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

By Gabriel Blaazer

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Anyone interested in joining can apply via the following link:

Tackling the winter crisis and future-proofing the NHS

By Rob Shaw CBE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Gabriel Blaazer

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

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

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

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

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

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

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

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

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

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

By Integrated Care Journal

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Can allied health professions catch up with NHS digitisation?

By Andy Soluk

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

This article was kindly supported by FormDr.

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

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

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

The process of an osteopath

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

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

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

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

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

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

How practices are impeding their future progress

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

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

What can practices and small businesses do?

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

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

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

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

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

3) Digitise where you can.

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

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

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

Pharmacy First service agreed as Recovery Plan set to launch

By Gabriel Blaazer

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Not just for Christmas: Winter clinics a shining example of innovation we cannot overlook

By Dr Owain Rhys Hughes

Amid news that no funding is expected for community acute respiratory hubs this winter, Dr Owain Rhys Hughes explains why these are a shining beacon of innovation that the NHS cannot afford to overlook.

As winter fast approaches, the NHS is gearing up for another incredibly tough season. Waiting lists have hit a new record high of 7.8 million people and ongoing staff shortages continue to pile pressure on overstretched services. Innovation has a vital role to play in supporting the NHS to navigate these periods of intensified pressure. The winter clinics that provided lifeline support during last year’s winter months, which are yet to receive repeat funding for this year, are a shining example of the importance of such innovation – and the danger in overlooking it.

While primary care services deal with an existing backlog of appointments and referrals, the additional influx of patients expected to hit GP surgeries during the winter months – due to spikes in cold and flu complaints, for example – threatens to be overwhelming. Expanding the capacity and resources of primary, community and secondary care during this period is therefore essential. Winter clinics provided a crucial first line of defence for patients experiencing cold and flu symptoms last year. This deflected pressure from GPs and emergency services, boosting their capacity to see the patients they really needed to see.

Without initiatives like these, which facilitate the joined-up collaboration desperately needed to ease pressure on individual services and streamline patient triage, the NHS is facing a winter of unprecedented strain. A lack of capacity within primary care could leave many patients turning to A&E for support. In turn, this could place excessive pressure on secondary care, pushing up wait times for those in most urgent need of treatment.

We cannot afford to overlook the vital necessity of innovation that can unlock and support more collaborative care delivery and boost clinical capacity where it is needed most.

Winter clinics are just one example of the value and potential of such innovation during times of excessive pressure and need. There is a wealth of holistic and tech-powered solutions offering the tools for wider collaboration and more effective clinical communication. Harnessing these is essential to providing the infrastructure and support needed to ensure that the NHS can continue delivering exceptional levels of care amid growing strain.

Streamlining referrals into secondary care and introducing new sites for care delivery and diagnosis is a key way in which innovation is helping to do this. The rapid rollout of Community Diagnostic Centres (CDCs) across the health service is providing additional capacity and working to help reduce the number of patients being sent into secondary care for diagnostic tests and consultation. This is not only helping to diagnose illnesses such as cancer sooner, but is also allowing for triage to a wider range of services, ensuring only those who really need to be seen in urgent care are sent into hospital.

Another way in which diagnosis and referrals are being streamlined to free up capacity is through the introduction of digital advice and guidance. The use of digital tools to connect clinicians across different services can enable GPs and community clinicians to contact specialist consultants in real-time. This allows for advice and guidance to be easily and securely shared, and joint referral decisions to be made. As a result, the number of unnecessary referrals into secondary care can be reduced. Meanwhile, patients can be triaged to the most appropriate form of care sooner, avoiding repeat referrals and additional admin for GPs, boosting their capacity to spend with patients.

In my role at Cinapsis, I’ve seen this have an incredibly positive impact. Through our work in Norfolk and Waveney, for example, we’ve seen the use of digital advice and guidance reduce the wait time for specialist advice from 50 weeks to just 48 hours. This benefit has a knock-on effect by reducing the number of patients entering secondary care when they don’t need to. It also saves GPs time previously spent on copious admin and processing unnecessary referrals, freeing them up to see a higher number of patients.

As each new winter brings a fresh wave of increased pressure on our NHS, we must do everything we can to brace for and reduce the strain it puts services under. We cannot remove this pressure altogether; but we must embrace innovation wherever possible to facilitate the cross-service collaboration and vital communication needed to help clinicians unlock capacity and manage heightened patient demand.

Dr Owain Rhys Hughes, Founder and CEO, Cynapsis

Digital Implementation, Health Inequality, News, Population Health, Thought Leadership November 15, 2023

Inclusive innovation: using community co-innovation to tackle health inequalities and digital exclusion

By Fran Ward and Dr Paulina Ramirez

By Fran Ward, Project Manager, NHS Arden & GEM CSU and Dr Paulina Ramirez, Academic, Birmingham Business School.

Digitalisation of the NHS has the potential to enable more personalised care and improve health outcomes. But it can also widen health inequalities. Some people in communities facing social and economic deprivation, which are also those experiencing the poorest health, find accessing care increasingly difficult as the NHS becomes more digital.

If those most in need of health services become less able to access them, health outcomes for these communities will worsen and the overall cost of healthcare will increase. Integrated care systems (ICSs), therefore, need to maximise the value of their investment in digitalisation by making it work for all their communities, not just the ones they know and understand well.

The ‘Building Inclusive Digital Health Innovation Ecosystems’ research programme, led by University of Birmingham’s Business School and supported by NHS Arden & GEM’s digital transformation team and Walsall Housing Group (whg), explores how community co-innovation could be used to develop digital healthcare that works for diverse communities and reduces the risk of exclusion.

Co-innovation is about understanding and framing problems and taking a bottom-up approach to generating new ideas in response. Specifically, this programme of community co-innovation is socially inclusive by design, creating an opportunity for disadvantaged communities to share their knowledge and lived experience. It gives these communities an equal share of voice alongside commissioners, clinicians and other stakeholders in the development of new digital health technologies or design of new online services.

Peer research

To genuinely hear what more deprived communities need, it is important to rethink how we in the NHS structure engagement to make it easier and more comfortable for those we most want to hear from. Training peer researchers from whg and local voluntary organisations enabled us to build on existing skills, connections and relationships. As trusted members of the community, peer researchers were better able to have relevant conversations within people’s homes, and elicit more honest and open responses on how people access technology and the barriers they face.

The resulting insights challenged some assumptions around barriers to adoption of digital technologies. The main source of inequality was found to be the lack of skills and confidence to engage with online services, with an individual’s type of work or family support structure often having a greater influence on digital proficiency than age, for example. Concerns around data privacy and information sharing were high, causing some not to access potentially valuable support. Despite positive attitudes towards digital in general, many felt digital services such as online GP appointments were not an adequate replacement for face-to-face health services due to a combination of trust, complexity and importance of healthcare in people’s lives.

Simply developing more digital services without addressing these fundamental barriers is inevitably going to limit success.

Changing the nature of engagement

Although good examples of user engagement in digital health services exist, there are constraints too. In particular, technology companies often have little or no engagement with deprived communities so can’t be sure their technology will work for those most likely to have the highest health needs. Alongside peer research, we need to create spaces for co-innovation to happen, bringing together these stakeholders to share information and work together to come up with new ideas.

A locally hosted co-innovation event enabled system partners in the Black Country ICS and health technology companies to hear from and engage with peer researchers and other local community organisations to start putting theory into action. Based on health priorities identified through the peer research, table group discussions addressed challenges such as how to ensure that a mental health app was used by those who most needed it, and how to increase numbers of patients from areas of high deprivation attending diabetes reviews. Peer researchers were able to articulate the day-to-day challenges people in their communities face and why, for example, simplicity and ease of use is often preferable to feature-packed, complex apps.

The event has already resulted in a dedicated task and finish group being set up at NHS Black Country Integrated Care Board to explore how community co-innovation can be applied to issues such as digital GP access. Whg is also keen to continue building a space for co-innovation within its community. More broadly, however, there is a wealth of learning from this approach which can be applied to digital transformation across the country.

Developing best practice

It is clear from this work that input from communities facing social and economic deprivation is essential in finding solutions to some of the nation’s most complex health challenges – and that how we do that is as important as why.

Findings from the ‘Building Inclusive Digital Health Innovation Ecosystems’ research have been used to develop a What good looks like for our communities report to support the NHS Digitalisation Framework. This highlights the need for affordable, simple, safe and inclusive technology that is well integrated with in-person services, guarantees data privacy and is supported with local skills training and support.

We have also developed a playbook to guide ICSs in using community co-innovation to develop digital health services, drawing on the learning from this programme to encourage greater use of this approach across the NHS. After all, there is no point in developing digital services that aren’t going to work for the communities we most need to help.

Photo caption: Peer researchers interviewing community members in their own homes in Walsall.

To find out more about digital inclusion and health inequalities, see: The digital divide: Reducing inequalities for better, prepared by Public Policy Projects.

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Recognising the value and impact of AHP support workers within healthcare

By Integrated Care Journal

This week the Chartered Society of Physiotherapy, along with a coalition of 13 other allied health professional (AHP) bodies, is celebrating Support Worker Awareness Week.

AHP support workers are an integral part of multidisciplinary teams. They are relied upon for the transformative role they have to play across many different services, including physiotherapy. They work within their scope of practice to carry out a wide range of tasks and are supervised by a registered healthcare professional who retains responsibility for patient care.

The value of support workers cannot be underestimated. The contribution to services by support workers, both in the NHS and the independent sector, enhances patient outcomes, improves patient experience and increases service efficiency. They also provide immeasurable guidance and support to the wider health and care team.

Currently, we see increasing numbers of support workers playing a vital role in facilitating education by supporting physiotherapy students with their learning. By supporting physiotherapy students with practice-based learning during their placements, support workers offer a safe and supportive space, and contribute to the growth of the profession.

During the pandemic, support workers demonstrated great flexibility and brought new skills to the role. Their responsibilities increased and elements of their practice developed to meet the extraordinary pressures on the system.

Need for more support workers

More physiotherapy support workers are needed within the NHS, but this demand can’t be met by increasing the registered workforce alone. With ever-increasing physiotherapy waiting lists, an ageing population and more patients living with multiple conditions, more support workers are needed to fulfil population, patient and service delivery needs in safe, effective ways.

The CSP has recently conducted a physiotherapy workforce review in England and is calling for 6,500 additional non-registered physio posts in the NHS over the next five years. Additionally, the recent NHSE intermediate care framework recommends maximising the use of skilled support workers. If utilised at the right points in intermediate care pathways, their skills and expertise will improve access to high quality rehab that is timely, safe and person-centred.

In Northern Ireland, we want to see the implementation of the recommendations outlined in the Physiotherapy Workforce Review Report published in 2020, including the establishment of apprenticeships for physiotherapy support workers. In Scotland, we are calling for funded ‘earn and learn’ routes to be established and in Wales, the expansion of the level 4 apprenticeship scheme for support workers.

The support worker role is evolving, with increased opportunity to carry out additional responsibilities in practice. Higher-level support workers have additional responsibilities across the four pillars of practice. These roles are important to provide a positive impact on patient flow, quality of patient care and to meet new national policy developments.

What support workers need

Support workers need clear opportunities and pathways to develop capabilities and pursue career development. Each UK country should have a programme of work to develop support worker roles including those at higher level. This should both develop CPD opportunities, a greater consistency in levels of practice, capabilities and governance arrangements.

Higher-level support worker roles are one example of career development and provide opportunity for managers to think creatively about the skills mix within their teams.

With the right systems and support in place, support workers can do so much more.

Looking to the future

With the opening of the National Rehabilitation Centre (NRC) in East Midlands planned in early 2025, there is a new pioneering role.

The centre will offer a foundation degree apprenticeship for a rehab assistant practitioner role (band 4 equivalent). The rehab assistant practitioner will work across OT, physio and nursing with an evidence and training base behind them.

The NRC plans to offer around three to four hours a day of rehab as opposed to the 30-40 mins per day rehab normally offered in the NHS. Rehab Assistant Practitioners will be key in meeting these ambitious targets.

It is clearly time to recognise and shine a spotlight on the vital role of support workers but also most crucially to invest in their pathway and career opportunities.

Pioneering diabetes prehab service launches in Wirral

By Integrated Care Journal

Service uses population health data to identify those most at risk of having surgery postponed

One Wirral CIC, a non-profit community interest company that proactively helps to bridge gaps in health services and support for local communities, has launched a ground-breaking diabetes prehabilitation service to reduce surgery postponements, tackle waiting lists, and improve postoperative outcomes for patients. The service uses population health tools and analysis of hospital waiting lists to identify and support those most at risk of having surgery postponed.

Since April 2023, the service has supported two Primary Care Networks – Moreton and Meols PCN and North Coast Alliance PCN, funded by the North West Coast Clinical Networks. However, the service will now be extended across Wirral to all Primary Care Networks. The goal is for the approach to be adopted nationally.

The diabetes prehabilitation service uses the Cheshire & Merseyside Combined Intelligence for Population Health Action (CIPHA) population health management system, on Graphnet Health’s CareCentric platform. CIPHA surgical waiting lists at Wirral’s Arrowe Park Hospital are used to identify diabetic patients who are awaiting surgery and have a HbA1C (hemoglobin A1C – a test commonly used to diagnose diabetes and prediabetes) over 69mmol/mol or a BMI above 40.

The early identification of patients at risk of having their surgery postponed removes the need for GP surgeries to make referrals. The service also receives referrals directly from secondary care, for people that have had their surgery postponed, and have diabetic risk factors.

Once identified, patients are contacted within 48 hours and booked in for an appointment with a diabetes prehabilitation health coach, in a local community setting, such as a library. If a person’s HbA1c is over 69, they are automatically booked in for an appointment with a diabetes specialist nurse, who will look at medicines management and optimisation. Once they have seen the health coach and nurse, they commence a personalised prehabilitation lifestyle plan, which they follow up until surgery, whether that is a matter of weeks or months.

Lucy Holmes, Wellbeing Lead at One Wirral CIC, explained: “The population health and data-driven approach means we are able to contact the right people at the right time and give them the best intervention before their procedure, without anyone slipping through the net. We look at their lifestyle and they’re encouraged to participate in activities, including the free diabetes exercise sessions that are held in the community each week. Their medications are also assessed. It means we’re looking at a person from a holistic point of view, not just clinically and not just non-clinically. It’s a true community-based, multi-disciplinary team approach.

“We’re so pleased to be able to roll this out across Wirral, but it’s an approach that could easily be lifted and shifted. We would love to see it adopted nationally, because we have seen the many benefits of getting people fit before surgery.”

Dr Dave Thomas, Wirral Diabetes GP Lead, added: “With diabetes, we know that if someone is living with excess weight or their sugar levels are very high, then that comes with additional surgical risks, higher complication rates, they’re more likely to have a longer hospital stay, and they’re more likely to generally have a poorer outcome. So, a service where we’re getting people fit and healthy, and optimising their diabetes care prior to their operation can only benefit the patients. From a Wirral-wide point of view, it’s going to help reduce surgical waiting times, reduce complication rates, and it will allow us to reduce hospital stays.

“This really is a fantastic service. We haven’t seen anything like it anywhere else, which is really exciting and hugely positive for the patients that we’re supporting.”

To hear more about the benefits of the diabetes prehabilitation service, please click the video link: Wirral Diabetes Prehabilitation Service | How It’s Changing Lives.