What Steve Barclay must do for the NHS to survive the winter

By Professor Terry Young, BSc, PhD, FBCS

England’s Integrated Care Systems are still finding their feet as another winter sets in. What must the new Health Secretary do if the NHS is to survive the winter?

Three areas in which Steve Barclay, the new Secretary of State for Health and Social Care, could help are backlogs, health inequalities and digital. In each case, the lag between where we are and where we need to be is big enough for the right creative leap to put us ahead of the curve (and everyone else).

Backlogs

The NHS’s waiting list is about 7 million (although under revision). This number exceeds a tenth of the population, so if you are not waiting you probably know someone who is – but how big is this problem?

The NHS costs options in terms of QALYs – the quality adjusted life year. If a person were dying from a road traffic accident, for instance, and A&E enabled them to walk out in perfect heath, they would have received roughly one QALY of benefit by the anniversary of their discharge.

However, most of us benefit in increments. For instance, a knee implant may support an extra 10-15 years of active life – perhaps a benefit of just over 0.2 QALYs per year for 15 years, or nearly 3 QALYs overall. A few years ago, Lomas et al calculated that it cost the NHS around £13,000 for every QALY delivered. Now, we need to know how many QALYs are needed by the average person who is waiting.

Nobody knows the case mix, but we can set limits on the cost of addressing their needs. It’s hard to see how the average can be less than 0.15 QALYs per person (which means a £14 billion problem) or how the average could exceed a whole QALY per person (a £90 billion pound problem). England’s entire health and social care budget in 2021/22 was £190 billion, so these are colossal numbers, even as limits.

This problem is huge and unaffordable if set about in the traditional way. The Secretary of State could use this crisis to leverage innovation at unprecedented scale. As an example of a small success that would scale, I have been working with Badger, a social enterprise that pioneered drive through clinics during lockdown (see articles below). Badger’s approach to smart service design, information management and new pathways could be scaled up to shrink national waiting lists quickly.

Health inequalities

A potentially bigger problem is health inequality (which we can identify but are only just learning to scope). Very simply, the needy die earlier than that the affluent and enjoy poorer health, as do ethnic minorities and other groups recognisable through mental health or long-term conditions. In the UK, there are communities whose healthy life expectancy is 10-20 years shorter than others in the same city. Still more worrying, there are regions where around half the population now suffers from unequal access to health care or unequal outcomes when they do gain access.

Signposting, or creating positions to direct those suffering poor health outcomes towards the services they need, or adding staff to tailor ineffective services is very expensive, while more GP slots cannot improve a system that consistently inconveniences those who need it most. We know that most aspects of service, from appointments to diagnosis and treatment, are difficult even for the majority so it is hardly surprising that anyone with even a small extra challenge in life will be disproportionately affected.

An alternative is to redesign key aspects of ICS delivery so that they work easily for everyone. Better still, use the poor outcomes from health inequalities as a barometer. By focusing on their needs, the care system would be critically reformed at system level, benefitting us all as a by-product.

Digital

Finally, there is a widespread belief that digital can solve many of our care delivery problems – and it’s true, in principle. Digital access and services will certainly work for the affluent, IT literate and whoever uses the most popular services. In doing so, they will also worsen health inequalities, unless designed and rolled out with exceptional skill and ingenuity to narrow the digital divide.

The examples below showcase how smart information systems are critical to innovation. It’s not just about apps – the health system’s entire information infrastructure needs attention. The new Secretary of State can nudge the NHS from simply collecting information to deploying real-time data to identify and serve those who are suffering most.

Every ICS needs advanced information, analytics and simulation, capabilities to continuously improve existing services, deploy new services and track the near-invisible populations who are missing out.

If the new Secretary of State can ease ICSs in this direction, he will long be remembered and for all the right reasons.

For further reading on a small-scale demonstration of smart systems in care deliver:

Rapid access care: how to make your call centres really work (NHE, July 2022)
Driving innovation: a case study using a simple evaluation tool (ICJ, June 2022)
Getting to zero: why it can’t work (ICJ, May 2022)
The flywheel: Silicon valley, Nightingale Hospitals and the health data system of the future (Chamber UK, April 2022)
Agile care in a time of lockdown (Health Estate Journal, April 2022)
Making the creative leap: a healthcare case study (ICJ, April 2022)
How to design and build a care system: from jargon to achievement (Chamber UK, March 2022)

Integrated care and service transformation – the role of experience

By Emil Peters

Emil Peters, Group CEO at Tunstall Healthcare, discusses the role of experience for all stakeholders within the health and social care systems, and how ICSs will enable improvements to care provision and delivery for all.

When it comes to the transformation of health and care services, there have been numerous iterations of reforms. The current implementation of Integrated Care Systems (ICSs) and Integrated Care Boards (ICBs) in my view, presents an opportunity to truly transform our services and become a global leader within the health and care landscape.

However, it is important to remember that there are still key issues that need to be addressed at the heart of the health and social care landscape if we’re going to innovate and improve the care that health systems are able to provide the population. Addressing the concerns of all stakeholders, from users and residents to professionals and leaders in health and social care, and where technology sits within this, will give us a good chance of working with ICSs to create a landscape that is able to effectively serve everyone.

Experience is key

Experience matters, but not only in the traditional sense. While there are many key facets involved in the development and transformation of services, the experiences of patients, the workforce, and the entire community are crucial. If we align with these stakeholders and their lived experiences, we can begin to change the health and social care landscape.

Identifying the needs of each individual, and understanding that every population is made up of a set of people, will make it easier to deliver better services. If the entire ecosystem works in harmony, citizens will receive better care and their outcomes will be improved. It’ll also mean that health systems are better equipped to meet the expectations of the population when it comes to care delivery.

It will also be essential to keep the experiences of the workforce, from challenges to working practices, at the forefront. If we can meet the various needs of professionals, it will be easier to engage with them, and they will be more open to trying and deploying new solutions and services, such as technology. Ultimately, if professionals are cared for first, the care of citizens is likely to be improved in a consistent and sustainable way. While professionals keep in mind the compensated workforce, must also include the voluntary sector as a vital cog in our ability to deliver the lived experience we all want.

By working together, the health system will be better equipped to navigate care provision for residents and the community when it is required. We’ll know what the care is going to look like, how we’re going to deliver it, and communicate to service users what they can expect. This in turn will give them the information they need to become empowered and able to make the best decisions for themselves. As people become more empowered and involved in their own health, wellbeing and care provision, their outcomes are much more likely to improve.

Experience and technology

Technology has a key part to play in enabling the UK to become a global leader in the health and social care space, but a holistic view which looks beyond technology on its own is vital. While digital solutions have the ability to become sustainable if done right, focusing on how users interact with technology will also be crucial.

Regardless of the huge range of technology that is available and the incredible features that it can provide, it’s the people involved who will enable the true potential of digital solutions to be reached. If the experience of users and caregivers with technology is subpar, it’ll be difficult to deliver digital solutions that are sustainable and impactful.

When it comes to the public’s perceptions of the nation’s health services, many people consider the different levels and organisations of health and care in the UK to be effectively joined up, rather than the reality where many are working in silo. Investing in technology will enable an environment where the workforce can share vital information, communicate effectively and provide better care for residents. This in turn will create better outcomes for everyone involved and will promote care that is tailored to every individual within the care system, whether it be a nurse, a patient, or a family member.

The more that professionals are able to engage with digital solutions, the more that their time will be freed up to listen to the people that they care for. Patients and service users are very aware of the care that they are receiving, particularly when it comes to the small things, and technology can help to change their perception in a positive way.

Integrated care systems and their role

It’s important that stakeholders look beyond the monetary gains that can be achieved through the successful implementation and integration of ICSs and ICBs. If service transformation is viewed solely through the lens of finance, it’s easy to forget about the people and stakeholders who actually make the transformation possible and how they can be engaged.

ICSs can help us to involve all people from the top down, and provide the tools that to support everyone and deliver proactive and preventative care. Both the health and social care services are ultimately caring industries, with the majority of professionals working within them to support the health and wellbeing of communities through effective care provision.

ICSs are also giving us the opportunity to work with groups beyond the immediate health and social care sectors that are still able to have a significant impact on the health and wellbeing of residents. For many, good health begins in the community, and so if ICSs can engage with organisations and places such as public libraries, this will lead to better care across the board. It’s also important to focus more on upstream interventions and maintaining wellbeing to reduce the pressures on acute services and promote good health.

ICSs have provided a unique opportunity to merge the health and social care workforce across the spectrum, and optimise the experience of these professionals. The improved collaborations through ICSs should also support a reduction in the fear of the workforce when it comes to adopting new products and services, such as technology, and working closely together to embed them into new models of care. Collaboration will be key to supporting an improvement in the lived experiences of the populations we serve.

This article was kindly sponsored by Tunstall Healthcare.

For more information, please visit www.tunstall.co.uk.

21st Century Healthcare: why the details really matter to the NHS

By Professor Terry Young, BSc, PhD, FBCS

As the NHS sets up integrated care systems, the greatest worry must be how well it can connect executive intent to on-the ground activity.

Given its failure to manage major change in the past half century, how well equipped are boards to run the most interactive and responsive mode of care yet attempted, anywhere in the world?

First, some history. Brunel lived in an era of golden engineers who ran all aspects of the business. He knew when to build wooden bridges to complete a railway, so that the operators could launch the services that would fund better bridges later. He dealt directly with his backers and his father’s spell in debtors’ prison overshadowed his overworked and gilded career.

This hands-on approach persisted a surprisingly long time. The Ocean Railway (2004), for instance, tells how 19th century marine engineers drove the passenger experience with a hand on the technology and a seat on the board. They took financial risks and ran operations, building ships that would outpace the competition while carrying more passengers in ever greater luxury.

A rising corporatism isolated the working end – industry, innovation and integration – from the funding flows and strategy. By the ‘70s British Leyland epitomised how dangerously disconnected the two had become. Management and unions missed what was wrong, each focused on its part of the problem, and neither realising that build quality and process engineering were the new keys to success.

As this industrial scene disintegrated and the NHS was in its prime, a new breed of entrepreneurs – let’s call them e-Titans – was emerging, with roots in computing instead of steel. With a hand on the keyboard and a seat on the board, Bill Gates and Steve Jobs became household names, and we soon adopted Google even if we didn’t know who Sergey and Larry were.

The NHS is one of the 20th century’s golden legacies, but it’s not commercial, so what can it learn from this most commercially minded breed? First, it is notable that e-Titans are not focused on commerce alone but maintain a creative and active interest across society, including health and the environment. The NHS is all about knowledge, and so cannot neglect the e-Titans’ discoveries.

So, how have e-Titans changed the world? David Edwards (I’m feeling lucky, 2012: p18) describes Google’s CableFest ’99 – when Larry Page and a few engineers played jigsaw puzzles with servers to squeeze 4 motherboards per tray, stacked into 8-foot high racks. It’s not that this reverse-and-rebuild-engineering was extreme, it’s that a CEO would dive in to find the highest packing density. This hunger for efficiency powered Google away from the pack.

e-Titans remain fanatical about detail. In some senses, their style is closer to the 19th century than the 20th, and they certainly don’t believe you can leave innovation or process tuning to others.

Critically, and trillions of dollars of wealth creation later, e-Titans are rewriting the manuals. In Creativity Inc. (2014), Ed Catmull shows how companies can harness ingenuity, while Reed Hastings and Erin Meyer (No Rules Rules, 2020) are taking big investment decisions out of the boardroom to the fringes, where Netflix staff meet their clients.

Amazon’s online books sales did not just threaten poorly run bookstores: it shook an entire sector. A third-party logistics MD recently complained to me that he must compete, on meagre resources, for customers whose expectations are shaped by Amazon’s technology and processes.

So, as the NHS recovers from Covid backlogs and blockages, how can it connect its consolidated multi-billion-pound cash flows better to more timely and responsive care? Colin Bryer and Bill Carr (Working Backwards, 2021) explain how to build agile teams to deliver within colossal organisations that are often cash starved because they are growing so quickly.

The e-Titans may not have provided a set of universal or sustainable standards nor do they agree among themselves but they are converging around norms that are radically different from anything the NHS has experienced. Healthcare may be perceived to be immune from the curiosity of the e-Titans with their implacable love of data and efficiency, their hands-on innovative involvement, maybe even their social consciences.

The auto industry was not worried when an e-Titan announced plans for a better car. Whether Tesla booms or goes bust, it has already left its electric mark on the landscape with transport thought to be at least a generation away.

As with British Leyland in the ‘70s, the NHS’s challenge is whether we learn what it takes for ourselves or leave others to run the sector for us. We do not know what universal healthcare would cost as a knowledge industry deeply dependent on data and running supremely smart processes. At least, we don’t know, yet.

About the author

Prof Terry Young worked in R&D before becoming an academic, where his research focused on the value of medical technology and the design of health services. He is an Emeritus Professor at Brunel University.

Fujifilm primed for leadership in pulmonary solutions

By Peter Mansell

Pictured above: Samiran Dey, European Business Development Manager, Fujifilm Europe

An established pioneer in digital X-rays, flexible endoscopy, ultrasound and CT scans, Fujifilm Healthcare has been using these technologies to address pulmonary conditions for nearly two decades.

Yet, the company is better known in gastroenterology, and particularly for its advanced endoscopy products.

The acquisition of Hitachi’s diagnostic imaging business in March 2021 strengthened Fujifilm’s hand as a medical-imaging specialist and a comprehensive provider of healthcare solutions. Now, Fujifilm is leveraging cross-business synergies to pursue a bold new vision as a one-stop pulmonary solutions supplier.

That includes an expanded product portfolio, enhanced with innovations in fields such as image processing and artificial intelligence. With new additions such as the slim EB-710-P bronchoscope, Fujifilm offers a broad suite of pulmonology solutions extending right along the whole patient pathway, from screening to treatment planning.

Integrated, cutting-edge technologies that facilitate and clarify pulmonary screening and diagnosis can help improve patient outcomes in areas such as lung cancer, where survival rates still lag significantly behind other oncology settings. Streamlining patient pathways is also about tackling the capacity and efficiency issues that routinely confront time- and budget-constrained pulmonologists.

These issues, together with the inherent challenges of lung screening and diagnosis, are part of what has historically relegated lung-cancer detection to too little, too late. As Samiran Dey, European Business Development Manager for Fujifilm Europe, notes, hospital endoscopy units tend to have just one room out of five dedicated to bronchoscopy.

**Fujifilm’s booth at ERS Conference, Barcelona (click to enlarge)**

There are indications, though, that lung cancer is moving up the screening hierarchy. In its recent report on Strengthening Europe in the fight against cancer – towards a comprehensive and coordinated strategy, the European Parliament’s Special Committee on Beating Cancer called on the Commission and Council to consider including targeted lung cancer screening in this year’s updated guidance on cancer screening.

In England, lung-cancer screening pilots are being rolled out across the National Health Service in three phases under the Targeted Lung Health Check programme. Low-dose CT scans are available for anyone aged between 55 and 75 years who has ever smoked.

Unmet needs

This growing recognition of unmet needs brings the benefits of innovations such as the EB-710-P, or of 3-D visualisations to help plot a course through the lung to peripheral lesions, clearly into focus. Pulmonologists are also dealing with limitations of time and space, which is where Fujifilm assets such as faster image processing or compact, portable X-ray machines, come into their own.

Accessing all of this from a single supplier, with joined-up support services and data transfers, plus seamless transitions from disease detection through to surgical modelling, also underlines how important ease of use is to clinicians in the field. In Fujifilm’s experience, what matters most to pulmonologists is not so much technical ingenuity or image quality, but rather how these qualities determine useability.

As Dey comments, “it’s human nature, wanting things to run smoothly. Being able to have that integrated is the main issue for healthcare. Where things can talk to each other, especially the service side from industry, and they come from one provider, that makes it easier for clinicians to run their practice”.

It can also drive efficiency and, potentially, cost-efficiency gains. Fujifilm is not only offering distinctive products, such as the EB-710-P or its FDR Nano X-ray system, but offering them as part of an inclusive package of pulmonology solutions that helps clinicians to do more, better, and in less time.

New ambitions

Patterned on Fujifilm’s EndoSolutions strategy and its successful focus on gastroenterology, the new ambitions for pulmonology started taking shape more than a year ago, with the creation of a dedicated respiratory business unit and Dey’s appointment to head up European business development. Monthly R&D meetings followed, while expert meetings kicked off in September 2022.

A roadmap for the evolving business envisages Fujifilm as a unique solutions provider in a very substantial European pulmonology market. Along with Fujifilm’s one-stop offering, cross-business unit synergies will be a key differentiator in this respect. “What’s really unique is synergising what the cross-business units can offer,” Dey explains. “Over six months, I’ve found out that we actually do have a solution.”

That runs from screening with X-rays and CT scanners, to Fujifilm’s core diagnostics offering with bronchoscopy, and then on to software that facilitates treatment planning. “There are obviously many other companies out there doing many things,” Dey says. “But no one other company has that full solution. We are a one-stop solution for the lung-patient pathway.”

Something else that distinguishes Fujifilm in pulmonology is its commitment to training and education. The company’s mobile training hub, the Endorunner, “allows us to take our products and education to the respiratory community, as opposed to them having to come to us”, Dey observes. “We’re also kicking off two-day pulmonology courses, dedicated to training physicians and all of the staff in the bronchoscopy suite.”

Long-term vision

As Dey points out, “we’ve always been in pulmonology”. However, Fujifilm has realised that “with lung-cancer screening coming to light in European countries, the UK probably being the first, more focus is needed. We had a product range; now we have a broader product range, thanks to some new bronchoscopes. And we can offer solutions to the respiratory community.”

**The Fujifilm team at ERS Conference, Barcelona (click to enlarge)**

The long-term vision, Dey adds, is to be “the number one provider of pulmonary solutions to the healthcare market”, offering “the products, services and education physicians need for their lung patients”. At the same time, Fujifilm is determined to carry on innovating for even better pulmonology solutions.

That could eventually extend beyond treatment planning and into the surgical space. “We will never stop trying to find the full solution for the pulmonology pathway,” Dey says. “And, for these patients, surgery is still the gold standard.”

This is a sponsored article.

Support through the menopause is a necessity, not a luxury

By Professor Dame Jane Dacre

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How the ICS can unify data and relieve elective care

By David Duffy

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

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

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

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

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

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

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

Articulating the problem

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

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

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

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

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

A strategic partnership approach

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

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

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

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

How has the ICS enabled this change?

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

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

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

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

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

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

Digital Implementation May 27, 2022

How ICSs can help uproot risk aversion and progress innovation

By David Duffy

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

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

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

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

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

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

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

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

Fostering a culture of innovation

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

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

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

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

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

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

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

Innovation as an antidote to health inequality

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

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

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

Risk appetite

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

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

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

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

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

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

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

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

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

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GMC urges removal of barriers to help tackle NHS workforce crisis

By Gabriel Blaazer

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

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

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

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

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

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

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

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

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

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

Building sustainable ICS staffing to weather the workforce crisis

By Dr Anas Nader

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

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

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

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

Harnessing the power of collaborative temporary staffing

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

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

Increasing data oversight

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

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

Introducing more flexible rostering

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

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

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

Prioritising system integration

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

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

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

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

Billions needed to plug growing NHS maintenance backlog

By Integrated Care Journal

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

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

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

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

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

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

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

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

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

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

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