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Levelling up or levelling down: the impact of integrated care systems on the delivery of care
The Medical Technology Group – 2024
This report examines the complexities of health inequalities and variations in patient access to treatment and access to medical technology within integrated care boards (ICBs), and highlights the opportunities to share best practice across the country.
Levelling up or levelling down: the impact of integrated care systems on the delivery of care
How would clinicians use time freed up by technology?
Health Foundation – May 2024
Key points
- The idea that technology can free up ‘time to care’ for NHS staff, allowing the health service to increase volumes of clinical activity, has become a major focus of health policy, informing the NHS Long Term Workforce Plan and the NHS productivity plan announced in the 2024 Spring Budget. This analysis from the Health Foundation explores how freed-up time might be used, drawing on a survey of clinical staff, expert interviews and a rapid evidence review.
- If potentially time-saving technologies are to generate productivity benefits, then the time freed up has to be used effectively. This is often assumed but by no means guaranteed. The evidence review estimated that less than 1% of the literature on the impact of technology on staff time in health care actually considers how freed-up time is repurposed. Given this significant evidence gap, more research is needed.
- Our analysis cautions against the assumption that time freed up by technology will automatically translate into the equivalent amount of time being used for patient care. When we asked clinical staff how they would likely use freed-up time, survey respondents allocated only 27% of that time to patient care or direct clinical activity. It is important that policymakers, system leaders and those involved in workforce planning use realistic assumptions when it comes to modelling how freed-up time may be used.
- This figure, however, should not be taken as a general rule or upper limit on the use of freed-up time for patient care. Explicit planning is required to ensure the effective repurposing of time, and this should be done with staff and wider stakeholders. So good change management is critical to deriving the benefits from time-saving technologies.
- Our survey respondents and expert interviewees suggested that, in addition to potentially increasing care volumes, freed-up time could be used in a range of ways, from enhancing the quality of patient consultations to having more time to think and undertake wider professional activities like training, research and quality improvement. These activities can also benefit productivity – for example, through boosting care quality, enhancing knowledge and skills, streamlining service delivery and supporting staff wellbeing and retention. A broad view of how freed-up time can contribute to improved NHS productivity is therefore crucial.
- There is an important opportunity here for NHS leaders and employers to create a compelling ‘offer’ for staff, one making it clear that – in addition to increasing care volumes – a proportion of freed-up time could be used for activities, such as training or research, that would not only benefit productivity but make a crucial contribution to improving job quality.
Further information – How would clinicians use time freed up by technology?
Listen to Mums: Ending the Postcode Lottery on Perinatal Care
A report by The All-Party Parliamentary Group on Birth Trauma – May 2024
The inquiry received more than 1,300 submissions from people who had experienced traumatic
birth, as well as nearly 100 submissions from maternity professionals. It also held seven evidence
sessions, in which it heard testimony from both parents and experts, including maternity
professionals and academics.
The picture to emerge was of a maternity system where poor care is all-too-frequently tolerated as
normal, and women are treated as an inconvenience. We have made a set of recommendations that
aim to address these problems and work towards a maternity system that is woman-centred and
where poor care is the exception rather than the rule.
Read the report – Listen to Mums: Ending the Postcode Lottery on Perinatal Care
Maternity support worker competency, education and career development framework
NHS England – 8th May 2024
Framework and toolkit providing the blueprint for the development of support worker roles across maternity services.
Maternity support worker competency, education and career development framework
Best Practice Pathway – Non-Ambulatory Fragility Fracture (NAFF) – GIRFT.
GIRFT – 9th May 2024
GIRFT has shared a new national pathway outlining the best practice concepts for ensuring patients with all types of fragility fracture receive excellent and equitable NHS care. Many thousands of older people are admitted to hospital with a fracture every year; hip fractures alone lead to around 70,000 older people hospital admissions in England annually, and the number is significantly higher when all anatomical sites of fracture (eg; shoulder, spine) are taken into account. While the anatomical site of injury may be different, fragility fracture patients have similar needs, such as pain relief, restoration of mobility, management of co-morbidities and the prevention of delirium. The GIRFT Non-Ambulatory Fragility Fracture (NAFF) pathway offers guidance for all stages of the patient journey – from presentation in secondary care, to admission and initial care, ongoing ward care and discharge and follow-up – which should be applied to all NAFF patients, regardless of their injury.
Read the Guidance – Non-Ambulatory Fragility Fracture (NAFF)
Prevention, population health and prosperity: a new era in devolution
NHS Confederation – 9 May 2024
Key points
- There are growing parallels between local government devolution and integrated care systems (ICSs), in terms of a genuine and shared interest in geography, place, role, purpose and outcomes. Leaders are now actively asking how they can work together to best serve their populations.
- In spring 2023, the NHS Confederation and Local Government Association jointly established a Health and Devolution Working Group to understand the priorities, opportunities and challenges in bringing together health and local government devolution.
- This report builds on the rich learning from the working group and sets out why ICSs and devolved administrations (referred to throughout this report as combined authorities) should work together to jointly improve health and support economic prosperity, how they can maximise their collective impact for their shared populations, and what government needs to do to support and accelerate the health and devolution agenda in future.
- Devolution in England is the delegation of powers, programmes and funding from Westminster to local government. As of November 2023, devolution deals have been agreed with 17 areas in England and this trend is set to continue and accelerate. With every part of England an ICS, we
will see increasing and sustained interactions between these models. - Even before the pandemic, there was a growing focus on fostering more inclusive forms of growth that balance economic and social development and seek to spread wealth much more evenly across places. Given the tumult of the past four years and the current state of the economy, it is rapidly becoming apparent that health, and the NHS, plays a key role in our prosperity. In recognition of this shift, health is now explicitly and implicitly part of many local devolution deal discussions.
- In many parts of the country, local devolution arrangements are already an integral part of an ICS. In all current combined authority arrangements, local authorities are statutory partners in the ICS, while the mayoral combined authority (MCA) as a body itself is often represented on
system partnership boards. With these building blocks already in place, the challenge is to understand the commonality in reforms, and further develop the relationships between NHS and local government partners to better understand and use their collective value. - It is important when seeking to understand the connections between health and devolution that leaders are firstly able to visualise, comprehend and explain what closer, more effective integrated working could feel like for colleagues on the front line and, importantly, what it would mean for local populations. This report articulates a new central vision for the shared future for health and devolution.
- While this central vision can underpin health and devolution more broadly, local leaders will be required to implement it according to their own context and nuance. We believe making this new vision for health and devolution a reality will require a phased, three-stage approach, developed
through coordinated local leadership and sustained national support. - These three steps include: focusing on people and the places where they live and work; supporting populations to improve their own health; and recognising that everything has an impact on health. For each of these steps, this report sets out the context, findings, national
recommendations, local priorities and illustrative case studies. - Delivering on these steps, and this report, will involve stretching what we can do within existing frameworks, duties and powers, before understanding what is needed to go further still; increasing and resourcing local capacity and capability; focusing on community engagement and empowerment; understanding and using soft power and system working; and above all, consistently engaging and co-developing a future of shared thinking, shared projects and shared positions.
Read the report – Prevention, population health and prosperity: a new era in devolution
English literacy as a barrier to participation in clinical trials and how PIL’s should be improved
Nataional Voices – 25 APRIL 2024
We were commissioned to work with our member charities and the people they advocate for to identify how PILs should be improved and understand wider barriers to participation in research.
18 people attended an online workshop – these were a mixture of professionals working in health charities and people with lived experience of long-term health conditions and/or disability. A further five individuals were consulted individually in follow-up conversations.
Our report is the result of these discussions, and contains insightful quotes from participants, whilst identifying key themes and learning points that applied specifically to two sample leaflets, shared in advance, as well as wider learnings on PILs more broadly.
Some of our findings and recommendations include:
- We saw positive support for the attempt to make PILs more accessible.
- The ability to take away a written leaflet to consider the opportunity to take part in clinical research is a strong benefit.
- Images make leaflets easier to understand, but they must be visually literate to the information provided.
- Leaflet wording must strike the correct balance between being simple and making people feel patronised.
- Leaflets need to contain more information around consent, side effects, and details around getting in contact.
- People should be signposted to additional information or alternative resources after reading the initial leaflet.
- There must be a clear commitment to providing alternative formats for those with additional communication needs.
- Co-production is incredibly important – and needs to go much further, being extended to the entire research process. This could overcome wider participation barriers that were not within the scope of this project.
Read the report – English literacy as a barrier to participation in clinical trials
Balancing the risks and benefits of AI in the production of health information
Patient Information Forum – April 2024
Use of artificial intelligence (AI) in healthcare is on the rise. Bodies including UK Governments, the National Institute for Health and Care Research and the NHS AI Lab are all investing in developing and deploying the technology.
As the landscape evolves, health information producers are investigating the risks and benefits of using AI in their everyday work. Developed in collaboration with PIF’s AI working group (see page 9), this position statement aims to help members understand the AI landscape and how to manage it. A full framework for policy creation is in development and will be published in the autumn of 2024
Further information – Balancing the risks and benefits of AI in the production of health information
UK 5-year action plan for antimicrobial resistance 2024 to 2029
Department of Health and Social Care, – 8th May 2024
This second 5-year national action plan supports the UK 20-year vision for antimicrobial resistance.
It was developed across the government, its agencies and administrations in Scotland, Wales and Northern Ireland, with support from a range of stakeholders.
Investigation report: Patients at risk of self-harm: continuous observation
HSSIB – 9th May 2024
Our latest investigation has found ‘limited evidence’ that the current approach to continuous observation of adult patients at risk of self-harm when on hospitals wards is effective.
The report, published today, details an investigation which explores in depth the activity of continuous observation and its use in reducing the risk of patients self-harming while receiving care for physical healthcare needs in an acute hospital ward. For context, the term ‘continuous observation’ is a ‘widely used intervention’ for staff to monitor and assess the mental and physical health of a person who may harm themselves. Self-harm is one of the most common reasons that people go to hospital. The report cites data from the Office of Disparities showing that between April 2021 – April 2022, nearly 94,000 were admitted to hospital in England as an emergency due to self-harm.
The report reveals that there is variation in hospital settings as to why, when, how and by whom continuous observation was carried out. There was limited evidence of the effectiveness of the observation and no consistency in patients experience. In addition, the investigation found that growing financial pressures and staff shortages within healthcare have resulted in continuous observation being increasingly scrutinised at all levels of healthcare. We also emphasise that human factors principles often are not considered, and this is needed to understand the complexities of this intervention and the environments in which it may take place – for example if staff are carrying out a mentally challenging task in poor light whilst fatigued is unreliable.
Read the report – Patients at risk of self-harm: continuous observation
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