the stress of revisiting the room where I was given my diagnosis – all that is gone now.”

NHSE’s operating priorities will not be achieved by overworking caregivers and staff, but by enabling them to work smarter and more collaboratively. Contact Cerner Corporation if you share a belief in the power of technology-enabled transformation and want to discuss how Cerner can support your system as in tackling the unprecedented backlog of demand.

Why is technology underrepresented in the training of health, housing and care professionals?

By Tunstall Healthcare

Andy Hart, Head of Delivery and Technical Support at Tunstall Healthcare, discusses why educating health, housing and social care professionals is vital to meet the needs of our growing and ageing population.

People today are living much longer. It’s recently been reported that the UK’s population hit a record with over-65s overtaking under-15s, and by 2030 it is estimated that 1 in 6 people globally will be aged 60 years or over.

But living longer does not necessarily mean living more healthily. Long-term health conditions are more prevalent in older people, with approximately 15 million people in the UK requiring health and social care services for chronic illnesses.

Andy Hart, Head of Delivery and Technical Support at Tunstall Healthcare, discusses why educating health, housing and social care professionals in the benefits and appropriate use of technology is crucial if we are to improve service provision, and why technology continues to be underrepresented in training.

Why technology is underrepresented

The urgent need to invest in preventative services and early interventions to reduce pressures on our services is being increasingly recognised. In fact, almost two thirds (63 per cent) of directors of adult social care recently indicated that their local authorities were taking positive investment strategies in digital and technology.

However, large-scale change involving health and care technology is complex and presents many challenges for the stakeholders involved. Key barriers to successful digital evolution include the budget constraints and the cost of implementing new systems, organisational attitudes towards risk, and the relationships that exist between health, housing and social care services.

Most of these barriers can be mitigated through greater training and the education of professionals. Greater education will help to build partnerships, maximise the use of data, drive cultural change and bring staff on the digital journey, whilst supporting them in their roles.

Investing in education

People are the greatest asset of any organisation and, like any other asset, they need investment and maintenance. The next generation of health, housing and care leaders require support if they are to continue to develop themselves, and therefore their teams and services.

The education of professionals within these sectors is crucial in enabling a cultural shift so that staff understand the value and use of technology, and how it can support them in effective caregiving, as well as improving the quality of life of the people being cared for.

With the right education staff should reap a number of benefits, including becoming more aware of the features of telecare devices, developing confidence in assessing and referring end users to the right solutions, and understanding the positive impact of telecare on working practices.

As the Occupational Therapy programme lead at the University of Lincoln, Carol Duff is significantly involved in the education of Occupational Therapists. She commented: “It’s very important that we give our students the opportunity to gain practical confidence in the use of digital solutions in a safe setting that are essential to support their practice in health and social care.

“Technological solutions may mean our patients are able to remain safely at home for longer and avoid or delay moving into hospital or into care. It is essential that our occupational therapists of the future can confidently and creatively explore digital solutions that may also reduce pressure on the system and release time to care.”

A digital future

With the impending changes to our telecoms network, digital is fast becoming the industry standard to ensure the safety of health and social care services, staff and end users.

New kinds of leadership will be needed to deliver change and evolve governance, while at the same time improving the working lives and motivation of employees. Cementing a cultural shift towards technology driven, outcomes-led approaches is required to achieve this, and in turn, this needs early engagement from professionals and an understanding that technology is designed to provide support, rather than to replace.

By harnessing the benefits of training and education, we can raise awareness of the value and potential of technology across the healthcare landscape, and provide enhanced support to users, carers, professionals and providers.

For more information on educating the future generation of health, housing and social care professionals, please visit www.tunstall.co.uk/training-services.

Digital revolution – the benefits of paperless

By Marvin Douglas

The digital revolution is well underway, and the innovative new technologies utilised by start-ups have completely transformed business operations. However, there is still a significant number of SMEs and larger corporations that are completely reliant on paper. 41 per cent of businesses agree that moving to digital would cut operational costs significantly. However, the heavy initial investment and potential skills gap is presenting a tough hurdle for many organisations.

According to a study by Xerox, 55 per cent of businesses across western Europe and North America are still completely reliant on paper. A similar study found that 70 per cent of these businesses admit that they would fail within just three weeks should key documents go missing. With all this in mind, we look at the key benefits of going digital.

Why risk it?

Words like ‘audit’, ‘security breach’ and ‘compromised data’ are enough to raise the hairs on any businesses neck. Physical documents pose a multitude of problems when it comes to security, there is a huge reduction in the level of control the business has over them. Paper documents can be scanned, shared, and viewed indefinitely by anyone at all.

Research by AIIM reported that up to 50 per cent of businesses surveyed were unsure whether they had ever suffered a security breach due to a complete lack of visibility. Moreover, 31 per cent stated they had encountered poor record keeping to the extent that it would negatively impact regulation checks and audits.

Smarter, faster, stronger

Productivity is a key priority on any business’s agenda, to get the most from their employees a business should endeavour to establish streamlined processes, efficient operations and transparency. Utilising digital document management reduces the amount of time spent looking for required information dramatically.

Digitally stored data is easier to find, and the quality of data collected is improved; through digital templates and pre-agreed parameters companies can maintain consistent data standards universally. Lengthy approval processes and over complicated workflows are also a thing of the past, digital signatures make authorisation and communication much more efficient. The ability to access documents anywhere at any time through a centralised digital solution will reduce the risk of missed deadlines when employees need to work remotely.

Going digital provides a centralised view of all documents. Access can be controlled, allowing only the necessary and authorised employees to view confidential data. Clear trails can be established to monitor the progression and movement of key information and backups are easily created to avoid the heart-stopping loss of key business information.

Cutting the cost

The reason behind most business activity is to protect and improve profitability; going digital also has a compelling impact on a company’s operational costs. US research from The EPA found that companies choosing to go digital could save as much as $80 per employee in printing resources and the efficiencies that come with streamlining manual processes. For a business of 400 employees this is a sizeable saving of $32,000 per year.

Small businesses can benefit too. For smaller, less established businesses the transition to digital is likely to be much easier as there is less physical documentation to convert. This could mean the ROI is visible much sooner. Digitalisation will make the business considerably more agile and responsive, where competition is fierce the need to respond quickly and accurately to customer enquiries, competitor activity and market demand is essential – this is made much easier with visibility and strict organisation.

Going green – not to be barked at

Although this could quite easily be tied into an organisation’s profitability, reducing carbon footprint often comes with more benefits than just lower operational costs. Corporate social responsibility is a hot topic globally and is only set to get hotter. Recent data in the US showed that the average employee uses a staggering 10,000 sheets of paper a year, the equivalent of a 100ft fir tree.

In many cases, a company’s activity surrounding CSR has become an integral part of a prospects decision-making process. For those in B2B, many businesses with strong CSR values will actively seek out equally responsible organisations to purchase from.

Digital revolution requires effective physical device management solutions

As part of the digital revolution, businesses will be investing heavily in the devices that enable the process. The increasing number of physical devices in the workplace such as laptops, Chromebooks, tablets, smartphones, and other media devices means it has become necessary to implement effective physical device management solutions, protecting the longevity of the initial investment.

To find out why LapCabby provides the perfect storage, charging and syncing solutions for your new tech please visit our website: www.lapcabby.com.

The Health and Social Care Committee’s report on the care workforce; what is missing?

By Mary Brown

On 25th July, the Health and Social Care Committee (HSCC) published their report, Workforce: recruitment, training and retention in health and social care.

The report calls for the government to provide its workforce plan for the NHS and social care (promised in spring 2022 but still not yet published), and provides several practical recommendations for the plan. Refreshingly, large sections of the report focus specifically on the social care workforce; a workforce often ignored in conversations around health and care.

The report appropriately recognises the gravity of the situation facing the social care sector, stating that, in comparison to the NHS, “the situation is regrettably worse in social care”, referencing incredibly high staff vacancy and turnover rates and poor working conditions.

Key recommendations in the HSSC report regarding the social care workforce include:

Higher baseline pay for care workers, reflecting the true value to society of the services they provide
Sustainable strategies in terms of pay progression, professional development, and career pathways
Contract choices offered to care workers on zero-hours contracts
A call for the government to produce an externally validated care certificate, provided at no cost to care providers, and is transferable between care providers and the NHS

While the report makes some promising recommendations, it falls short in several areas. On 26th July, Public Policy Projects (PPP) launched its report, The Social Care Workforce: averting a crisis.

This report was based on two roundtables with PPP’s Social Care Policy Network, held in May 2022, made up of key stakeholders in the adult social care sector and a lived experience panel (comprising five individuals with first-hand experience of the social care system). While many of the conclusions and recommendations of the HSCC’s report have parallels in PPP’s report, PPP highlights further areas that the workforce plan should address.

A fairer deal for the social care workforce

The reports from HSCC and PPP are broadly aligned regarding their sentiments and recommendations around pay for care workers. It is evident that care workers must be paid more, and equivalent to, their NHS counterparts.

Both reports therefore include recommendations advocating increases to the baseline pay for care workers, to reflect the true value that care workers bring to society and reduce the number of care workers leaving for better paid jobs in retail, hospitality, or elsewhere. Both reports also agree that there must be pay progression in the care sector in line with that of the NHS Agenda for Change pay scale, providing opportunities for care workers to be paid fairly and to advance their careers.

The two reports agree that terms and conditions, as well as pay, must be improved for social care workers. They acknowledge that zero-hours contracts can provide instability for many adult social care workers, and that care workers do not tend to enjoy the same pension options, sick pay or overtime renumeration as equivalent NHS workers, nor do they receive the public admiration or ‘sweeteners’ (including NHS staff discounts offered by many businesses).

It is no secret that the social care sector is severely underfunded. In order to appropriately pay care workers, both reports agree that local authorities must be appropriately funded to provide the fair cost of care to providers, to ensure that self-funders are not subsidising the cost of workers’ wages. This will require substantial investment from government.

However, PPP’s report provides several additional recommendations for the elevation of the social care workforce. Crucially, PPP’s report focuses on the need for an elevation in the status of care work, to raise the profile of those working in care. The report notes the boost in public sentiment towards nursing that followed Florence Nightingale’s work during the Crimean war, and stresses the need for a similar shift to take place for care work. Not only would this ‘Nightingale shift’ boost staff morale, PPP’s report argues that it would help to address recruitment and retention issues, provided it is accompanied by improvements to pay and conditions.

To kickstart this ‘Nightingale shift’, PPP’s report recommends that the government should provide investment for positive advertising campaigns for social care careers, with clear messaging of the immense value of a career in care and its potential to transform lives. In conjunction with this, it recommends that care providers should be working with careers advisors in schools to promote care work to young people as an attractive and fulfilling career.

Another recommendation in PPP’s report, which was not addressed by the HSCC report, is the potential creation of cross-sector roles between health and care, as well as placements and secondments of NHS staff into social care. This would help raise the status of social care by actualising a parity of esteem between the NHS and social care workforces. It would also serve to increase the awareness and visibility of the social care system within the NHS, and aide in the integration of the workforces.

More training is not a panacea

Training was highlighted as a key area in the HSCC report. However, PPP’s Social Care Policy Network argues in the report that extra workforce training should not be conflated with the wider issues around attracting and retaining staff. PPP’s Lived Experience Panel were at pains to express that constant training and annual training renewal is often a poor use of time and resources and cannot be a substitute for meaningful sector reform.

Where PPP’s report addresses training is in their recommendation around the proposed Social Care Leaders Scheme, dubbed the ‘Teach First’ of social care. The care sector is in need of strong leadership, as registered managers are not always sufficiently prepared or trained for a job that carries substantial responsibility.

The Social Care Leaders Scheme, proposed by a steering group of leaders from the social care sector convened by the CareTech foundation, aims to attract high calibre talent to the sector by training bright university graduates for leadership roles in social care, emulating the successful Teach First model. The report calls for the government to reconsider its position on the partial funding of the scheme, which promises to elevate the sector, provide attractive careers, and improve leadership structures.

The HSCC report also focuses on mandatory Care Certificates, which should be offered, at no cost, to care providers, and are transferrable between care providers and the NHS. This is undoubtedly a sensible recommendation, and PPP’s report further recommends the establishment of a Royal College of Care Professionals. The institution of a Royal College would serve the dual purpose of professionalising the workforce and secure an elevation in its status, as well as providing a central body which can represent, support, and oversee the development of, the care workforce.

Finally, the report by the HSCC makes no mention of a vital section of the care workforce: volunteers. PPP finds that volunteers can greatly alleviate the burden on social care professionals and improve the experience of recipients of care. It is essential that volunteers are included in the workforce equation.

PPP recommends that the volunteer sector should be integrated into the workforce strategy and planning for social care, given the substantial value it provides. Further, it warns that the government must act soon to seize upon the enthusiasm for volunteering that built up during the COVID-19 pandemic.

For a truly comprehensive workforce plan which will truly elevate social care and reduce the immense pressure on the sector, these recommendations must, too, be incorporated. For more information on the report, please contact PPP’s Social Care Policy Analyst, Mary Brown, at mary.brown@publicpolicyprojects.com

News, Workforce July 29, 2022

Could a review of cancer and diagnostics staffing and career pathways reverse waiting times?

By Integrated Care Journal

NHS waiting times for cancer treatment and diagnosis in England are now the longest on record, with the Health and Social Care Committee publishing a report urging the government to take action or risk jeopardising patient care.

At the core of the issue is staffing.

The national shortage of nurses, including cancer nurses, is well known – a problem seemingly exacerbated by the pandemic, with a reported 170,000 NHS staff voluntarily leaving the service in the last two years.

Despite being brought into sharp focus most recently, there has, for some time, been mounting concern among healthcare leaders regarding staffing in cancer care, which is why a group of ten NHS trusts and cancer alliances across South East England have been collaborating on scalable strategies and solutions to overcome their workforce challenges.

In partnership with Skills for Health and Health Education England South East, these local NHS Trusts and Cancer Alliances are blazing a trail when it comes to opening up career pathways, finding new and smarter ways of working and streamlining patient journeys, with the aim of transforming cancer care and diagnostic services.

East Sussex Healthcare (ESHT) is one of the NHS Trusts in question and has been a pioneer in the creation of a range of new roles to support Consultants, Doctors, Nurses and Allied Health Professionals (AHPs) caring for patients on the cancer and diagnostics pathway.

Building upon their award-winning rollout of band 3 Doctors’ Assistants across the Trust, which cut the administrative burden of doctors in half, EHST have also developed other new roles to support cancer and diagnostic services.

A new approach to recruitment

Having experienced difficulties recruiting Endoscopy Nurses for its two endoscopy sites in Eastbourne and Hastings, ESHT took the decision to develop the band 3 Endoscopy Assistant role to work alongside an Endoscopist and ease the pressure on its Endoscopy Nurses.

The impact of this new role has enabled EHST to support cancer wait times, says Service Lead for Endoscopy Sue Winser.

“ESHT handles 21,800 cancer referrals, 283,000 X-rays and scans and 7 million pathology tests every year, including 14,500 endoscopy procedures, so the pressure is on.

“Easing the burden on existing staff is crucial in a tight labour market, where specialist skills are in short supply. Our pilot has reduced the need for two nurses being involved in any one procedure – this has massively freed up nursing time, enabling our team to see more patients.” she continued.

Also embracing new roles and routes into cancer care and diagnostics support is University Hospital Southampton NHS Foundation Trust (UHS).

With UHS’s pathology departments handling over 6 million clinical laboratory requests a year, it is hoped that by offering enhanced career progression the Trust will reap its rewards in terms of staff recruitment and retention in harder to recruit services.

Among the various different apprenticeship standards adopted by UHS, the new level 6 Healthcare Science Practitioner apprenticeship provides a platform to achieving the BSc in Biomedical Science and undertaking the role of band 5 Biomedical Scientist.

An evolving workforce

The threat of a mass shortage of cancer nurses including Cancer Nurse Specialists has similarly prompted a rethink of career progression routes by Thames Valley Cancer Alliance (TVCA).

Bringing together cancer leaders, commissioners, service providers and third sector organisations, TVCA takes a whole population approach to improving cancer services across the three Integrated Care Systems of Buckinghamshire, Oxfordshire and West Berkshire (BOB ICS), Bath & North East Somerset, Swindon and Wiltshire (BSW) and Frimley Health and Care ICS.

Key to the approach of TVCA has been to raise the visibility and awareness of careers in cancer. This includes the roles of band 5 nurses as well as of Cancer Nurse Specialist and the Nurse Consultant.

“Faced with an ageing workforce, we took the decision to create a visible cancer nursing (and Allied Health Professional) career progression route from pre-registration nurse through to registered, enhanced, advanced, consultant and strategic leadership to encourage specialisation in this vital field of healthcare.” said Lyndel Moore, Lead Cancer Nurse.

“We want to align to the national Aspirant Cancer Career and Education Development Programme (ACCEND) and in the interim we are supporting the development and training of the different roles for Allied Health Professionals and Cancer Nurse Specialists.’’

Bringing down waiting times

The Royal Berkshire Breast Cancer Service in Reading, which is part of TVCA, has seen patient numbers increase over the last five years. 555 patients were diagnosed with new primary breast cancer in 2021, and a further 211 patients with metastatic breast cancer are in the overall workload, meaning that a total of 1339 breast cancer patients are being monitored by the Centre’s follow-up pathway.

To meet this demand, the Centre conducted a review of the breast cancer pathway and the cancer nursing and other staffing requirements needed to support it.

The Nurse Consultant role was identified as being key in the pathway, and this advanced role, which is embedded in practice, enables care of the patient at an independent autonomous level.

With advanced clinical decision–making and a non-medical prescribing role, running independent chemotherapy and follow-up clinics, giving patients results and discussing treatment options, the Nurse Consultant plays an essential role against the backdrop of a national shortage of Oncologist Consultants.

Better use of resources coupled with clearer career progression routes has provided a platform for Great Western Hospitals NHS Foundation Trust (also part of TVCA) to expand patient support by setting up a new ‘Personalised Care Service’ with the help of Macmillan Cancer Support.

The Service, launched in 2021, is designed to look holistically at the needs of cancer patients, enabling them to self-manage their illness better. The Service received 60 referrals in its first three months alone and is, according to Cancer Nurse Specialist Michelle Taylor of the Macmillan Personalised Care Team, proving highly beneficial in streamlining patient pathways.

“Some newly diagnosed cancer patients can feel overwhelmed and anxious about their diagnosis and pathway. The Cancer Nurse Specialist teams are now able to refer to the Personalised Care Service so we can all work together to help their needs and offer tailored support for improved health and wellbeing requirements.”

Staffing capacity to undertake diagnostic imaging (such as x-rays and scans) too is essential for patients on the cancer pathway and to meet demand for routine imaging.

With the challenges of an ageing workforce, Trusts in the Surrey and Sussex Cancer Alliance (SSCA) struggled to recruit both diagnostic and therapeutic radiographers, before deciding to take a fresh approach to workforce planning.

Rethinking career progression

It was recognised that existing roles had a lack of career progression opportunities. This prompted the Sussex Imaging Transformation Workforce Group – representing services across the region – to facilitate a patient pathway-mapping workshop, which identified a shortfall in the workforce required to undertake routine, elective computerised tomography (CT) examinations.

As a result of this exercise, a competence map was developed with the aim of increasing the skill mix and consistency of roles to meet service needs. Furthermore, it identified the need for a career framework across the CT pathway and to support new roles across the diagnostic workforce, such as the Radiography Department Assistant as an entry point.

Dawn Probert is a Senior Consultant at Skills for Health and has been leading on the project along with Health Education England South East. She comments:

“Workforce planning is crucial to identifying and alleviating blockages in the system that delay diagnosis and treatment of cancer patients.

“Now more than ever, detailed skills analysis and robust workforce planning is required if cancer and diagnostic services as a whole are to meet patient demand in the medium to long-term.

“What this regional project has demonstrated is that there are many positive and transformational approaches and roles which have been developed and utilised to finding solutions to the recruitment, retention and training of the workforce to improve cancer patient journeys and diagnostic services.

“Designed to be scalable, they offer NHS trusts and cancer alliances nationwide innovative tools and strategies to get to grips with recruiting, retaining and developing staff and to meet the increasing demand for cancer and diagnostic services and improve patient care into the future.”

Skills for Health, in partnership with Health Education England South East, has developed 10 cancer and diagnostics workforce case studies and an accompanying Resource Guide to showcase the work of NHS trusts and cancer alliances across South East England. To find out more about the innovative tools and strategies they developed to help with recruiting, retaining and developing staff and to meet the increasing demand for cancer and diagnostic services visit: https://www.skillsforhealth.org.uk/info-hub/cancer-and-diagnostics-careers/

All news

North Lincs and Goole replace data warehouse in preparation for shared digital services across region

By Integrated Care Journal

NLaG chose Insource as strategic data management partner – initially as unified data foundation across three hospitals and community services.

Insource has been chosen by Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) as its foundational data management platform and ultimately as a joint strategic solution in its move towards shared digital services with partner trust, Hull University Teaching Hospitals NHS Trust.

The partnership falls under the NHS Digital Aspirant programme, which is providing funds to nearly 60 NHS trusts to facilitate digitisation and help deliver a set of core digital capabilities. It is hoped that Insource’s platform, Health Data Enterprise, will see a significant upgrade to NLaG’s ageing data infrastructure system.

Christopher Evans, Associate Director of Information Systems, for NLaG commented, “whilst this is initially about replacing our ageing data warehouse, the core decision is primarily to ensure strategic alignment and collaboration between our two organisations. We already have a shared vision between NLaG and HUTH and we will be merging onto a single platform across both organisations within the next couple of years. What Insource gives us is data consistency and continuity of reporting across the wider regional footprint while we redesign clinical services and pathways to meet our integrated care goals.”

Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) serves a population of more than 450,000 people covering North Lincolnshire, North East Lincolnshire and East Riding of Yorkshire. The Trust runs three hospitals: Diana, Princess of Wales in Grimsby, Scunthorpe General Hospital, Goole and District Hospital and also provides a range of community services across North and North East Lincolnshire.

More groups join call for fairer deal for social care

By Gabriel Blaazer

As the race to become the next Conservative leader and Prime Minister of the UK heats up, and the government accepts the recommendations from the independent NHS pay review bodies in full, Care England and Access for Social Care have urged the government to act to protect the standing of social care workers, in statements issued yesterday.

The calls echo recommendations contained in a summary document of a recent Public Policy Projects report on integrated care. The report argues that the social care sector should be placed on an equal footing with the NHS, both in terms of its representation within integrated care partnerships and investments made to accelerate digitisation and modernisation.

Representative groups are increasingly urging the government to ensure suitable plans are in place to protect social care, amid an increasingly dire workforce shortage that is threatening the sector’s ability to provide its services. Vacancy rates in social care (9.5 per cent in January 2022) remain stubbornly above the national average (4.4 per cent from December 2021 to February 2022), while more than 400,000 social care workers left their roles in 2021.

A fairer deal for social care must be a priority

On Tuesday 19th of July, the government accepted, in full, the recommendations of the independent NHS pay bodies, meaning more than one million staff who fall under the Agenda for Change contract will receive a pay rise. This includes nurses, midwives, and paramedics, who are set to benefit from a pay rise of at least £1,400 this year, backdated to April 2022.

Groups who represent and advocate for the social care sector are now urging the government to implement a similar deal for care workers.

While rates of pay for social care work have increased in real terms since 2014, the rate of increase has not kept pace with other sectors, decreasing the social care sector’s ability to compete in the jobs market. Data shows that when overall national employment rates fall, vacancies in social care rise, suggesting that the sector is struggling to attract and retain workers.

The King’s Fund cites “high levels of staff vacancies, sickness absence, turnover, and work-related stress [as] having a damaging impact on staff,” and calls “the case for a fully funded, multi-year health and social care workforce plan… overwhelming.” Although many of these factors were exacerbated by the Covid-19 pandemic, the King’s Fund and other groups maintain that they long predate the pandemic and are the results of successive governments neglecting the social care sector.

In October 2021, the Workforce Recruitment and Retention Fund made £162.5 million available to local authorities to help recruit and retain social care workers, along with a further £300 million in December 2021. However, both funds lapsed in March 2022.

A neglected care sector

Poor staff retention is being further compounded by increased pressure on the social care system. The number of new requests for social care support have increased by 5.6 per cent, while costs have risen by more than a quarter, with areas with higher levels of deprivation being disproportionately affected.

Lack of available social care capacity is also increasing pressure on the acute hospital sector as hospitals have fewer methods of discharging patients safely. This is causing unsustainably high hospital occupancy rates and serving to undermine the wider healthcare system.

In a statement issued yesterday, CEO of Access Social Care, Kari Gerstheimer, warned about a “complete lack of discourse about the future of the social care system,” in the current leadership race, and claims the outgoing Prime Minister, Boris Johnson, has all but abandoned his pledge to “fix social care once and for all.”

The concerns mirror those expressed by UNISON Social Care Lead, Gavin Edwards, who said on Wednesday that “the scale of vacancies is alarming, and not just for those who rely on care and their families. The sorry state of social care is having a disastrous effect on the NHS, causing massive treatment waits, letting down patients and putting unbearable pressure on health staff.

“The care sector is acutely underfunded. Wages are way too low leaving staff unable to cope with the rising cost of living. Supermarkets are paying better rates without the stress, so it’s no surprise that people are jumping ship.”
In Care England’s statement, released on Thursday, Chief Executive Professor Martin Green OBE, said: “The adult social care workforce is our biggest resource. The lack of government action has had an inevitable consequence on the nature of employment opportunities within the sector and has hampered providers’ efforts to recruit and retain staff, as evidenced by the 52% increase in vacant posts in the sector over the past year. This has not only affected the overall financial attractiveness of the adult social care sector as an entity, but also providers’ ability to compete with the NHS.

“As a first step, Care England suggests the Government accepts the recommendations of the Low Pay Commission for the 2023 rates, however, this increase must be properly funded. Simply applying National Living Wage inflation without appropriate funding undermines the ability of providers to aid workforce pressures, especially given the fact that providers are having to pay increases above the National Living Wage annual uplifts as a means of recruiting and retaining staff.”

Kari Gerstheimer added that ”as Sunak and Truss fight it out, there is everything to play for by way of their approach to Health and Social Care. The Association of Directors of Adult Social Services has warned that the year ahead will be the most challenging people needing and working in adult social care have ever faced. I am saddened, however, to see social care being kicked down the road with little mention of any commitments from either leadership contender about the future of the social care system.

“Failure to invest in social care amounts to poor fiscal planning and inefficient use of taxpayers’ money – it harms our productivity because people with unmet social care needs can’t reach their potential, and unmanageable caring roles keep people out of work. It harms those working in social care, who are choosing to leave the sector because of problems with pay. And it harms our health system because a failure to invest early in preventative social care leads to more crisis admissions in critical care.”

Emil Peters discusses the next steps for the health and care technology sector

By David Duffy

Emil Peters speaks to Integrated Care Journal

Recently appointed CEO of Tunstall Healthcare, Emil Peters speaks to ICJ about the future of telecare and telehealth and the impact of a seismic era of system transformation for UK health and care.

“Great advances in medicine have been made during periods of immense stress and strain,” says Emil Peters, recently appointed Tunstall CEO. Peters finds himself at the helm of the largest social care technology provider in the country during a period of critical reform for the health sector. “A lot of our early medicinal advances originated from battlefields and war injuries,” explains Peters and the pandemic, he insists, has been the latest catalyst for change in the health sector – but the reform has not come from new antibiotics or medicines, but a newfound acceptance of the value of medical technologies, such as telehealth.

“Tunstall today has become an integral part of a constantly evolving definition of health and care“

Peters, who moved to Tunstall after 25 years at health technology giant Cerner (the last five of which were spent as President of the International markets), is no stranger to major upheaval in health reform – but even he would admit that the current period of turbulence is unlike any other the sector has faced. He enters his new role as the UK government releases a slew of policy reforms, with the intention of turbo charging a digital and data led transformation of the health and care sector. The latest paper Digital revolution to bust COVID backlogs and deliver more tailored care for patients, places telehealth as a central priority of the government’s digital transformation of the sector.

Peters likens Covid-19 to a dark cloud with a silver lining, “the pandemic has given us lived experience of technology, forcing our lives to be lived through screens whether they be your phone or whether they be your computer or your television.” Interestingly, Tunstall began as a Yorkshire based television repair company but has since grow to over five million users globally and almost two million in the UK alone, becoming one of the biggest players in telecare in the process. Now, Peters hopes to use this position of strengths to take on a newfound leadership position within the sector, helping to drive technology based transformational change, enhancing access to health care to disenfranchised communities and reducing rampant health inequality across the country.

At one point, the health tech industry was still arguing with hospitals as to the benefits of using digital over paper-based methods. Today it is widely accepted that telehealth is now central to the evolution of the concepts of health and care. “Through being able to connect patients and carers in the broadest possible terms, Tunstall today has become an integral part of a constantly evolving definition of health and care,” affirms Peters.

Evolving telehealth in an ICS context

If Covid was the “slap in the face” as to the value and potential of health and care technologies, then the prospect of integrated care in the UK could prove to be the mechanism which permanently embeds technology like telecare and telehealth into care pathways.

Each integrated care system (ICS) has placed preventative and personalised care, defined through population health management approaches, as central priorities to care delivery. In many ways, telecare and telehealth could be the glue that connects ICS wellness strategy, via enhanced access to care and reduced strain on healthcare services.

“The pandemic reminded all of us of the value of working together”

Previous barriers to technology adoption are being eroded in favour of holistically implemented transformational change and the rapid growth of the telehealth sector is helping to shift discourse away from simply reducing acute sector pressures. Priorities are now shifting towards maintaining good health for people as long as possible, keeping people healthy and supporting them in the best version of their life as they define it.

“Among many other things, the pandemic reminded all of us of the value of working together. Previous hesitations to collaboration have held the sector back – but these barriers are gradually being eroded and this collaborative momentum has manifested itself in the integrated care agenda.

“In the same vein that we used technology for our supply and demand calculations for the testing of PPE, we now need to think about that in terms of cancer, orthopaedics, neurology, all the other things that we need to be bringing to people because frankly, we kind of went away with that.”

A new era for health and care technology?

Peters considers the current moment a once in a generation opportunity to shift norms. “Historically the system has found ways of preserving itself. We were constantly training for trying to find ways to preserve what we have. Business as usual is no longer an option.”

“I’ve seen a lot of ‘tech for tech’s sake’, and those endeavours tend to be like shooting stars. They burn bright and they fade away“

“Telehealth can enable clinicians to see the people they need to see. It allows people within the clinical space to operate to the top of their licence. And it allows me as a son and as a neighbour to operate to the top of my licence when caring for loved ones. Technology like telecare can help me check in on my elderly neighbour, to check in on my mother, who lives in San Antonio, Texas, thousands of miles away.”

Peters’ bread and butter is facilitating health and care innovation but his focus with Tunstall will be less on the outright ‘technical innovation’. Rather, Peters is interested in innovating the constructs of how they apply technology. “Our focus is much more centred on value. What is the value of what we’re about to go do? Is it just tech for tech’s sake? Or is there a clearly defined purpose in mind?”

Peters wants to move the sector from a ‘thousand flowers blooming at once’ mentality to innovation, and towards a focused approach built upon consistent standards. “I’ve seen a lot of ‘tech for tech’s sake’, and those endeavours tend to be like shooting stars. They burn bright and they fade away. But the innovations that really produce value for the provider, for the person, for the family, those are the things that that will truly be lasting.”

“It’s up to us, how much we harness this moment,” insists Peters, who warns that a complacent approach to innovation risks returning to a ‘business as normal scenario’. “Are we going to try to fight to go back to the way that we did and run our outpatient clinics the way that we had? Or has this given us a new view on how things can happen? Clinicians want and need to spend time with the people that truly need attention from someone of their levels of qualifications and who can truly have an impact.”

In Peters’ mind, the impact that is needed with technology cannot be understated insisting that, “it must become this century’s version of a clean water supply for the health and care sector.”

In September 2022, Tunstall will be joining ICJ and PPP for the ICS Roadhshow, a series of regional conferences to discuss the progress of integrated care at a localised level. To find out how to get involved, please visit our ICS Roadshow homepage.

Digital communications tool provides solution for healthcare data protection

By Joost Bruggeman

Joost Bruggeman, former surgery resident at Amsterdam University Medical Centre, and CEO and co-founder of Siilo, discusses how secure digital communications tools can ensure patient confidentiality and solve healthcare data protection issues.

Instant messaging apps have become essential tools in our daily lives – their convenience, reliability and sheer ubiquity have transformed how most people communicate, both socially and professionally. At the height of the pandemic, their value within the healthcare sector became even more pronounced, as they enabled rapid information-sharing to help medical professionals learn how to deal with a hitherto unknown virus.

In these circumstances, medical staff came to appreciate the benefits of being able to share details about individual patient cases, including photographs and other sensitive medical data. It facilitated timely and seamless collaboration, without which many more lives would have been lost.

The benefits of ‘off-the-shelf’ messaging apps, however, don’t come without risks. Within the medical sphere in particular, a mistaken message could put patient confidentiality and data protection in jeopardy, while threatening one of the most fundamental aspects of healthcare ethics.

Overcoming data protection issues

Since instant messaging apps are clearly of value within the health and social care sectors, a solution is needed to overcome data protection issues. In fact, this challenge was understood some time ago, and was a key influence behind the development of specialist healthcare apps such as Siilo, which places data security and medical compliance at the heart of its development.

Designed specifically for healthcare professionals, Siilo undertook the task of preserving the usability that people expect from the technology, while simultaneously ensuring that patient data could be exchanged safely and compliantly.

Paul Cowley, Chief Information Officer at St. John & St. Elizabeth Hospital (HJE) in St. John’s Wood, London, recognised the importance of adopting a messenger service which has been tailored to the healthcare sector’s unique challenges. “Timely, effective and safe patient care often requires rapid communication with multiple clinicians and sometimes offsite. A secure, easy-to-use app is needed to facilitate this level of care.

“While temporary guidance was issued during the pandemic that allowed the use of well-known commercial messenger services to help reduce the risk of patient care being compromised, as a hospital we recognised that such services increase risk both in terms of patient data security and patient care, particularly because of the need to anonymise communications wherever practical.”

Security and compliance

Unfortunately, many health and social care professionals and organisations are unacquainted with these issues. Indeed, a survey by the European Heart Rhythm Association (EHRA) revealed that 88.3 per cent of its members regularly use commercial instant messaging apps, like WhatsApp, for sharing clinical information with medical colleagues, yet 29.3 per cent admitted they were unaware of EU data protection regulations. A further 46.7 per cent indicated there are no regulations in place at their institution regarding the sharing of clinical data via instant messaging.

Given that specialist tools have been developed, why are they not mandated among healthcare professionals? The problem is that many health and social care providers still don’t understand the risks involved with off-the-shelf messaging apps because of a simple failure to differentiate between security and compliance.

The basic promise of ‘end-to-end’ encryption, which is offered by the best-known messaging apps, certainly provides a strong element of security. It means the servers of the vendor cannot decrypt the message data even if they wanted to because they don’t have access to the encryption keys that belong to this encrypted data. However, this only applies to data while it is ‘in transit’ from one phone to another. What happens when the data is ‘at rest’, i.e. delivered to a phone or other device?

After a phone receives a message, several synchronisations take place with common messaging apps;photos and videos are synced automatically to the photo library of the phone, where the media is not encrypted; all conversations are backed-up by default and automatically go onto the cloud services of the phone provider – where message data is also stored unencrypted. As such, all these unencrypted conversations are exposed to unauthorized third parties.

Importantly, the professional who makes the decision to share information about their patient is always held responsible for protecting the patient’s confidential data. On a messenger app, this remains the same – the sender is always responsible and therefore needs to have control of what happens with the information on the receiving end of that communication. This control is often not possible and means many conversations taking place over common messenger apps are not compliant with medical confidentiality laws.

This is a huge problem because it becomes impossible for any healthcare professional sending an instant message on most services to be able to guarantee patient confidentiality. A way which is often used to get around this is to anonymise patient information within communications, but this also brings problems.

As recognised early on by Paul and his team at HJE, if healthcare teams cannot clearly identify which patient they are communicating about, it will almost certainly lead to confusion and mistakes. Since all healthcare professionals have sworn an oath to “do no harm”, this risk is often one not worth taking.

Communication and collaboration

For staff at HJE, Siilo has become a key tool in improving communication and collaboration between staff, and therefore improving patient care. A good example of this can be highlighted via its use in supporting the hospital’s Urgent Care Clinic (UCC), which is also helping to drive adoption in other departments.

“If a UCC doctor feels the need for input from a specialist consultant or the patient needs onward referral to a consultant, the UCC doctor can now use Siilo to contact a relevant specialist consultant rapidly and securely wherever they are.”

It is also proving to be an invaluable component in the day-to-day running of its medical team. “Siilo is now the ‘go to’ for some of our multi-disciplinary team meetings (MDTs). It solved a problem with a desire to increase the frequency of our MDT meetings without placing undue burden on the clinicians that contribute.

“It also allows ad-hoc MDT meetings where clinical circumstances dictate a patient’s case needs a review ahead of the next scheduled meeting. The messenger app allows clinicians to collaborate securely and contribute from whatever location they are working, regardless of their diary commitments.

We know the opportunities for the app are vast and since adoption, we are already seeing options becoming wider and wider, with more exciting use-cases being frequently put forward by staff.”

A growing number of healthcare organisations in the UK are recognising the tremendous benefits offered by digitalisation to the healthcare sector. While this is encouraging, it is essential that tools and technologies are truly fit to meet the standards expected. For communications technologies, this means applying absolute rigour to ensure patient confidentiality.

Joost Bruggeman is a former surgery resident at Amsterdam University Medical Centre and now CEO and co-founder of Siilo. For more information, please visit www.siilo.com.

For more information about St. John and St. Elizabeth Hospital, please visit: www.hje.org.uk

NHS leaders offered free access to resource to help address air pollution across England

By Gabriel Blaazer

A new resource is to be offered to every NHS Integrated Care System (ICS) to support their development as ‘Clean Air Champions’.

Data confirms that everyone in the UK is exposed to the threat of air pollution, with more than 97 per cent of postcodes in breach of at least one World Health Organisation (WHO) limit for toxic pollutants.¹

This includes vulnerable environments such as healthcare settings, including the one million people who attend GP appointments every day in the UK and the approximately 16 million people who travel to major A&E departments in England every year.²

In the UK, 36,000 premature deaths per year are caused by air pollution, one in five of all premature deaths, and tackling air pollution will be a vital strand of integrated care systems’ (ICS) efforts to address and reduce environmental determinants of poor health.^3,4

Launched at the NHS ConfedExpo, the ICS Clean Air Framework is a practical tool that empowers healthcare leaders to take action on cleaner air and has been developed to support every ICS in England to become a ‘Clean Air Champion’. Joining forces to drive the initiative forward are the environmental change charity Global Action Plan, Newcastle Hospitals and Boehringer Ingelheim. The Framework is freely available to all 42 ICSs nationally to aid the development of an action plan to improve air quality around all healthcare access points in England.

The Framework links to the mandated requirements of Green Plans, the NHS Standard Contract, the Delivering a greener NHS report and the UN’s Sustainable Development Goals. The tool supports the newly established ICS healthcare leaders to incorporate air quality improvement measures around hospitals and health hubs as part of their broader commitment to address environmental challenges.

The Framework launch coincides with Clean Air Day on June 16th, which this year reveals how air pollution impacts almost every organ in the body. Professor Sir Stephen Holgate, Special Advisor on air quality to the Royal College of Physicians and UKRI’s Clean Air Champion, explains “Air pollution is an invisible killer and plays a role in many of today’s major health challenges. The ICS Clean Air Framework is a ground-breaking resource to support the NHS in implementing air quality improvement initiatives that will ultimately protect the health, wellbeing and economic sustainability of today’s communities and future generations.”

The Framework is being pioneered by Newcastle Hospitals, who are first to drive the development of an action plan in their region. James Dixon, Associate Director of Sustainability at Newcastle Hospitals, explains “The NHS has an opportunity to lead by example and set the benchmark for clean air and safe workplaces. Through the creation of an action plan guided by the ICS Clean Air Framework, here at Newcastle Hospitals, we are already making progress and seeing direct benefits to our communities.”

Larissa Lockwood, Director of Clean Air, Global Action Plan, explains how the ICS Clean Air Framework can support healthcare leaders in taking action: “Air pollution kills seven million people globally each year, which is more than malaria, HIV/AIDS and obesity combined.^5,6,7 It is a public health crisis that needs immediate action from the health sector. It also cannot be right that our most vulnerable are exposed to it in our places of care – is it fair that a baby must take its first breath in a polluted environment? By developing this framework and working at the Integrated Care System level, we have the opportunity to tackle some of those area-wide issues, empowering healthcare leaders to pursue action on air pollution to secure a healthier future for their region.”

Uday Bose, Managing Director at Boehringer Ingelheim UK & Ireland, explains the impact of the project both now and for future generations, “People who are already suffering with poor health are most at risk of the detrimental effects of air pollution, so this initiative plays an important role in addressing health inequalities. Our commitment to transforming lives goes beyond the provision of medicines, as this initiative clearly illustrates. It also demonstrates the power of partnerships and delivers a real opportunity to create a healthier future for families, the NHS and the planet.”

The ICS Clean Air Framework aims to provide healthcare leaders with a platform to drive positive change and support the implementation of initiatives to improve air quality, without adding to the administrative burden. The NHS net zero targets are as ambitious as possible and are supported by the need for immediate action and commitment to continuous monitoring, evaluation and innovation. It is therefore critical that key stakeholders and local authorities work collectively to turn ambition into action.

More information regarding the Integrated Care for Cleaner Air initiative and the ICS Clean Air Framework is available from today at www.actionforcleanair.org.uk/health/ics-framework.

¹ addresspollution.org. 2022. Providing the public with the most accurate air pollution data available. [online] Available at: <https://www.addresspollution.org/> [Accessed 26 May 2022].

_{2</sup)The Kings Fund. 2019. Key facts and figures about the NHS. [online] Available at: <https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs#what-does-the-average-day-in-the-nhs-look-like> [Accessed 12 May 2022].}

³GOV.UK. 2019. Public Health England publishes air pollution evidence review. [online] Available at: <https://www.gov.uk/government/news/public-health-england-publishes-air-pollution-evidence-review#:~:text=Air%20pollution%20is%20the%20biggest,lung%20cancer%2C%20and%20exacerbates%20asthma.> [Accessed 26 May 2022].

⁴Who.int. n.d. Air pollution. [online] Available at: <https://www.who.int/health-topics/air-pollution#tab=tab_2> [Accessed 25 May 2022].

⁵Who.int. 2022. Fact sheet about malaria. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/malaria> [Accessed 25 May 2022].

⁶Who.int. 2021. Obesity. [online] Available at: <https://www.who.int/news-room/facts-in-pictures/detail/6-facts-on-obesity> [Accessed 25 May 2022].

⁷Who.int. 2021. HIV/AIDS. [online] Available at: <https://www.who.int/data/gho/data/themes/hiv-aids> [Accessed 25 May 2022].