Why value-based procurement is key to cutting costs and improving outcomes: learning from Lincolnshire


Alison Wileman is a Market Access Specialist – Continence at health and hygiene product provider, Essity, Specialist Nurse at Bladder and Bowel UK, and Trustee at ERIC, The Children’s Bowel and Bladder Charity. She is also former chair of the Royal College of Nursing’s Bladder and Bowel Forum.

For as long as universal healthcare has existed in Britain, the debate between the cost and quality of care has simmered – and at times – raged on.

Depending on how well the government of the day has balanced the books, the needle would often oscillate between cost-cutting measures for a cash-strapped services – in which quality of care is inevitably among the first casualties – or a healthier healthcare system where positive patient outcomes are prioritised.

But, as the NHS continues to suffer unprecedented pressures in the wake of the global pandemic and systemic shortages in resources and capacity, it’s clear, at present, where the needle is firmly pointed.

And while the crisis in our healthcare system undoubtedly demands a degree of money-saving measures, there does often exist a false economy in this equation which needlessly sacrifices patient outcomes only to return a higher bill for the taxpayer.

Redefining ‘value’

Take the endemic issue of incontinence, for example, which affects an estimated 14 million people in the UK today. A groundbreaking pilot conducted at care homes by the Lincolnshire Community Health Services (LCHS) in partnership with global hygiene and health company, Essity, revealed that ‘the NHS is leaking more than half a billion a year through substandard incontinence care’.

At the crux of the eight-week study was the crucial finding that the cheaper, blanket provision of generic absorbent pads – chosen on their low upfront cost and prescribed en masse to manage incontinence – resulted in a higher overall cost of care than more premium, yet clinically more appropriate, products.

This was because, as researchers found, patients using so-called “cost-effective” pads were far more likely on average to suffer up to 2.5 leakages per day, requiring the use of more products, and in turn – a greater time demand on typically overstretched carers and community nursing teams to replace patients’ pads, laundry of bedding and clothes, as well as other sanitising costs.

By contrast, continence pads prescribed based on an individual assessment of patient need, while generally resulted in the use of more expensive products, delivered a drastic reduction in overall service spend across participating care homes – bringing the average cost of daily care down from £15.33 to £6.68 per patient. Through appropriately prescribed products, patients experienced an average of just 0.5 leakages per day, which significantly reduced carer time and associated costs.

Equally important were the significant health improvements experienced by patients. The pronounced reduction in leakages had the welcome effect of a decrease in urinary tract infections, falls and hospital admissions linked to urinary urgency, as well as poor fluid intake that typically afflicts elderly patients with continence challenges. Quality of life was also enhanced, as fewer leakages led to an 18 per cent increase in patient self-toileting.

Delivering long-term value

This plethora of positive patient outcomes as a result of appropriately prescribed pads also, unsurprisingly, translated into greater carer satisfaction. Across several core functions, including ease of product application and removal, and whether the pad helped avoid unnecessary patient moving, the pilot’s core aim to replace cheaper products with more clinically appropriate pads saw a surge in satisfaction scores among carers.

This approach, modelled on the principles of ‘value-based procurement’, is key to understanding the resounding success in cutting costs and improving patient outcomes across participating care homes in Lincolnshire. By centring patient needs and considering the overall cost of care across the patient pathway – as opposed to the procurement orthodoxy’s obsession with the lowest possible price tag – services can significantly reduce outlays in a budgetary crunch. And, critically, not only does the typical trade-off between costs and patient care disappear entirely – but the latter is in effect considerably improved.

With more than 160,000 people in the UK with continence challenges living in care and nursing homes, it is vital that the instructional lessons from Lincolnshire are learned, generalised and adapted across the country.

While the government has committed to the adoption of value-based procurement across the health and care system, in reality, uptake by purchasing and procurement managers and individual integrated care systems has been far too sluggish, and at the continued expense of patients.

And while news of government’s further exploration of value-based procurement for continence care is welcome, more must be done practically to accelerate the institutional shift towards a practice that prioritises patient care and outcomes as well as service costs.

Further clear and consistent guidance from the Department for Health and Social Care and NHS England would no doubt strengthen this strategic steer. While at the granular level, reform of the NHS procurement framework to prioritise patient outcomes and the overall cost of care would supercharge the transition.

Lincolnshire’s pilot has proven beyond doubt that a value-based procurement approach to continence care delivers for patients and services. It’s crucial now that the wider health and care system follows the evidence and changes for good the way continence care is provided across the country.

Health Inequality, News

Report highlights potential of pharmacy sector in tackling health inequalities


The report from Optum identifies the barriers holding the pharmacy sector back from an enhanced role in addressing health inequalities and issues recommendations to allow the sector to take a more prominent role in tackling persistent disparities.

A report from health service innovation company, Optum, has called for an enhanced role for the pharmacy sector to help drive progress on health inequalities. The report, Action on health inequalities: Perspectives from the pharmacy profession, finds that there is an appetite within the sector to contribute more to the health inequality agenda, but that it is stymied by systemic issues and day-to-day challenges which make it difficult to go beyond day-to-day functions.

The report describes the key insights garnered from a roundtable discussion that took place in October 2023. Around 30 senior pharmacy professionals attended the roundtable from across primary and secondary care, integrated care board (ICB) leadership and community pharmacy to answer the question “how can pharmacy and medicines teams take a leading role to close the gap on health inequalities in their communities?”.

Participants were asked to give their views on a range of subjects, including how to define pharmacy’s role in tackling health inequalities; the opportunities for pharmacy professionals to achieve better outcomes for marginalised groups; the barriers from preventing pharmacy from making a broader contribution within their integrated care systems; and possible measures that would enhance the sector’s influence on the health inequalities agenda.

The report makes five recommendations to the pharmacy sector around how it can be empowered, and its role enhanced to help deliver health inequality improvements. These are:

  1. Create a stronger, system-wide understanding of the value pharmacy can bring.
  2. Achieve greater coherence and impact by building a single professional voice.
  3. Give pharmacists the means to make better use of data in a safe, smart and sensible way.
  4. Enhance the training and continuous professional development opportunities available for pharmacists.
  5. Put patients and citizens at the heart of everything we do.

Reframing the value of pharmacy

Pharmacy and medicines management have assumed increasingly prominent roles in recent years, and the two have been placed at the heart of the drive to improve preventative services and tackle health inequalities in the NHS in both the Major Conditions Strategy and NHS England’s Core20PLUS5 programme.

However, the report finds that pharmacy’s potential impact on health inequalities is hampered by the fact that medicines management is too often perceived as a “cost-saving opportunity” by NHS England and ICB financial teams. It calls for a reframing of the debate around pharmacy’s offering, arguing it should centre on the role of pharmacy in creating value for systems, rather than a short-term approach focusing on cost-reduction.

While short-term savings can be found in many areas, the report finds that these savings could be eclipsed were substantive action on health inequalities taken today. It cites figures that the cost of socio-economic inequalities to the NHS acute sector is £4.8bn every year, while people in the most deprived fifth of neighbourhoods account for 72 per cent more emergency admissions than the most affluent fifth. Addressing these trends, the report contends, would contribute more to the health inequalities agenda than any efficiency savings could over the long-term.

The report notes that ICSs, through the work of integrated care partnerships (ICPs), have a clear mandate to reduce the health inequalities gap and that pharmacy has a key role to play in achieving this. However, it identifies a lack of influence of the pharmacy profession at senior levels within ICSs, typified by the fact that not all ICSs have appointed a Chief Pharmacist and not all have full board representation. The report calls on the pharmacy sector itself to organise and come to resemble a single, coherent professional group to strengthen its voice and the impact of its advocacy. It also suggests that the development of “pharmacy collaboratives”, mirroring structures that exist in the provider and primary care sectors, would help the sector to improve its collective presence and impact.

Among other barriers discussed was the sector’s ability to access high-quality patient data from which it can generate meaningful population intelligence about specific cohorts or groups. Data linkage – drawing together data from multiple sources – was identified as being of particular concern, but this remains a troublesome issue across many ICSs. It was noted, however, that data alone cannot tell the whole story about a patient or population group, and that data insights must be paired with community intelligence and co-production to develop truly impactful interventions that will shift the dial on health inequalities.

In his foreword to the report, Chief Medical Officer at Optum UK, Dr Martin McShane, said: “My experience has shown me that the pharmacy profession is one of the NHS’s hidden jewels: agile, inventive, wholly focused on the needs of their patients, pharmacists do so much across primary and secondary care to keep people safe and supported. The recognition they are now getting — as key agents in the national drive to address health inequalities and drive up-stream improvements in preventative care — is both long overdue and a testament to their unique skill set.

“Yet if we want our pharmacist colleagues to make the fullest possible contribution to this agenda, we need to do something the NHS hasn’t always been very good at over the course of my career. And that is, to listen to them, act on their concerns and make them a genuine partner in change.”

The full report can be accessed here.

Digital Implementation, News

Primary care network to adopt new digital pathway for heart health


New approach to heart failure care will enhance provision of digital services to patients across Widnes primary care network.

Widnes PCN, a locality in NHS Cheshire and Merseyside, has launched a new digital health pathway for heart health. It will support healthcare professionals (HCPs) “to feel confident in prescribing trusted and assessed digital health apps for patients living with heart and circulatory diseases” across the locality.

The digital care pathway will provide HCPs across primary, secondary and tertiary care with the most appropriate apps to prescribe to patients as a digital adjunct to treatment, aiming to improve outcomes for patients who have, or will be diagnosed with, heart failure.

Heart failure affects more than 900,000 people in the UK, accounting for 5 per cent of all emergency hospital admissions. 200,000 new cases are diagnosed annually, and it is the leading cause of hospital admissions among over 65s. Care for heart failure patients meanwhile accounts for 2 per cent of the total NHS budget and it is estimated that hospital admissions for heart failure will rise by more than 50 per cent over the next 25 years.

Five-year survival rates for heart failure are worse than breast or prostate cancer and it is a strategic priority in Chesire and Merseyside. In the Halton locality, heart disease accounts for 10 per cent of all deaths, giving it a higher prevalence than the national average.

Widnes PCN has launched the new digital care pathway in partnership with Boehringer Ingelheim and the Organisation for the Review and Care of Health Apps (ORCHA) for the NHS. There are more than 350,000 digital health technologies on the market, including apps that can help prevent, diagnose and monitor heart health, as well as educational apps. However, only 20 per cent of apps currently meet ORCHA’s set quality thresholds.

The apps included in the pathway have been assessed, critiqued and selected after a three-month period of testing conducted by NHS Cheshire and Merseyside, ORCHA and Boehringer Ingelheim. Staff working across heart health services in the locality have received training on how to use the pathway and the apps within it.

Both the digital care pathway and the featured apps are held in NHS Cheshire and Merseyside’s Digital Health Formulary – a single platform where staff can quickly find and recommend approved apps to patients. Once an HCP prescribes a tool, the patient receives a text or email with a link to download the app and access it via a website.

“Heart failure is a prevalent and incurable condition that requires a focus on managing symptoms and slowing its progression,” said Dr Henry Chan, GP and Heart Failure Lead in Widnes. “Unfortunately, it leads to early mortality and often results in emergency hospital admissions, placing a significant long-term demand on healthcare and social services.

“We are delighted to introduce this innovative digital pathway for heart health to recommend the most appropriate digital tools to support patients throughout their care journey.”

Liz Ashall-Payne, CEO of ORCHA, commented: “Increasing the adoption of digital health is the key to creating a more sustainable healthcare system and has vast potential to save lives. All apps available have been assessed and approved against ORCHA’s standards, so they are only directed to quality-assured tools and this ensures the most effective are recommended consistently across the system.”

Country Managing Director and Head of Human Pharma at Boehringer Ingelheim UK & Ireland, Vani Manja, said: “This project was led by a deep understanding from heart failure patients and clinicians themselves about their experiences and we collaboratively generated solutions that underpin this new pathway. I am hopeful that we can improve the experience and outcomes for patients across heart failure pathways, with a view to offering it more widely in other regions.”

News, Workforce

How NHS leaders can ease staffing pressures over winter


Dr Anas Nader discusses the steps the NHS can take to deliver sustainable and long-term workforce improvements that benefit staff, systems and patients.

The NHS is bracing for another tough winter. Exacerbated by a record waiting list of almost 8 million and a rise in flu and norovirus hospitalisations, all signs point to an intense period of pressure for an NHS that’s already struggling.

To even begin to tackle the challenges this season will bring, the NHS needs a healthy, well-equipped workforce manning the front lines. But with 84 per cent of healthcare leaders understandably worried about the impact of winter pressures on levels of clinical burnout, there’s never been a more acute need to embrace solutions that will ease workforce pressures and support staff in the short and long-term.

Turn flexibility commitments into tangible offers

Recent years have seen a lot of discussion around flexibility for healthcare professionals. And despite the challenges involved in enabling flexibility in an organisational system as complex as the NHS, we are starting to see this rhetoric translate into action.

There is no better time than now to pick up the pace and drive these efforts forward. Facilitating better work-life balance by accounting for staff preferences when rostering is foundational to a healthy future for the NHS workforce and is key to turning the tide on worrying levels of staff exit.

If we can make it easier for clinicians to balance their personal and professional commitments, while maintaining patient safety, the NHS can become a place where every staff member feels supported and valued in their role.

A genuine flexible workforce puts employee empowerment at the heart of decision making. Crucially, this commitment to flexibility doesn’t necessarily mean staff working fewer hours – but it does mean enabling them to have a say in their rota. This can be achieved in many ways. From rolling-out self-rostering technology and moving from a spreadsheet system to one powered by the latest technology and algorithms, to ending the archaic way in which swaps are handled and ensuring staff can book leave much further in advance.

The NHS Staff Survey brought to light that only half (50.2 per cent) of the NHS workforce felt as though they were involved in decisions about changes affecting their work area or team. Being at the mercy of an impersonal, centralised rota will inevitably lead to frustration for staff and increase the likelihood of burnout. It’s time to empower the NHS workforce so they can remain in their roles without compromising their personal lives.

Leverage your data

Our ability to access and analyse data has never been greater. In the NHS, we are collecting reams of data constantly. But not every organisation has access to the necessary tools to put it to good use. Developing ways to leverage organisational data to spot staffing trends can be a game-changer.

Data is the perfect tool for optimising human decision-making. Analysing workforce activity, costs and performance metrics to improve judgements is vital to boosting cost efficiency and growth when it comes to staffing. If we are able to systematically match demand for care with the supply of staff, we can more easily identify hotspots of pressure and redeploy staff appropriately.

This gives managers actionable insights and saves precious decision-making time. Weaving up-to-date data into decision-making also allows teams to be anticipatory – modelling staffing solutions in response to emerging trends, instead of simply firefighting. If we can reliably predict which shifts might be understaffed, we can try and reduce the impact on those working, equipping them with the right support in advance.

A data-first culture also facilitates transparency and accountability on multiple levels. Staff are more likely to unite around decisions informed by, and tailored to, data that matches their reality. And once new initiatives have been put into motion, data has the unique ability to illuminate their successes and setbacks in granular detail, ensuring that no opportunities are missed.

It’s critical that NHS leaders take time now to engage with data, employing it to drive their decisions and empower staff as demand intensifies this winter.

Prioritise collaboration

In order to unlock vital resources in particularly pressured times, regional collaboration can help. Pooling resources across organisations and within integrated care systems (ICSs) can be made to work effectively; enabling staff to safely move in line with demand.

The North West Doctors in Training Collaborative Bank (NWCB), for example, is the largest of its kind in the UK. It has acted as a staffing safety net for the 24 participating trusts since its creation in 2020. The bank has allowed thousands of approved clinical trainees to work shifts outside of their host organisation, reducing the need for extra paperwork which previously restricted movement. The initiative is just one example of how collaboration can grant staff more autonomy when choosing shifts whilst also helping managers plug staffing gaps in line with patient demand.

With the formal introduction of ICSs last year, NHS leaders have the perfect opportunity to make collaborating a priority, in the hopes of delivering more joined up care for patients, but also as a necessary shift towards more sustainable staffing solutions and a healthier workforce.

The root cause of the pressure on NHS workers is often buried beneath the backlog of patients waiting for treatment – in reality, it’s the rigidity of schedules and lack of sufficient staff and resources supporting them, which leads to burnout.

By prioritising flexibility, data-driven decision making and collaboration over the coming months, NHS leaders can drive forward improvements which are tailored and genuinely effective for the clinicians and managers feeling the winter strain.

Dr Anas Nader, Co-Founder and CEO of Patchwork Health
News, Workforce

New endoscopy staff bank to boost NHS capacity in Cheshire and Merseyside


NHS Cheshire and Merseyside Integrated Care System (ICS) has established a new endoscopy staff bank to help boost local capacity and give endoscopy staff greater flexibility over when and where they work.

Developed in partnership with Mersey and West Lancashire Teaching Hospitals NHS Trust as lead employer, a new collaborative staffing bank for endoscopy staff will enable local trusts to pool their individual networks of temporary workers and adjust staffing levels according to demand. A total of seven trusts, which provide endoscopy services at 10 hospital sites and are part of the Cheshire and Merseyside Endoscopy Network, are participating.

The new bank is available to all NHS staff who specialise in endoscopy across the seven trusts taking part, including clinical, administrative, nursing and medical staff, and it is hoped that greater flexibility for staff will help boost staff retention. The bank will enable staff to pick up additional shifts as and where they wish, allowing them to view and select shifts at any of the 10 hospital sites via a mobile app, connected to a new digital platform built in partnership with workforce solutions provider Patchwork Health.

Participating trusts will be able to manage and approve payments through the platform, as well as gain access to a data reporting tool providing key staffing insights from across the collaborative bank, including staffing levels, pay rates and shift fill rates at the 10 hospitals. Workers joining the staff bank will be engaged through Mersey and West Lancashire Teaching Hospitals’ (MWL’s) Lead Employer team and added to their workforce and payroll systems.

Much of the information required on staff will be imported automatically from their existing NHS employment, reducing ‘time to hire’ and avoiding the duplication of checks including pre-employment screening and mandatory training. The new bank will also mean staff do not need honorarium contracts, which were previously required when staff worked for trusts other than their primary employer.

It is hoped that this will benefit staff by introducing greater flexibility to respond to personal circumstances, thereby boosting staff retention.

The ability to allocate workforce and resources within a region according to real-time need has long been touted as a potential strength of ICSs. Cheshire and Merseyside ICS hope that the establishment of the staffing bank will help to reduce reliance on agency staff, cutting costs and leading to shorter waiting times for patients. Visibility of staffing data will help teams across Cheshire and Merseyside Acute and Specialist Trusts (CMAST) – the provider collaborative which covers the ten hospital sites – to monitor staffing trends and identify areas for improvement, supporting them to meet rising patient demand.

The Cheshire and Merseyside endoscopy staff bank is the second major collaborative staffing initiative launched by lead employer, MWL Teaching Hospitals NHS Trust. In 2020, it launched the North West Doctors in Training Collaborative Staff Bank, the largest initiative of its kind in the UK, which brings together 24 trusts across the North West and has helped retain an estimated £6 million within the NHS to date.

The seven trusts, which provide endoscopy at 10 hospital sites and are all part of Cheshire and Merseyside Endoscopy Network, are:

  • Countess of Chester Hospital NHS Foundation Trust;
  • Mid Cheshire Hospitals NHS Foundation Trust – Leighton hospital;
  • East Cheshire NHS Trust – Macclesfield hospital;
  • Mersey and West Lancashire Teaching Hospitals NHS Trust – including Whiston, St Helens and Ormskirk hospital sites;
  • Warrington and Halton Teaching Hospitals NHS Foundation Trust – Warrington hospital;
  • Liverpool University Hospitals NHS Foundation Trust – including Liverpool Royal and Aintree hospital sites; and
  • Wirral University Teaching Hospital NHS Foundation Trust – Arrowe Park hospital.

Tracey Cole, Diagnostics Programme Director, Cheshire and Merseyside, said: “We are delighted to be able to offer this new way of flexible working so that staff can select where and when they want to work to ensure that all our patients are seen with the shortest possible waiting time.

“Each trust across Cheshire and Merseyside can access this secondary bank in addition to their own internal bank, which means that there will be less reliance on agencies when additional capacity is required.

“Staff are able to work and earn in addition to their substantive employment and share learning and best practice with their peers.”

Dr Anas Nader, CEO and Co-Founder at Patchwork Health, said: “It’s a privilege to be working with Cheshire and Merseyside and lead employer Mersey and West Lancashire Teaching Hospitals NHS Trust to expand access to collaborative staffing in the region through the new ‘Diagnostics Collaborative Bank’.

“By connecting workforces from across the region, it is helping to increase flexibility for staff and workforce teams alike. This is especially important as services face unprecedented demand; more flexible, collaborative workforce planning is making it easier for staff to be deployed in line with patient need.

“We’re excited to continue growing this initiative as we onboard more staff and support them to work flexibly through the collaborative staff bank. By doing so, we hope to help support retention, boost collaboration and ease staffing pressures across the region, empowering services to work together to facilitate more sustainable staffing.”

Anyone interested in joining can apply via the following link:

Tackling the winter crisis and future-proofing the NHS


By Rob Shaw CBE, Mastek Adviser and former Deputy CEO of NHS Digital.

Digital infrastructure has the potential to transform the NHS’s response to additional winter pressures by delivering seamless routes of discharge, which accelerate patient flow and maximise available capacity.

For too long, digital infrastructure has been viewed by the NHS as discretionary spending rather than a core budget. If we are serious about protecting the NHS ahead of future winter pressures, digital infrastructure must be at the heart of winter planning and a key priority for NHS England and local NHS systems.

Last winter, 60 per cent of patients in NHS hospital beds were medically fit for discharge. Ahead of this winter, the NHS has invested £200 million and expanded its program of “traffic control centers” to provide an initial point of discharge to ease patient flow through the NHS. This additional capacity aims to free up NHS beds, but it fails to solve the problem of where patients go next.

NHS hospitals shouldn’t be used as traffic control centres; they should be equipped to act as digital command centres, empowered to unlock community care in their local area.

We need to look beyond the provision of extra beds as a solution, and move to a data-driven approach of managing patient flow through NHS hospitals and into community settings. Digital infrastructure in the NHS is key to reducing delayed discharge and maximising community capacity. Digital infrastructure has the potential to seamlessly match community care with a patient who needs it and to coordinate staff to deliver any step-down care that is required.

The Digital Command Centre model currently exists in pockets of the NHS, providing a comprehensive data taxonomy of capacity and staffing levels within a local health ecosystem. It allows NHS staff to quickly identify an appropriate point of discharge within their local area, coordinate urgent and elective care against available staffing numbers, and arrange discharge transport and medicine delivery for at-home care.

Digital Command Centre models can be found in the London Care Record, where patient records from across the capital can be accessed across acute and community settings and have been proven to accelerate discharge from the hospital to care homes.

A Digital Command Centre approach can also be found within the Leeds Care Record, which has created interoperable data sharing across acute hospitals, community services, GPs, social care, and hospices in the region. Nurses reported that the Leeds Care Record allowed them to “discharge and refer more quickly as information is more readily available, and we’re aware of what community care is in place.”

Currently, these examples of local best practice exist as islands of interoperability amid a wider NHS landscape where data on local NHS capacity is trapped within inadequate digital systems and is inaccessible to staff who are desperately trying to match a patient with a point of discharge.

The route to NHS Digital Command Centres: a three-step plan

Step 1: First, do no harm. The depth of winter is not the time to introduce a system-wide overhaul of digital interoperability. Digital solutions must empower staff at times of peak capacity and not act as a hindrance to the delivery of patient care. Before anything else, digital solutions must be resilient. At points of peak winter capacity, digital outages can be fatal, and autumn should be used to test digital systems and to rehearse for adverse events. The introduction of updated digital systems should also build upon existing infrastructure and should avoid forcing NHS staff to work with alien digital tools. Digital infrastructure should identify efficiency within existing patterns of work and empower staff to work effectively during peak winter pressures.

Step 2: Start with what you have. No single operating system will magically combine all the existing data sharing systems in the NHS. The NHS data landscape is messy and complex and requires tailored solutions that target fragility in local systems and maximise their strengths. March to September is a crucial window for the adoption of new digital solutions. It allows us to build on the experience of the winter past and provides an opportunity for staff to gain familiarity with new systems. Focus on data security and system resilience. These are the foundation stones of effective delivery during peak winter months. Digital systems should be dependable, accessible, and should promote confidence in data sharing between NHS services.

Step 3: A Call to Action for NHS England. Digital suppliers and local NHS services can’t promote system interoperability alone. There is a key role for NHS England to play in outlining national standards for interoperability which local NHS services can strive towards. National standard setting also puts suppliers on notice and holds them to account for the systems they provide and how they can support the delivery of joined-up care. Without these standards, we risk perpetuating a landscape of islands of interoperability, where mature systems neighbour immature ones, without any direction of travel towards wider dissemination and adoption of best practice.

To truly transform the NHS and prevent winter pressures becoming crises, the NHS must move to a more digital and data-driven approach, where data serves as an enabler for a system under constant pressure. The above three-point plan can serve as a framework for delivering real change, while recognising the challenges in the NHS.

About the author: Rob Shaw CBE is an Adviser to Mastek, having previously worked as Deputy CEO of NHS Digital.

About Mastek: Mastek is an enterprise digital & cloud transformation specialist that engineers excellence for customers across 40 countries, including the UK, Europe, US, Middle East, Asia Pacific and India. We help enterprises navigate the digital landscape and stay competitive by unlocking the power of data, modernising applications, and accelerating digital advantage for our customers.

Mental Health, News, Workforce

Number of nurses experiencing suicidal thoughts up 98%, RCN finds


The findings have been described as a “frightening wake-up call”, with mental health support for nursing staff declining amid increased pressures.

The number of nurses experiencing suicidal thoughts has risen by 98 per cent compared to the same period last year, according to new data released by the Royal College of Nursing (RCN).

Calls to the RCN’s Advice Line in October found that an equivalent of one person each working day was reporting suffering from suicidal ideation in their initial call, compared to just one per week in October 2021. In response to its findings, the college has commissioned research to understand in greater detail the reasons behind poor wellbeing among members, and to discern whether or not marginalised groups are being impacted disproportionately.

The RCN has previously highlighted the “failure of [the] UK government’s promise to recruit 50,000 nurses”, and points to a 12 per cent fall in the number of people expected to take up nursing courses in England this year as evidence that the nursing workforce is facing “dangerous staff shortages”, which are proving harmful to staff morale and patient care.

The RCN is renewing its call on the government to invest in dedicated mental health support for nurses who are suffering from “persistent understaffing, intolerable pressures at work and financial insecurity at home”. Despite these pressures, one third of the 41 mental health hubs established by NHS England have closed, including seven specialist hubs established during the Covid-19 pandemic. A further seven reported in May 2023 that they had less than a year’s funding to stay open.

The RCN’s Interim Head of Nursing Practice, Stephen Jones, has described the findings as a “frightening wake-up call”, adding: “Nursing staff contribute so much to our society, but working in an inherently stressful job can come at an enormous personal cost. Yet we see support services cut when we should be seeing greater investment in looking after those who care for us.

“The increasing burden on nursing staff, as they try to help clear the excessive backlog in care, has created intolerable working conditions on every shift. Coupled with nursing pay not keeping up with the cost-of-living, we’re alarmed by this growing mental health crisis among nursing staff.
“The UK government must understand that cuts to mental health support for nursing staff can’t continue – when you invest in the health of nursing staff you also invest in the health of patients.”

Saffron Cordery, Deputy Chief Executive at NHS Providers, said that: “The RCN is right to highlight the impact of escalating pressure on nurses’ mental health due to increased demand and staff shortages. We need urgent action to tackle this situation, which has led to an alarming rise in suicidal thoughts among nursing staff.

“Nurses play a vital role in our society but cannot be expected to meet such high demand without proper national support for, and investment in, frontline services.”

Digital Implementation, News

NHS to begin roll-out of federated data platform in spring 2024


The supply contract has been awarded to software company Palantir Technologies UK and will see up to £330 million in investment over the seven-year contract period.

The NHS will introduce a new platform in spring 2024 to enhance patient care, reduce waiting times, and expedite hospital discharge procedures. The Federated Data Platform (FDP) will consolidate existing NHS data, enabling healthcare professionals to access critical information more readily, resulting in improved and timelier patient care.

This new platform will integrate key data currently held in disparate NHS systems, addressing some of the healthcare system’s post-pandemic challenges. By aggregating real-time data, such as hospital bed availability, elective waiting list sizes, staff schedules, medical supply inventories, and social care placements, healthcare professionals can optimise resource allocation, including operating theatre and outpatient clinic utilisation, to ensure patients receive timely care.

Palantir Technologies UK, supported by Accenture, PwC, NECS, and Carnall Farrar, was awarded the software supply contract following an open and competitive tender process. The contract will entail a seven-year investment period as more trusts adopt the platform. The initial contract year is expected to see an investment of at least £25.6 million, with total investment over the seven-year contract period reaching up to £330 million for the FDP and associated services. Following the award of the contract for the FDP this week, there will be a six-month implementation period where products supported by the current platform will be transitioned across.

Data access within the FDP is strictly controlled by the NHS, requiring explicit permission for any company involved in the platform. Data usage within the platform is solely for direct care and planning purposes. It will not be utilised for research purposes, and GP data will not be incorporated into the national version of the software platform.

Pilot projects utilising the new data-sharing approach have demonstrated reduced waiting times for planned care and discharge delays, as well as faster diagnosis and treatment times. Since implementing the system, North Tees and Hartlepool Trust has reduced long-term stays (21 days or more) by 36 per cent despite increased demand, with a 7.7 per cent increase in hospital admissions.

NHS National Director for Transformation, Dr Vin Diwakar, said: “Better use of data is essential for the NHS to tackle waiting times, join up patient care and make the health service sustainable for the future. Patients come to the NHS at some of the most vulnerable points in their lives, and they want to know that our healthcare teams have access to the best possible information when it comes to their treatment and care.

“This new tool provides a safe and secure environment to bring together data, which enables us to develop and deliver more responsive services for patients and will help the health service drive the recovery in elective care.”

Palantir CEO Alex Karp said: “This award is the culmination of 20 years of developing software that enables complex, sensitive data to be integrated in a way that protects security, respects privacy and puts the customer in full control.

“There is no more important institution in the UK than the NHS and we are humbled to have now been chosen to provide that software across England to help bring down waiting lists, improve patient care and reduce health inequalities.

“It builds on our role supporting the delivery of the COVID-19 vaccine and, more recently, helping individual NHS Trusts to schedule more operations.”

Matthew Taylor, Chief Executive of the NHS Confederation, commented: “Health leaders will welcome the introduction of the Federated Data Platform as an important tool to help organisations across the NHS more rapidly connect and access data, free up vital clinical time and deliver more efficient, faster and safe care for patients.

“For the platform to succeed, it will also be crucial that the public continue to be engaged with, and that any concerns they have on the sharing of their data are addressed meaningfully. Likewise, Government and the wider NHS will need to ensure that there are adequate numbers of staff working in digital and patient data roles.

“We hope the new platform will offer much needed capacity for many Integrated Care Systems and for those systems that have already built their own effective platforms, we welcome both the assurance that they will be able to decide if and when to opt into it, and that they will continue to be supported.”

Digital Implementation, News

Can allied health professions catch up with NHS digitisation?


As the UK healthcare landscape undergoes a radical digital transformation, can the independent sector adapt or will it be left behind?

This article was kindly supported by FormDr.

Thousands of independent practices and health-adjacent businesses are being left behind as the NHS moves towards digitisation. The extensive report on June 30th 2023 from Parliament’s Health and Social Care Committee recommends a plethora of changes to the NHS and integrated care systems (ICSs), with barely a mention of the tens of thousands of health and wellness professionals who work outside of the NHS.

Yet, private practices and allied health professionals around the country are interacting with tens, if not hundreds, of thousands of people who would equally benefit from digitisation. Many of these practices are still using pen and paper for their basic functions.

This is a mistake, and these health professionals cannot be left behind.

The process of an osteopath

Let us step into the shoes of an osteopath to explore the process that thousands of people face. While the NHS might cover osteopathy in some areas, most people pay for private treatment and are decoupled from NHS systems.

Upon registration, a patient would fill out a litany of paperwork, from medical history forms to informed consent. Perhaps an osteopath can email a copy of these forms to a patient before the first appointment. However, in our increasingly digital age, only 52 per cent of people living in the UK own a printer, so about half the population will need to complete paperwork in the office.

A patient likely arrives 20 minutes early to complete paperwork and review with the front desk staff. If his or her handwriting is illegible, then the process takes longer and creates additional delays.

Once this initial paperwork is sorted, staff must file it and ensure security. Practices have a false assumption that paper is safe, though we have seen fines under GDPR up to £275,000 for not handling paper health data properly. The Information Commissioner’s Office (ICO) is becoming more active and could strike at any time.

Returning patients might need to complete less paperwork, but the inefficiencies in paper still compound and take up valuable time and resources. One of our own surveys found that small practices saved an average of 21 minutes per patient when digitising.

This hypothetical osteopath is only one example, but it is not difficult to imagine how fitness centres, genetics testers, pharmacies, fertility clinics, anyone offering elective surgery, or small health-adjacent businesses are wasting hours each week on paperwork. For these practices, time spent on paperwork directly impacts client and patient care. These health and wellness professionals also need help digitising.

How practices are impeding their future progress

There is another, less obvious problem with paper processes. As the NHS moves towards digitisation and integration, practices and businesses without electronic records exclude themselves from future involvement. The NHS wants to streamline its processes and make data more accessible for GPs, but paper forms do not allow for this.

The foreseeable future of health care in the UK is built around ICSs. The wider NHS is also focusing more on preventative care, which, due to resource constraints, increasingly falls under the purview of the independent sector. The opportunities for growth in these practices and businesses will exponentially increase as they digitise and can more easily link with the NHS.

What can practices and small businesses do?

Fortunately, solutions to streamline paper processes exist and the rapid expansion of telehealth during Covid-19 shows that digitisation is possible and necessary. While the NHS is moving towards its goal, there are three steps that all practices and businesses, regardless of size, can take today to ensure they do not fall behind.

1) Examine your current process of sending and receiving paperwork.

Any good change management strategy starts with an assessment of current workflow. Do you only offer paper forms when a patient or client comes to the office? How many staff members are dedicated to intake? What do you do if someone is concerned about a Covid-19 resurgence and refuses to sit near strangers? Dive into your process.

2) Look for small, yet impactful changes you can make.

Perhaps you can put a copy of your forms on your website so that patients know what to expect. Emailing or text messaging forms can also be an easy step in streamlining your paperwork. Even a simple change such as highlighting required questions on your form could save hours each week.

3) Digitise where you can.

The more you can digitise your process, the easier it will be for everyone. While the goal should be to digitise everything, small steps are an improvement and worth celebrating. Building secure online forms and creating fillable documents might seem like a large hurdle to overcome, but the time and money savings will be astounding. Moving your paperwork online also allows you to keep electronic records and store information such as photographs in one place.

It is clear that the future of the health care sector will have digitisation at the heart. The unfortunate reality is that most of the focus is on the NHS. However, there are steps that small private practices and businesses can take to move towards a paperless existence and prepare for future benefits. Digitisation will soon be ubiquitous across health and care, so why not start saving time and money today?

Andy Soluk is the Director of European Operations for FormDr: a digital platform for health professionals to build, send, and receive custom forms. Get in touch to learn how we can help streamline and digitise your paper processes.

Pharmacy First service agreed as Recovery Plan set to launch


Negotiations have concluded around the implementation of the Pharmacy First scheme, which is now set to launch in full on 31st January 2024.

The government, NHS England, and Community Pharmacy England (CPE), which represents all community pharmacy owners in England, have reached agreement regarding the launch of the new national Pharmacy First service, set out in this year’s Delivery plan for recovering access to primary care.

CPE’s Committee unanimously accepted the proposed deal, which outlines how the £645 million investment pledged in the Delivery plan will be used to support the rollout of expanded community pharmacy services. The agreement was reached following months of negotiation between CPE, the Department of Health and Social Care and NHS England.

Public Policy Projects has recently advocated for an expansion of pharmacy services in England in its report, Driving true value from medicines and pharmacy, which was chaired by Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation at Frimley Health and Care Integrated Care System.

It is now confirmed that the Pharmacy First services will be launched on 31st January 2024 as an Advanced Service, subject to the required IT infrastructure being in place. Under the new service, pharmacists will be able to offer advice and prescribe treatment for seven minor ailments, including sore throats, insect bites and uncomplicated urinary tract infections for women. Patients will be able to access the service without an appointment, as well as via referrals from NHS 111 and GPs.

Following consultations with pharmacists, patients with symptoms indicative of the seven conditions covered will be offered advice and prescription-only treatments where necessary, under a Patient Group Direction (PGD). CPE hopes that in the future, independent prescribers will be empowered to complete episodes of care without requiring a PGD.

As per CPE, the following stipulations have also been agreed:

  • The writing-off of previous funding over-delivery worth £112 million for CPCF Years 3, 4 and 5. If this money had been re-claimed from pharmacy owners over a year, it would have resulted in a reduction in the Single Activity Fee of around 10 pence per item.
  • Protecting baseline CPCF funding: the new money will be accessible as soon as possible rather than risk further over-delivery against Year 5 CPCF funding – the writing off of some Year 5 projected over-delivery supports this.
  • The inclusion of an upfront payment for of £2000 for Pharmacy First to support pharmacy owners to prepare and build capacity for the new service.
  • Increasing service fees to support ongoing capacity to deliver Pharmacy First, and for an uplift in fees across all services.
  • Reducing activity thresholds at the start of the scheme to “more achievable levels”.

The National Pharmacy Association (NPA) has welcomed the announcement, while also repeating calls for an increase in core funding for the community pharmacy contract to underpin sustainable future growth for the sector. NPA Chair, Nick Kaye, said: “We welcome this commitment to invest in a nationwide Pharmacy First service for common conditions. The new funding, whilst welcome, will not in itself solve the financial crisis in community pharmacy, but it is a substantial investment in a key service that could be a stepping stone to more.

“NHS England have put their faith in us, having seen community pharmacy successfully deliver other clinical services at scale. I’ve no doubt that pharmacies will once again deliver an impressive return on investment for the health service.

Highstreet pharmacist Boots has also welcomed the announcement pharmacy reforms. The chain announced today that it will roll out the NHS Pharmacy Contraception Service, allowing pharmacists to provide contraceptive advice and prescriptions, in the coming months. The service has already been successfully piloted in 22 stores in England.

The NHS Blood Pressure Check Service will also be expanded to most Boots stores in England, allowing pharmacists to check patients’ blood pressure and provide advice on reducing their risk of cardiovascular disease. Boots has said that the new and expanded NHS services will be good news for patients, pharmacy teams and GPs alike.

Seb James, Managing Director of Boots UK & Ireland, said: “We welcome the government’s announcement of plans to launch new contraception and minor ailments services in England, which will make life easier for patients to access the care and medicines they need quickly and help reduce GP wait lists.

“We have been working with our pharmacy teams in stores to roll out these new services to patients in England. We are already commissioned to deliver similar services for the NHS in Scotland and Wales and these are very popular with our patients and pharmacy team members.

“The free NHS blood pressure checks that we offer at most of our stores in England can save lives by spotting potential cardiovascular problems at an early stage, which also helps to reduce the burden on the NHS longer term.”