RIVIAM Digital Care’s Hospital Discharge: ready for NHSE’s Care Traffic Control Centre roll out

By Claire Hopkins, RIVIAM Digital Care

Delayed discharge cost the NHS an estimated £1.7 billion in 2022/23. RIVIAM’s Hospital Discharge service connects third sector partners and NHS trusts with the data they need, speeding up discharge, reducing readmission rates and supporting system-wide efficiency.

In 2023, RIVIAM introduced its Hospital Discharge service which is currently being piloted at the Royal United Hospitals Bath NHS Foundation Trust (RUH). Following the pilot, the service will be available on all wards to fast-track patient hospital discharge. The service enables RUH ward teams to make patient referrals simultaneously to multiple community, housing and voluntary sector services working together using RIVIAM at the Community Wellbeing Hub (CWH) in Bath and North East Somerset.¹

Staff at the RUH can then see the status of the care in real time via RIVIAM’s Care Control Dashboard. NHS England plans to expand such Care Traffic Control Centres across England to boostcapacity and improve patient flow^.2 RIVIAM’s Hospital Discharge service is a ready-made digital solution to support this ambition.

The challenge

According to NHS England, there are “more than 12,000 patients every day in hospital despite being medically fit for discharge.”³ Data from The King’s Fund also suggests that discharge delays in England increased throughout 2022 and that the cost of delays in 2022/2023 was at least £1.7 billion, at a time when the NHS is pushing to find cost savings.⁴ For patients, being stuck in hospital when they are fit enough to leave is also upsetting.

One of the challenges with reducing delayed discharges is how to access capacity in the care system provided by social care, community, housing and voluntary sector organisations. To make and coordinate discharge dependent referrals to these services often means multiple different referral routes and phone calls – this takes time that hinders patient flow and could be better spent delivering care.

For community, housing and voluntary sector services receiving referrals, it’s hard to access the latest patient information and to co-ordinate referrals for the best follow up care.

RIVIAM’s Solution

With RIVIAM’s Hospital Discharge service, ward teams at the RUH complete an Onward Admission Referral form giving them one place to refer a patient to a wide range of available community, housing and voluntary sector services at the CWH. This includes commissioned discharge dependent services which cross local authority boundaries.

Immediately reducing admin burden, the referral process is quick and seamless. RIVIAM also auto checks the patient’s details against the NHS Spine Mini service ensuring a high level of data accuracy is captured during the referral process.

Ward teams then use a Care Control Dashboard to see in real time what’s happening regarding the care they have requested for a person. Status updates and useful information are easily accessible. Online communication reduces the need for phone calls and emails which introduce time delays to a patient’s discharge.

A view of the dashboard is also available for the 20 different partners at the CWH so staff can easily see the person’s most recent ward, their expected discharge date and the different services requested.

Integration with the hospital’s Electronic Health Record (EHR), Cerner Millennium®, means that the dashboard data is seamlessly updated in near real time providing timely visibility of this critical information.

For CWH partners, RIVIAM makes it easy to co-ordinate care for a person with each other, reducing duplication, providing efficiencies, and improving the person’s experience.

Benefits of using RIVIAM’s Hospital Discharge service:

Improves patient care and prevents readmission. People leave hospital as soon as they are medically fit with the right support in place.
Frees up beds. Patient flow of those who are Clinically Ready for Discharge is improved, relieving pressure on hospital beds.
Utilises community and voluntary sector capacity. People can recover from a hospital visit at home, with access to local services.
Increases team productivity through data-driven decision making. There is one place for ward staff to see the latest information about the community care lined up for a person, communicate with them more easily and make quick decisions about discharge.
Delivers integrated care. Health, social care and voluntary sector providers can receive, manage and co-ordinate and care delivery and communicate with hospital ward teams.
Greater system-wide efficiency. Real time integration with electronic health records (EHR) provides seamless information flows and insights to reduce time delays, duplication and enable improved care.

“The impact of this digital transformation is plain to see. For ward staff, the ability to easily make referrals to multiple organisations at the click of a button is revolutionary. However, the ability for Discharge Co-ordinators to then easily see when support has been put in place gives much more assurance that a person can return home safely. This platform is not just a tool; it’s a conduit for change, enabling us to reach those who need us most,right when they need us.” – Simon Allen, CEO, Age UK Bath and North East Somerset

To find out how RIVIAM can support your organisation via hello@riviam.com or 01225 945020.

Visit www.riviam.com

¹ The CWH uses RIVIAM’s Multi-agency Referral Hub service to receive and manage referrals in Bath and North East Somerset for 20 social care, community, housing and voluntary sector organisations.

² https://www.england.nhs.uk/2023/07/nhs-sets-out-plans-for-winter-with-new-measures-to-help-speed-up-discharge-for-patients-and-improve-care

³ https://www.england.nhs.uk/2023/07/nhs-sets-out-plans-for-winter-with-new-measures-to-help-speed-up-discharge-for-patients-and-improve-care

⁴ https://www.kingsfund.org.uk/blog/2023/03/hidden-problems-behind-delayed-discharges#:~:text=That%20means%20that%20the%20direct,at%20least%20%C2%A31.7%20billion

Using digital across adult social care to enable independence for longer

By Integrated Care Journal

This content is supported by Access Group.

In January of this year, PPP published their report, A care system for the future: how digital development can transform adult social care. The report examined the status of the social care system, focusing on the use of technology to support services, and the steps that need to be taken to support the full digital transformation of the sector for improved care, increased efficiency, and workforce satisfaction.

Recommendations from the report covered enabling DHSC to ease the burden of social care providers operating in multiple ICS footprints who deal with a variety of Shared Care Record formats, the support of digital inclusion among people receiving adult social care by local authorities and mandatory basic digital training for adult social care professionals.

The government has recently announced that £600 million is to be allocated to the adult social care sector to boost winter capacity, fund a research programme to determine future policies for social care, and follow through on commitments made in the Next Steps to Put People at the Heart of Care white paper. In order to achieve these goals, DHSC should not undermine the importance of investing in digital technologies within the social care sector, which will increase efficiencies and reduce pressure on frontline staff.

Examples of this type of technology are provided by The Access Group and include Access Assure and Oysta Technology – part of their Technology Enabled Care (TEC) solutions. The Health, Support and Care division (HSC), of which Access TEC is a part, works with more than 10,000 registered care providers, more than 200 local authority departments, and 50 NHS trusts, providing technology that helps these organisations deliver more efficient and personalised care.

Access Assure is a key pioneering technology supporting the adult social care sector by allowing vulnerable individuals to live independently for as long as possible and giving their loved ones peace of mind that they are safe, even when alone in their homes.

Alex Nash founded Alcuris – now Access Assure – in 2015 following his grandfather’s diagnosis with dementia, after noticing a lack of sufficient updates on his wellbeing. He developed a digital care solution that learns the behaviours of individuals and supports their independent living, while also providing the necessary information to the relevant health and care professionals.

The platform uses insights from social alarm and smart sensor technology to enable caregivers to provide proactive care by seeing where anomalies in data could be caused by health complications. These can include notifying carers if someone hasn’t been mobile, which could be due to a potential fall, or if they haven’t been going to the toilet regularly, which may be a symptom of a urinary tract infection (UTI), which is one of the biggest causes of hospital admissions for older people in the UK.

NHS East Lothian has been using the product since 2019 to review patient data and make decisions about the care of each individual. The system has enabled them to change care packages by identifying issues such as UTIs, making their delivery of care preventive of larger issues. By connecting direct costs in care to the use of Access Assure at NHS Lothian, it can be seen that each UTI avoided, or detected early on, produces a cost avoidance of around £3,000 per event.

A 2020 white paper titled Next Generation Telecare: The evidence to date, focusing on 29 family members users using Access Assure, also showed that 83 per cent of families felt it provided increased reassurance because even when not with their loved ones, they can still support them remotely and check-in.

Across the Access Assure customer base, staff have reported significant improvements to their work experience since using the technology. Tools embedded within the system have streamlined administration processes, helping staff cut admin time from 4 hours to a few minutes per individual, releasing time to care. Local authorities can also access the data to intervene swiftly, reducing the need for emergency care and improving quality of life for individuals. When the average wait time for an ambulance is 56 minutes and each callout costs the NHS around £252, the ability to pinpoint potential health complications early with platforms like Access Assure can prove significant in alleviating current pressures on emergency care.

Plus, the Access Assure dashboard, which has been developed over the last year, allows all Access Assure devices and their data to be pulled together into a single resource. Considering the insights provided by Access Assure, the Next Generation Telecare white paper also highlighted that over 40 per cent of care plans were amended after close interrogation of the data, resulting in better care for individuals and a reduction in hospital visits. The dashboard highlights information which can be saved as a PDF so that local authorities can quickly recognise any anomalies and spot where intervention may be needed.

Using Access Assure, patients can be supported to live independently for longer, and care providers and staff are able to drive care management forward. And collectively, with Access’ other technology enabled care solution, Oysta Technology, and wider HSC portfolio of technology, health and care professionals can take a more proactive and preventative approac h to person-centred and participatory care. Access TEC supports NHS, local government and registered care organisation customers wishing to ensure service-users maintain and enhance their independence and confidence, while having dignity, security, and reassurance. These solutions also prevent, reduce or delay hospital admissions or the need to access care home settings and improve the quality of life for the cared for as well as family members and informal carers so that people are supported to stay safe, happy, and healthy in the communities they call home.

Gypsy, Roma and Traveller communities subject to stark access and mental health outcome inequalities, report finds

By Integrated Care Journal and Gabriel Blaazer

Suicide rate among Gypsy, Roma and Traveller community is up to seven times higher than for all other communities in England, with poor service provision identified as major factor.

A report published last week says that Gypsy, Roma and Traveller communities experience among the starkest inequalities in access to healthcare of any community in England. The report was commissioned by the NHS Race and Health Observatory and was led by The University of Worcester.

It addresses a marked lack of mental health care provision and captures first-hand insights from service users and providers, as well as examples of good practice from six effective services. Most of these services are run by voluntary organisations from within the Gypsy, Roma, and Traveller community themselves.

Inequalities in Mental Health Care for Gypsy, Roma, and Traveller Communities estimates that the suicide rate among this group is up to seven times higher for this community than for others, and that life expectancy among the Gypsy, Roma and Traveller community is up to 10 years lower than the national average.

It further identifies a lack of access to digital services, low literacy levels, shortage of local and national data collection, and limited financial investment as presenting significant barriers to accessing to local health services and preventing the development of customised services.

Considerable stigma is still attached to mental health concerns within many communities, and a lack of granular data to support tailored services is contributing to the problem of poor access for Gypsy, Roma and Traveller communities.

Data was difficult to fully assess regarding the uptake and impact of services, due in part to the organisations studied not having the resources to collect and analyse such data and also to non-reporting of ethnicity (for fear of discrimination).

In response, Joan Saddler, who is Director of Partnerships and Equality at the NHS Confederation, said: “Leaders will be increasingly concerned about the troubling findings this report has illustrated which show a huge disparity in access, experiences and outcomes for gyspy, roma and traveller communities. These are people’s lives – impacted and in some cases shortened by preventable inequalities.

“We have known for some time that Gypsy, Roma and Traveller communities experience poorer care access, experience, and outcomes as a result of discrimination. The Race and Health Observatory report helpfully builds on this, but we must now focus on action. We would welcome the opportunity to be part of a coalition working with NHS England to reduce such inequalities particularly with Gypsy, Roma and Traveller communities at the heart of creating solutions, so we can take the first step to finally eradicating discrimination.”

National strategy lacking

Professionals’ lack of expertise and knowledge about Gypsy, Roma, and Traveller cultures was further identified as a significant deterrent to take-up of mainstream services. In 2022, Friends, Families and Travellers noted that out of 89 suicide prevention plans in England, only five mentioned Gypsy, Roma, and Traveller communities and only two listed any action plan strategy.

The government’s latest England Suicide Strategy (2023-2028) mentions the Gypsy, Roma and Traveller community twice, but does not afford these communities priority status nor mention them in its associated Action Plan.

Despite the lack of national investment in national mental health care provision, there are many examples of locally organised services doing targeted work with these communities. Researchers visited effective services run in Hertfordshire, Leeds, Lincolnshire, York, Cambridgeshire, and Ireland (the latter due to its provision for young people). Each site represents an example of novel, progressive initiatives which have broken down barriers for Gypsy, Roma, and Traveller communities in need of mental health support.

These, and more findings, were presented at an online report launch of Inequalities in Mental Health Care for Gypsy, Roma, and Traveller Communities, Identifying Best Practice, on Thursday September 28.

The launch included a presentation of the research around the significant mental health needs of these communities; first-hand experience and insight from those involved in the case study sites; a Q&A and practical recommendations for health and mental health providers to action around the country.

Panellists included representatives of the Observatory’s Mental Health working group, the Gypsy, Roma and Traveller Social Work Association and the University of Worcester. Insight gathered over 12 months of research was undertaken in collaboration with research co-authors, Gypsy and Traveller Empowerment Hertfordshire UK (GATE Herts), and the Gypsy, Roma, Traveller Social Work Association (GRTSWA) and involved 70 community and 21 staff members.

“Deeply concerning”

Speaking ahead of the launch, Dr Habib Naqvi, Chief Executive of the NHS Race and Health Observatory said: “We know that Gypsy, Roma, and Traveller communities face stark challenges in accessing psychological therapies and other mental health services. This report lays bare the mental health issues and stigma faced by these communities first hand. We are pleased to have co-produced with these communities, a clear set of practical, tangible actions and recommendations for more equitable mental healthcare provision.”

Dr Peter Unwin, Principal Lecturer in Social Work, University of Worcester, said: “It has been a pleasure to carry out this research in co- production with community members and to have met so many inspiring people who have developed mental health services against the odds. We should all now work together to ensure that this report on the health inequalities in Gypsy, Roma and Traveller communities leads to real change and equality of opportunity.”

Responding to the Race and Health Observatory report, Saffron Cordery, Deputy Chief Executive at NHS Providers, said: “Gypsy, Roma and Traveller (GRT) people’s experiences of health services are dented severely by discrimination. It is deeply concerning to see how GRT communities struggle to access mental health services they need.

“There should be no ‘winners and losers’ when it comes to physical and mental health provision. NHS trusts work hard to reduce health inequalities but years of funding cuts to councils’ public health and preventative services mean that already stretched NHS services face more strain.

“Government must tackle the root causes of why some minorities are more likely to have worse physical and mental health outcomes and address barriers and discrimination facing too many groups of people including GRT communities.”

Government launches pilot pathway to accelerate access to innovative medical technologies

By Integrated Care Journal

The new Innovative Devices Access Pathway (IDAP) pilot is an initiative to bring new technologies and solutions to the NHS faster and will focus on addressing unmet needs.

The government has launched the pilot of IDAP, a new initiative aiming to accelerate the adoption of “innovative and transformative medical devices” within the NHS. Supported by £10m of government funding, the IDAP is a multi-partner pathway that offers product developers and manufacturers access to tailored support and scientific advice from a team of experts. The latter will in turn develop a bespoke Target Development Profile (TDP) roadmap for successful applicants to help bring their products to market more quickly.

The TDP roadmap will define the regulatory and access touchpoints pertaining to each product’s development, which can include:

Quality management system support
Advice on system navigation
A fast-tracked clinical investigation
Joint scientific advice with partners
Support with Health Technology Assessments (HTA) for product realisation and adoption
Safe-harbour meetings to discuss adoption within the NHS
Exceptional use authorisation granted by the Medicines and Healthcare products Regulatory Agency (MHRA), provided necessary safety standards are met

The IDAP is open to applications from UK and international commercial and non-commercial technology developers, subject to eligibility criteria. During the pilot phase, the IDAP partners, which include the Department of Health and Social Care, the MHRA, NICE and the Office of Life Sciences, will select eight products that best meet the eligibility criteria and that are most likely to benefit from the support and advice available. The pilot will see the main elements of the pathway tested and used to inform the future development of the IDAP.

Dr Marc Bailey, MHRA Chief Science and Innovation Officer, said: “The IDAP launch marks an exciting step in accelerating the delivery of cutting-edge medical technologies safely to patients across the UK. The insights gained during the pilot phase will be crucial in shaping the future direction of this new pathway.

“We encourage medical technology innovators in the UK and abroad to submit their applications and benefit from this combined support service. By working together, we can fast-track access to the most advanced technologies for those in urgent need.”

Mark Chapman, interim Director of Medical Technology and Digital Evaluations at NICE, commented: “We look forward to working with industry to continue the acceleration of our evaluations and with the MHRA to align our work for the benefit of patients.”

Tackle microaggressions to transform services

By Ishmael Beckford

Ishmael Beckford is the Chair of Council at the Chartered Society of Physiotherapy. Here, he writes about the impact of microaggressions on both staff and patients, and says that tackling the issue should be a priority for the NHS.

“But where are you really from?”

I doubt there can be many NHS staff of colour who have not been asked this question at some point.

The insinuation – whether conscious or not – is that our ethnicity means we cannot be from the UK, an alienating statement that tells us we don’t belong. It’s an example of what’s known as a microaggression, an often-overlooked form of discrimination and one that NHS system leaders could deliver a transformative effect on by tackling.

It won’t be easy.

The professional body and trade union that I chair, the Chartered Society of Physiotherapy, sought testimony from its members with marginalised protected characteristics, such as ethnicity, disability and sexual orientation, about their experiences of microaggressions – and the findings were stark, yet unsurprising.

Members spoke of regular incidents where they felt belittled, othered or insulted through the words or actions of someone in their workplace. Examples given by minority ethnic physiotherapy staff included repeatedly mispronounced names and being asked who the decision-maker was, despite it clearly being them – something I experience myself.

Members of our LGBTQIA+ community said they often heard the pejorative phrase, “that’s so gay”, and were told they “didn’t look gay”, while trans physio staff were asked for their “real name”. Physio staff with disabilities, meanwhile, spoke of being excluded from everyday activities and having their status questioned.

It seems highly unlikely that the experiences of physiotherapy staff differ from those of any other profession working in the NHS. And while this is, of course, a societal issue and not one exclusive to the NHS, the UK’s biggest employer has a responsibility to protect its staff – and its patients – from experiencing these behaviours in its settings.

More than a quarter of NHS workers are from an ethnic minority, while nearly 5 per cent have a disability and at least the same number identify as LGBTQIA+. Obviously there will be intersectionality across those numbers but that’s a hugely significant part of the workforce facing painful, damaging experiences in the workplace on a regular basis.

We also need to be honest and acknowledge that patients experience these behaviours when receiving NHS care. The evidence base demonstrating the poorer health outcomes among marginalised groups is well established. Those outcomes are shown to be made worse by communities experiencing poorer care due to racism, ableism, homophobia and transphobia.

Microaggressions form part of those experiences and will undoubtably deter some patients from seeking the care they need.

So, this is an issue facing staff and patients alike, and during a workforce crisis when retention is of such importance – and with record numbers of people waiting for care – the case for action on microaggressions is overwhelming.

But what should that action involve?

Education for staff and patients is important, clearly. There remains low awareness of the term microaggressions and, from the regularity that they occur, a limited understanding of their impact.

Our campaign includes posters and an animation that services may find helpful to display in public spaces and staffrooms. But crucially, our members also reported significant concerns about reporting microaggressions, fearing they wouldn’t be taken seriously and no action would be taken. There were also concerns about consequences for them of making a complaint and, dispiritingly, the idea that they happen so regularly that they aren’t worth reporting.

So, it is essential that systems, and specifically managers, create environments where people feel supported, heard and confident to report. These workplaces must be inclusive, culturally sensitive, and no longer somewhere microaggressions can go unchallenged. Our campaign includes training, guides and resources for managers to deliver that and encouragingly, after the first phase of the CSP’s campaign, members reported increased confidence to report microaggressions.

So change is possible. It just needs to be a priority.

Because don’t let the name fool you – microaggressions can have an enormous impact on the physical and mental health of those on the receiving end.

They chip away at you, bit by bit, day by day.

The constant challenge is how to navigate these experiences but still be yourself, because often a response to being exposed to these forms of prejudice is to dilute yourself, not be authentic and to conform to reduce the opportunity for people to point out that you’re different.

You start to see the world in a different light which can result in you feeling like you have to put armour on to go to work and this is a heavy weight to carry every day. Many people will never know that invisible armour exists for a lot of people.

That’s why it’s so important to bring the issue into the light and the enormous pressures facing the NHS cannot be used as an excuse for inaction.

Tackling microaggressions is not an add-on to easing those pressures.

It’s essential for delivering a workplace where staff feel valued and want to remain and where patients can feel confident they will receive equitable, quality care.

Access guides, resources and training for managers and staff at www.csp.org.uk/microaggressions.

Ishmael is the Chair of Council at the Chartered Society of Physiotherapy, the trade union and professional body representing 64,000 physiotherapists, support staff and students across the UK. He is also a director at Vita Health Group, an independent provider of physical and mental health services, where his current remit covers Equality, Diversity and Inclusion and Sustainability. His clinical background is in MSK physiotherapy, primarily within private practice and occupational health settings. Ishmael has undertaken leadership roles including as a clinical manager and operations lead and has worked away from physiotherapy as a Talking Therapies service lead.

Transforming leg ulcer service provision

By Leanne Stevens, Abbe Ruston, Laura Hallas Hoyes

It is estimated that more than a million people in the UK have lower limb ulceration. With their 160 years’ experience in developing wound care solutions, L&R hypothesised that a self-care delivery model could both improve outcomes and ease the burden on the healthcare system.

L&R has more than 160 years of experience in developing outstanding wound care and compression therapy solutions. They are passionate about transforming outcomes in leg ulcer service provision to support the NHS, the nursing workforce, and patients. Working in partnership with organisations, L&R supports them to drive the self-care agenda, which frees up resources, reduces appointment times and clinic costs, and releases nursing time to care.

Lower limb ulceration is a common cause of suffering in patients and its management poses a significant burden on the NHS, with venous leg ulcers (VLUs) being the most common hard-to-heal wound in the UK. It is estimated that more than one million people in the UK have lower limb ulceration, of which 560,000 are categorised as VLUs. Much of burden of VLUs currently sits within the community and primary nursing workforce, with up to 50 per cent of community nursing workload being taken up by chronic wound management.

In South West Yorkshire Partnership Trust (SWYPT), it was hypothesised that a self-care delivery model, in partnership with the Leg Ulcer Pathway could reduce wound care burden on the health service and improve patient empowerment, with little or no reduction in healing outcomes.¹ Therefore, L&R, in partnership with SWYPT, created a project called the “Big Squeeze”, with the aim of delivering transformative outcomes for venous leg ulcer care, achieving a big squeeze on its financial burden and unwarranted variation in treatment and outcomes.

This was implemented through L&R’s three-step approach:

Implementation of a best practice leg ulcer pathway¹ – ensuring the right treatment for the right patient at the right time in line with the National Wound Care Strategy Programme recommendations.
Service efficiencies – driving clinical and health economic outcomes through adoption of the self-care delivery model.
An education and coaching programme – for patients and clinical workforce to embed sustainable practice.

Evidence of success

95 patients were enrolled into the service evaluation, and:

VLUs of 84 patients had healed by week 24 on the pathway.
VLUs in a further 10 had healed by week 42.
One remaining patient reached 42 weeks without healing.

Comparing the results of implementing the Best Practice Leg Ulcer Pathway in isolation and the Best Practice Leg Ulcer Pathway and the Self Care Delivery Model combined:

Nursing hours per patient reduced from 24.5 to 1.3, releasing up to 95 per cent in nursing hours.
Total cost per patient reduced from £2,168 to £361, saving up to 83 per cent in total cost of care per patient.
Product cost per patient reduced from £629 to £177, saving up to 72 per cent in product costs per patient.

In addition to healing and financial outcomes, improvements in staff motivation and wellbeing were recorded through survey feedback, as well as 1,471kg saving in C0₂ per 100 patients through a reduction in miles driven by the community workforce.

¹ Leanne Atkin and Joy Tickle (2016). Wounds UK, A new pathway for lower limb ulceration. Available from: https://www.researchgate.net/publication/304989292_A_new_pathway_for_lower_limb_ulceration

Urgent action needed to prevent retirement disability benefit ‘timebomb’ – report

By Gabriel Blaazer

Report finds total number of retired benefits recipients likely to rise by 60 per cent in next decade, with costs expected to rise to £10.5bn.

A significant increase in the number of people spending a decade or more of their retirement on disability benefits is expected unless urgent preventative action is taken, according to new research from consultancy firm LCP.

Although much of the public discussion around ‘economic inactivity’ focuses on those of working age in receipt of benefits for those unfit to work, these benefits stop at pension age, when individuals switch to a state retirement pension. By contrast, disability benefits such as Personal Independence Payments (PIP) continue to be paid throughout retirement for those already eligible when they retire. The new analysis suggests that unless action is taken to improve the health of these individuals, the cost of funding these benefits will rise significantly in the coming years.

The research finds that just under 100,000 people aged 66 (the state retirement age) are currently in receipt of PIP or its predecessor, Disability Living Allowance (DLA), and are expected to draw these benefits for another 11 years, on average. It estimates that of those individuals, half will continue claiming PIP until they die. The total payment per person would be around £70,000, but this could rise for individuals on low incomes and those claiming means-tested benefits.

Without mitigation, the total number of pensioners on PIP/DLA is likely to rise by around 60 per cent in the next decade, from approximately 1 million now to 1.6 million in 2023, LCP’s research suggests. The total cost of funding these benefits would rise from around £6bn to £10.5bn.The total current cost of PIP in 2023/24 is £21.8 billion, and the benefit is paid to 3.2m people.

The number of adults in receipt of PIP (plus DLA) has risen by around 1 million in the last decade and is forecast by DWP to rise by another million in the next three years. For younger PIP recipients, the fastest growing reported health condition is mental health problems, whereas, for older claimants, it is more likely to be musculoskeletal complaints. The fastest growing group of recipients is those who have been in receipt for five years or more, suggesting a risk of a large and growing ‘core’ of recipients with a dwindling prospect of flowing off benefit at all.

Looking at all PIP/DLA recipients aged 16 or over, receipt of benefits is heavily concentrated in more deprived areas. The table (below) shows the 10 parliamentary constituencies with the highest absolute numbers of PIP/DLA recipients as of 2023, and how the number has changed in the last decade. Five of the top six are in the Merseyside area, and all have seen a growth in numbers of between 20-30 per cent in the last decade.

If targeted action is not taken, many of the working age claimants in these areas will reach pension age on disability benefits and then be more likely to die in receipt than cease claiming.

Table: Westminster constituencies with largest numbers of 16+ recipients of PIP / DLA in 2023 (England and Wales only). Source: DWP ‘Stat Xplore’ database. Click to enlarge.

The higher levels of benefit receipt in more deprived areas suggest the potential for targeted health interventions, which could reduce the number of people who need to claim in the first place and/or reduce the length of claim for those who do receive benefits. However, the authors argue that past government interventions have proven insufficiently focused on those most in need.

The research cites as an example the DWP’s recent expansion of the “Individual Placement and Support in Primary Care Programme” (IPSPC), which was designed to support individuals in receipt of disability benefits. However, the list of local authorities chosen to date excludes those where disability benefit receipt is at its highest.

Another example is NHS England’s ‘Elective Recovery Programme’, which aims to increase capacity to tackle the waiting list backlog that significantly worsened during the Covid-19 pandemic. This programme has not specifically prioritised areas of greatest unmet health need, according to the researchers.

The paper argues that with each person who reaches pension age on PIP likely to receive another £70,000 in benefit on average, there is great potential for cost-effective interventions which would benefit the individuals concerned as well as the taxpayer. For example:

Clinically recommended Diabetes meters for those with Type-2 Diabetes cost just £5.50 each; roughly 13,000 such meters could be funded from the savings of just one person fewer needing PIP through retirement.
Where people have mental health problems alongside physical problems, low intensity psychological treatments have been demonstrated to be a cost-effective method of treatment. The cost of such ‘collaborative care’ is around £2,140 per person, a fraction of the potential cost saving of £70,000 through avoided benefit payments.

Commenting on the results, co-author and Head of Health Analytics at LCP, Dr Jonathan Pearson-Stuttard, said: “The prospect of large numbers of people going into retirement facing long-term disability benefit receipt is not in the interests of the individuals concerned or the taxpayer. If just one less person needs to claim Personal Independence Payment through retirement the saving is likely to be around £70,000 and that money could be much better spent keeping people well and supporting those who have disabilities. More targeted interventions, particularly focused on areas of greatest deprivation and highest health needs, could pay off many times over in terms of benefit savings and gains to the wider economy.”

Why healthtech providers to the NHS have a responsibility to design interoperable solutions

By Dr Anas Nader

Boosting access to innovative technology has never been more important for the NHS. But providers have a duty to ensure interoperability is at the core of all solutions, writes Dr Anas Nader.

With the NHS facing increasing challenges, from extensive waiting lists to rising staff burn-out, boosting access to innovative technology across the industry is becoming a growing priority. The Health Secretary has promised to ringfence funding for health tech, highlighting it as a key investment for the future of the health service; and there is no shortage of emerging tech offering to step to the fore and build new solutions.

Many are already shaping up to deliver on this promise – from remote patient monitoring to increased surgical accuracy. But there is one thing that must not be overlooked: if these solutions are to have a long-term tangible impact, and support more joined-up care delivery across new integrated care systems (ICSs), they must be designed with interoperability in mind.

An interoperable solution is one that can connect with other systems, allowing for information to be easily and safely shared without the need for manual intervention. With hundreds of digital systems in use across the NHS – including databases such as the Electronic Staff Record – new tech must be able to ‘speak to’ these and share information directly if it is to have a viable long-term benefit. This is especially vital for facilitating cross-service collaboration within ICSs, enabling systems at different organisations to effectively and securely send information to each other.

For this reason, NHS England has identified interoperability as a key area of focus, to help boost the capabilities of ICSs, which were set up to drive the shift towards more joined-up care. This is a goal echoed by other recent reports, including the Hewitt Review, which highlights the importance of joined-up care and the effective interchange of information across organisational boundaries.

While new healthtech innovations are often built with the best of intentions, tech that cannot be successfully used in conjunction with other systems can inhibit this much-needed collaboration. Whether that’s by creating silos which slow down communication or increasing the admin burden on clinicians by requiring data to be manually re-entered; without interoperability, new technology can become difficult to use, and ultimately risks being abandoned by the clinicians it was built to support.

Indeed, a lack of interoperability between systems has been flagged as an ongoing problem in the NHS, with 76 per cent of doctors viewing this as a ‘significant barrier’ to digital transformation. According to the BMA, 13.5 million working hours are lost in England each year as a result of fragmented tech and IT systems.

To create a successful product that can make real change in the NHS, and facilitate genuine ICS-wide collaboration, healthtech companies must take into account the complex ecosystem of healthcare IT systems within the NHS. Providers have a responsibility to build in a way that ensures our solutions deliver genuine interoperability as standard.

How healthtech providers can deliver on interoperability

The biggest mistake that health innovators building tech for the NHS can make when approaching interoperability is viewing their product and the NHS as completely separate entities. Rather than being built for and with the NHS, solutions are often built in isolation, and then have to be retrofitted to meet the needs of each ICS. This is a surefire way to create a tech solution that is inherently incompatible with other NHS systems. To avoid this, companies must build in a way that prioritises interoperability from day one, with a close appreciation for the other systems tech must work alongside.

In the same vein, innovators must ensure their solution can be adapted to the many different healthcare contexts in which it could be used across each ICS. It may need to communicate with systems in primary care, hospitals, outpatient settings, or community and mental health care services. Ensuring full interoperability will allow for greater flexibility and mean it can be successfully adopted in different settings across ICSs, facilitating effective cross-service collaboration as a result.

Interoperability is not a ‘one and done’ exercise. Within systems as complex as the NHS, tech solutions must be flexible and able to continually evolve to meet the changing needs of the services using them. Healthtech companies should provide ongoing technical support and remain on-hand post-implementation to ensure that the solution continues to be a success. Parachuting in tech without this continued support may simply place a shelf life on the solution, especially if it is unable to integrate with future systems that are brought in across the ICS.

If technology is to fulfil the needs of the NHS’s staff and patients, interoperability must be prioritised at every step. This is vital for ensuring that the solution helps, rather than hinders, the healthcare service and offers a long-term solution which enables effective collaboration within the ICSs using it.

A failure to design interoperable software will result not only in an increased burden for NHS staff, but a lack of adoption and success. It’s a two-way street: working in partnership with the NHS to ensure systems are able to embrace new technologies is key. But innovators must actively take up the charge to prioritise interoperability and build solutions equipped to effectively support more ICS-wide, joined-up care.

Dr Anas Nader is the Co-founder and CEO of Patchwork Health: a digital solution that connects NHS organisations to a growing number of healthcare workers, reducing the reliance on locum agencies and improving the experience of flexible working in the NHS.

Acute Care, Community Care, Digital Implementation, News September 13, 2023

Winter is coming: how Doccla’s virtual ward pathways support Urgent and Emergency Care

By Tara Donnelly

Tara Donnelly, Founder of Digital Care Limited, explains how Doccla is supporting NHS Urgent and Emergency Care through an innovative suite of virtual ward and remote patient monitoring technologies.

Emergency Departments (EDs) across the NHS in England have experienced another record-breaking year, both in terms of increased volumes of patients attending – more than 24 million emergency attendances – and decreases in performance against waiting time standards. Pressures on EDs are no longer seasonal but exist all year round, leading to adverse patient experiences. It is imperative that all those involved reimagine how Urgent and Emergency Care (UEC) services are delivered to support NHS colleagues who are bracing for a challenging winter ahead.

There is increased recognition that digital solutions could help to alleviate some of this burden. NHS England’s latest guidance to deliver the UEC Recovery Plan spotlights the expansion of virtual wards as a high impact intervention this winter. Doccla, a leading provider of virtual wards and remote patient monitoring, is working closely with its NHS partners to provide alternatives to admission and to relieve bed congestion by supporting early discharge. The team works with more than a third of integrated care boards, providing:

A customised suite of technology to help clinicians and carers monitor patients at home.
Clinical dashboards that enhance caseload management through holistic views of patient cohorts and visualisations of patient data trends over time.
Integration with electronic patient records to enable flow of coded data from the Doccla dashboard to the patient’s medical record during their stay on the virtual ward.
Access to multi-disciplinary clinicians with specialist training in remote monitoring.
An end-to-end logistics service that task-shifts administrative and non-clinical activity from busy clinicians.
Access to a patient support team, which uses a variety of accessibility tools to ensure patients from all demographics are aptly supported on virtual wards, from onboarding through to discharge.

Doccla’s technology has been pivotal in enhancing various admission avoidance pathways within UEC settings.

Remote monitoring available to community urgent response teams

Doccla’s technology is integrated within Hertfordshire Community NHS Trust’s (HCT) virtual ward service. Under the guidance of HCT’s Medical Director, Dr. Elizabeth Kendrick, the service has enabled the rapid assessment, diagnosis, early treatment and discharge of over 4,000 patients – recently winning a Parliamentary Award for its work.

Hertforshire Community Trust’s Hospital at Home service, using Doccla technology, has recently won a Parliamentary Award for its work.

Most recently, the technology has been deployed to HCT’s urgent care and response teams tackling ambulance wait times. Rather alarmingly, one in 10 ambulances spend more than an hour waiting outside hospitals. Joining forces with the East of England Ambulance Service, HCT equipped its community urgent response service with Doccla remote monitoring boxes so they could have an additional tool to support people to stay at home. Early evaluation of the pilot showed promising results, including:

Reduced ambulance conveyance rate to 33 per cent (from an anticipated 100per cent conveyance rate).
Reduced ambulance attendances by 18 per cent at East and North Herts NHS Trust.
Increased time available for crew to respond to acute emergency calls.
Reduced handover delays outside hospital.

Tackling surges in respiratory admissions this winter

Seasonal variations in respiratory admissions are a major contributor to pressures within emergency care settings over winter. There are 80 per cent more lung disease admissions in the winter months of December, January and February than there are in the warmer spring months of March, April and May.

Virtual wards provide an alternative mechanism for services to manage patient flow and to cope with the surge in respiratory admissions. The Doccla-supported ARI pathway at Northampton General Hospital (NGH) has demonstrated considerable efficiencies for the delivery of care. By supporting early discharge, NGH’s virtual ward service achieved:

11 per cent reduction in length of stay.
30 per cent reduction in bed days.

Likewise, tech-enabled remote monitoring enabled earlier detection of, and interventions for, deteriorating patients, resulting in a 15 per cent reduction in readmission.

While additional UEC funding has been injected into integrated care systems, allocation of monies is challenging when there are competing needs across care settings. It is paramount that the additional funding is maximised. NGH’s virtual ward service demonstrates a £13,000 per month saving (associated with the reduction in bed days) and more broadly, has enabled workforce capacity savings. Analysis in 2021 showed on non-tech enabled wards, there is 1 nurse per 8.3 patients on average. Doccla’s tech efficiency gains have expanded this to 1 nurse per 10 patients.

Augmenting SDEC services

Bristol, North Somerset and South Gloucestershire (BNSSG) is another example of how effective partnership between clinical and operational teams, in conjunction with Doccla’s innovative technology, can reduce admission rates. Between February and May this year alone, BNSSG’s NHS@Home service:

Provided an alternative to admission or supported earlier discharge 487 times.
Enabled local people to be cared for at home for an additional 4442 days
Supported cost savings of £1,479,186.
Avoided readmission for 87 per cent of patients.

In collaboration with Doccla’s remote monitoring technology, BNSSG NHS@Home teams are pioneering the use of remote monitoring for same day emergency care (SDEC) patients to avoid inpatient stays within North Bristol Trust – with the SDEC model contributing approximately 20 per cent of NBT’s weekly referrals to the NHS@Home service.

An example of a presenting condition being cared for in this way is the bacterial infection Cellulitis, which results in more than 100,000 hospital admissions per year in England alone. The new pathway has the patient set up for remote monitoring while in the hospital; they are given a Doccla box to take home and asked to send in their readings over the next few days, to indicate to the clinical teams whether or not the infection is under control. Given that 1.6 per cent of all NHS hospital admissions are due to Cellulitis, enabling speedy discharge or reduction of inpatient stays for patients with the condition has the potential to shift the dial on bed pressures this winter.

Conclusion

It feels important both for patients and the sustainability of the NHS that we do everything in our power to rapidly scale innovative solutions that are demonstrating impact in tackling pressures in Urgent and Emergency Care pressures.

As a trusted partner to health systems and providers, Doccla’s technology is being flexed in agile and impactful ways to support urgent care pathways this winter.

If this has sparked ideas that you are keen to action locally, please reach out to the Doccla team here. Doccla will be attending Public Policy Projects’ ICS Delivery Forum on 4th October to continue the conversation.

Tara Donnelly, Founder of Digital Care Limited

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People with severe eczema face a hidden cost of living crisis

By Rippon Ubhi, Sanofi Specialty Care General Manager

New report from Sanofi shines a light on the hidden financial burden faced by sufferers of severe atopic eczema.

Nearly everybody has felt the pressures of the cost-of-living crisis. Prices rising, bills soaring, and having to do more with less. This is a real concern for so many, but it’s even worse for people living with uncontrolled atopic eczema, who have to contend with additional costs, both direct and indirect, which are causing a significant strain on both individuals and the healthcare system.

Atopic eczema – known medically as atopic dermatitis (AD) – is the most common form of eczema in the UK, affecting 5-10 per cent of all adults, and causing the skin to become itchy; during a flare-up it can become red, cracked and sore. From the financial costs of medications to an increased risk of developing depression, the costs of uncontrolled eczema to many people living with the condition are wide-ranging and detrimental to their quality of life, particularly for people from lower socioeconomic backgrounds.

Eczema can often be overlooked as a healthcare issue by the general public, and Sanofi recognises the significance of highlighting the genuine effects on the individual that it can cause. Sanofi’s aim is to increase awareness and shine a light on the true cost of the condition. So, we commissioned leading cross-party think tank Demos to produce a report which analyses the impact that uncontrolled atopic eczema has on patients, the NHS and wider society.

The Costs of Atopic Dermatitis report, published in April 2023, draws on an evidence review of UK and international literature, interviews with clinicians in England and the experiences of people living with eczema to examine the costs, the current state of patient care and how patient care can be improved.

The financial burden of eczema

The report provides insights into the costs borne by people living with uncontrolled eczema. This financial burden is far more significant than many might expect. One clinician Demos interviewed said that sometimes patients with lower socioeconomic status have to make a choice between paying for medication or buying food. This cost to society goes beyond just the healthcare system, hitting the economy as a whole. In the UK, the indirect costs of work impairment to the economy for adult patients with moderate-to-severe atopic eczema is estimated to be between £6,741-£14,166 per patient, per year.

But why does it cost so much? Firstly, people living with severe eczema have to spend money on both medical and non-medical item s such as medicines, emollients and moisturizers. The impact the condition has on their ability to work also adds to the personal financial cost. Patients with severe, uncontrolled atopic eczema often need to take additional sick days and they may even lose work because of their condition. Then there are the intangible costs: people living with eczema may have to deal with sleep impairment and other mental health issues exacerbated by the irritation and appearance of their skin.

There is an impact on the NHS too. The direct cost of mild-to-moderate eczema to the health service was estimated as being at least £257m in 2020, though there have been no comprehensive studies encompassing the costs of severe atopic eczema. It is estimated that around 15-20 per cent of GPs’ workload is dermatology, with a large quantity of that work being eczema.

Reforming dermatology pathways

The Costs of Atopic Dermatitis report has shone a light on the problem. We now need to focus on how we can alleviate this financial burden. That means investment in improvements to the standard of care for people living with atopic eczema, to drive positive outcomes for patients and reduce long-term costs to the health service and the economy.

If integrated care systems develop dermatology strategies and ensure that psychological support is commissioned as part of the dermatology pathway, these costs can be significantly reduced, by lessening the mental burden of eczema. We as a country need to do more to ensure that healthcare professionals know about the full range of support available to patients. It is vital that patients feel supported by their doctors to access mental health care where appropriate, and that GPs have the training and resources needed to provide the best care possible to their patients with eczema.

Through commissioning this report, Sanofi hopes it has played some small part in bringing the issue of atopic eczema and its cost to us all into relief. The next steps, however, need to be taken by decision makers as they decide whether they want to act to rescue the costs of eczema to patients and our healthcare system.

This article was written by Sanofi.

Job bag code: MAT-XU-2304180 (V1.0)
Date of prep: Sept 2023