Health Inequality, News, Thought Leadership February 6, 2025

The fundamental inequalities in women’s health

By Jane Johnston LFEPID

Jane Johnston, Co-CEO of the Association of Professional Healthcare Analysts (AphA), discusses the decision to drop Women’s Health targets from the latest NHS planning guidance, and its impact on persisting inequalities in women’s health.

The latest NHS planning guidance was released last week. But that’s not what I’m going to write about today; I thought I’d bring to your attention to the decision to drop Women’s Health targets from the NHS plan.

It was mooted a week or so ago that this was because there was concern that the NHS gives in too easily to interest group lobbyists. I don’t see that 51 per cent of the population is an ‘interest group’ – they are actually pretty important if we want to reduce inequalities and reduce costs of long-term care through preventative medicine and appropriate treatments and interventions. But the reason, we are assured, is because the target for Women’s Health hubs in every system achieved 93 per cent (39 out of 42) in 2024/25 and therefore need not be repeated in this year’s guidance.

However, a recent poll shows that 18 per cent of women had reduced their working hours or left the workforce because of Women’s Health related issues. Of those, 39 per cent said they would definitely have been able to stay in work or maintain their hours if they had had better access to timely and effective healthcare. Half of the respondents said they had suffered dismissive, discriminatory or harmful treatment at the hands of the NHS.

So perhaps Women’s Health targets need to be reassessed and included in the NHS plan.

Inequalities in research matter

But planning guidance and women’s health hubs aside, there is still an alarming amount of inequality in Women’s Health. This is not just about health hubs and services – it’s much more fundamental than that.

I’m talking about scientific research, drugs, medical devices and lived experience. I would like to present the case for why biology is important because in the treatment of diseases; it’s the biological sex that counts – XX chromosomes, in the case of females.

Let me give one brief example of why the biological sex overrules the gender a person has chosen to identify with. 76 per cent of cell cultures used in lab research are male, i.e. XY chromosomes. In the USA, a five-year cohort study into road traffic accidents involving a high proportion of women found the common factor that many were taking medication for insomnia. It was discovered that the female metabolism metabolises slower than the male metabolism. Yet still, in some cases it took more than two decades for sex-specific doses to be considered. How many more drugs out there are over-medicating women with doses continually optimised for men?

Previous studies on the benefits of aspirin for heart health were optimised for males. Yet, more women die from heart disease in the UK than men. And over a decade, 72 per cent of drugs were introduced to the market without data on pregnant or breastfeeding women, the default advice being to “ask your GP”, who often didn’t know any more than the patient. Women experience five times more side effects from drugs than men – is this because more than 60 per cent of clinical trials are on men? Even in animal testing, using males is the default.

Endometriosis has been cured twice in animals but in human trials it has failed, arguably because scientific discovery which is male based often does not work when translated into human females.

The are of course some amazing examples of funding, and rightly so, for research into horrific diseases such as cancer. Breast cancer research specifically gets 10 times more funding than research for female-specific heart disease. However, twice as many women die from heart disease than do from breast cancer.

Lack of suitable treatments

One thing that is a certainty for all women is menstruation, or problems with menstruation. One in eight women of working age took time off work last year because of symptoms, increasing economic burden through lost productivity.

10 per cent of women suffer adenomyosis where the endometrial cells invade the muscular cells of the uterus. This causes extreme pelvic pain. Often there are no diagnostics and no treatments, so patients are prescribed long-term pain medication or, in some cases, have a hysterectomy. Fibroids are another common occurrence in 70-80 per cent of women, although less than half are debilitated by them and 30 per cent end up having surgery to remove them, or a hysterectomy.

10 per cent of women suffer endometriosis, but again, there is no cure, so they are prescribed long-term painkillers, hormone treatments, surgery to cut away the affected areas, or a hysterectomy. Then there is the lesser discussed pelvic congestion syndrome causing chronic pelvic pain. 49 per cent of gynae appointments are because of pelvic pain and 30 per cent of these are likely pelvic congestion syndrome. As it is difficult to diagnose because of similarity of symptoms to all of the above, the patient is usually given painkillers, hormone treatments or of course, the default hysterectomy. 20 per cent of women in the UK will end up having a hysterectomy at some point.

This is mainly because research does not invest enough in diagnostics, drugs, or devices specifically tailored to Women’s Health. Only 2 per cent of funded research is for pregnancy, childbirth and female reproductive health. Over half of the population suffer conditions specific only to them, yet only 2 per cent of research is dedicated to trying to find cures and treatments for women. The other half have 27 per cent of research dedicated to male-only health and the rest, we know, is optimised for men.

One shocking example of underfunding in research for medical devices for women, is vaginal stents for paediatric surgery, where little girls are operated on because of e.g. tumour removal, trauma or birth defects. There is no such thing as a paediatric vaginal stent. Surgical gloves are stuffed with gauze and inserted to maintain integrity. There have been amazing advancements in medicine and medical devices, yet something as simple as a paediatric vaginal stent is yet to be made readily available.

There is also the very real problem of medical gaslighting. Women tend to go to the doctor a lot more than men, because they are suffering extreme, sometimes chronic, pain, regular excessive and debilitating blood loss with associated fainting nausea and vomiting. But more often than not, they’re made to feel that they’re overreacting, just being oversensitive and there’s nothing really wrong, it’s just part of being a woman.

Among countless documented examples, I have also heard heart-breaking first-hand accounts from female clinicians, who in pregnancy, have voiced their concerns about their unborn child to both male and female doctors, only to be dismissed as overthinking due to their medical background—only to later suffer a stillbirth. They knew their bodies but were persuaded otherwise.

Another first-hand experience was told to me by a colleague, a senior nurse of many years’ experience, who suffered pelvic congestion syndrome. She was prescribed the usual treatments of long-term painkillers and hormones. After being bedbound with pain and finally being offered a hysterectomy, she did her own research and ended up paying privately for scans and ultimately vein embolisation, a minimally invasive day case procedure that according to the private consultant, is frequently overlooked in the NHS. These were women who were trained in medicine. How the rest of the population can possibly feel they can speak up against such gaslighting or have the knowledge or confidence to research their options is worrying.

Inequalities impact the NHS

A consequence of underfunding of research into female-specific diseases in comparison to the burden of diseases, apart from the economic burden, is the cost to the NHS is in terms of long-term medication and preventable surgery. Not to mention mental health services, as some women who have lost a child or who are living with chronic pain, or who find it difficult to come to terms with hysterectomy, will require support through therapies.

And considering the number of hysterectomies being performed, studies show that the long-term consequences indicate potential associations with increased risk of cardiovascular disease, metabolic issues like diabetes and high cholesterol, osteoporosis, depression and even certain cancers and possibly even Alzheimer’s. What is the downstream cost to the NHS for these potentially preventable co-morbidities?

So, if we’re really about reducing inequalities and looking at preventative medicine, better treatments and reducing costs, then maybe we need to start at the bottom, with the building blocks of medicine. By investing more in women’s health, the 39 out of 42 women’s health hubs can provide cutting edge, optimised care, reducing pressures on the system and vastly improving women’s health outcomes and experience.

I would like to thank Brittany Barreto, Ph.D., author of of Unlocking Women’s Health, FemTech & the Quest for Gender Equity for inspiring me and sharing global research stats with me.

All news

AXREM publishes AI manifesto

By Integrated Care Journal

Association for Healthcare Technology Providers for Imaging, Radiotherapy and Care calls for collaboration on clear and consistent AI innovation to reduce duplication and risk while maximising benefits.

AXREM, the Association for Healthcare Technology Providers for Imaging, Radiotherapy and Care, has called for policymakers, NHS leadership, and AI developers to collaborate on clear, consistent innovation pathways that support the responsible scaling of AI technology in healthcare. In its AI manifesto, AXREM calls on the NHS to avoiding duplication in compliance and validation and to take a balanced approach to risk stemming from the use of AI.

AXREM is the UK Trade association representing the interests of suppliers of diagnostic medical imaging, radiotherapy, healthcare IT and care equipment including patient monitoring in the UK. AXREM members supply the majority of diagnostic medical imaging and radiotherapy equipment installed in UK hospitals. Its member companies and their employees work alongside Radiologists, Radiographers and Practitioners, Oncologists and a wide range of healthcare professionals in delivering healthcare to patients using its technologies.

AXREM’s members have always driven innovation in imaging and oncology. Since 2020, the AI Special Focus Group have been champions of promoting the responsible adoption and upscaling of artificial intelligence and machine learning enabled diagnostics. The group comprises most of the AI providers in the radiology market who innovate by providing research and development to improve accuracy and workflow in the diagnostic portions of care pathways.

The challenges of healthcare delivery are well known, including workforce shortages, increasing demand for services and a real risk of staff burnout. In their 2023 census, the UK Royal College of Radiologists calculated that there are 30 per cent fewer radiologists than needed to meet demand, estimated to rise to 40 per cent by 2028. These are placing immense pressure on healthcare systems. Innovation is needed, not for its own sake, but to help address these challenges and to enable healthcare professionals to focus on higher-value caring tasks instead of wrangling large amounts of information.

The manifesto recognises the UK healthcare system is currently complex, with much duplication of effort. A more consistent approach to innovation for AI is needed if it is to be adopted at scale. The manifesto touches on Innovation: bridging the gap, Ensuring Trust and safety, Regulation and compliance Protecting information, Policy and data access challenges, Practical deployment – balancing risk and more.

Graham King, Solutions Architect at Annalise.ai, Convenor of the AXREM AI Special Focus Group, and one of the authors of the document, said upon its release: “We welcome many positive moves forward on AI in radiology and oncology from the NHS across the UK nations. Our manifesto addresses areas where our members are still experiencing duplicated effort and proposes solutions to help scale the much-needed adoption of AI assistance.”

AXREM Chairman, Huw Shurmer, said: “AI is a powerful tool that will undoubtedly support and address many of the pressures facing the health service. I am pleased to see our members taking on responsibility to set out a clear understanding on how this solution can expand in a safe, regulated and consistent way.”

Sally Edgington, AXREM Chief Executive Officer, said: “I am really pleased the AI SFG have worked collectively, so hard on this manifesto. The group have been very active since we launched it and this manifesto makes clear that we need to work with NHSE, DHSC, MHRA and many other organisations to collaborate and ensure safe adoption, but adoption at scale, as this really can help create efficiencies in the system, at a time when the NHS really needs them.”

You can read the manifesto in full here.

Patients increasingly want access to personalised medicine, research finds

By Integrated Care Journal

Nearly two-thirds of UK adults believe that access to both standard and personalised medicine is important, as more than a third of UK adults say standard GP-prescribed medicines often fail to meet their health needs.

New research reveals over a third (36 per cent) of UK adults report that standard GP-prescribed medicines often fail to meet their health needs, leaving both patients and their healthcare providers searching for better solutions. The findings, released by Roseway Labs, a private compounding pharmacy specialising in personalised medicines, underscore the opportunity for personalised medicine to fill critical gaps in care.

Healthcare professionals on the front line see daily the challenges of overwhelmed GP services and mounting patient dissatisfaction with standardised treatment options; for patients, more than a quarter (28 per cent) feel resigned that 2025 won’t bring solutions for their health conditions.

The research underscores the potential of personalised medicine to tackle these pressing issues and highlights the growing demand for this choice. 73 per cent of people expressed openness to using a pharmacy that personalises medicines and supplements to better address their health concerns. While compounded medicine is accessible through private care, the findings indicate a growing number of NHS patients want access to greater choice over the medicines they use.

Additionally, 58 per cent believe having the option between standard and personalised medicines is important, rising to 80 per cent among Gen Z and 76 per cent of millennials. The demand for personalised care among younger generations is likely to grow as they age and encounter age-related conditions, highlighting the need for a step change now to ensure future healthcare options meet their evolving expectations.

The government’s cash incentive scheme highlights the urgent need for innovative solutions to alleviate growing GP and hospital waiting times. Compounding pharmacies like Roseway Labs can help ease this pressure by providing personalised treatments that address individual needs and reduce repeat GP visits caused by ineffective standard prescriptions. The average 10-minute face-to-face GP consultation currently costs £56, so it is hoped that providing more effective treatments first time will reduce the need for repeat GP visits, saving costs and alleviating pressure on general practice and wider primary care.

For healthcare professionals unfamiliar with compounding or personalised medicine, safety is paramount. All processes comply with the General Pharmaceutical Council (GPhC) guidelines and the Human Medicines Regulations 2012, ensuring all compounds are made exclusively from valid UK prescriptions as a fully regulated pharmacy.

Skin conditions and allergies are good examples of where compounded medicines can help patients. Simply changing the medication’s form – from pill to liquid – or removing certain ingredients in the pill that are allergenic, can be the difference between a patient finding relief from an allergy or even being able to take their medication as prescribed.

Miriam Martinez Callejas, Superintendent Pharmacist and Founder of Roseway Labs, commented: “With an ageing population and growing demand for tailored care among Gen Z and millennials, personalised medicine provides an essential option for those whose needs aren’t met by standard treatments. Often likened to the Savile Row of medicine, compounded treatments offer custom dosages, formulations, and combination of ingredients, much like a tailored suit fits where off-the-rack clothing cannot. Our goal is to collaborate with GPs and healthcare professionals to make personalised medicine a key part of future healthcare innovations in the UK.”

Compounding pharmacies play a crucial role in addressing medication shortages by formulating alternative solutions when commercially available drugs are unavailable. They can create customised doses, replicate discontinued medications, or offer equivalent treatments, ensuring patients have access to the care they need without interruption.

Elizabeth Philp, CEO and Founder of Roseway Labs, commented: “A one-size-fits-all approach often fails to address the complexities of individual health needs, leaving many patients feeling despondent about their future. While regular prescriptions work well for some, others face challenges such as inadequate symptom relief, adverse effects, or difficulty adhering to treatment plans. Personalised medicine can complement NHS treatments and care, offering tailored solutions that empower patients and help them lead healthier lives.”

AI software tool aims to use high street eye tests to spot dementia risk

By Integrated Care Journal

First-of-its-kind collaboration offers potential for “step change” in the early detection of dementia, using routine eye scans to gain deeper insight into brain health and monitor cognitive decline.

Data scientists and clinical researchers are working with high street opticians for the first time to develop a digital tool that can predict a person’s risk of dementia from a routine eye test.

The NeurEYE research team, led by the University of Edinburgh, with Glasgow Caledonian University, has collected almost a million eye scans from opticians across Scotland, forming the world’s largest data set of its kind.

The scientists will then use artificial intelligence and machine learning to analyse the image data, along with relevant patient data on demographics, treatment history and pre-existing conditions. This data is anonymised and patients can’t be identified, but it allows researchers to find patterns that could indicate a person’s risk of developing dementia, as well as giving a broad picture of brain health.

Permission to use the data comes from the Public Benefit and Privacy Panel for Health and Social Care, a part of NHS Scotland.

The project is the second funded and supported by NEURii, a first-of-its-kind global collaboration between the pharmaceutical company Eisai, Gates Ventures, the University of Edinburgh, the medical research charity LifeArc and the national health data science institute Health Data Research UK. Together, the partners are giving innovative digital projects the chance to become real world solutions that could benefit millions of patients with neurodegenerative conditions like dementia. The first NEURii project, SCAN-DAN, is using brain scans and AI to predict dementia risk.

Retired mechanical engineer, David Steele, 65, whose mum has Alzheimer’s, said predictive software like this could have saved his family ten years of heartache and struggle. He said:“It took ten years for my mum to be diagnosed with Alzheimer’s.

“She was initially diagnosed with dry macular degeneration, but this masked the underlying issue that we now know to be cerebral blindness linked to Alzheimer’s. The connection between brain and eye was the missing link in her case.

“The missing diagnosis meant that my late father, who was also elderly, cared for mum throughout a difficult period without knowing what was wrong.

“If we had known, then we would have had help with the additional and demanding support that became necessary. Preventing the cliff edge, when it becomes too late for the person to understand what is wrong with them, is so important.”

Professor of Clinical Ophthalmology at the University of Edinburgh and NeurEYE co-lead, Baljean Dhillon, said: “The eye can tell us far more than we thought possible. The blood vessels and neural pathways of retina and brain are intimately related. But, unlike the brain, we can see the retina with the simple, inexpensive equipment found in every high street in the UK and beyond.”

Optometrists will be able to use the software subsequently developed as a predictive or diagnostic tool for conditions such as Alzheimer’s, as a triage tool to refer patients to secondary health services if signs of brain disease are spotted, and potentially as a way to monitor cognitive decline.

Identifying people at risk of dementia could also accelerate the development of new treatments by identifying those who are more likely to benefit from trials and enabling better monitoring of treatment responses.

And being aware of a risk of dementia could also help individuals and medical professionals modify the risk through lifestyle changes such as physical activity and diet, according to a Lancet Commission, which added vision loss this year as one of its dementia risk factors.

Optometrist Ian Cameron, who runs Cameron Optometry in Edinburgh, said: “Optometrists as primary carers is not a new thing, and in Scotland we’re becoming an increasingly allied part of the NHS. We see the same people year on year, whether they’re ill or not, we have all the right equipment, so it makes sense for us to be the GP of the eyes and monitor as much health as we can see.

“What is new is that, with AI, we can see even more, and that is extremely powerful.”

Professor of Computational Medicine at the Usher Institute and NeurEYE co-lead Miguel Bernabeu said: “Recent advances in artificial Intelligence promise to revolutionise medical image interpretation and disease prediction. However, in order to develop algorithms that are equitable and unbiased, we need to train them on datasets that are representative of the whole population at risk. This dataset, along with decades-long research at University of Edinburgh into ethical AI, can bring a step change in early detection of dementia for all.”

Dr Dave Powell is Chief Scientific Officer at LifeArc, one of the NEURii collaborators. Speaking on behalf of the partners he said: “Harnessing the potential of digital innovations in this way could ultimately save the NHS more than £37m a year because the hope is that it will speed up the diagnosis and treatment of neurodegenerative conditions like dementia.

“The UK, with its single healthcare provider, is also well placed to become a global leader in the development of new tests that use health data. This is why we are collaborating to advance promising digital health projects that have the potential to improve millions of lives.”

The data will be held safely in the Scottish National Safe Haven which provides a secure platform for the research use of NHS electronic data. This resource is commissioned by Public Health Scotland and hosted by the Edinburgh International Data Facility through EPCC at the University of Edinburgh.

Unlocking the potential of NHS data: A vision for a unified health data platform

By Ruth Holland and Mark Kewley

By Ruth Holland, Director of Data & Analytics, London Secure Data Environment, OneLondon Health Data Portfolio, and Mark Kewley, Programme Director, London Secure Data Environment, OneLondon Health Data Portfolio.

The landscape of healthcare is increasingly being shaped by the effective use of data, yet the journey towards realising the full potential of NHS data is fraught with challenges. At the core of this transformation is the OneLondon programme, an ambitious initiative that seeks to overcome the fragmentation of health data across the capital and, ultimately, improve patient care, operational efficiency, and research outcomes.

The origins of OneLondon: Addressing fragmentation

The OneLondon programme was born out of a need to address a longstanding issue within the NHS: the fragmentation of health data. Historically, patient information has been scattered across various care settings, making it difficult for both healthcare providers and patients to access a complete picture of an individual’s health. This fragmentation not only hampers the delivery of efficient care but also limits the ability to derive meaningful insights from the data.

In response, London’s healthcare leaders embarked on a journey to create the London Care Record, a unified platform that allows for the sharing of relevant patient data across care settings. Initially focused on providing a ‘view-only’ access to patient information, the programme has now evolved into a more sophisticated data platform capable of generating actionable insights for both direct care and research purposes.

Building a comprehensive data platform to support integrated care

Our efforts have now moved beyond simply making data accessible. The goal, which is supported by funding from the NHS England Data for R&D Programme and London’s integrated care systems (ICSs), is to create a London-wide data platform that can provide insights that inform care decisions at both the individual and population levels. The transition from a ‘view-only’ system to a dynamic data platform represents a significant milestone. It allows us to harness data from across London’s health system to support integrated care, drive proactive care strategies and facilitate advanced research.

In North West London ICS, for example, we’ve seen the success of integrating data across different care settings. Clinicians now have access to a comprehensive view of their patients, enabling them to deliver more informed care. The next step is to expand across London and incorporate data from all other care settings for the population of 10.6 million people.

Leveraging advanced technologies

Central to this transformation is the integration of cutting-edge technologies like Federated Learning Interoperability Platform (FLIP) and AI tools. These tools enable us to bring together different types of data, such as electronic patient records and radiology images, into a single, interoperable platform. By doing so, we can develop predictive models that not only support clinical decision-making but also enhance the accuracy and efficacy of research.

The use of natural language processing (NLP) to convert unstructured data into structured formats is a significant advancement. With approximately 80-90 per cent of healthcare data stored in unstructured formats, such as clinical notes and images, NLP allows us to unlock a wealth of information that was previously inaccessible. This capability is crucial as it significantly increases the insights we can derive from our data, paving the way for more personalised and effective healthcare solutions.

Ruth Holland will be the Chair of a Spotlight session with Dr Jessica Morley at Digital Health Rewired 2025, taking place 18-19 March in Birmingham.

Overcoming challenges through collaboration

The scale and ambition of the OneLondon programme are unprecedented, and so are the challenges. Integrating data across multiple care settings, ensuring stakeholder alignment and navigating complex information governance (IG) issues are just a few of the hurdles we face. However, these challenges also highlight the importance of collaboration.

We’ve worked extensively with the public to understand their expectations around data use, and this feedback has been invaluable in shaping our approach to IG. The public’s support for data integration across care settings has provided a strong mandate for us to push forward with this initiative. Additionally, our collaboration with data controllers, particularly GPs, has been critical in ensuring that the platform brings tangible benefits back to the practitioners who contribute to it.

A vision for the future

The vision for OneLondon is clear: a comprehensive, interoperable data platform that not only supports the immediate needs of patient care but also drives long-term improvements in population health and research. While we recognise that we are still at the early stages of this journey, the progress we’ve made thus far is encouraging. The successful integration of data in North West London serves as a model for the rest of the city, and with continued investment and collaboration, we are confident that we can achieve our goals.

The OneLondon programme represents a bold and necessary step towards a future where data is used to its fullest potential to improve health outcomes. By overcoming the challenges of data fragmentation, leveraging advanced technologies, and fostering collaboration across the healthcare ecosystem, we are laying the foundation for a more integrated, efficient, and patient-centred NHS.

Ruth Holland will be the Chair of a Spotlight session with Dr Jessica Morley at Digital Health Rewired 2025, taking place 18-19 March in Birmingham.

*Ruth Holland, Director of Data & Analytics, London Secure Data Environment, OneLondon Health Data Portfolio*

Nominations open for Our Health Heroes Awards 2025, delivered by Skills for Health

By Integrated Care Journal

Nominations are now open for the Our Health Heroes Awards 2025, celebrating the wider healthcare workforce – from porters and cleaners to receptionists, gardeners and security guards – that supports NHS doctors and nurses on the frontline.

Supported by NHS England, NHS Employers, NHS Shared Business Services, NHS Race & Health Observatory and Integrated Care Journal, Our Health Heroes celebrates the wider healthcare workforce that supports NHS doctors and nurses on the frontline.

From porters and cleaners to receptionists, gardeners and security guards, these often unsung heroes make up roughly 40 per cent of the NHS’s million strong workforce.

Our Health Heroes Awards is a national celebration of their achievements and an opportunity to give thanks for the important role that they play in keeping the health service functioning.

Our Health Heroes Awards 2025 categories:

Individual awards

Clinical Support Worker of the Year
Operational Support Worker of the Year
Outstanding Lifetime Contribution to Healthcare
Apprentice of the Year
Healthcare Volunteer of the Year

Team awards

Best Healthcare Workforce Collaboration
Dedication to a Lifelong Learning Culture
Equity, Diversity, and Inclusion Champion
Digital Innovation

Nominations close at midday on Tuesday 4 March. An expert panel of judges will then decide the finalists in each category.

John Rogers, Chief Executive of Skills for Health, comments: “Our Health Heroes is an opportunity to recognise and celebrate the remarkable dedication of the wider NHS workforce.

“The awards shine a much-deserved spotlight on the unsung heroes – cleaners, porters, security staff, receptionists, medical secretaries and many more – who don’t often get the recognition that they deserve.

“The commitment, compassion and hard work displayed day in day out by the wider healthcare workforce is a credit to, and the backbone of, our NHS.”

Erika Bannerman, Managing Director of NHS Shared Business Services, comments: “The Our Health Heroes Awards are an expression of appreciation for those who make such a significant impact on patient care and the wider community.

“It is vital to acknowledge the contributions of individuals and teams who go above and support the delivery of outstanding care, and we are proud to be able to support the awards again this year.”

The winners of the awards will be announced at a glittering ceremony held at the Queen Elizabeth II Centre in London on 22 May 2025.

To make a nomination visit: www.skillsforhealth.org.uk/awards

Harnessing data-led approaches to patient safety: a case study

By Jonathan Webb, Head of Safety and Learning at NHS Wales

Jonathan Webb, Head of Safety and Learning at NHS Wales, relates two data-led approaches aimed at reducing avoidable harm and litigation costs across Wales, demonstrating the success of unified and standardised approaches to patient safety.

NHS Wales faced growing challenges in improving patient safety and reducing harm across its healthcare system. Rising litigation costs, inconsistent training, and fragmented data across health boards limited the ability to identify trends and implement evidence-based improvements. Specific issues, such as preventable harm in maternity services and the lack of a unified approach to handling incidents, complaints, and claims, highlighted the need for systemic solutions.

These challenges created opportunities to:

Implement a unified training programme to improve outcomes in maternity services (PROMPT Wales).
Develop centralised data systems to connect incidents, complaints, and claims and workforce data, enabling shared learning and improvements (Once for Wales Concerns Management System).

The solutions

PROMPT Wales

This initiative introduced a structured, multi-professional training programme for maternity teams across NHS Wales. Designed to improve safety, teamwork, and communication, PROMPT Wales delivered:

Standardised, scenario-based training for all staff.
Data-informed guidance to address identified risks, such as postpartum haemorrhage.
Comprehensive engagement, with 93 per cent of maternity staff trained within a year.

Once for Wales Concerns Management System (OfWCMS):

Led by the Welsh Risk Pool, part of NHS Wales Shared Services Partnership, this platform centralised incident, complaint, and claim management across all health boards. By unifying disparate systems:

Data could be analysed holistically, identifying trends across complaints, incidents, and claims.
Integration ensured consistent national approaches to handling patient concerns and improving quality of care.

Collaboration between healthcare teams, Welsh Government, and RLDatix ensured that initiatives were implemented with consistency and aligned with national safety goals.

Scalability

The scalability of these initiatives lies in their structured and integrative approaches.

PROMPT Wales: Its team-based training model and use of data can be adapted to other clinical specialities or regions. The methodology ensures alignment with local needs while maintaining national standards.
Once for Wales: The centralised framework can be replicated in other healthcare systems to unify and optimise incident management, feedback collection, and data analysis.

Enablers:

National buy-in and strong governance frameworks.
Robust technology platforms for data collection and integration.
Proven impact, such as measurable safety improvements and cultural change.

Constraints:

Initial investment in technology and training.
Variation in local infrastructure and staff capacity.
Need for sustained leadership and stakeholder engagement.

Evidence of success

PROMPT Wales, along with the sheer hard work of staff within services, delivered significant clinical improvements:

33.8 per cent reduction in severe postpartum haemorrhage (≥2500mL).
43.5 per cent reduction in term APGAR scores <7 at 5 minutes.
Enhanced safety culture, as evidenced by improved staff safety attitude scores.

Once for Wales outcomes included:

Uniform data collection across all health boards and trusts.
Real-time insights into patient and staff feedback, enabling proactive safety measures.
Improved learning from incidents and claims, contributing to better service quality and reduced harm.

Quantitative data from PROMPT Wales shows statistically significant improvements in clinical outcomes (P-value <0.0001). Feedback from OfWCMS users highlights enhanced decision-making due to integrated data systems.

Lasting benefits

Patients receive safer care and improved health outcomes across maternity and broader services.

Staff benefit from greater confidence, reduced stress, and better training support.

Systems benefit from enhanced efficiency, reduced costs, and a model for future healthcare improvements.

Building confidence in AI telephony tools for primary care

By Max Gattlin

Max Gattlin discusses whether AI telephony tools are ready to deliver transformation in primary care and help end the ‘8am rush’, accelerating patients’ time-to-care.

The latest figures show that general practice delivered a record 38.6m appointments in October 2024 (or more than 40m when counting COVID-19 jabs). That’s the highest ever one-month total on record. Amid this surging demand this, primary care is struggling with overwhelming demand and clinician shortages, and GP leaders have warned that the pressure facing services is not sustainable.

The solution cannot lie solely in hiring more staff at practices – there’s a bigger picture at play. It’s about making better use of the tools and technology already available to ease the load on existing teams. This is an area where AI can help, but in order to maximise benefits and ensure use and adoption at scale, ensuring that clinicians and patients trust in the tools is critical.

Why is AI in digital telephony so important?

Use of the ‘digital front door’ is ever-increasing, but despite advancements, over two thirds (68 per cent) of patients continue to contact their GP practice via telephone as the first port of call. The shift from analogue to digital is something we all know is coming in the 10 Year Health Plan, and as the most used element of the digital front door, it is clear that primary care has a fantastic opportunity to embrace the use of AI in telephony. It’s also something that the Social Market Foundation has touched on recently in its report, In the blink of an AI, which has recommended further integration AI and automation into user-facing workstreams.

What benefits could it bring?

The integration of AI in digital telephony for primary care can offer transformative benefits, addressing some of the pressing challenges facing the sector. Integrating technologies such as cloud telephony, unified communications, and AI-enabled healthcare tools, means practices can alleviate the pressure on GPs and other clinicians. By integrating AI-powered features such as voice agents, call routing, speech-to-text, and automated signposting, practices can alleviate the inbound pressure on call handlers while simultaneously improving access. This will also enable practices to accelerate a patient’s time-to-care by offering an assessment of need at the first point of contact, in line with NHS national priorities.

By removing the notorious 8am rush, AI-powered systems can enable more efficient call handling, prioritising urgent cases and directing patients to other appropriate services, such as pharmacy and community, without delay. This enhanced accessibility not only improves patient satisfaction but also fosters better health outcomes by ensuring timely care. Additionally, these streamlined processes reduce administrative burdens and repetitive tasks for staff, creating a more manageable workload and mitigating burnout. Together, these advancements pave the way for a more sustainable, patient-centred approach to primary care.

How do we get patients and clinicians onboard?

The challenge is how do we ensure that patients and clinicians are harmonised with the progress to build their trust?

To build trust among patients is not a simple process, particularly when considering digital poverty, which creates many disparities and makes it harder for people to access the very tools that are designed to help them. Patients value human interaction, especially when discussing health concerns, so AI tools must simplify communication and prioritise empathy in design. Data monitoring is key here, and should be used to help evidence that effective digital tools will also improve access for all, including those less digitally-abled who require human contact.

Patients should not feel intimidated by the use of AI, and it needs to be introduced in a straightforward way, focusing on the benefits in relatable terms. However, transparency of data usage is vital, otherwise we risk the further creation of a two-tier system for those that trust the data and those that do not, also increasing the burden for GP teams and undermining broader population health management strategies.

Patient empowerment means putting AI in their hands and allowing them to self-serve for non-urgent needs, allowing clinicians to focus on more complex patient needs and preventative care. If we can remove the demand before it flows into the practice then it eases the burden immediately.

For clinicians and practice staff, it needs to be clear that AI is an opportunity to reduce the pressure, not a threat to jobs. Clinicians are more likely to trust tools that they understand how to use, so time dedicated to training can demystify the AI’s capabilities and limitations. The tech may be transformative but it needs the support around it and training for staff to make best use of systems already in place, as well as to integrate additional tools such, as Surgery Assist.

Take for example Tudor Lodge, a practice in South-West London that is an early adopter of AI tools. The implemented Surgery Assist, a digital assistant, as part of a wider Access Optimisation Service and the practice has experienced 54 per cent fewer calls in the 8am rush as a direct result. Applied nationally, it is estimated that this service could result in 9.1 million fewer calls received per month by GP surgeries.

Will AI live up to the hype?

One of the questions asked to the discussion panel at X-on Health’s recent AI in primary care event was ‘will it live up to the hype?’ AI is by no means a magic bullet, and it could be said that it is currently not up to the hype, but applied correctly AI has the potential to move primary care forward beyond all expectations.

As referenced by an integrated care board member at the recent X-on AI in primary care event, AI is a tool, not a solution and must be viewed as such. To my mind it’s the correct approach and AI is just one of the tools available to reduce the burden. There is a crisis at the door of primary care and the technology is needed now to help practices survive. Technology cannot simply be layered over inefficient processes; instead, the two need to be addressed hand-in-hand to build trust and preserve the NHS as we enter the AI era.

What are the next steps?

While some GP partners have pushed on, giving lots of their time to self-appraising AI products in the pursuit of improved efficiencies to support their staff, there have been calls for the formation of an AI advisory board or list of approved AI suppliers to expedite procurement and adoption. To further build trust, the technology testing needs approval at a national level and the creation of a framework of consistency is something that is essential. The In the blink of an AI report supports the creation of a strong Digital Centre of Government in the Department for Science Innovation and Technology (DSIT) and recommends that it becomes a one-stop-shop for all public sector AI and automation needs, highlighting tools that are already working and have been successfully implemented.

One thing is clear – if the NHS doesn’t work out how to become agile enough to embrace the technology and build trust quickly then organisations like Google will do, as is clear from the Public First report, AI and the public sector, that was recently commissioned by Google Cloud.

New AI initiative to reduce demand on urgent and emergency care in North East London

By Integrated Care Journal

Thousands of patients across North East London are set to benefit from new initiative, using artificial intelligence (AI) and personalised clinical coaching, easing pressure on NHS services.

NHS North East London Integrated Care System, in collaboration with Health Navigator and UCLPartners, this week (Thursday 12 December) launched a new, three-year programme, providing preventative care for patients with long-term conditions. This comes as urgent and emergency care services in North East London are facing unprecedented pressure and all-time high demand.

Through advanced AI screening technology and targeted, phone-based clinical coaching, patients at high risk of needing unplanned emergency care will be identified and offered personalised support from healthcare professionals trained in delivering preventative care and self-management techniques.

The initiative is designed to identify and better support people with long-term conditions, like asthma, by taking a proactive and preventative approach to healthcare delivery.

Forecasting models estimate that the programme will save 26,673 unplanned bed days in North East London hospitals across the three years of the programme, with an anticipated reduction of 13,000 A&E attendances annually.

Dr Paul Gilluley, Chief Medical Officer at NHS North East London, said: “More than 15 million people in England live with one or more long-term conditions, accounting for 50 per cent of all GP appointments, 64 per cent of outpatient visits, and over 70 per cent of inpatient bed days. This new approach represents a landmark step in harnessing technology for preventative care to better support these patients before they reach crisis points.”

Supported by the largest randomised controlled trial to date on AI-assisted preventative care, the initiative has shown significant impact when piloted in Staffordshire. Notable results include a 46 per cent reduction in deaths among men over 75, a 34 per cent reduction in emergency attendances and 25 per cent reduction in bed days, and a 26 per cent reduction in GP referrals to secondary care, further supporting sustainable healthcare delivery.

Tim, who benefited from clinical coaching when it was piloted in Staffordshire, said of the programme: “If you are brave enough to take control with the help of the coach, you truly can make a difference to the immediate crises as they turn up. In my case I went from being an asthmatic, to someone who happens to have asthma. I went from six admissions to hospital to none within a couple of months.”

Waltham Forest will be the first area to receive this new initiative through Barts Health NHS Trust and Barking, Havering and Redbridge University Hospitals NHS Trust, with plans to expand across North East London in the coming weeks. The AI technology and clinical coaching will then be implemented throughout the rest of North East London in the coming months.

Shane DeGaris, Group Chief Executive at Barts Health NHS Trust, added: “As winter approaches, the pressure on A&E services is rising. By predicting demand and providing earlier interventions, we can improve patient outcomes and reduce the burden on the NHS.”

Dr Chris Laing, Chief Executive Officer of UCLPartners, said: “This project provides a template for how the NHS can use modern technology to deliver predictive, proactive and preventive care that is customised for local communities and prioritises those most in need of our help. Our collaboration with Health Navigator and NHS North East London will not only enhance the lives of at-risk patients but will also relieve critical pressure on our healthcare system too, aligning with the government’s prevention priority.”

Dr Simon Swift, Chief Executive of Health Navigator said: “Our AI-driven technology, combined with personalised clinical coaching, has consistently demonstrated its ability to improve patient lives and shift care, allowing hospitals to be more productive. This collaboration represents a major step forward in proactive, preventative healthcare. We’re confident that this program will enhance the quality of life for patients and contribute to a more efficient and sustainable healthcare system.”

There is no integrated care without cross-sector data sharing

By Hannah Barnett

Integrated care systems strive to provide seamless, equitable healthcare by coordinating services, but fragmented data sharing remains a major challenge. Strong data partnerships are vital for continuous care, addressing health inequities, and optimising resources. Yet, technology, governance, and collaboration gaps hinder progress, disconnecting patients and providers.

Why data sharing matters in integrated care systems

The success of integrated care systems (ICS) relies on robust, strategic data sharing across multiple care settings. Effective data partnerships enable more coordinated and continuous care, empower population health management and self-care, tackle health and access inequalities, and drive informed resource allocation.

In today’s diverse, fragmented healthcare system, patients often navigate multiple providers across sectors. However, their data does not always follow, and this is disempowering as much as it is frustrating. Many ICSs still lag in adopting comprehensive data sharing practices and infrastructures, posing a significant barrier to achieving greater system efficiency, transparency, and supporting patients effectively.

Current limitations in data sharing practices

When data sharing does occur, it often flows in one direction. For example, NHS commissioners frequently rely on activity and service-user data provided by Voluntary, Community, and Social Enterprise (VCSE) organisations or primary care network (PCN) systems data to evaluate the impact of funding. This narrow focus excludes data on service users’ interactions with other health and care services, creating blind spots in patient outcomes and hidden needs, while undervaluing how these services reduce pressure on the broader system.

Comprehensive data sharing partnerships could transform this dynamic, enabling full tracking of patient pathways and better identifying access inequities across services and sectors. This shift would not only improve service delivery and resource allocation but also foster shared purpose and cross-sector accountability, while promoting consistent data collection and truly evidence-based evaluation practices.

Overcoming barriers to consistent and effective data sharing

Achieving this vision requires overcoming several cultural, technological, operational, and legal challenges. Patient data remains fragmented across multiple management systems, complicating access, aggregation, and sharing. While some advocate for a unified data capture system, the diversity of digital maturity across delivery partners makes this impractical. Instead, ICSs should prioritise system interoperability and shared care platforms, the latter being widely considered the cornerstone of integrated data sharing. When anonymised and aggregated, these shared databases become invaluable resources for population health management by enabling healthcare leaders to identify and anticipate care gaps across geographies and demographics.

All technical advancements, including the integration of artificial intelligence (AI), must be accompanied by centralised guidance on data collection, coding standards, and sharing agreements. Currently, many providers hesitate to share patient data due to confidentiality concerns and unclear information governance, GDPR or AI guidelines, which often vary across contracts and care settings. Clear protocols and governance structures are essential to balance privacy requirements with healthcare planning needs, ensuring both patient confidentiality and system efficiency. A cohesive system with transparent data processes would not only build public trust in data use but also reduce the frustration and fatigue patients often experience when navigating multiple disconnected care providers. Such structures must be clearly communicated to patients as the primary owners of their data.

Relationships, capacity, and power diffusion

Despite government mandates, limited progress in ICS investment in data infrastructure reveals the persistent barriers posed by entrenched organisational cultures and practices. As the King’s Fund observed in a 2022 report, “Good technology is not enough for interoperability to succeed; relationships between staff and organisations are vital for success.” Persistent power imbalances within ICSs can undermine enthusiasm for data sharing partnerships, especially when the benefits of integration appear unclear or unevenly distributed.

To foster trust and collaboration, health, social care, and voluntary sector leaders must work as equal partners in planning and delivering services. By setting, understanding, and contributing to shared priorities and agendas, all sectors would be mutually recognised as key contributors to progress. This approach would also increase buy-in for data collection at the local level, ensuring that digital infrastructures are viewed as enablers of collaboration rather than isolated technologies.

Many health and care providers currently lack the capacity or funding to dedicate staff time to data collection. Short-term contracts further limit incentives to build data sharing capabilities or use data beyond immediate funding requirements. Longer-term contracts would support consistent delivery, sustainability, and capacity building across sectors, while substantially reducing data fragmentation. Building a sustainable ecosystem requires trust and ongoing investment through collaborative, long-term partnerships, rather than transactional, repeated contracting cycles.

The NHS must lead this transformation by embedding information technology, governance, AI, and analytics at the heart of system implementation while supporting partners with varying levels of digital maturity. This includes equipping the workforce with the technical skills required to effectively collect and utilise data. Recognising the current strain on workforce capacity, the NHS must leverage resources and time for upskilling (including from its own suppliers), and ensure the transition is backed by ongoing investments in accessible analytics.

Conclusion

As patient pathways become increasingly dispersed across care settings, robust and proportionate data sharing infrastructure grows more essential for tackling health inequities, streamlining cross-sector resource allocation, and empowering the system to better empower patients. A sustained commitment to technological and cultural innovation, coupled with workforce upskilling will reshape how providers collaborate and deliver care, enhancing population health outcomes and building a more responsive, equitable healthcare system.