Virtual wards are failing patients and clinicians: we must bridge the gaps before winter

By Elliott Engers; Tom Whicher; Elina Naydenova

With virtual wards vital to the NHS’s ability to function this winter, three experts assess what is needed to bridge the gaps in provision ahead of increased demand.

In early August, NHS England unveiled its new plan to increase the NHS’s capacity and resilience ahead of winter’s inevitable pressures. An increased use of virtual wards featured prominently in this plan, in line with their national target of 25,000 virtual beds to be operational by 2023.

With hospitals overwhelmed like never before, it’s not hard to understand why transferring patient care into the home – in a safe and controlled way – is an extremely beneficial proposition. But existing solutions are missing the mark. Despite much innovation, delays in adoption mean that the full transformative potential of the tech-enabled hospital at home has not yet been realised. We are now at a tipping point: on the heels of a global pandemic and one of the busiest summers yet, a tough winter is looming. It is time to get virtual wards right; for patients, for healthcare professionals and for the NHS.

Existing solutions don’t go far enough

‘Virtual wards’ are not new and versions of the concept – including ‘Hospital at Home’ – are already being used to support unwell and deteriorating patients to stay at home, as well as to discharge patients from hospital sooner.

What is generally considered to be a virtual ward often extends to little more than remote monitoring at home. While this does free up hospital beds, the impact on both clinical time saving and patient outcomes falls well short of potential.

This is because, overwhelmingly, staff must use old, inappropriate tools to manage remote patients – tools that weren’t built for this new paradigm. Many approaches are manual, slow, admin-intensive, and not advanced enough to scale.

New ways of working need new solutions

Remote care requires an entirely different way of working, and needs new technologies to manage it and make it scalable. Right now, communication and the flow of critical information is blocked. Electronic task lists and care coordination features are not flexible enough to fulfil the unique needs of virtual wards, where patients are not co-located with healthcare staff. Integration is near non-existent, and workflows are not built for mobile access, nor do they allow tasks to be allocated and tracked in real-time.

We must go further for patients or clinicians. A true virtual ward solution can do more – should do more – to protect patients and make clinicians’ jobs more manageable.

Creating a true virtual ward

If virtual wards are to be done correctly, and their potential fully realised, innovation and action must focus on six areas:

1. The right information at the right time

For virtual wards to save valuable clinical time and ensure high quality care, data generated in patients’ homes must be of equivalent quality to that captured in hospital. It should also be distilled into actionable insights to save clinicians from filtering large amounts of data. And here lies the problem.

The 2019 Topol Review emphasised that large volumes of unfiltered data can be immensely overwhelming for an already overworked workforce. We know that conventional remote monitoring generates noisy data that wastes clinical time and can mislead clinical assessments, introducing risk.

To overcome this, advanced tools are needed, such as those utilising AI, to take on the time-consuming task of reviewing millions of data points to ensure quality and translate data into insights.

2. Seamless patient engagement

Patient engagement tools must be a core component of virtual wards, ensuring patients have a positive experience and feel confident that they can contact the clinical team if they need.

Good patient engagement provides a seamless experience whether a patient is co-located with clinicians in an acute hospital setting, or in the community.

Patients should receive ad hoc or scheduled contact via a method that suits them. This could be a digital assessment form sent to the patient, providing a low cost but highly effective method that complements data gathered from remote monitoring devices.

Patients should also be able to easily request a phone, video, or in-person appointment at a time that suits them.

In combination with care coordination and remote monitoring tools, effective patient communications are a powerful way to keep patients safe and them and their families reassured.

3. Proactive rather than reactive management of health

Moving from reactive to proactive management of patients’ health means two things for virtual wards:

Firstly, care must be targeted to patients pre-admission to hospital instead of post-discharge. This means initiating virtual care in the community to minimise the risk of admission, especially for ambulatory care sensitive conditions. More importantly, when it comes to avoidable admissions to hospital and frail patients, this could prevent a deterioration in their condition, which could happen off the back of a hospitalisation and could cost them their independence.

Secondly, mechanisms must be in place for early detection of deterioration. Therefore, being able to identify early signs and intervene before complications and readmissions to hospital become inevitable.

4. Health equity by design

The pandemic has revealed the multi-layered inequities that impact healthcare access and healthcare outcomes. One way in which virtual wards must address these is by investing in scalable community workforce models – that include healthcare assistants – to support care delivery to patients who cannot self-administer.

A second way to promote equity is by ensuring that no one is digitally excluded due to, for example, poor WiFi connectivity or lack of digital confidence or capability. Equally important is to look beyond physical symptoms to integrate social determinants of health into the modelling, planning and delivery of virtual wards.

5. Effective skill-mixing and empowerment

Enabling a diverse network of multidisciplinary staff to participate in the delivery of virtual wards is critical to resourcing these new models of care without adding to doctors’ and nurses’ workloads.

From healthcare assistants, to patients, to their friends and family members, different stakeholders should be empowered to fuel a proactive model of care at home. This includes training, decision-support tools and streamlined workflow management – and requires tools to handover and assign the right tasks to the right healthcare professionals – to cover the effective identification and appropriate escalation of health issues.

6. Effective task management

The best outcomes from virtual wards will result from multidisciplinary staff having secure access to a shared list of patients and the tasks that need to be done for them. They should be able to review the list in virtual ward rounds or whenever required, add and allocate tasks, and mark them as accepted, in-progress, or completed for colleagues to see or track. The entire team ought to have visibility and be able to collaborate and coordinate care remotely, ensuring caseload management is efficient and safe.

Automated workflows can make it easy for staff to identify where readings from intelligent remote monitoring devices fall outside of set ranges, supporting safer and more effective clinical decision-making.

Enabling a new era of care delivery

At this moment, NHS organisations have a unique opportunity to begin the virtual wards roll out on the strongest possible footing, with the best solutions in place. A focus on the six pillars that encompass care coordination, patient communication and remote monitoring, will accelerate a successful transition to a new era for care delivery, and help establish virtual wards as a credible, scalable alternative to acute hospital admissions.

Elliott Engers is CEO at Infinity Health.

Tom Whicher is CEO at DrDoctor.

Elina Naydenova is CEO at Feebris.

More groups join call for fairer deal for social care

By Gabriel Blaazer

As the race to become the next Conservative leader and Prime Minister of the UK heats up, and the government accepts the recommendations from the independent NHS pay review bodies in full, Care England and Access for Social Care have urged the government to act to protect the standing of social care workers, in statements issued yesterday.

The calls echo recommendations contained in a summary document of a recent Public Policy Projects report on integrated care. The report argues that the social care sector should be placed on an equal footing with the NHS, both in terms of its representation within integrated care partnerships and investments made to accelerate digitisation and modernisation.

Representative groups are increasingly urging the government to ensure suitable plans are in place to protect social care, amid an increasingly dire workforce shortage that is threatening the sector’s ability to provide its services. Vacancy rates in social care (9.5 per cent in January 2022) remain stubbornly above the national average (4.4 per cent from December 2021 to February 2022), while more than 400,000 social care workers left their roles in 2021.

A fairer deal for social care must be a priority

On Tuesday 19th of July, the government accepted, in full, the recommendations of the independent NHS pay bodies, meaning more than one million staff who fall under the Agenda for Change contract will receive a pay rise. This includes nurses, midwives, and paramedics, who are set to benefit from a pay rise of at least £1,400 this year, backdated to April 2022.

Groups who represent and advocate for the social care sector are now urging the government to implement a similar deal for care workers.

While rates of pay for social care work have increased in real terms since 2014, the rate of increase has not kept pace with other sectors, decreasing the social care sector’s ability to compete in the jobs market. Data shows that when overall national employment rates fall, vacancies in social care rise, suggesting that the sector is struggling to attract and retain workers.

The King’s Fund cites “high levels of staff vacancies, sickness absence, turnover, and work-related stress [as] having a damaging impact on staff,” and calls “the case for a fully funded, multi-year health and social care workforce plan… overwhelming.” Although many of these factors were exacerbated by the Covid-19 pandemic, the King’s Fund and other groups maintain that they long predate the pandemic and are the results of successive governments neglecting the social care sector.

In October 2021, the Workforce Recruitment and Retention Fund made £162.5 million available to local authorities to help recruit and retain social care workers, along with a further £300 million in December 2021. However, both funds lapsed in March 2022.

A neglected care sector

Poor staff retention is being further compounded by increased pressure on the social care system. The number of new requests for social care support have increased by 5.6 per cent, while costs have risen by more than a quarter, with areas with higher levels of deprivation being disproportionately affected.

Lack of available social care capacity is also increasing pressure on the acute hospital sector as hospitals have fewer methods of discharging patients safely. This is causing unsustainably high hospital occupancy rates and serving to undermine the wider healthcare system.

In a statement issued yesterday, CEO of Access Social Care, Kari Gerstheimer, warned about a “complete lack of discourse about the future of the social care system,” in the current leadership race, and claims the outgoing Prime Minister, Boris Johnson, has all but abandoned his pledge to “fix social care once and for all.”

The concerns mirror those expressed by UNISON Social Care Lead, Gavin Edwards, who said on Wednesday that “the scale of vacancies is alarming, and not just for those who rely on care and their families. The sorry state of social care is having a disastrous effect on the NHS, causing massive treatment waits, letting down patients and putting unbearable pressure on health staff.

“The care sector is acutely underfunded. Wages are way too low leaving staff unable to cope with the rising cost of living. Supermarkets are paying better rates without the stress, so it’s no surprise that people are jumping ship.”
In Care England’s statement, released on Thursday, Chief Executive Professor Martin Green OBE, said: “The adult social care workforce is our biggest resource. The lack of government action has had an inevitable consequence on the nature of employment opportunities within the sector and has hampered providers’ efforts to recruit and retain staff, as evidenced by the 52% increase in vacant posts in the sector over the past year. This has not only affected the overall financial attractiveness of the adult social care sector as an entity, but also providers’ ability to compete with the NHS.

“As a first step, Care England suggests the Government accepts the recommendations of the Low Pay Commission for the 2023 rates, however, this increase must be properly funded. Simply applying National Living Wage inflation without appropriate funding undermines the ability of providers to aid workforce pressures, especially given the fact that providers are having to pay increases above the National Living Wage annual uplifts as a means of recruiting and retaining staff.”

Kari Gerstheimer added that ”as Sunak and Truss fight it out, there is everything to play for by way of their approach to Health and Social Care. The Association of Directors of Adult Social Services has warned that the year ahead will be the most challenging people needing and working in adult social care have ever faced. I am saddened, however, to see social care being kicked down the road with little mention of any commitments from either leadership contender about the future of the social care system.

“Failure to invest in social care amounts to poor fiscal planning and inefficient use of taxpayers’ money – it harms our productivity because people with unmet social care needs can’t reach their potential, and unmanageable caring roles keep people out of work. It harms those working in social care, who are choosing to leave the sector because of problems with pay. And it harms our health system because a failure to invest early in preventative social care leads to more crisis admissions in critical care.”

NHS leaders offered free access to resource to help address air pollution across England

By Gabriel Blaazer

A new resource is to be offered to every NHS Integrated Care System (ICS) to support their development as ‘Clean Air Champions’.

Data confirms that everyone in the UK is exposed to the threat of air pollution, with more than 97 per cent of postcodes in breach of at least one World Health Organisation (WHO) limit for toxic pollutants.¹

This includes vulnerable environments such as healthcare settings, including the one million people who attend GP appointments every day in the UK and the approximately 16 million people who travel to major A&E departments in England every year.²

In the UK, 36,000 premature deaths per year are caused by air pollution, one in five of all premature deaths, and tackling air pollution will be a vital strand of integrated care systems’ (ICS) efforts to address and reduce environmental determinants of poor health.^3,4

Launched at the NHS ConfedExpo, the ICS Clean Air Framework is a practical tool that empowers healthcare leaders to take action on cleaner air and has been developed to support every ICS in England to become a ‘Clean Air Champion’. Joining forces to drive the initiative forward are the environmental change charity Global Action Plan, Newcastle Hospitals and Boehringer Ingelheim. The Framework is freely available to all 42 ICSs nationally to aid the development of an action plan to improve air quality around all healthcare access points in England.

The Framework links to the mandated requirements of Green Plans, the NHS Standard Contract, the Delivering a greener NHS report and the UN’s Sustainable Development Goals. The tool supports the newly established ICS healthcare leaders to incorporate air quality improvement measures around hospitals and health hubs as part of their broader commitment to address environmental challenges.

The Framework launch coincides with Clean Air Day on June 16th, which this year reveals how air pollution impacts almost every organ in the body. Professor Sir Stephen Holgate, Special Advisor on air quality to the Royal College of Physicians and UKRI’s Clean Air Champion, explains “Air pollution is an invisible killer and plays a role in many of today’s major health challenges. The ICS Clean Air Framework is a ground-breaking resource to support the NHS in implementing air quality improvement initiatives that will ultimately protect the health, wellbeing and economic sustainability of today’s communities and future generations.”

The Framework is being pioneered by Newcastle Hospitals, who are first to drive the development of an action plan in their region. James Dixon, Associate Director of Sustainability at Newcastle Hospitals, explains “The NHS has an opportunity to lead by example and set the benchmark for clean air and safe workplaces. Through the creation of an action plan guided by the ICS Clean Air Framework, here at Newcastle Hospitals, we are already making progress and seeing direct benefits to our communities.”

Larissa Lockwood, Director of Clean Air, Global Action Plan, explains how the ICS Clean Air Framework can support healthcare leaders in taking action: “Air pollution kills seven million people globally each year, which is more than malaria, HIV/AIDS and obesity combined.^5,6,7 It is a public health crisis that needs immediate action from the health sector. It also cannot be right that our most vulnerable are exposed to it in our places of care – is it fair that a baby must take its first breath in a polluted environment? By developing this framework and working at the Integrated Care System level, we have the opportunity to tackle some of those area-wide issues, empowering healthcare leaders to pursue action on air pollution to secure a healthier future for their region.”

Uday Bose, Managing Director at Boehringer Ingelheim UK & Ireland, explains the impact of the project both now and for future generations, “People who are already suffering with poor health are most at risk of the detrimental effects of air pollution, so this initiative plays an important role in addressing health inequalities. Our commitment to transforming lives goes beyond the provision of medicines, as this initiative clearly illustrates. It also demonstrates the power of partnerships and delivers a real opportunity to create a healthier future for families, the NHS and the planet.”

The ICS Clean Air Framework aims to provide healthcare leaders with a platform to drive positive change and support the implementation of initiatives to improve air quality, without adding to the administrative burden. The NHS net zero targets are as ambitious as possible and are supported by the need for immediate action and commitment to continuous monitoring, evaluation and innovation. It is therefore critical that key stakeholders and local authorities work collectively to turn ambition into action.

More information regarding the Integrated Care for Cleaner Air initiative and the ICS Clean Air Framework is available from today at www.actionforcleanair.org.uk/health/ics-framework.

¹ addresspollution.org. 2022. Providing the public with the most accurate air pollution data available. [online] Available at: <https://www.addresspollution.org/> [Accessed 26 May 2022].

_{2</sup)The Kings Fund. 2019. Key facts and figures about the NHS. [online] Available at: <https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs#what-does-the-average-day-in-the-nhs-look-like> [Accessed 12 May 2022].}

³GOV.UK. 2019. Public Health England publishes air pollution evidence review. [online] Available at: <https://www.gov.uk/government/news/public-health-england-publishes-air-pollution-evidence-review#:~:text=Air%20pollution%20is%20the%20biggest,lung%20cancer%2C%20and%20exacerbates%20asthma.> [Accessed 26 May 2022].

⁴Who.int. n.d. Air pollution. [online] Available at: <https://www.who.int/health-topics/air-pollution#tab=tab_2> [Accessed 25 May 2022].

⁵Who.int. 2022. Fact sheet about malaria. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/malaria> [Accessed 25 May 2022].

⁶Who.int. 2021. Obesity. [online] Available at: <https://www.who.int/news-room/facts-in-pictures/detail/6-facts-on-obesity> [Accessed 25 May 2022].

⁷Who.int. 2021. HIV/AIDS. [online] Available at: <https://www.who.int/data/gho/data/themes/hiv-aids> [Accessed 25 May 2022].

North East and North Cumbria ICS initiative drives air quality improvement

By Niamh Macdonald

A new pilot project in the North East and North Cumbria aims to drive air quality improvement at an NHS systems level.

Poor air quality in the UK is an increasing health concern, new data published by The Lancet has revealed that pollution remains responsible for approximately nine million deaths per year, corresponding to one in six deaths worldwide.

Approximately 30 per cent of preventable deaths in England are due to non-communicable diseases explicitly connected to air pollution. The health and social care costs of air pollution in England could reach £18.6 billion by 2035 if air quality is not improved.

Global Action Plan, an environmental change charity, has been working with the North East and North Cumbria (NENC) Integrated Care System (ICS) over the last six months to identify opportunities to drive change around air quality improvement at healthcare access points.

The project aims to make sure air quality levels are controlled around health centres and help to protect the people who need to visit hospitals most frequently.

Newcastle upon Tyne Hospitals NHS Foundation Trust has committed to ensuring all employees will be given basic sustainability training. The green procurement is to be embedded across the organisation with the aim of encouraging all ICS members to switch to a renewable energy tariff.

The findings from the pilot project were published on 17 May in the ‘Levers for Change’ report. The report highlights how air pollution is linked to health challenges and inequalities and identifies key opportunities that developing an ICS focused action plan would present.

The progress being made in the NENC region forms part of the broader Integrated Care for Cleaner Air initiative with the goal of improving air quality around all healthcare access points in England.

Newcastle Hospitals, Global Action Plan, and Boehringer Ingelheim have formed a partnership with the joint goal of supporting every ICS in England to become a ‘Clean Air Champion.’

In preparation for ICS statutory footing in July, ICS leaders are currently submitting system-wide Green Plans. Many are already incorporating air quality improvement measures around hospitals as part of their broader commitment to tackle environmental challenges.

James Dixon, Associate Director Sustainability at The Newcastle upon Tyne Hospitals NHS Foundation Trust, said: “Sadly we know that people in the North East and North Cumbria are disproportionately burdened by ill health.

“The research presented in the ‘Levers for Change’ report is key to understanding the impact that air quality has on the health outcomes of the people of the region.

“The framework will be an extremely useful resource for us, as an ICS to use, to identify ways to work across organisations and reduce the impact that poor air quality has on the health and quality of life for the most vulnerable members of our society.”

Larissa Lockwood, Director of Clean Air, Global Action Plan, explains: ‘It is vital that we tackle air pollution at the regional ICS level, with partners from all across the health system, across primary and secondary care but also with local government.

“It is vital that everyone understands the NHS cannot tackle air pollution alone. Insights from the ‘Levers for Change’ report will be packaged into an interactive, freely available tool for all Integrated Care Systems in England to use. This tool will build on the Clean Air Hospital Framework developed in partnership with Great Ormond Street Hospital.”

Over half of Brits say their health has worsened due to rising cost of living

By Gabriel Blaazer

Over half of Brits (55 per cent) feel their health has been negatively affected by the rising cost of living, according to a YouGov poll commissioned by the Royal College of Physicians (RCP).

Of those who reported their health getting worse, 84 per cent said it was due to increased heating costs, over three quarters (78 per cent) a result of the rising cost of food and almost half (46 per cent) down to transport costs rising.

One in four (25 per cent) of those who said that their health had been negatively affected by the rising cost of living, had also been told this by a doctor or other medical professional.

16 per cent of those impacted by the rising cost of living had been told by a doctor or health professional in the last year that stress caused by rising living costs had worsened their health. 12 per cent had been told by a healthcare professional that their health had been made worse by the money they were having to spend on their heating and cooking.

The experiences of RCP members who responded to the poll include a woman whose ulcers on their fingertips were made worse by her house being cold and a patient not being able to afford to travel to hospital for lung cancer investigation and treatment. Other reports include respiratory conditions such as asthma and COPD being made worse by pollution and exposure to mould due to the location and quality of council housing.

Health inequalities – unfair and avoidable differences in health and access to healthcare across the population, and between different groups within society – have long been an issue in England, but the rising cost of living has exacerbated them.

The Inequalities in Health Alliance (IHA), a group of over 200 organisations convened by the RCP, is calling for a cross-government strategy to reduce health inequalities – one that covers areas such as poor housing, food quality, communities and place, employment, racism and discrimination, transport and air pollution. The government recently announced that it will publish a white paper on health disparities and the IHA is calling for it to commit to action on the social determinants of health. These largely sit outside the responsibility of the Department of Health and Social Care and the NHS.

Responding to these findings, Dr Andrew Goddard, President of the Royal College of Physicians, said: “The cost-of-living crisis has barely begun so the fact that one in two people is already experiencing worsening health should sound alarm bells, especially at a time when our health service is under more pressure than ever before.

“The health disparities white paper due later this year must lay out plans for a concerted effort from the whole of government to reduce health inequality. We can’t continue to see health inequality as an issue for health directives to solve. A cross-government approach to tackling the underlying causes of ill health will improve lives, protect the NHS and strengthen the economy.”

Professor Sir Michael Marmot, Director of the UCL Institute of Health Equity, commented: “This survey demonstrates that the cost of living crisis is damaging the perceived health and wellbeing of poorer people. The surprise is that people in above average income groups are affected, too. More than half say that their physical and mental health is affected by the rising cost of living, in particular food, heating and transport.

“In my recommendations for how to reduce health inequalities, sufficient income for a healthy life was one among six. But it is crucial as it relates so strongly to many of the others, in particular early child development, housing and health behaviours. As these figures show, the cost of living crisis is a potent cause of stress. If we require anything of government, at a minimum, it is to enable people to have the means to pursue a healthy life.”

Also responding to the survey was NHS Providers Chief Executive, Chris Hopson, who said: “Trust leaders are acutely aware of the soaring cost of living crisis facing the nation and the impact rising financial pressures could have on people’s health.

“This is particularly concerning in the wake of the COVID-19 pandemic which exposed deeply entrenched social, racial and health inequalities. As highlighted in this survey, there is a risk that the current cost of living crisis widens those inequalities.

“Trust leaders share the view that there is an opportunity to tackle the factors which lead to health inequalities and poor health. They have committed time and resource to reducing inequalities across their local communities.”

Health Inequality, News, Population Health, Primary Care, Thought Leadership May 17, 2022

How ICSs can help uproot risk aversion and progress innovation

By David Duffy

Integrated Care Journal speaks with Kathy Scott and Aejaz Zahid of the Yorkshire & Humber Academic Health Science Network (AHSN) on how the implementation of a dedicated innovation hub within ICS frameworks has helped to streamline innovation and improve patient care.

Above: Barnsley Hospital, part of South Yorkshire and Bassetlaw ICS.

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

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

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

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

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

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

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

Fostering a culture of innovation

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

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

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

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

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

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

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

Innovation as an antidote to health inequality

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

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

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

An appetite for risk

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

“Building a culture of innovation is fundamentally about building a culture of increased risk appetite, where failure is most certainly an option.”

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

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

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

Interestingly, many of the ideas that the Hub works with are non-tech solutions. For example, primary care providers working with local football teams via a 12-week health coaching programme to engage with fans who may be at risk of cardiovascular disease, or introducing Cognitive Behaviour Therapy techniques to patients with severe respiratory conditions to help reduce anxiety when experiencing an episode of breathlessness.

To nurture a mentality more open to change, the Innovation Hub has developed learning networks across South Yorkshire. Through these networks, the Innovation Hub and AHSN teams have been reaching out to key leads from each of the provider organisations who are involved in innovation, improvement or research and invited them to become innovation ambassadors. “These ambassadors have become our eyes and ears on the ground across health providers, where they can start to introduce what we do and also help capture unmet needs from colleagues in their respective organisations,” explains Kathy.

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

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

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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. ”