New digital maternity pathway goes live in Devon

By TPP UK

TPP SystmOne Maternity technology goes live at Torbay and South Devon NHS Foundation, digitising the entire maternity pathway, from ante to postnatal care.

This week, Torbay and South Devon NHS Foundation Trust have gone live with TPP SystmOne Maternity. The system has enabled the Trust to digitise their entire maternity pathway, from antenatal through to postnatal care. It is being used by all midwives in the region, including those based at the hospital and those working in the community. More than 2,500 women will benefit from the new system every year, with their maternity care now centred on a complete, integrated digital care record.

Following the go-live, midwives now have instant access to all of the maternity data they need. For example, midwives working in postnatal care can easily view all antenatal care and delivery details. All medical and nursing notes are captured in a single record. This provides staff with the information required to make the best clinical decisions and improve safety for mothers and babies. Advanced functionality in the system is also supporting staff with the management of more complex pregnancies, through enhanced clinical decision support, alerts, and a complete maternity timeline.

TPP maternity — TPP SystmOne Maternity in use at Torbay Hospital

There has been strong clinical engagement throughout the project, from midwives, doctors and nurses. The teams have used TPP’s powerful Clinical Development Kit (CDK) functionality to develop exactly the data entry templates and visualisations they wanted. All staff members can quickly capture the information they need for a complete antenatal, labour, delivery and postnatal record. The Trust have also used CDK functionality to create customised safeguarding content, helping to support and protect the most vulnerable families. Staff are also benefiting from interactive inpatient screens in the system, allowing them to manage bed capacity and perform safe, efficient handovers.

The go-live has also included providing TPP’s smartphone application, Airmid, to all women under the maternity service. This is putting women at the very centre of their pregnancy journey. Airmid allows women to access their maternity records, manage their upcoming appointments, complete questionnaires at home, and receive personalised advice and education material. Airmid supports better engagement and seamless communication between women and their maternity care team.

SystmOne also provides significant improvements to integrated care across the region and to multidisciplinary working. For example, maternity staff can immediately access any important information entered by GPs. This is significantly improving patient experience. Women only have to tell their story once, without having to repeat themselves. GPs can directly refer into the maternity unit, improving efficiency across both services. Additionally, all new births are now automatically registered with regional Child Health services, with no extra burden placed on NHS staff.

Tracy Moss, Head of Strategic Systems’ Software Development at the Trust, said: “We are excited to be working with TPP to introduce a new maternity IT system here at Torbay and South Devon NHS Foundation Trust. The new system is expected to bring a wealth of clinical as well as efficiency benefits for our maternity teams and the wider organisation. The families we care for will also benefit from the system, as the new associated Airmid patient app will allow them to view their records, access information and be more involved in their care. Moving forward, we would like to continue to work with TPP to deploy other SystmOne products, both within our maternity unit and across our wider Torbay and South Devon organisation.”

Charlotte Knowles, Managing Director at TPP, said that “maternity services will always hold a particular place in my heart. Having had three babies, I know, from personal experience, what a superb job they do. We are delighted that the Trust are already seeing significant benefits for staff and patients from TPP Maternity. The dedication of the staff here has been truly inspiring. We are looking forward to working together to continue to make better use of technology to improve the experience and outcomes for pregnant women and their families.”

Government failing on social care and health inequalities

By Kari Gerstheimer

The government’s failure to reform social care funding in the Health and Care Act is compounding regional health inequalities, writes Kari Gerstheimer, CEO and Founder of Access Social Care.

Speaking before a Cabinet meeting last month Boris Johnson stated that: “With household bills and living costs rising in the face of global challenges, easing the burden on the British people and growing our economy must be a team effort across Cabinet.” He added that “we will continue to do all we can to support people without letting Government spending and debt spiral, whilst continuing to help Brits to find good jobs and earn more, no matter where they live.”

However, the Prime Minister’s own assurances on protecting the British public from rising costs were set against the Government’s actions regarding the Health and Care Act, which has just been enshrined in law.

The Prime Minister continues to make promises to help the British people with the growing cost burden, while the Health and Care Act leaves those on the lowest income exposed to spending a greater proportion of their assets on care costs, during the worst financial crisis we have seen in generations.

The Government’s own amendment to the Bill, which was subject to a fierce debate in both chambers of Parliament before ultimately being voted through, means that the local authority support people receive to help them meet their care costs, will no longer count towards the proposed £86,000 cap.

This is all the while that the PM has continued to make promises to address the decades-long social care funding crisis and widening health inequalities. The £5 billion in extra money announced for social care over the next 3 years, is of course welcome. But there is no mathematical link between the amount of money and the level of need. The Health Foundation calculates that at least £8 billion are needed per year, just to deliver what councils are legally obliged to.

Failure on “levelling-up”

Research commissioned by Access Social Care, which provides free legal advice for those with care needs, shows that poorer areas with lower council tax and business rate yields have been worse affected by the reduction in the central Government grant for social care.

This means that people living in poorer areas where social care need is often the greatest, are already getting a bad deal compared to other parts of the country, which flies in the face of the much-vaunted concept of “levelling-up.”

Rather than addressing this unfairness, the Government’s amendment is compounding it, by leaving people living in ‘red wall’ areas having to spend a greater percentage of their total assets on care.

The Health and Care Act is a clear contradiction in the PM’s assurance to focus efforts on easing the burden for British people and protecting the public from rising costs. It will instead deepen the cost of living to the poorest of our society and widen long-standing health inequalities.

Access Social Care are already seeing cases where the cost of living crisis means that people cannot afford the social care they so desperately need. The Government urgently needs to do more to ensure that everyone can get the social care they need, at a price they can afford.

The UK must harness data and digital to revamp stroke aftercare – Mike Farrar

By Mike Farrar

Stroke is the single largest cause of complex disability and long-term thinking around stroke aftercare is critical in easing pressure on health and social care.

The NHS Long Term Plan places stroke aftercare as a key priority area for improvement. However, ongoing data shows that the promises to ensure the best performance in Europe for delivering clot-busting thrombolysis by 2025 and increasing the number of patients receiving reviews of their recovery needs (from 29 per cent to 90 per cent), is unlikely to be met.

The stroke pathway has seen significant improvements over the last decade. These include the introduction of hyperacute stroke units, improved brain-imaging, rapid thrombolysis and game-changing thrombectomy. However, it is likely that these interventions will be undermined by the failure to recognise the opportunities to help people return to productive lives after a stroke.

Stroke care is an area that has seen substantial improvement in the UK; while mortality rates have halved over the last 20 years, stroke remains the single largest cause of complex disability. Further to this, recent research from the Stroke Association five-year survival rates remains low.

The Stroke Association estimates that 100,000 people have a stroke in the UK every year, with two thirds of survivors leaving hospital with a disability. There are currently 1.2 million stroke survivors living in the UK, at an estimated cost to the health and care sector of £26 billion a year. This cost is expected to triple by 2035.

Missing parts of the stroke pathway

The provision of rehabilitation and aftercare is an essential element of the care pathway yet is often the least well supported and resourced, a situation not solely limited to stroke care.

This is not unique to the UK and clinicians in the USA are experiencing similar issues. Once a patient has left an acute situation, where the latest interventions, medications and technological advancements have been provided, the same level of attention just isn’t there post-discharge. There is often a marked deterioration in wellbeing with an undetermined longer-term impact.

Stroke aftercare: a faulty mindset

There is an underlying mindset within the system that the priority lies with acute care management and what happens after is less important. As a system, crisis response is generally exceptional, and innovation and resources tend to be focused on this stage of patient’s journey. But there is very little strategy – and the funding treadmill is perpetuated by continually focusing investment on acute interventions. But it is clear that the cost benefit is poor if a more strategic view of the whole care pathway is not taken.

The failure to provide effective rehabilitation immediately after an acute episode can lead to reduced functioning mobility and normal life for the individual. The consequence of this failure is an added cost for the health and care system, reduced economic productivity and can increase social care costs if it leads to patients losing their ability to live independently.

Masking the real data

The data currently collected typically identifies re-admitted patient episodes as a new case rather than allowing the system to recognise and then count it as a re-admission. This often masks the failure of the rehabilitation and ongoing support offered, which could have prevented further problems.

The link to co-morbidities is also missing, with more people dying in the first six months after a stroke from cardiac events, rather than consequences of a stroke – which means we are overlooking opportunities to influence outcomes in other ways.

The cost of high-quality rehabilitation may pay itself back over time but immediate cost pressures in the system can often mean that rehabilitation is not funded as a priority, in turn reducing patient outcomes.

Balancing the funding model

So, what should the path forward be from here? The key to achieving the right balance is to argue the need for a greater use of data and to provide the evidence to build up the business case. There are some professionals and clinicians leading the charge and looking for that evidence to balance the funding model.

The Mount Sinai health system in the USA recruited a randomly selected sample of people who were enrolled in a remote monitoring programme. Of the sample, 90 per cent of the sample had a crisis that the health system could have intervened on. Without the follow-up, these crises would never have been caught.

In Cardiff and Vale in Wales, they’re currently trialling a system that joins up the data to the patient – rather than the episode – to track the re-admissions and the patient’s entire journey through the health system. The data outcomes are providing interesting insights into chronic conditions and helping to modify care providers’ understanding of where they put their money.

The role of data and digital in stroke aftercare

There is also seeing a role for digital platforms to be used for virtual rehabilitation. There are many ways to do this and the growth of digital care technology in local authorities should be used to support and endorse these changes across the whole health and care system. As an example, Visionable’s platform allows any deterioration in health to be identified early to prevent serious problems occurring, including readmissions. As people wait longer for care, this early warning is crucial to avoid patient harm.

There’s a real opportunity to shift the way rehabilitation pathways are approached, and how outcomes are tracked. This dialogue should really appeal to the new integrated care systems and their integrated care boards as the NHS embark upon seismic structural shifts in 2022.

Through system-wide commissioning, there is the opportunity to balance the investment and provide transformation – and to deliver a genuine whole pathway, including more robust rehabilitation services. Enhancing data capture in real-time and making sure the money follows the patient could produce marked differences – not only for the public purse, but in the quality of people’s lives.

New IPPR report argues health is ‘holding back UK economy’

By Niamh Macdonald

The UK will suffer an £8 billion hit to economic activity this year due to lack of government action to improve the nation’s health, according to a report launching the new cross-party IPPR Health and Prosperity Commission.

The IPPR report published today marks the launch of a new Commission on Health and Prosperity. The report warns that health inequalities and ineffective policies are shortening life expectancy in the UK, coupled with more years spent in poor health.

New analysis by IPPR and health analytics company Lane, Clark & Peacock, reveals that the workforce is also being affected as people face barriers to staying in work.

The IPPR is calling for a ‘new post-pandemic approach’ to the nation’s health to ensure that people can live long healthy lives as well as to strengthen the UK’s suffering economy.

There are now more than a million workers missing from the workforce compared to pre-pandemic levels. About 400,000 of these individuals are no longer working due to health factors, including long Covid, disruption to healthcare and declining mental health. The researchers warn that without intervention, this will drag down economic activity this year by approximately £8 billion.

The report states that the relationship between health and the economy is a decisive factor in the UK’s low productivity, low growth and significant regional inequalities.

According to the report, local level analysis reveals that someone living in North East Lincolnshire can expect to fall into bad health eight years than the UK average, while the output of their work is also valued at £8 less than the average. The report argues that this is a vicious cycle and that factors like lack of job opportunities can harm people’s health.

To explore how good health can be the foundation for a fair and prosperous economy, IPPR is launching a new cross-party Health and Prosperity Commission. The cross-party commission will be chaired by Lord Ara Darzi and former Chief Medical Officer Dame Sally Davies.

The report argues that the UK’s poor health outcomes and stagnant economy are a result of poor policy choices. According to IPPR, policy makers must now ‘set about putting the building blocks of good health in place’, including ‘good work, quality housing, local public health services’ and a ‘well-funded and staffed NHS. ‘

Dame Sally Davies, former Chief Medical Officer and co-chair of the Commission on Health and Prosperity, said: “A fairer country is a healthier one, and a healthier country is a more prosperous one. While the restrictions have eased, the scars of the pandemic still remain deep on the nation’s health and our economy.

“Not only are we facing a severe cost of living crisis, driven in part by pandemic induced inflation, we’re also experiencing a workforce shortage driven by poor health that’s holding back the economy. It has never been more important to put good health at the heart of our society and economy – and our commission will bring forward a plan to do just that.”

Matthew Taylor, NHS Confederation chief executive and commission member said: “The pandemic has shown how deep health inequalities shape and cut across the lives and livelihoods of people across the country.

“Yet this is not new, disparities in health have not suddenly appeared, they have been part of the make-up of our society for decades. As millions of people now face the reality of a cost-of-living crisis there is an urgent need for a much bolder and more strident approach to tackling inequalities to create improved population health and stronger economic wellbeing.

“We are delighted to be part of the Commission on Health and Prosperity and look forward to reflecting member insight. ”

WHO reveals almost entire global population breathing unhealthy air

By Niamh Macdonald

Almost the entire global population (99 per cent) breathes air that exceeds World Health Organization (WHO) air quality limits, and threatens their health, according to the 2022 update of WHO air quality database.

The new air quality database, released on 4 April, is the most extensive yet in its coverage of air pollution exposure on the ground. The database now includes measurements of annual mean concentrations of nitrogen dioxide (NO2), a common urban pollutant and measurements of particulate matter with diameters equal or smaller than 10 μm (PM₁₀) or 2.5 μm (PM_2.5).

A record number of over 6,000 cities in 117 countries are now monitoring air quality, revealing how their populations are breathing unhealthy levels of fine particle matter and nitrogen dioxide. The data also shows that people in low and middle-income countries are suffering the highest exposures.

A worsening health emergency

The database demonstrates the threat of air pollution to human health. Particulate matter is capable of penetrating deep into the lungs and entering the bloodstream which can cause cardiovascular, stroke and respiratory impacts. There is also emerging evidence that particulate matter impacts other organs and causes other diseases.

Nitrogen dioxide is associated with respiratory diseases, particularly asthma, which lead to respiratory symptoms, such as coughing or difficulty breathing. This further leads to increased hospital admissions and visits to emergency rooms.

Dr Maria Neira, WHO Director, Department of Environment, Climate Change and Health, said: “After surviving a pandemic, it is unacceptable to still have 7 million preventable deaths and countless preventable lost years of good health due to air pollution. That’s what we’re saying when we look at the mountain of air pollution data, evidence, and solutions available. Yet too many investments are still being sunk into a polluted environment rather than in clean, healthy air.”

Last year, WHO responded to the growing evidence base for the significant harm caused by even low levels of many air pollutants by revising its Air Quality Guidelines. The guidelines were made more stringent, especially for Nitrogen dioxide and particulate matter, an action that was supported by the health community, medical associations and patient organisations.

Now, through the 2022 database WHO aims to monitor the state of the world’s air and feed into progress tracking of the Sustainable Development Goals.

Commenting on the report, Francesco Tamilia, Policy Analyst at Public Policy Projects and author of The climate crisis and its impacts report said: “The science and data are increasingly clear on the extreme threat air pollution poses on human health, damaging every organ in the human body. World Health Organization has done an incredible job revising its Air Quality Guidelines last year, making them more rigorous. The latest air quality database is another important step in measuring the damaging affects air pollution has on the population’s health.

“National governments have no excuses, either they implement those guidelines and avert millions of premature deaths, or they will knowingly neglect the health of their populations.”

More support needed for “fatigued” social care workforce

By Mary Brown

On the 16th March 2022, Public Policy Projects (PPP) hosted an evidence session entitled The Social Care Workforce: Averting a Crisis as part of its report series The Future of Social Care. PPP’s Social Care Network examines the most urgent issues facing social care and presents tangible solutions to address workforce challenges in the sector.

The crisis facing the social care sector is fundamentally a workforce one. The sector itself is a large employer in the UK, employing about 1.54 million people, equivalent to five per cent of the workforce. As one participant noted, “the sector itself is a huge contributor to the economy and to society”. Given that staff pay is the single biggest expenditure faced by care homes, workforce management should be front and centre whenever system finances are being considered.

Even before the pandemic, there were about 112,000 social care vacancies in England, with jobs paying only £8.50 an hour. Following the pandemic, the vacancy figures are assumed to be worse. Key issues driving individuals away from working in the social care sector include low pay, stressful working conditions and a low sense of worth.

A participant of the evidence session emphasised that the working conditions of the social care sector have led to 74 per cent of care professionals reporting that they regularly experience stress at work, an average number of sick days 25 per cent above the national average, and a staff turnover rate significantly higher than the national average.

As phrased by one participant, social care is suffering from a “fatigued workforce” not only due to the pressures of the pandemic, but issues which have existed within the sector for much longer. The problems within the social care workforce are chronic , and are considered by many to constitute a crisis. As one participant said, “clearly a workforce strategy is one of the absolute essentials that we need to have to make a success of the sector over the next decade or so”.

“The social care sector should work alongside recruitment organisations to recruit young, bright people into social care, and help them consider where a career may lead.”

One problem identified was narrow recruitment to the sector. It was stressed that within social care, “we should cast our nets wider in a recruitment approach… and recruit not only people with previous experience”. The social care sector should work alongside recruitment organisations to recruit young, bright people into social care, and help them consider where a career may lead.

It was also suggested that more effort must be made to recruit hard-to-reach and underemployed groups, including people living with disabilities, and immigrant workers. “What frustrates me is that there are individuals in these groups who can be wonderful, caring staff [but]are missed, because hiring managers are too narrow in their focus”, said one participant.

Staff retention rates in social care are low. Network members noted that social care workers often leave the sector for other, similarly paid jobs, such as retail roles, while few choose to leave and work for the NHS. One network member identified that “between care assistants in the NHS and the social care sector, there is around a 23 per cent deficit in social care. The terms and conditions are vastly better in the NHS. Pensions, sick pay, overtime and unsocial hours all contribute to that deficit.”

Essentially, social care workers are underpaid and undervalued. For both better recruitment and retention, social care workers must be appropriately paid and treated as though they are valued. Some network members identified low pay as the key driver for individuals choosing to leave the social care workforce, and yet, it was emphasised that social care is a both a skilled and psychologically demanding profession, and should be commensurately well-paid.

However, funding in the system is limited, and paying the workforce is the sector’s single biggest expense. One participant said “there is not a settlement from government or local government that actually meets the cost of care to enable us to pay a proper wage for the level of skill, ability, responsibility, dedication that [care workers] have”. Furthermore, a high proportion of social care workers are on zero-hours contracts; in London, this figure stands at 41 per cent of social care workers. Therefore, many social care workers have to deal with pay inconsistency and insecurity, on top of being low-paid.

“Network members were in agreement that social care is, and should be publicly regarded as, a skilled profession.”

While pay is regularly described as the most pressing issue in the workforce, one participant argued that in their experience of conducting exit interviews with workers, it is not low pay, but rather a low sense of worth which leads people to leave the profession. While higher pay is one way in which care workers can be practically appreciated, it was agreed that more must be done to value care work both by improving the public image of care workers and ensuring that internal structures provide support and give value to workers.

Network members were in agreement that social care is, and should be publicly regarded as, a skilled profession. “It is not the kind of job that everyone can do,” said one participant. “It is a skilled job, which requires the creation of quality human relationships and working with people who have complex care needs… it is a real skill and should be regarded as the same as working in health.”

Social work is challenging and worthy of respect, all participants agreed. One commented that “no two days in social care will be the same; you have to be agile and move with that, so it does take very special people to take those roles”. The public status of social care work must be elevated to reflect this, and the workforce to feel appropriately valued if these retention issues are to be effectively addressed.

Securing an integrated future

For a supported workforce, good leadership is essential. One participant noted that in the social care system “there is a varied approach to leadership”, and good leadership is not always evident in the system. Given the demanding nature of social care work, it is essential that carers feel well supported in their roles. One participant added that “workers do not stay because of a good job, they stay because of a good manager”, and therefore, proper leadership training must be a central goal of the workforce plan.

A practical solution suggested by one of the network members to combat low recruitment, retention and the poor image of the profession was a ‘social-care-first’ scheme, mirroring the successful teach-first scheme. Many other sectors have emulated the ‘teach-first’ template with great success. The aim of the scheme is to engage with young people to consider social care work as a career by espousing the value of a career in care. Such a scheme would emphasise how care work has the potential to transform the lives of dependent individuals, and the importance and value in building personal relationships with system users, improving the image of the profession. As part of the scheme, there should also be structured leadership, coaching and mentoring training, for the purpose of also transforming the quality of social care. This may serve to solve some of the leadership issues in the sector, as young and bright individuals will be well trained to manage and lead social care in the future.

Now that the NHS and social care are moving towards integration, participants noted that for a true and fair integration of the systems, employees should be paid and treated equally. One participant called for a joint recruitment scheme for the NHS and social care, with equal pay offered. It was also emphasised that NHS workers receive many ‘perks’, particularly since the start of the pandemic, which social care workers do not (including food and drinks discounts from certain companies).

Other suggestions to aid the integration of the NHS and social care workforce included social care placements and secondments for NHS staff, in which they are exposed to social care, and the richness and value of social care work. The status of care work must be elevated for proper integration of the two systems can occur, in order that social work and NHS work can be equally respected.

A large part of the discussion focused on the role of volunteers within the social care sector, and the value they bring to both paid carers and system users. Volunteers are an invaluable part of the social care workforce given that they reduce pressure on care workers, improve patient experiences, facilitate higher quality of care to drive better health outcomes, and strengthen community connections. One participant said that in the context of social care, “volunteering is a public health tool. There is a body of medical research which talks about the huge benefits for mental health and physical wellbeing for patients”. Volunteers also serve to raise the visibility of the social care sector.

Since the start of the Covid-19 pandemic, the UK has seen an unprecedented rise in the numbers of people volunteering in their local communities. During the pandemic, the UK had 12.4 million people volunteering in their local communities. 4.6 million of these were first-time volunteers. Currently, the UK has a window of opportunity to make the most of the interest in volunteering to reduce the immense pressure on care workers.

As part of the workforce strategy, there needs to be investment to drive the volunteer sector, for the wellbeing of the social care system and its users. However, time is undoubtedly of the essence; as one participant emphasised, “there is an urgency to the conversation we are having. As Covid dissipates, what we don’t want is for people to go back into the corners of their community and not come out again to contribute.”

How integrated care systems can improve digital inclusion

By Gabriel Blaazer

Sarah Boyd, Head of Digital Experience and Transformation at Norfolk & Waveney Health and Social Care Partnership (NWHSCP), explores how her integrated care system (ICS) is using digital health to improve patient inclusion and help reduce health inequalities.

Health inequality is a growing problem but is still too often discussed separately from the core business of the NHS. Patients are treated through siloed care pathways, with conversations about why some populations have poorer health outcomes often treated as an aside.

The pandemic brought this into greater focus, especially around digital inclusion. Technology rolled out across the NHS in response to Covid-19 often widened the gap between those who could access online services and those who couldn’t.

The benefits of ICSs

When it comes to digital inclusion, there is little doubt that ICSs offer a huge opportunity to deliver more equitable access to healthcare and improved health outcomes for those previously underserved by the health system.

NWHSCP is a new type of organisation, working as a system across the Norfolk and Waveney region. Operating across the public sector, along with health and social care, councils and with voluntary organisations, presents an opportunity tackle health inequality and exclusion in a person-centred way.

The ICS allows health leaders to work across organisational boundaries, to test assumptions about exclusion, and to leverage the work that happens at the level of individual places.

Fixing existing digital inequalities

At every stage, NWHSCP are ensuring that their digital projects address digital inequalities. By implementing a pan-public sector hub-and-spoke model that provides personalised support to excluded groups, their plan is to gain the wider benefits of digital inclusion by engaging people – not only in health services – but more broadly in society.

For example, if a GP detects that an elderly person in their care is socially isolated, they can refer them to a central digital inclusion service. From there, they may be passed to a library or volunteer service who are able to provide connectivity or a 5G-enabled device, along with the ongoing support to use it. This allows the patient to order repeat prescriptions, but also to food shop online or video call family and friends, with positive benefits for their wider health and wellbeing.

“Creating an environment in which every service is digitally inclusive offers benefits not just to individuals, but also to wider society”

Asking people to go to an appointment at an unfamiliar location can create unnecessary barriers. As it proceeds, the ambition of NWHSCP is to work towards using services that people already access to provide a trusted contact point. If patients are already known to a church group or domestic violence shelter, for example, they might receive support there.

Through community partnerships, ICSs can build a network of digital tools and skill provision. For example, if a partially-sighted person, or family member, needs a speech-to-text reader, NWHSCP can point them towards their trusted toolkit. Once a person has access to this network, they can then download tools freely, ahead of their health needs.

Building an inclusive service

Creating an environment in which every service is digitally inclusive offers benefits not just to individuals, but also to wider society. As the Good Things Foundation’s Widening Digital Participation report found in March 2020, digital inclusion pays for itself in better mental and physical health, and stronger participation in the economy. For every pound spent, £6.20 is made back.

With this in mind, ICSs can leverage skills found in the private sector to identify new ways to increase inclusivity. Companies in the space include ThriveByDesign and CardMedic, an award-winning digital tool that provides instant access to communications options to improve engagement with healthcare professionals.

CardMedic is designed to help patients with a language barrier, visual, hearing or cognitive impairment, or to communicate through PPE and is unique in its space.

One issue with digital inclusivity tools is that they’re often seen as only affecting excluded communities, but digital inclusivity applies to everyone. Many people often struggle to retain emotionally-sensitive medical information, such as details about a cancer diagnosis. Tools like CardMedic allow any patient to review the basics of a hospital procedure or consultation – helping them to feel more secure in their care.

Applying innovation

Through pulling together with public sector and voluntary organisations, NWHSCP has built a strong, interconnected and multi-disciplinary team to implement their digital transformation agenda. As ICSs move towards statutory footing, the hope is to build on their initial successes though good recruitment and the implementation of innovative technology.

But there is only so much one system organisation can achieve on its own. To maximise the potential of integrated care systems, the NHS will require a national system for picking up on digital innovation. It should not be up to individual ICSs to find products, such as CardMedic, themselves. Digital inclusivity should be available to all.

Community Care, News, Population Health, Social Care, Workforce March 16, 2022

Taking practical steps to address a growing crisis in domiciliary care

By Gabriel Blaazer

John Bryant, Head of Strategy and Development for Torbay Council, outlines a series of practical steps to enhance the role of the care worker and address the growing crisis in domiciliary care.

The solution to the domiciliary care crisis is to enable the sector to do more, not to simply ask more of it. The distinction is important, as the development of integrated care provides opportunities to enhance system efficiency like never before. And yet, the scope of what could be asked of, and performed by, trained, supported, committed community-based practitioners is yet to be fully explored or achieved.

All the while, the expectations of those receiving care, and certainly those considering a future career in health and care, are greater than they have ever been.

To meet these ever-rising expectations, system leaders are likely to find fertile ground in looking to better embrace the assets that already exist within the system. This includes domiciliary care workers, whose skillset could be expanded and developed, a move that could encourage others into the system. This can happen by re-positioning the expectation, skills and rewards to produce and provide, for example, enhanced wellbeing services (EWS) provided by enhanced wellbeing practitioners (EWP), of which domiciliary care is a major component among a portfolio of beneficial interventions and service provision.

The 6Cs of care are prevalent within our frontline domiciliary partner staff; the opportunity is there to optimise their engagement and knowledge of patients and clients to:

Support retention and recruitment
Respond to the discharge and reablement challenges
Drive early intervention and prevention
Offer a developed interface with general practice
Engage with population health management

The support of these four key drivers for public service change: politics, policy, measurement and money, are positioning us as never before to achieve success. The government’s social care reform white paper, People at the Heart of Care, connects to the £5.4 billion pledged for adult social care reform between 2022 to 2025. It is notable that healthcare is a major beneficiary of this funding in early years, however within the policy of integrated care the opportunity exists to bring about radical, beneficial system reform from the outset.

“Together, these measures aim to put people at the heart of social care and move us towards our 10-year reform vision.”

(Department of Health and Social Care, 2022).

These themes were also present in the subsequent integration white paper, Joining up Care for People, Places and Populations. The measures set out in the paper provide clear areas of opportunity, focus and policy support.

A growing crisis

These government white papers are in no small part a response to a care crisis the likes of which we have never seen. One key element of that is domiciliary care, the unseen service that is delivered behind the front doors of our communities to keep people safe, comfortable, medicated and cared-for. For over a decade the policy has been to bring care closer to home, and the People at the Heart of Care paper reinforces that. The Covid-19 pandemic has compounded the need to ensure people are cared for and supported in this way, minimising their movement between different health settings to reduce infection risk.

“The endeavours of care providers to recruit at this level should be celebrated alonside any other part of the system that has been able to do the same”

Present estimates indicate that there is a care shortage/vacancy rate of 17 per cent which equates to at least 100,000 jobs based on Skills for Care data in England. Given the challenges in recruitment felt by providers, there can often be a projection that care providers are not ’good‘ at recruitment. However, in looking behind the headlines we find that in one area, Torbay, care providers have increased their capacity through recruitment by 39 per cent in the 18 months leading to September 2021. The problem is that the demand for their services has totally outstripped this staffing influx, increasing by 47 per cent in the same time period. This trend is consistent across the country’s health and care ecosystem.

The endeavours of care providers to recruit at this level should be celebrated alongside any other part of the system that has been able to do the same. If organisations who have been able to recruit as well as Torbay have done are finding it difficult, is it probable that any other part of the system will do better?

The Health Foundation recently published research suggesting that over a million more health and care staff will be needed in the next decade to meet growing demand for care. What is clear is that these shortages were well established trends before the Covid-19 pandemic. If the challenge of capacity is to be permanently addressed, then retention followed by recruitment is essential – as any marketing of roles from ‘the system’ will be trumped by the messages communicated by those working in or leaving the services.

Recognising a new future, communicating that and providing examples of what could be achieved will produce opportunities for beneficial results.

Practical steps

In this respect, returning to the domiciliary care issue, what might emerge if we were to turn the issue on its head?

To address the crisis currently seen in domiciliary care, I propose a series of practical steps to enhance the role of the care worker and to use the ICS framework to transform system level efficiency:

Addressing the domiciliary care shortage: expand the potential of the service and provide those delivering it with more responsibility and control by becoming EWPs
Supporting the community nursing challenge: offer them the opportunity to have a wider team of EWPs at their disposal; enable them to work to the top of their licence
To address GP availability: create neighbourhood teams of EWPs that are able to be with patients, directly support with digital literacy and connectivity, and be a physical presence to further enhance the experience of the remote general practice
To reduce A&E admissions and improve the discharge process: use EWS to support the safe discharge of increasingly complex patients to optimise recuperation in at-home settings, have the digital skills and tools to monitor and report e.g. RESTORE2 for early intervention and re-admission avoidance, and be able to support reablement; the stepping stone to independence
Develop greener care:reducing mileage by minimising cross-overs between staff and building a wider multi-disciplinary team

The practical possibilities for this are supported by the further development of the Allied Health Professionals strategy. The publication of the Allied Health Professions’ Support Worker Competency, Education and Career Development Framework received support from Trades Unions, Professional Bodies and Trade Union partners. Whether it is development within roles or providing new career paths, new forms of offer and opportunities are going to be central in encouraging a post-Brexit, domestic workforce into the social care and health sector; along with producing the impact value of those roles and associated care interventions which enable commensurate levels of pay and reward.

Underpinning all endeavours and quality care and support are the 6Cs of Care. These emerged as part of ‘Compassion in Practice’ and were rolled out by NHS England to all staff in 2014 with subsequent promotion to the wider care sector by the national body Skills for Care.

“But what cannot happen is that domiciliary care continues to be overprescribed without receiving more support or being allowed to expand its offering”

The characteristics of commitment, care, compassion, competence, communication and courage are prevalent throughout our community care partners and their staff. With that commonality between the professions what might we do to deliver even more fulfilling roles: more people doing fulfilling roles, more fulfilment within the roles, more roles in addition to the present ones that are also fulfilling?

The alchemy that will bring this about is within the gift of every system in England and available to all domestic nations. It is the meaningful flourishing and delivery of an integrated care system (ICS). The ‘holy grail’ of ICS development is to provide timely, personalised care that maximises the independence of the individual receiving care which, naturally, points to a home-based solution. But what cannot happen is that domiciliary care continues to be overprescribed without receiving more support or being allowed to expand its offering.

This article seeks only to look at one small area of that; however, it is a vital area, being felt by the 957,000 people in the UK that receive domiciliary care and their families, along with the 822,000 staff looking after them (as recorded by RCN surveys). This, quite rightly, is now receiving both political support and national media attention.

The pandemic should be recognised as a catalyst for accelerated change, avoiding any sense of ‘once we’re through this we can get down to business as usual’. What has been done, and is being done in response to the pandemic, has demonstrated the creativity and pace of change possible as system partners have collaborated. Fostering and building on that is in itself both an opportunity and a challenge.

Across the sector there are understandable concerns of implementing radical service reform on an already exhausted and beleaguered workforce. But there are examples we can look to where workforce wellbeing is protected while simultaneously enhancing capacity and quality of care that motivates staff.

Some facts from one system

To service 800 clients in a 75-mile geographical perimeter, home care staff drive almost one million miles per annum. In work supported by the Health Foundation, it was found that at a (sub)urban travel speed averaging 20 mph, over 43,500 hours were being spent in vehicles; a substantial proportion of that could be put to new ways of working.

Work has shown that by reorganising the rounds, 5,220 hours of care could be released from the existing workforce. This would provide opportunities not only for more care to be delivered but importantly, and in respect of future retention and recruitment across the system, time for wellbeing, supervision, learning and development, accreditation of skills and assurance in their application. And with no extra hours of care being purchased.

In terms of application and the development of broader multi-disciplinary teams within ICSs, it was established that of the community nursing patients nearly 20 per cent were also social care clients. People were being visited by multiple staff in one day, requiring travel from multiple staff.

There are of course many activities and health interventions which can only be done by those with nursing and clinical qualifications. However, in approaching this issue with a mindset of curiosity, courage and compassion there are many interventions that could be performed in different ways.

For instance, one of the many activities that domiciliary care staff undertake is washing and creaming clients’ legs when there are wounds to be attended to. Nursing staff will then arrive to apply a bandage. While certain grades of wound clearly need nursing attention there are many at lower levels of severity that are capable of being attended to by a well-trained EWP – and of being checked on regularly, though less frequently, by the stretched community nursing complement.

Benefits of EWS for participants and for system development

Enhanced wellbeing practitioners:

Feel respected and able to develop their domiciliary care roles, feel even more a part of the system and that their contribution is valued. This could lead to enhanced profile and esteem. The additional activity means more time with the client and the opportunity to further enhance the relationship that exists
Opportunities will be presented to work in strengths-based ways and with programmes such as Making Every Contact Count, leading to enhanced wellbeing of the clients and a development of their connectivity and circle of support
This leads to improved job/role satisfaction – improved retention leading to increased recruitment. Developed circle of support for clients, enabling them to step up towards independence and reduce their reliance on statutory interventions. Release of capacity for those with assessed needs to have their needs met and begin their journey towards well-being

Community nurses

Feel an increased level of support with a bigger, more integrated, team available to them. They are then able to work with the more complex cases and make the very best use of their skills and knowledge while enabling and supporting other integrated team members to develop
Through enabling better management of case-loads, job satisfaction is increased and stress is reduced. As the RCN has established, with 75 per cent of community nurses reporting that they had left necessary activities undone, the professional dissonance of the role is alleviated, supporting staff wellbeing and retention
With the nursing and Allied Health Professional colleagues active in this way, early intervention and reductions in exacerbations of conditions lead to reduced admissions. With greater capacity, along with the skills to manage more complex discharges, hospital flow is improved

Benefits of EWS for health providers

Admissions through A&E:

Are reduced by earlier interventions and the ability to deploy the highly skilled staff in the community to support patients and reduce the deterioration in their condition
Improved flow through A&E with reduced admissions, enhancing the wellbeing of staff as well as the patients, and contributing to the enhanced application of funding to meet elective care

Discharges and re-admission rates:

Are further improved with the skills and capacity made available to support increasing numbers of and increasingly complex patients. With the integrated approach to working and early intervention opportunities, people are supported to remain at home, with their condition even better managed and do not require a re-admission to hospital
Skills and capacity across the community integrated team are available to support timely, safe discharge from hospital and discharge to assess and ensure people remain at home
The patient/client gets less ill and recovers more quickly being supported by a team that has the resources, capacity and skills to meet their needs. This increases the ability for them to remain well or recover quickly in their home setting, which include care homes and supported living
Increased numbers of people cared for closer to home with reduced exacerbations in conditions. Complex clinical requirements being met in community settings with both care-giver and the patient having a well developed strengths-based relationship throughout the care and support period, enabling a step up to independence

It is understandable that there will be anxieties associated with the shift in activities. In order to ascertain who delivers what and where to achieve the five aims of population health management (as illustrated below), the mantra to hold onto is right person, right care, right place, right time. Risk-managed prototyping using good design methodologies is key and implicit within the title on the tin of sustainability and transformation partnerships (the predecessor to ICSs).

There are many practical examples already available and still plenty of headroom for further development, which will accelerate the transformation in health and care models which are both sought for and needed.

Covid has shown us how much can be done in a short space of time; even with all the pressures in the system, GPs, acute trusts, AHSN and domiciliary care providers worked together to train 148 staff in the RESTORE2 methodology in just three months, with some going further to be trainers themselves.

Practical steps to developing and implementing enhanced wellbeing services

Train domiciliary care and care home staff to use the protocols and develop relationships with primary care practices
Ensure that training is accessible and that the nursing staff are corporately supported in the delegation of tasks
Look to see if care packages are allocated by geographically focussed provider or on first-come-first-served basis, and what the mileage component to the care rounds is for providers
Review the wounds being attended to in community settings and what best practice can offer in tackling the £5 billion cost of wound management
Consult on ways in which the Allied Health Professions’ Support Worker Competency, Education, and Career Development Framework can be optimised
Get the best facilitators and design thinkers, often found outside the system, to help ask the questions, listen and gather the answers and develop action-orientated plans with system partners – which includes the care unit, the patient/client and those caring for them

Whichever of the four policy drivers (politics, policy, money or measurements) one wishes to consider, they are captured within the Five Aims of Population Health Management; moving to EWS and development of the practitioners supports their delivery. Beyond this the one element that is maybe more implicit within the ‘petals’ below is capacity. EWS supports this explicitly.

Achieving more with less

In summary, below is the 30-second elevator review of how we can achieve more with less on the topic of domiciliary care.

More:

Time to care, more time to be more caring
Development and enrichment of roles
Person-centred care
Satisfaction with the role
Retention
Recruitment
Prevention and early intervention

Less:

Dissonance in the role and 6Cs
Siloed working
Variation in care team and discontinuity of care
Dissatisfaction with roles and system design
Turnover and leaving before retirement, or at the earliest opportunity
Vacancy and cost to trying to encourage people into services
Illness and cost

Addressing the care crisis

With the job-seeking public indicating that insufficient numbers of them wish to work in domiciliary care, now would be the time, supported by the policy of integrated care, to develop a new offer that enables truly integrated roles. This should seek to provide enhanced wellbeing services through an increasingly broad, multi-disciplinary, person-centred team.

To address this multifaceted care crisis, we should do more than seeking to invite people into traditional domiciliary care. The system might benefit from offering people a new role(s) that encompasses the domiciliary care that they are proud to already be doing, but also one that offers development, inclusion, satisfaction, esteem and commensurate compensation. This could become increasingly available if and when ICSs fulfil the potential that exists; one that reflects those stated aims within the recent white paper(s) and meets the five tenets of Population Health Management.

This should also note the observations of the CQC and their likely support to engage in discovery sessions for regulation alignment towards new ways of working. In doing so this should create a virtuous cycle towards a sustainable system, both financially and with capacity, through the delivery of integrated care.

John Bryant is Head of Strategy and Development for Torbay Council and an ICJ contributor. To contact John, become an ICJ contributor or to obtain a full reference list for this article, please write to news@integratedcarejournal.co.uk, and one of our Editors will assist.

All news

PPP calls for adequate social care funding to end postcode lottery

By Integrated Care Journal

Public Policy Projects (PPP) has launched its first Social Care Network report, Mind the Cap: choices and consequences for financing social care, addressing the need for radical financial restructuring within the UK social care system.

The report, launched on 14 March, finds that the standard and financing of social care in the UK is subject to a postcode lottery. Given that social care is funded locally, there is vast regional inequality in the standard of care in the country.

Even with some level of means-tested support, and the newly introduced cap, the PPP Social Care Network found it a system unaffordable for many. The report concludes that these measures do not protect some low-middle income households from having to spend entire savings on social care.

PPP brought together 25 senior stakeholders and experts within the sector to discuss solutions to the crisis ahead of the spring budget. The report is sponsored by Radar Healthcare and the Royal Voluntary Service.

In September, parliament agreed to increase National Insurance Contributions by 1.25 per cent to establish a new ‘Health and Social Care Levy’ and introduced a new measure to cap care costs at £86,000. However, only a small proportion of money generated by the levy will go to social care, and the cap does not protect low-middle income individuals or families.

PPP’s social care network find that the Levy proposed by the government will not even begin to address the costs of care required by the system, and the cap protects those who are least likely to use the system.

Speaking at the report launch event, former Deputy Prime Minister Damian Green, said: “The current Health and Social Care Levy falls on the working age population, all of whom will be faced with inflationary cost of living pressures which we haven’t seen since the 1970s. It is falling on a particularly vulnerable portion of society.”

Key recommendations from the report include:

The government must focus its attention on how best to stimulate a wider insurance-based approach to care, encouraging individuals to participate in voluntary insurance schemes to cover costs up to the cap
The government should widen the scope of the Health and Social Care Levy; other forms of income and wealth for which National Insurance does not apply, such as rental income for private landlords, should also be considered for a social care levy
The government should explore greater flexibility around the Health and Social Care Levy, including the option of directing a proportion of the levy to an individual’s social care insurance scheme and/or contributions being made up by employers, as with pension schemes

The report emphasises that there is insufficient funding overall in the sector and that local authorities and care providers must be adequately funded for any improvement of the social care system. It also outlines that this funding should come from both private payment and higher state provision.

Mr Green said: “The adequate financing of social care is vital for the proper functioning of the system. Once we inject an appropriate amount of money into the system which has, quite frankly, been on its knees for years, we will begin to see the problems of the social care system begin to melt away. The measures proposed by the government are not sufficient, and more must be done to support those in need of care.”

Commenting on the report, Dame Esther Rantzen, Broadcaster and Founder of ChildLine and The Silver Line, said: “I know how crucial adequate funding is, both for those who offer care, and for those who receive it. The caring profession needs far better funding to give carers the opportunities and status they should have and enable them to give their work the time and skill it needs. And vulnerable people who need support should not have to worry whether they can afford the right care. Without proper funding carers will continue to be undervalued and their work unappreciated when in fact more and more people depend upon it.”

A new network to drive the integration agenda forward

By Chris Skidmore

Historical divisions between hospitals and family doctors, between physical and mental health, and between NHS and council services, have resulted in too many people experiencing disjointed care. All too often, it has been those from the most disadvantaged backgrounds and communities who have borne the brunt of disjointed care delivery, experiencing worse health outcomes than others.

Integrating both health and care has become a central mission both for the government and the NHS, with a clear focus on recently established integrated care systems (ICSs) as the driver of change.

Having been in development since 2018, July 2022 will see ICSs take up new statutory footing, providing a legal obligation to deliver joined up care and arrange services along a place-based approach. This will help ensure that decisions about how services are arranged should be made as closely as possible to those who use them. For most people their day-to-day health and care needs will be met locally in the town or district where they live or work. Partnership in these ‘places’ is therefore an important building block of integration, often in line with long-established local authority boundaries.

Yet the formal legal constitution of ICSs and their underlying new structures and governance, underpinned by integrated care boards (ICBs), can only be the start of a journey towards a fully realised vision of integrated care. With ICSs soon to be legally independent entities, the focus must now turn to their decision-making processes, and how they choose to adapt their services to meet local population needs.

Within this decision making will come the opportunity for more agile and rapid procurement processes, that allow for a more collaborative approach. Already the Department of Health has sought to support ICSs in their decisions, and has recently conducted a consultation on a new approach to arranging services – the Provider Selection Regime – which should make it easier to develop stable collaboration and to reduce some of the costs associated with the current procurement rules.

The government’s Integration White Paper: driving digital change in ICSs

Further to ICSs being established in law, the government’s Integration White Paper, published on 9 February 2022, goes further in ascribing a future strategic direction for ICSs and sets out a roadmap for better integration of services.

ICBs are expected to agree a plan for embedding population health management capabilities and ensuring these are supported by the necessary data and digital infrastructure, such as shared datasets and digital interventions. ICSs will use population health management (PHM) to help deliver personalised and predictive care based on an individual’s risk – which will be determined based upon an individual’s wider determinants of health.

Real-time insights from aggregated data will be crucial to achieving success in the fields of multi-disciplinary working, clinical decision support and waiting list management, at the same time as ensuring new diagnostic centres in the community can become a real success.

The Department of Health has also set out in the white paper an ‘ICS first’ approach, which will encourage organisations within an ICS to use the same digital systems, this will provide care teams with accurate and timely data, encouraging ease of information sharing. The department has set out a goal of 80 per cent adoption of digital social care records among CQC-registered social care providers by March 2024. To achieve this, ICSs must work with partners to drive adoption. Digital investment plans are expected to be finalised by June 2022, which include the steps being taken locally to support digital inclusion.

While more than 60 per cent of NHS trusts have made good progress into digitisation, with 21 per cent now digitally mature (as set out in the What Good Looks Like Framework), and only 10 per cent continuing to rely heavily on paper, the picture is often much more challenging in social care. Only 40 per cent of social care providers have electronic care records, and this is only improving slowly, at around three per cent per year. The Integration White Paper outlines a plan for adult social care that will ensure within six months of providers having an operational digital social care record in place, that staff are able to access and contribute to their local shared care record. Work is also underway to enable citizens to be able to amend their shared care records.

With these clear ambitions now set out in the Integration White Paper, there is a clear need to link policy ambition with the reality of enabling healthcare providers to deliver care within new ICS structures. As facilitators of joined up care delivery, ICSs will not be able to improve health outcomes without working closely with partners who share their vision of integration.

Integration can only be achieved by working alongside organisations with expertise in delivering patient management records and improved data collection methods – as well as with the pharmaceutical and health technology communities to deliver improved early-stage diagnostics and early access to treatments and therapies.

It is indeed these four areas of focus that represent the greatest opportunity both in the short and long term for ICSs to deliver real population health improvements in their local areas:

The future of healthcare data and the single patient record
The digital provision of healthcare
The improvement of diagnostics
The enhanced access to treatment and therapies

While the priorities for each ICS will rightly vary depending on the local patient needs and wider demographic demands, there is now a clear need to establish where common interests between ICSs exist, in order to enhance best practice. If ICSs are truly to become the benchmark of healthcare integration, then their own standards and performance will be monitored at a national level. It will therefore be incumbent for every ICS to engage fully in the wider policy debate about how they can deliver on the modernisation of healthcare through data, digital, treatments and technology. A wider forum is needed to help instruct ICSs on the right pathways to take for the future.

Public Policy Projects (PPP) has, for 25 years, been at the forefront of the healthcare policy debate; as an independent policy institute chaired by former Health Secretary Rt Hon Stephen Dorrell, it is recognised as a leading policy organisation that works with thought leaders across both health and social care, pharmaceuticals and more recently genomics. PPP has made the policy framework around the provision of integrated services a central mission of its work, and is responsible for publication of the Integrated Care Jounral.

ICJ brings together leaders in health, social care, local government, policy and research to engage with the latest insights and analysis surrounding the future of health and social care in the UK. Content is produced by and for the very leaders tasked with delivering joined up care across the country – covering every facet of ICS development.

To spearhead its outcomes-based approach to content, ICJ has recently established an Editorial Advisory Board. The board oversees content production pipeline, ensuring that our articles are insightful, practical and credible. The board is made up of some the country’s leading health and care experts and features system leaders at the very forefront of UK integrated care.

As part of its policy work for 2022, PPP is now seeking to establish a new Integrated Care Network which, alongside Integrated Care Jounral, will help provide ICS leaders with the policy guidance and support to make the best decisions for achieving improved patient health outcomes. PPP has already hosted a number of ICS related events, including a recent roundtable alongside IQVIA.

The start of this new Integrated Care Network work will begin with an ‘Integrated Futures’ roundtable series, beginning this Spring 2022, to mark the formal adoption of ICSs into law.

As part of the ‘Integrated Futures’ series, PPP will organise four roundtables focusing on the core areas of partnership between ICSs and healthcare providers which can deliver the greatest impact and benefit:

The future of healthcare data and the single patient record
The digital provision of healthcare
The improvement of diagnostics
The enhanced access to treatment and therapies

These roundtables will bring together both ICS representatives and leaders, together with healthcare partners at the forefront of working with ICSs to deliver on better care through innovation and improved access to data, digital technologies and enhanced treatments and therapies.

The Integrated Futures series will seek to position PPP as the forum for the high quality exchange of ideas and future policy, with those ideas intended to influence both NHS strategy and ICS leaders. As such, this will be an important forum for companies and organisations to be involved in, at a time when the future direction of ICSs both at a local and national level is still to be fully established.