Clarifying the metrics: A true picture of system wide activity
By Maria Kane
Maria Kane, Chief Executive of North Bristol NHS Trust, addresses the need for defined and aligned metrics to provide one overall picture of system wide activity and reveal where improvements can be made.
Every acute trust is facing three challenges: the elective care debt, urgent care recovery and an exhausted and depleted workforce. With Integrated Care Systems (ICSs) on the horizon, we have an opportunity to step back and look at the bigger picture to see where we can make system improvements to meet these challenges and add value to the patient, public and taxpayer.
However, it is difficult to understand what is going on in any given health and care system. This is because the finance framework and metrics currently available are not defined or aligned enough to help determine the exact value (cost and outcome) of activity the funding is producing.
A clear picture of each health system
Each ICS will be responsible for allocation of funding at system level. The aim is to distribute resources according to population need and to help reduce health inequalities. However, all payment systems are complex and to ensure the right calculations for payment of care and enable health systems to provide the right care in the right places, it is vital to have access to the right sources of data. Where patient-level data is limited, this can impact on how system budgets are allocated.
Currently, trusts are operating with a mixed economy of block and activity contracts. Most of these are now block contracts since Covid-19 began, but there are also have large numbers of individual providers on specialist and general contracts, which makes it difficult to see the big picture. Specialist contracts, for example, can cover wide areas which makes it harder to pin down what is happening in each ICS. Operating with a variety of contracts like this can create significant challenges when trying to set out a whole system budget.
A greater understanding of each system
ICSs provide the health system with an opportunity to clarify and get on top of the metrics and to have a single interpretation within each system. This will allow the scope to broaden and incorporate areas such as mental health.
Giving full responsibility of finances to ICSs and enabling them to operate the whole budget will bring many benefits and allow good population health management. However, there needs to be a shared understanding of how local services are run to ensure all areas of the system are given adequate funding. All members of the ICS need to understand how each part of the system works and it is crucial that financial decisions are based on a sound knowledge of the challenges across the whole system.
Bringing together sources of data from across community, primary and acute care can help to provide one overall picture of how the system is performing. Data can highlight where funding needs to be focused to help create change, improvement and the best patient care, as well as being able to highlight areas where proactive care can start to make a difference, but the finance framework and metrics need to be tackled first.
Capita Healthcare Decisions have been at the forefront of tackling the challenges within healthcare systems for over 27 years. To find out more visit: https://capitahealthcaredecisions.com/
Digital Health Academy to provide free digital skills training
By Gabriel Blaazer
The Digital Health Academy opens today and aims to provide free digital skills training to all NHS staff by 2031.
From today, the Digital Health Academy, a free, digital training tool for NHS frontline staff, is in operation. Aimed at providing digital skills training to all NHS staff by 2031, the modules are now freely available on the Health Education England NHS Learning Hub. As highlighted by Health and Social Care Secretary, Sajid Javid, in a recent speech, it’s crucial that the NHS improves digital provision across all health and care services and the Digital Health Academy aims to address this by building on the digital skills of all NHS staff.
A survey from the Organisation for the Review of Care and Health Apps (ORCHA), reveals that although 65 per cent of the public are open to trying digital health technologies, only a fraction of tools are recommended by health or care professionals.
In total, amongst those using digital health, only a small proportion of recommendations came from healthcare professionals, with 17 per cent of recommendations coming from GPs, eight per cent from hospital doctors, and two per cent from nurses.
The need to support a digitally ready workforce has been highlighted by the NHSX Readiness Plan and the CPD-accredited Digital Health Academy responds to the critical requirement to invest in developing front-line skills for digital health through professional development.
Currently, there is still no mandatory digital health training for health and care professionals, and the courses that frontline workers can attend are often scarcely available. In response to this need, ORCHA, with the support of universities and healthcare professionals, and with financial support from Boehringer Ingelheim, developed the Digital Health Academy, the foundation level modules of which will be freely available at orcha-academy.com and on the Health Education England NHS Learning Hub.
The academy’s online training modules are designed specifically for frontline health and care professionals who want to use and recommend digital health tools but have been struggling to access the knowledge to do so safely.
ORCHA has created the infrastructure of the online training portal and designed courses, drawing on experience gained reviewing more than 17,000 health apps and operating health app libraries in 70 per cent of NHS regions.
The Digital Health Academy’s aims include:
Free access for all NHS and social care staff
Availability on Health Education England NHS Learning Hub
Enabling staff to gain Continuing Professional Development (CPD) points in a vital new area of professional development
The CPD-accredited Digital Health Academy programme includes:
Short, bite-sized learning modules to suit busy schedules, which can be accessed at any time
Two foundation modules which explain the function of health apps, the current digital health landscape, the barriers to using and adopting digital health and the importance of prescribing good quality digital health products
Coming soon, a series of specialist modules including topics such as digital health for mental health, diabetes, physiotherapy, long Covid and winter pressures
Commenting on the academy’s resources, Dr Neil Ralph, Head of Health Education England Technology Enhanced Learning (who has previously written about the need to prepare the NHS for digitally-driven healthcare), said: “COVID-19 accelerated the rapid adoption of digital health across health and care services and the need to embed digital health in the long term. We are delighted that ORCHA has contributed its Digital Health Academy foundation content to the Learning Hub and look forward to hosting new content in the future, further supporting health and care professionals in their roles.”
Learning about the value the Academy offers frontline staff, Boehringer Ingelheim committed to sponsor the foundation modules. This has enabled it to be opened up at no cost to health and care professionals. Commenting on this, Uday Bose, Managing Director at Boehringer Ingelheim UK & Ireland, said: “There’s widespread recognition of the need for digital health training for frontline workers, with organisations from the King’s Fund to the Royal College of General Practitioners calling for it. With six million people now waiting for elective care, and with first-class digital tools available which could support healthcare workers with many of the high volume and low complexity cases, the need to improve digital skills and digital confidence in the NHS has become critical. We felt the academy was a perfect way to address this very real need amongst frontline staff.”
Ahead of the launch, the academy has been introduced to professionals using the ORCHA digital health libraries to a positive reception:
Dr Michelle Webster, Chief Clinical Information Officer & Consultant Clinical Psychologist at Coventry and Warwickshire NHS Partnership Trust, said: “The ORCHA Digital Health Academy has helped to demystify digital health, strengthen our clinicians’ digital skills and boost their confidence in using healthcare apps. The bite-sized modules are easy to follow, interesting and relevant and designed to flexibly fit around their busy jobs. I would highly recommend.”
Najia Qureshi, Director of Education and Professional Practice, British Dietetic Association, said: “This is a really welcome resource for our members, who work across the NHS supporting patients with a wide range of health conditions. Innovation in healthcare is introducing new ways of working and is transforming patient care. This programme will help dietitians and other health and care professionals to develop the professional skills needed to confidently use and recommend the right digital health products – helping patients to benefit from digital healthcare.”
Reviewing a foundation module course, Dr Joel Brown said: “It takes quite a paradigm shift to move physicians away from seeing prescribing as an exclusively pharmaceutical enterprise. As medicine is increasingly digitised, clinicians need to take seriously the opportunity to prescribe digital health. The course by ORCHA, as part of their Digital Health Academy, makes this point brilliantly.”
If there is a Cinderella in health infrastructure, it is primary care
By Chris Green MP
Chris Green MP, Chair of the APPG for Healthcare Infrastructure, calls for the government to properly prioritise the primary care estate in its upcoming refresh of the Health Infrastructure Plan.
In recent years, attention has been focused on a national level on the government’s headline hospital building programme. While investment in acute infrastructure is imperative, we have been waiting with bated breath for a year for the refresh of the Health Infrastructure Plan (HIP).
Addressing the NHS England and NHS Improvement National Estates and Facilities Forum in March 2021, Health Minister Ed Argar MP promised it would set out “the direction of travel for the primary care estate”.
Since then, the radio silence from Whitehall has been one of the factors behind cross-party parliamentarians coming together to revive the All-Party Parliamentary Group for Healthcare Infrastructure.
Our mission is simple: to highlight the importance of high-quality healthcare infrastructure to support the NHS in meeting the demands of the future, including post-pandemic care.
The state of the primary care estate and the lack of a long-term strategic framework is holding back everything from modernisation and integration of NHS care, to tackling the maintenance backlog and embedding new roles into primary care. A YouGov survey of healthcare professionals conducted last autumn found 40 per cent saying the premises they worked in constrained the services they could provide to patients.
In a report published in February on integrating additional roles into primary care networks (PCNs), The King’s Fund concluded that a lack of adequate estate was becoming an issue across primary care and would require expertise in the design and use of space to support multidisciplinary teamworking. This is just one area where the refresh of HIP must offer concrete solutions.
The direction of travel for the primary care estate must reflect the lessons we have learned throughout the Covid-19. A survey of professionals working in hospitals, health centres, GP surgeries and mental health sites at the height of the pandemic found that half felt the sites they were using were fit-for-purpose. In addition, 70 per cent called for more flexible space and 49 per cent for external space for patients and staff.
Work is going on to achieve these aims at primary care facilities across the country like Gracefield Gardens in Streatham or Lowe House in St Helens or at Bolton One which serves my constituents. But we need the refresh of HIP to prove NHS infrastructure is about more than just hospitals.
An analysis of PCN clinical directors conducted by the NHS Confederation last year found that more than 90 per cent felt a lack of estates infrastructure was hindering their progress, while more than 98 per cent felt more funding for primary care estates was needed.
One the important questions that the refresh of HIP must address is what the first iteration identified as a “significant unmet demand for capital in the system”. We need clarity how the necessary investment in primary care estates fits with the post-pandemic public finances.
There are steps that the emerging ICSs can take. Karin Smyth MP and I proposed an amendment to the Health and Care Bill to empower the new Integrated Care Boards to reclaim their stake in projects delivered under the NHS Local Improvement Finance Trust programme. We hope ICBs will take back their share in these vital schemes to ensure they are best used to serve the needs of the primary care estate in their local areas.
The APPG will be launching a call for evidence on meeting short, medium, and long-term health infrastructure needs shortly. We want to hear from those at the centre of ICSs responsible for primary care.
A refreshed version of HIP will be the bedrock for the return to normality as we move on from Covid. We want to hear what you need to succeed.
How integrated care systems can improve digital inclusion
By Gabriel Blaazer
Sarah Boyd, Head of Digital Experience and Transformation at Norfolk & Waveney Health and Social Care Partnership (NWHSCP), explores how her integrated care system (ICS) is using digital health to improve patient inclusion and help reduce health inequalities.
Health inequality is a growing problem but is still too often discussed separately from the core business of the NHS. Patients are treated through siloed care pathways, with conversations about why some populations have poorer health outcomes often treated as an aside.
The pandemic brought this into greater focus, especially around digital inclusion. Technology rolled out across the NHS in response to Covid-19 often widened the gap between those who could access online services and those who couldn’t.
The benefits of ICSs
When it comes to digital inclusion, there is little doubt that ICSs offer a huge opportunity to deliver more equitable access to healthcare and improved health outcomes for those previously underserved by the health system.
NWHSCP is a new type of organisation, working as a system across the Norfolk and Waveney region. Operating across the public sector, along with health and social care, councils and with voluntary organisations, presents an opportunity tackle health inequality and exclusion in a person-centred way.
The ICS allows health leaders to work across organisational boundaries, to test assumptions about exclusion, and to leverage the work that happens at the level of individual places.
Fixing existing digital inequalities
At every stage, NWHSCP are ensuring that their digital projects address digital inequalities. By implementing a pan-public sector hub-and-spoke model that provides personalised support to excluded groups, their plan is to gain the wider benefits of digital inclusion by engaging people – not only in health services – but more broadly in society.
For example, if a GP detects that an elderly person in their care is socially isolated, they can refer them to a central digital inclusion service. From there, they may be passed to a library or volunteer service who are able to provide connectivity or a 5G-enabled device, along with the ongoing support to use it. This allows the patient to order repeat prescriptions, but also to food shop online or video call family and friends, with positive benefits for their wider health and wellbeing.
“Creating an environment in which every service is digitally inclusive offers benefits not just to individuals, but also to wider society”
Asking people to go to an appointment at an unfamiliar location can create unnecessary barriers. As it proceeds, the ambition of NWHSCP is to work towards using services that people already access to provide a trusted contact point. If patients are already known to a church group or domestic violence shelter, for example, they might receive support there.
Through community partnerships, ICSs can build a network of digital tools and skill provision. For example, if a partially-sighted person, or family member, needs a speech-to-text reader, NWHSCP can point them towards their trusted toolkit. Once a person has access to this network, they can then download tools freely, ahead of their health needs.
Building an inclusive service
Creating an environment in which every service is digitally inclusive offers benefits not just to individuals, but also to wider society. As the Good Things Foundation’s Widening Digital Participation report found in March 2020, digital inclusion pays for itself in better mental and physical health, and stronger participation in the economy. For every pound spent, £6.20 is made back.
With this in mind, ICSs can leverage skills found in the private sector to identify new ways to increase inclusivity. Companies in the space include ThriveByDesign and CardMedic, an award-winning digital tool that provides instant access to communications options to improve engagement with healthcare professionals.
CardMedic is designed to help patients with a language barrier, visual, hearing or cognitive impairment, or to communicate through PPE and is unique in its space.
One issue with digital inclusivity tools is that they’re often seen as only affecting excluded communities, but digital inclusivity applies to everyone. Many people often struggle to retain emotionally-sensitive medical information, such as details about a cancer diagnosis. Tools like CardMedic allow any patient to review the basics of a hospital procedure or consultation – helping them to feel more secure in their care.
Applying innovation
Through pulling together with public sector and voluntary organisations, NWHSCP has built a strong, interconnected and multi-disciplinary team to implement their digital transformation agenda. As ICSs move towards statutory footing, the hope is to build on their initial successes though good recruitment and the implementation of innovative technology.
But there is only so much one system organisation can achieve on its own. To maximise the potential of integrated care systems, the NHS will require a national system for picking up on digital innovation. It should not be up to individual ICSs to find products, such as CardMedic, themselves. Digital inclusivity should be available to all.
Taking practical steps to address a growing crisis in domiciliary care
By Gabriel Blaazer
John Bryant, Head of Strategy and Development for Torbay Council, outlines a series of practical steps to enhance the role of the care worker and address the growing crisis in domiciliary care.
The solution to the domiciliary care crisis is to enable the sector to do more, not to simply ask more of it. The distinction is important, as the development of integrated care provides opportunities to enhance system efficiency like never before. And yet, the scope of what could be asked of, and performed by, trained, supported, committed community-based practitioners is yet to be fully explored or achieved.
All the while, the expectations of those receiving care, and certainly those considering a future career in health and care, are greater than they have ever been.
To meet these ever-rising expectations, system leaders are likely to find fertile ground in looking to better embrace the assets that already exist within the system. This includes domiciliary care workers, whose skillset could be expanded and developed, a move that could encourage others into the system. This can happen by re-positioning the expectation, skills and rewards to produce and provide, for example, enhanced wellbeing services (EWS) provided by enhanced wellbeing practitioners (EWP), of which domiciliary care is a major component among a portfolio of beneficial interventions and service provision.
The 6Cs of care are prevalent within our frontline domiciliary partner staff; the opportunity is there to optimise their engagement and knowledge of patients and clients to:
Support retention and recruitment
Respond to the discharge and reablement challenges
Drive early intervention and prevention
Offer a developed interface with general practice
Engage with population health management
The support of these four key drivers for public service change: politics, policy, measurement and money, are positioning us as never before to achieve success. The government’s social care reform white paper, People at the Heart of Care, connects to the £5.4 billion pledged for adult social care reform between 2022 to 2025. It is notable that healthcare is a major beneficiary of this funding in early years, however within the policy of integrated care the opportunity exists to bring about radical, beneficial system reform from the outset.
“Together, these measures aim to put people at the heart of social care and move us towards our 10-year reform vision.”
(Department of Health and Social Care, 2022).
These themes were also present in the subsequent integration white paper, Joining up Care for People, Places and Populations. The measures set out in the paper provide clear areas of opportunity, focus and policy support.
A growing crisis
These government white papers are in no small part a response to a care crisis the likes of which we have never seen. One key element of that is domiciliary care, the unseen service that is delivered behind the front doors of our communities to keep people safe, comfortable, medicated and cared-for. For over a decade the policy has been to bring care closer to home, and the People at the Heart of Care paper reinforces that. The Covid-19 pandemic has compounded the need to ensure people are cared for and supported in this way, minimising their movement between different health settings to reduce infection risk.
“The endeavours of care providers to recruit at this level should be celebrated alonside any other part of the system that has been able to do the same”
Present estimates indicate that there is a care shortage/vacancy rate of 17 per cent which equates to at least 100,000 jobs based on Skills for Care data in England. Given the challenges in recruitment felt by providers, there can often be a projection that care providers are not ’good‘ at recruitment. However, in looking behind the headlines we find that in one area, Torbay, care providers have increased their capacity through recruitment by 39 per cent in the 18 months leading to September 2021. The problem is that the demand for their services has totally outstripped this staffing influx, increasing by 47 per cent in the same time period. This trend is consistent across the country’s health and care ecosystem.
The endeavours of care providers to recruit at this level should be celebrated alongside any other part of the system that has been able to do the same. If organisations who have been able to recruit as well as Torbay have done are finding it difficult, is it probable that any other part of the system will do better?
The Health Foundation recently published research suggesting that over a million more health and care staff will be needed in the next decade to meet growing demand for care. What is clear is that these shortages were well established trends before the Covid-19 pandemic. If the challenge of capacity is to be permanently addressed, then retention followed by recruitment is essential – as any marketing of roles from ‘the system’ will be trumped by the messages communicated by those working in or leaving the services.
Recognising a new future, communicating that and providing examples of what could be achieved will produce opportunities for beneficial results.
Practical steps
In this respect, returning to the domiciliary care issue, what might emerge if we were to turn the issue on its head?
To address the crisis currently seen in domiciliary care, I propose a series of practical steps to enhance the role of the care worker and to use the ICS framework to transform system level efficiency:
Addressing the domiciliary care shortage: expand the potential of the service and provide those delivering it with more responsibility and control by becoming EWPs
Supporting the community nursing challenge: offer them the opportunity to have a wider team of EWPs at their disposal; enable them to work to the top of their licence
To address GP availability: create neighbourhood teams of EWPs that are able to be with patients, directly support with digital literacy and connectivity, and be a physical presence to further enhance the experience of the remote general practice
To reduce A&E admissions and improve the discharge process: use EWS to support the safe discharge of increasingly complex patients to optimise recuperation in at-home settings, have the digital skills and tools to monitor and report e.g. RESTORE2 for early intervention and re-admission avoidance, and be able to support reablement; the stepping stone to independence
Develop greener care:reducing mileage by minimising cross-overs between staff and building a wider multi-disciplinary team
The practical possibilities for this are supported by the further development of the Allied Health Professionals strategy. The publication of the Allied Health Professions’ Support Worker Competency, Education and Career Development Framework received support from Trades Unions, Professional Bodies and Trade Union partners. Whether it is development within roles or providing new career paths, new forms of offer and opportunities are going to be central in encouraging a post-Brexit, domestic workforce into the social care and health sector; along with producing the impact value of those roles and associated care interventions which enable commensurate levels of pay and reward.
Underpinning all endeavours and quality care and support are the 6Cs of Care. These emerged as part of ‘Compassion in Practice’ and were rolled out by NHS England to all staff in 2014 with subsequent promotion to the wider care sector by the national body Skills for Care.
“But what cannot happen is that domiciliary care continues to be overprescribed without receiving more support or being allowed to expand its offering”
The characteristics of commitment, care, compassion, competence, communication and courage are prevalent throughout our community care partners and their staff. With that commonality between the professions what might we do to deliver even more fulfilling roles: more people doing fulfilling roles, more fulfilment within the roles, more roles in addition to the present ones that are also fulfilling?
The alchemy that will bring this about is within the gift of every system in England and available to all domestic nations. It is the meaningful flourishing and delivery of an integrated care system (ICS). The ‘holy grail’ of ICS development is to provide timely, personalised care that maximises the independence of the individual receiving care which, naturally, points to a home-based solution. But what cannot happen is that domiciliary care continues to be overprescribed without receiving more support or being allowed to expand its offering.
This article seeks only to look at one small area of that; however, it is a vital area, being felt by the 957,000 people in the UK that receive domiciliary care and their families, along with the 822,000 staff looking after them (as recorded by RCN surveys). This, quite rightly, is now receiving both political support and national media attention.
The pandemic should be recognised as a catalyst for accelerated change, avoiding any sense of ‘once we’re through this we can get down to business as usual’. What has been done, and is being done in response to the pandemic, has demonstrated the creativity and pace of change possible as system partners have collaborated. Fostering and building on that is in itself both an opportunity and a challenge.
Across the sector there are understandable concerns of implementing radical service reform on an already exhausted and beleaguered workforce. But there are examples we can look to where workforce wellbeing is protected while simultaneously enhancing capacity and quality of care that motivates staff.
Some facts from one system
To service 800 clients in a 75-mile geographical perimeter, home care staff drive almost one million miles per annum. In work supported by the Health Foundation, it was found that at a (sub)urban travel speed averaging 20 mph, over 43,500 hours were being spent in vehicles; a substantial proportion of that could be put to new ways of working.
Work has shown that by reorganising the rounds, 5,220 hours of care could be released from the existing workforce. This would provide opportunities not only for more care to be delivered but importantly, and in respect of future retention and recruitment across the system, time for wellbeing, supervision, learning and development, accreditation of skills and assurance in their application. And with no extra hours of care being purchased.
In terms of application and the development of broader multi-disciplinary teams within ICSs, it was established that of the community nursing patients nearly 20 per cent were also social care clients. People were being visited by multiple staff in one day, requiring travel from multiple staff.
There are of course many activities and health interventions which can only be done by those with nursing and clinical qualifications. However, in approaching this issue with a mindset of curiosity, courage and compassion there are many interventions that could be performed in different ways.
For instance, one of the many activities that domiciliary care staff undertake is washing and creaming clients’ legs when there are wounds to be attended to. Nursing staff will then arrive to apply a bandage. While certain grades of wound clearly need nursing attention there are many at lower levels of severity that are capable of being attended to by a well-trained EWP – and of being checked on regularly, though less frequently, by the stretched community nursing complement.
Benefits of EWS for participants and for system development
Enhanced wellbeing practitioners:
Feel respected and able to develop their domiciliary care roles, feel even more a part of the system and that their contribution is valued. This could lead to enhanced profile and esteem. The additional activity means more time with the client and the opportunity to further enhance the relationship that exists
Opportunities will be presented to work in strengths-based ways and with programmes such as Making Every Contact Count, leading to enhanced wellbeing of the clients and a development of their connectivity and circle of support
This leads to improved job/role satisfaction – improved retention leading to increased recruitment. Developed circle of support for clients, enabling them to step up towards independence and reduce their reliance on statutory interventions. Release of capacity for those with assessed needs to have their needs met and begin their journey towards well-being
Community nurses
Feel an increased level of support with a bigger, more integrated, team available to them. They are then able to work with the more complex cases and make the very best use of their skills and knowledge while enabling and supporting other integrated team members to develop
Through enabling better management of case-loads, job satisfaction is increased and stress is reduced. As the RCN has established, with 75 per cent of community nurses reporting that they had left necessary activities undone, the professional dissonance of the role is alleviated, supporting staffwellbeing and retention
With the nursing and Allied Health Professional colleagues active in this way, early intervention and reductions in exacerbations of conditions lead to reduced admissions. With greater capacity, along with the skills to manage more complex discharges, hospital flow is improved
Benefits of EWS for health providers
Admissions through A&E:
Are reduced by earlier interventions and the ability to deploy the highly skilled staff in the community to support patients and reduce the deterioration in their condition
Improved flow through A&E with reduced admissions, enhancing the wellbeing of staff as well as the patients, and contributing to the enhanced application of funding to meet elective care
Discharges and re-admission rates:
Are further improved with the skills and capacity made available to support increasing numbers of and increasingly complex patients. With the integrated approach to working and early intervention opportunities, people are supported to remain at home, with their condition even better managed and do not require a re-admission to hospital
Skills and capacity across the community integrated team are available to support timely, safe discharge from hospital and discharge to assess and ensure people remain at home
The patient/client gets less ill and recovers more quickly being supported by a team that has the resources, capacity and skills to meet their needs. This increases the ability for them to remain well or recover quickly in their home setting, which include care homes and supported living
Increased numbers of people cared for closer to home with reduced exacerbations in conditions. Complex clinical requirements being met in community settings with both care-giver and the patient having a well developed strengths-based relationship throughout the care and support period, enabling a step up to independence
It is understandable that there will be anxieties associated with the shift in activities. In order to ascertain who delivers what and where to achieve the five aims of population health management (as illustrated below), the mantra to hold onto is right person, right care, right place, right time. Risk-managed prototyping using good design methodologies is key and implicit within the title on the tin of sustainability and transformation partnerships (the predecessor to ICSs).
There are many practical examples already available and still plenty of headroom for further development, which will accelerate the transformation in health and care models which are both sought for and needed.
Covid has shown us how much can be done in a short space of time; even with all the pressures in the system, GPs, acute trusts, AHSN and domiciliary care providers worked together to train 148 staff in the RESTORE2 methodology in just three months, with some going further to be trainers themselves.
Practical steps to developing and implementing enhanced wellbeing services
Train domiciliary care and care home staff to use the protocols and develop relationships with primary care practices
Ensure that training is accessible and that the nursing staff are corporately supported in the delegation of tasks
Look to see if care packages are allocated by geographically focussed provider or on first-come-first-served basis, and what the mileage component to the care rounds is for providers
Review the wounds being attended to in community settings and what best practice can offer in tackling the £5 billion cost of wound management
Consult on ways in which the Allied Health Professions’ Support Worker Competency, Education, and Career Development Framework can be optimised
Get the best facilitators and design thinkers, often found outside the system, to help ask the questions, listen and gather the answers and develop action-orientated plans with system partners – which includes the care unit, the patient/client and those caring for them
Whichever of the four policy drivers (politics, policy, money or measurements) one wishes to consider, they are captured within the Five Aims of Population Health Management; moving to EWS and development of the practitioners supports their delivery. Beyond this the one element that is maybe more implicit within the ‘petals’ below is capacity. EWS supports this explicitly.
Achieving more with less
In summary, below is the 30-second elevator review of how we can achieve more with less on the topic of domiciliary care.
More:
Time to care, more time to be more caring
Development and enrichment of roles
Person-centred care
Satisfaction with the role
Retention
Recruitment
Prevention and early intervention
Less:
Dissonance in the role and 6Cs
Siloed working
Variation in care team and discontinuity of care
Dissatisfaction with roles and system design
Turnover and leaving before retirement, or at the earliest opportunity
Vacancy and cost to trying to encourage people into services
Illness and cost
Addressing the care crisis
With the job-seeking public indicating that insufficient numbers of them wish to work in domiciliary care, now would be the time, supported by the policy of integrated care, to develop a new offer that enables truly integrated roles. This should seek to provide enhanced wellbeing services through an increasingly broad, multi-disciplinary, person-centred team.
To address this multifaceted care crisis, we should do more than seeking to invite people into traditional domiciliary care. The system might benefit from offering people a new role(s) that encompasses the domiciliary care that they are proud to already be doing, but also one that offers development, inclusion, satisfaction, esteem and commensurate compensation. This could become increasingly available if and when ICSs fulfil the potential that exists; one that reflects those stated aims within the recent white paper(s) and meets the five tenets of Population Health Management.
This should also note the observations of the CQC and their likely support to engage in discovery sessions for regulation alignment towards new ways of working. In doing so this should create a virtuous cycle towards a sustainable system, both financially and with capacity, through the delivery of integrated care.
John Bryant is Head of Strategy and Development for Torbay Council and an ICJ contributor. To contact John, become an ICJ contributor or to obtain a full reference list for this article, please write to news@integratedcarejournal.co.uk, and one of our Editors will assist.
PPP calls for adequate social care funding to end postcode lottery
By Integrated Care Journal
Public Policy Projects (PPP) has launched its first Social Care Network report, Mind the Cap: choices and consequences for financing social care, addressing the need for radical financial restructuring within the UK social care system.
The report, launched on 14 March, finds that the standard and financing of social care in the UK is subject to a postcode lottery. Given that social care is funded locally, there is vast regional inequality in the standard of care in the country.
Even with some level of means-tested support, and the newly introduced cap, the PPP Social Care Network found it a system unaffordable for many. The report concludes that these measures do not protect some low-middle income households from having to spend entire savings on social care.
PPP brought together 25 senior stakeholders and experts within the sector to discuss solutions to the crisis ahead of the spring budget. The report is sponsored by Radar Healthcare and the Royal Voluntary Service.
In September, parliament agreed to increase National Insurance Contributions by 1.25 per cent to establish a new ‘Health and Social Care Levy’ and introduced a new measure to cap care costs at £86,000. However, only a small proportion of money generated by the levy will go to social care, and the cap does not protect low-middle income individuals or families.
PPP’s social care network find that the Levy proposed by the government will not even begin to address the costs of care required by the system, and the cap protects those who are least likely to use the system.
Speaking at the report launch event, former Deputy Prime Minister Damian Green, said: “The current Health and Social Care Levy falls on the working age population, all of whom will be faced with inflationary cost of living pressures which we haven’t seen since the 1970s. It is falling on a particularly vulnerable portion of society.”
Key recommendations from the report include:
The government must focus its attention on how best to stimulate a wider insurance-based approach to care, encouraging individuals to participate in voluntary insurance schemes to cover costs up to the cap
The government should widen the scope of the Health and Social Care Levy; other forms of income and wealth for which National Insurance does not apply, such as rental income for private landlords, should also be considered for a social care levy
The government should explore greater flexibility around the Health and Social Care Levy, including the option of directing a proportion of the levy to an individual’s social care insurance scheme and/or contributions being made up by employers, as with pension schemes
The report emphasises that there is insufficient funding overall in the sector and that local authorities and care providers must be adequately funded for any improvement of the social care system. It also outlines that this funding should come from both private payment and higher state provision.
Mr Green said: “The adequate financing of social care is vital for the proper functioning of the system. Once we inject an appropriate amount of money into the system which has, quite frankly, been on its knees for years, we will begin to see the problems of the social care system begin to melt away. The measures proposed by the government are not sufficient, and more must be done to support those in need of care.”
Commenting on the report, Dame Esther Rantzen, Broadcaster and Founder of ChildLine and The Silver Line, said: “I know how crucial adequate funding is, both for those who offer care, and for those who receive it. The caring profession needs far better funding to give carers the opportunities and status they should have and enable them to give their work the time and skill it needs. And vulnerable people who need support should not have to worry whether they can afford the right care. Without proper funding carers will continue to be undervalued and their work unappreciated when in fact more and more people depend upon it.”
Cheshire & Merseyside ICS teledermatology innovation helps relieve system pressure
By Niamh Macdonald
Cheshire and Merseyside ICS have launched a suite of new teledermatology technology as part of an initiative to streamline the triaging and referral of dermatology patients.
The initiative has been rolled out across four Acute Trusts in Liverpool, Wirral, and Cheshire, including Liverpool University Hospital NHS Foundation Trust. The regions primary and secondary care services have been under extreme pressure with backlogs and record service demand. The aim of the technology is to support 228 GP practices in the delivery of timely, effective and collaborative dermatology care.
The solution consists of a smartphone-compatible Dermatoscope, a connected app and an integrated digital platform, funded by the National Teledermatology Investment Programme (NTIP). Cheshire and Merseyside ICS also partnered with Cinapsis SmartReferrals to make the initiative possible.
The 228 participating GP practices have all been provided with Heine dermatoscopes, with a universal adaptor that attaches to any smartphone camera. GPs are able to use their own phones to capture high-quality clinical images of moles and other skin lesions in a data-compliant manner.
The clinical images can be attached to dermatology referrals or Advice and Guidance requests made through the Cinapsis SmartReferrals app. A secondary care specialist is able to review the case and suggest the best next steps for the patient. The images, and the outcomes of the referral or advice and guidance, are automatically updated in the patient record via an NHS ERS and EMIS integration.
Paul McGovern, Elective Care Programme Manager at Cheshire and Merseyside Health and Care Partnership said: “This technology roll-out is the product of two years’ worth of planning and trials; several solutions were rigorously tested before the ICS team settled on Cinapsis SmartReferrals as selected as the most impactful teledermatology solution.
“The resource commitment and genuine partnership approach taken by Cinapsis has been first-class, enabling us to build a proof-of-concept model within the Liverpool area, secure further investment, then take the project forward across the city and into neighbouring Clinical Commissioning Groups (CCGs) within the ICS model.”
One important benefit of the initiative is that it is reducing the high number of benign moles and skin lesions being referred into secondary care via the Two Week Wait (2WW) cancer pathway. This has previously been a drain on resources and also caused needless concern for thousands of patients.
Prior to the technology roll-out 30 per cent of dermatology 2WW referrals in the region were being referred unnecessarily. This was amounting to approximately 7,000 unnecessary referrals a year, costing over £1 million. Since the Cinapsis technology was launched, 49 per cent of cases submitted on the platform are successfully managed with advice and guidance alone. Clinicians resources have been freed up to tackle wait times for other dermatological conditions, such as inflammatory dermatoses.
Dr Stephanie Gallard, GP & Primary Care Lead for Elective Dermatology within Cheshire and Merseyside Health & Care Partnership, said: “Historically, my GP colleagues and I had to waste hours wrestling with clunky, poorly-integrated photo-sharing technologies if we were able to attach photos at all in a data compliant manner. Aside from the heavy burden it was placing on our time, this was leading too many dermatology referrals to be made without high-quality images. This meant that patients were often called in for a face-to-face specialist appointment when they did not need special treatment, or when they could have been more appropriately managed in primary care.
“Now that I can use the Cinapsis SmartReferrals platform to manage patient referrals and access specialist second-opinions within days, I’ve been able to work more efficiently and treat patients more effectively.”
Dr Owain Rhys Hughes, founder & CEO of Cinapsis, said: “As a surgeon with over 20 years of experience, I know exactly how important streamlined communication is to the delivery of the NHS’s world-class patient care. That’s why the Cinapsis team has worked very closely with the Clinical Leads and the Teledermatology Programme team in Cheshire and Merseyside to build this bespoke, tailored solution.
“We’re passionate about delivering technologies that save time for clinicians, save money for the NHS, and ultimately could save patients’ lives. This partnership will make collaborative working between primary and secondary care teams a reality, and Cinapsis is proud to be playing a part in that.”
A new network to drive the integration agenda forward
By Chris Skidmore
Historical divisions between hospitals and family doctors, between physical and mental health, and between NHS and council services, have resulted in too many people experiencing disjointed care. All too often, it has been those from the most disadvantaged backgrounds and communities who have borne the brunt of disjointed care delivery, experiencing worse health outcomes than others.
Integrating both health and care has become a central mission both for the government and the NHS, with a clear focus on recently established integrated care systems (ICSs) as the driver of change.
Having been in development since 2018, July 2022 will see ICSs take up new statutory footing, providing a legal obligation to deliver joined up care and arrange services along a place-based approach. This will help ensure that decisions about how services are arranged should be made as closely as possible to those who use them. For most people their day-to-day health and care needs will be met locally in the town or district where they live or work. Partnership in these ‘places’ is therefore an important building block of integration, often in line with long-established local authority boundaries.
Yet the formal legal constitution of ICSs and their underlying new structures and governance, underpinned by integrated care boards (ICBs), can only be the start of a journey towards a fully realised vision of integrated care. With ICSs soon to be legally independent entities, the focus must now turn to their decision-making processes, and how they choose to adapt their services to meet local population needs.
Within this decision making will come the opportunity for more agile and rapid procurement processes, that allow for a more collaborative approach. Already the Department of Health has sought to support ICSs in their decisions, and has recently conducted a consultation on a new approach to arranging services – the Provider Selection Regime – which should make it easier to develop stable collaboration and to reduce some of the costs associated with the current procurement rules.
The government’s Integration White Paper: driving digital change in ICSs
Further to ICSs being established in law, the government’s Integration White Paper, published on 9 February 2022, goes further in ascribing a future strategic direction for ICSs and sets out a roadmap for better integration of services.
ICBs are expected to agree a plan for embedding population health management capabilities and ensuring these are supported by the necessary data and digital infrastructure, such as shared datasets and digital interventions. ICSs will use population health management (PHM) to help deliver personalised and predictive care based on an individual’s risk – which will be determined based upon an individual’s wider determinants of health.
Real-time insights from aggregated data will be crucial to achieving success in the fields of multi-disciplinary working, clinical decision support and waiting list management, at the same time as ensuring new diagnostic centres in the community can become a real success.
The Department of Health has also set out in the white paper an ‘ICS first’ approach, which will encourage organisations within an ICS to use the same digital systems, this will provide care teams with accurate and timely data, encouraging ease of information sharing. The department has set out a goal of 80 per cent adoption of digital social care records among CQC-registered social care providers by March 2024. To achieve this, ICSs must work with partners to drive adoption. Digital investment plans are expected to be finalised by June 2022, which include the steps being taken locally to support digital inclusion.
While more than 60 per cent of NHS trusts have made good progress into digitisation, with 21 per cent now digitally mature (as set out in the What Good Looks Like Framework), and only 10 per cent continuing to rely heavily on paper, the picture is often much more challenging in social care. Only 40 per cent of social care providers have electronic care records, and this is only improving slowly, at around three per cent per year. The Integration White Paper outlines a plan for adult social care that will ensure within six months of providers having an operational digital social care record in place, that staff are able to access and contribute to their local shared care record. Work is also underway to enable citizens to be able to amend their shared care records.
With these clear ambitions now set out in the Integration White Paper, there is a clear need to link policy ambition with the reality of enabling healthcare providers to deliver care within new ICS structures. As facilitators of joined up care delivery, ICSs will not be able to improve health outcomes without working closely with partners who share their vision of integration.
Integration can only be achieved by working alongside organisations with expertise in delivering patient management records and improved data collection methods – as well as with the pharmaceutical and health technology communities to deliver improved early-stage diagnostics and early access to treatments and therapies.
It is indeed these four areas of focus that represent the greatest opportunity both in the short and long term for ICSs to deliver real population health improvements in their local areas:
The future of healthcare data and the single patient record
The digital provision of healthcare
The improvement of diagnostics
The enhanced access to treatment and therapies
While the priorities for each ICS will rightly vary depending on the local patient needs and wider demographic demands, there is now a clear need to establish where common interests between ICSs exist, in order to enhance best practice. If ICSs are truly to become the benchmark of healthcare integration, then their own standards and performance will be monitored at a national level. It will therefore be incumbent for every ICS to engage fully in the wider policy debate about how they can deliver on the modernisation of healthcare through data, digital, treatments and technology. A wider forum is needed to help instruct ICSs on the right pathways to take for the future.
Public Policy Projects (PPP) has, for 25 years, been at the forefront of the healthcare policy debate; as an independent policy institute chaired by former Health Secretary Rt Hon Stephen Dorrell, it is recognised as a leading policy organisation that works with thought leaders across both health and social care, pharmaceuticals and more recently genomics. PPP has made the policy framework around the provision of integrated services a central mission of its work, and is responsible for publication of the Integrated Care Jounral.
ICJ brings together leaders in health, social care, local government, policy and research to engage with the latest insights and analysis surrounding the future of health and social care in the UK. Content is produced by and for the very leaders tasked with delivering joined up care across the country – covering every facet of ICS development.
To spearhead its outcomes-based approach to content, ICJ has recently established an Editorial Advisory Board. The board oversees content production pipeline, ensuring that our articles are insightful, practical and credible. The board is made up of some the country’s leading health and care experts and features system leaders at the very forefront of UK integrated care.
As part of its policy work for 2022, PPP is now seeking to establish a new Integrated Care Network which, alongside Integrated Care Jounral, will help provide ICS leaders with the policy guidance and support to make the best decisions for achieving improved patient health outcomes. PPP has already hosted a number of ICS related events, including a recent roundtable alongside IQVIA.
The start of this new Integrated Care Network work will begin with an ‘Integrated Futures’ roundtable series, beginning this Spring 2022, to mark the formal adoption of ICSs into law.
As part of the ‘Integrated Futures’ series, PPP will organise four roundtables focusing on the core areas of partnership between ICSs and healthcare providers which can deliver the greatest impact and benefit:
The future of healthcare data and the single patient record
The digital provision of healthcare
The improvement of diagnostics
The enhanced access to treatment and therapies
These roundtables will bring together both ICS representatives and leaders, together with healthcare partners at the forefront of working with ICSs to deliver on better care through innovation and improved access to data, digital technologies and enhanced treatments and therapies.
The Integrated Futures series will seek to position PPP as the forum for the high quality exchange of ideas and future policy, with those ideas intended to influence both NHS strategy and ICS leaders. As such, this will be an important forum for companies and organisations to be involved in, at a time when the future direction of ICSs both at a local and national level is still to be fully established.
To achieve the NHS Long Term Plan goal of preventing health inequalities and improving health outcomes, the voices of those delivering and receiving dental care on a local level must be prioritised.
Top-down change, if not informed by local experience, will fail to address issues faced by service users and service providers. Therefore, the voice and experience of local councils, local Healthwatch and local service providers is key to creating an environment through which NHS dentistry can play its part in reducing health inequalities and improving health outcomes. This is why building strong relationships with these bodies is central to the role played by Local Dental Committees (LCCs).
The LDC Confederation is a membership body for LDCs which represent primary care dentists delivering care under an NHS contract. We actively support our member LDCs to engage with local stakeholders, to take the time to explain the complex NHS dental contract and to make clear how, if properly supported, NHS dentistry could help meet their local objectives. These local relationships have created sympathetic alliances and a strong desire at the local level to see a reformed dental contract introduced that would remove barriers to care, which in turn would help to reduce health inequalities and improve health outcomes.
The local councils and local Healthwatch know their populations, understand their issues and seek to identify areas for improvement. Even before the pandemic, we were pleased to see a growing interest in NHS dental services from local stakeholders. Since then, of course, we have seen access to NHS dental services and appropriate provision of NHS dental care grow into a burning issue for almost every local authority.
Member LDCs have enjoyed close working with their local Healthwatch partners, helping with reports and speaking at events throughout London. During the pandemic we provided updates and patient facing information for our local partners to help them and their communities to navigate NHS dental services. This interest has increased dramatically throughout the pandemic as services have struggled to meet patient demand.
Barriers to access
The barriers to access exacerbated by the pandemic have existed since 2006. The pandemic simply brought them to the fore and demonstrated the historic neglect that NHS dentistry has suffered, but also the huge importance that the public place on NHS dentistry. Time and again we have seen reports which show clearly that dental services are highly valued and that satisfaction with the quality and outcome of the care received is high.
NHS dentistry should be one of the great success stories within the wider NHS: a high achieving clinical specialty, with high patient satisfaction, providing clinical care able to give instant pain relief and rapid functional outcomes. Instead, sadly, it is treated as an ancillary service which is not vital to health and wellbeing.
Local stakeholders know differently. They hear stories from patients in pain on a regular basis, from parents of children in pain, from those who are ashamed to go out or eat in public, from people who are afraid to access care because of the NHS charges and those who simply cannot navigate the system and end up at the GP or in A&E. We have been working hard with local partners to press for improvements to holistic care, especially for the most vulnerable such as those in residential care homes and those with conditions such as Alzheimer’s and other dementias, diabetes and stroke rehabilitation. These groups in particular need the system to work with them and for them if they are to lead lives free from avoidable pain and discomfort. Integration of services at the local level will support a holistic approach to care which would pay dividends in improved general health outcomes and quality of life.
Dental contract pilots
Dental contract pilots, later termed prototypes, have been the great hope of the profession since they began in 2010. These pilots were testing new models for the contracting of NHS dental care and were based on blends of capitation and activity. Appointments were longer and the focus was on prevention.
90 per cent of patients had reduced or maintained levels of tooth decay
80 per cent of patients had reduced or maintained levels of gum disease
97 per cent of patients said they were satisfied with the dental care they received
At the start of 2022 the NHS announced the end of the prototypes and all dental practices operating as prototypes for the NHS are now reverting to their previous contracts. Despite the models showing such promise it is not clear how much of the valuable information taken from these pilots will be applied to a reformed contract in the future.
Local voices are vital
The current Units of Dental Activity (UDA) contract, is based on activity and the NHS is heavily reliant on recouping funding for dentistry through patient charges. This creates a disincentive for the system to increase access among those with the highest need, as a greater number of treatments take longer and in doing so will reduce the amount of activity delivered, throughput of patients and the amount of funding the NHS can recoup from patient charges. The current activity based contract is not able to support local objectives of reducing health inequalities, and the focus on treatment rather than prevention does not support the local objective of improving health outcomes.
If the local councils, and in the future local care partnerships and Integrated Care Boards, want to see a reduction in health inequalities and improvement in health outcomes then a dental contract which supports those objectives is needed. The LDC Confederation ensures that local stakeholders understand NHS dental services and the role they can play in meeting these priorities. We will continue to work with our local partners to make sure local voices who know their populations best will be heard at the national level. Local voices are vital to inform dental contract reform and to make sure that the dental contract is fit for purpose.
The Minister for Primary Care, Maria Caulfield, recently outlined the aforementioned problems with the dental contract on BBC Radio Sussex, and also affirmed the importance of contract reform. Both of these statements are to be welcomed but real improvements will only be seen if that reform is based on the experiences and priorities of those delivering and receiving care at the local level.
Is the answer to improved health hiding in plain sight?
By Dr Anne Elliott and Professor Tim Evans
The UK is suffering from a major gap in the provision for exercise as a prevention or management tool for chronic disease. Outlining this growing healthcare crisis is Dr Anne Eliott, Senior Lecturer in Physical Activity for Special Populations and Healthy Ageing, and Prof Tim Evans, Professor in Business and Political Economy at Middlesex University London.
Over and above record NHS waiting lists1 and the adverse effects of the Covid pandemic, there is a tsunami of chronic disease on the horizon, and it is flowing towards us at a stately and predictable rate2. We can see the wave growing and developing, we can gauge its potential cost, we can foresee the amount and quality of resources that will be needed, and we can estimate the number of specialist healthcare professionals that will be required to address it – and yet we seem unable to avert what increasingly appears to be an inevitable disaster.
We cannot lay the blame for the growth in long-term illness on a lack of health education, as positive health messaging from both the state and private sectors is prevalent in all popular media and easily accessible for all age groups and populations. At the bare minimum, the general public understands the importance of ‘eat less’ and ‘move more’. Over the last 20 years, successive governments have sponsored numerous initiatives that have attempted to address such issues, from Change4Life (PHE 2009) that aimed to encourage families to exercise together, to the recent adoption of an old idea, social prescribing3 (NHS 2020), that targets loneliness and depression at a local community level.
However, differing socio-economic determinants have been identified as obstacles to participation. Although authorities try to address these barriers, sedentary behaviours and lifestyles are responsible for 40 per cent of premature mortalities and continue to be the weak spot for ‘preventative medicine’4, a term now well established within Parliament and across the UK’s broader political discourse.
Cost is consistently found to be one of the biggest barriers to moving towards a healthier lifestyle. Through physical activity in the private sector and with levels of economic status found to be correlated to health outcomes5, it would be beneficial to make access to exercise easy as both a preventative tool in the public sector and as a response to the onset of many diseases further adversely impacting the medical sector.
A gap in provision
There is a clear gap in provision for exercise as a prevention or management tool for chronic disease and there isn’t availability or knowledge in the existing medical workforce to bridge it
At present, general practitioners are the most efficient and effective pathway to intervention and support for people in local communities. However, there are limited options, such as exercise referral schemes6, found to be too short for exercise adherence and too expensive for most practices to utilise, or referral to a scheme such as the NHS Diabetes Prevention Programme. Apart from these ‘schemes’ the next level of physical specialism is physiotherapy and associated disciplines which are geared to address more clinically acute rehabilitative issues.
It is against this backdrop that there is a clear gap in provision for exercise as a prevention or management tool for chronic disease and there isn’t availability or knowledge in the existing medical workforce to bridge it. However, with some creative change and investment, the workforce required to fill this gap could be closer at hand than most commentators realise.
Currently, there are approximately 66,300 fitness instructors in the UK, of which 22,032 are personal trainers. They are well placed to work with the general public with diagnosed or undiagnosed chronic conditions – it is common for sufferers to live with low level conditions for up to 20 years before they seek help from their doctor, when the condition interferes with their quality of life. The Chartered Institute for the Management of Sport and Physical Activity (CIMPSA), acknowledges this specialist need and has drawn up professional standards for fitness7. Ukactive8 also discussed using trainers more within a wider community based social prescribing framework. We see professional bodies turning their consideration to this in light of Covid, which has created an awakening of understanding for the need to improve the physical and mental health of an ailing population.
Upskilling the workforce
While such upskilling requires investment, the costs will not be as great as leaving health outcomes to an unnecessarily disjointed and unreformed skills base
The fitness workforce has historically been eschewed by the medical profession on the basis that too many of its practitioners lack appropriate levels of educational attainment. Personal trainers are shown to have qualifications that range from a ‘two-week online course’ to a Masters degree in a sport specialisation such as Strength and Conditioning. Industry regulation has mitigated this to a certain extent by registering most practitioners with a vocational qualification equivalent to an A level. However, these fitness qualifications are not mapped to any NHS accreditation and qualification requirements and so a divide between health provisions runs deep.
An obvious solution to this division is to bring existing fitness qualifications into parity with the medical regulatory framework. The workforce can be upskilled into the range of existing NHS levels of qualifications and pathways, such as apprenticeships, which may then provide an opportunity to create roles acknowledged by the Health and Care Professions Council.
While such upskilling requires investment, the costs will not be as great as leaving health outcomes to an unnecessarily disjointed and unreformed skills base. At a time when the NHS is facing its largest ever backlog, it would be wholly inappropriate to invent a new category of worker, train them from scratch, or alternatively do absolutely nothing.
Workforce planning
While in the past the pressures of electoral politics have often prohibited effective workforce planning, inaction with regards to the country’s fitness workforce is contributing to a multifacted healthcare crisis
To mitigate the ill effects of both the waiting list backlog and the coming tsunami of chronic disease outcomes, it is important to make key investment and workforce planning decisions now. These plans should ideally be locked into our health system for the longer term through a robust cross-party agreement.
For decades, successive British governments of all stripes have avoided workforce planning issues. Incentivised by shorter-term electoral cycles, they have instead left the healthcare system dangerously exposed to the fragilities of professional overstretch. This is why the UK has so few doctors and nurses in comparison to other comparable countries in the developed world9.
However, with today’s spiralling costs, waiting lists setting ever higher records and more than 21 per cent of people now opting to use private healthcare10, the NHS urgently needs creative solutions if it is going to have space to develop and implement better planning.
It is in this context that this proposal to upskill and realign existing professional skills and resources makes so much sense. As a swift and effective solution to overcome a current and costly chasm in our health system, the objective has to be not only holding back the looming wave of chronic disease but to enact comparatively inexpensive reform that will mitigate its most damaging and costly effects.
Faced with an unprecedented and systemic crisis of demand, the time for imaginative supply side reform is now more pressing than ever. If several tens of thousands of people are not empowered to fill the gap in our health economy, then the NHS – and the electoral support that it has hitherto enjoyed – could become irreparably damaged. While in the past the pressures of electoral politics have often prohibited effective workforce planning, inaction with regards to the country’s fitness workforce is contributing to a multifacted healthcare crisis.
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