The Loop | Issue 11 | October - December 2023

ISSUE

11 OCTOBER - DECEMBER 2023

The Loop

IHSCM Quarterly E-magazine

Bridging

Data Discovery

Health starts

the gap

Platform

at home

Contents 4.

Editorial

6.

Change Management

ISSUE

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8. Change Leadership 12. Mental Health Awareness 16. The Silent Struggle: Ignoring the Voices of LGBTQ+ Individuals Living with Dementia

20. Firestorm to Burnout: The Impact of the Pandemic on Healthcare Professionals

22. Bridging the gap – hospital to home 26. Voror Health Technologies & the Discovery Data Platform

28. Use us, or lose us: why junior doctors should be involved in decisions about technology

30.

People, process and technology - the steps to an effective virtual ward

34. Clinical technology: short-termism or the golden thread?

38. Unlocking success in cancer care: harnessing the power of digital innovation

40.

We need to change the conversation about digital in primary care

44. Health starts at home 48. Reflection on Supporting Dignity and Respect Through Ethical Principles

CEO: Jon Wilks, Chairman: Roy Lilley, Strategic Advisor: Shane Tickell, Director of Social Care: Susan Jones, Membership Manager: Emma Caton, Operations Manager: Jade Maloney, Social Media Administrator: Rachel Jury, Operations Administrator: Charlotte Joseph, Digital Content Consultant: Luke Farmer

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EDITOR

Welcome to the latest edit The Loop.

By way of news, allow me to introduce you all to Susan Jones, our new Director of Social Care, who has replaced Adam Purnell in the role.

After aterrific couple of years with us Adam is returning to his first love – providing social care – and Susan has been appointed without any hesitation at all.

Chief Executive

JON WILKS

She has been a member for several years, absolutely understands what we are trying to do to support and encourage all of your individual development, and has a first class background in delivery of leadership and management training. Susan will be a huge asset to the organisation, I am sure.

Additionally, we are busy with the launch of a new coaching short course

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RIAL

tion of

masterclass, prepared and delivered

by Lucy Buxton, a very experienced professional coach who, again, has been involved with the Institute for some time now.

We expect to formally launch the new CPD accredited coaching short course masterclass in late October / early November and, having seen the first edits, I commend it to you.

It has also been wonderful to see and hear the progress being made by several of our Special Interest Groups.

Members have asked us to focus on practical outputs from the groups and recent meetings of the mental health; equality, diversity and inclusivity; digital technology; and women in leadership groups have been extremely positive.

If you would like to get involved in the groups, please contact Charlotte Joseph, our operations administrator via cjoseph@ihm.org.uk.

The women in leadership special interest group, in particular, is attracting huge interest from members and we were recently delighted to welcome Shirley Cramer CBE, as the group’s in-person interview guest in London. Members Claire Mould and Chand Kaur did a first class job of interviewing Shirley and you’ll be able to watch the recorded interview very shortly.

Best wishes and thank you for your continued fabulous support for the IHSCM.

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Change Managem What is it about change that creates such mixed responses from people?

At its heart, any change no matter how big or small, from moving desks to moving house to moving employer, generates a certain amount of anxiety.

The trick is how you, and others around you, embrace this anxiety and use it to unlock conversations, relationships, networks, and solutions that may not have been readily apparent. As a leader or manager of people, it’s down to you to set the climate that either embraces the uncertainty and acknowledges the anxiety or shut out the emotion and deal with the task in hand. Do you choose to focus on the ‘to-do list’ rather than the ‘to talk about’ list?

This is why most change programmes become victims of a Gantt chart or a detailed project plan; it’s far easier to manage the tasks than it is the conversations. And it’s certainly easier 006

to tick off items on a to-do list than it is to explore new perspectives and emotions that can create greater uncertainty (but can, when done right, unlock huge potential, innovative solutions, and greater engagement).

So, at the outset of any change programme, it becomes important to recognise the differences between change management and project management. They both work in harmony with each other, but each has a specific purpose. Change management focuses on hearts and minds whereas project management focuses on delivering tangible results. While change management primarily deals with addressing the human aspects of change, such as employee engagement, communication, and cultural shifts; project management is concerned with the practical execution of tasks and

David Benson, Organisational Development Programme Director, NHS South, Central and West

ment achieving predetermined objectives within a defined scope, budget, and timeline.

That’s not to say both disciplines are independent of one another.

Together, change management and project management form a cohesive partnership, ensuring a holistic approach to change initiatives that encompasses both the emotional and practical dimensions of the change journey. Good leaders recognise and appreciate this and harness the expertise of great change managers and project managers to help deliver sustainable change in their organisations.

Compassionate leadership, innovation, authentic listening, and empathy will all be critically important leadership traits that enable success. Leaders

For everyone across the health and care sector, being great at change is going to be more important than ever.

that focus on the people and enable them to be the architects and catalysts for change will be more effective than those that focus on the task alone.

Change is not just a project. Seek the support from great change managers and project managers alike, who recognise and embrace the value of both disciplines and can work together to deliver something truly spectacular.

If you’d like to discuss SCWs approach to great workforce change management, and the HR subject matter expertise we can bring to any workforce change challenge, please get in touch with David Benson, Organisational Development Programme Director, david.benson2@ nhs.net.

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THE LOOP Irene O Banahene, Director, Leader at G&G, HE Student

Change Leadership The article discusses the significance of emotional intelligence in effectively managing organizational change. It emphasizes the various aspects of emotional intelligence, including selfawareness, self-regulation, motivation, empathy, and social skills, and how they contribute to successful change leadership.

Additionally, the article explores how emotional intelligence helps build a strong team capable of implementing change initiatives and addresses potential resistance to change.

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Introduction Basically, as in the age of globalisation, the demand on organisations and institutions to change in order to survive and remain relevant cannot be overstated. As a result, leaders in the 21st century hold large responsibilities for successfully leading change in their organisations. However, the transformation process is emotional because no one wants to give up the comfort of the status quo or whatever they value.

Despite this, leaders must succeed in the midst of these hurdles, including the emotions of individuals who will be touched by the change. As a result, there is a greater emphasis on emotional intelligence in leadership managing the transformation process. In regards, people enjoy comfort, thus change always involves some type of emotional reaction.

Change, on the other hand, interrupts this comfort, causing anxieties and uncertainty among change recipients. For example, when change touches on issues close to the hearts of those affected, they will most likely react emotionally due to their minds constantly over thinking about what will happen; additionally, when change affects individuals' assumptions, values, beliefs, and, to a large extent, identities, change recipients may be reluctant to accept the proposed status.

Perspectives of Emotional Intelligence: As defined by MacCann (2012), emotional intelligence is the ability of individuals to understand, manage and use their own emotions in a positive way for stress0010

reducing, effectively communicating and understanding others empathically.

There are three understandings on the concept of "emotional intelligence": The "ability model" focuses on an individual's "ability to process emotional information and use it appropriately within the social environment," the "trait model focuses on behavioural dispositions and selfperceived abilities," and the "mixed model describes the combination of mental abilities, dispositions, and traits" Kaila and than gavel (2012).

The characteristics viewpoint, for example, focuses on "emotion-related predispositions"; it entails.

Change leadership and emotional intelligence: The extent to which the leader is able to convey the need for change to members of the organisation is a crucial indicator of the level of success in any circumstance of change. Hence, one of the criteria of change outlined by (Bourne, 2017). is "dissatisfaction with the status quo," and so the leader's capacity to successfully convey the need to change the status quo will affect the amount to which members of the organisation will accept the idea of change.

Building a Team/Coalition to Affect Change: Similarly, change in the current century necessitates a collaborative effort to create and explain the vision to a large number of people, overcome resistance, generate short-term victories, and incorporate the changes into the organisational culture (Kotter, 2012).

Leaders who try to make changes alone

are more likely to be ostracised and are subject to fail in the process. As a result, the leader's task is to put together a winning coalition to support the organization's effective change, coalition members must be enthusiastic, committed, and credible (Kotter, 2012).

Overcoming Resistance in Change Leadership: During the organisational transformation process, certain followers are hesitant to join in the change activities. Resistance has been classified into two types: rational resistance and illogical resistance.

According to deJager (2001), rational resistance encompasses followers' feelings of non-involvement, but irrational resistance refers to resistance from members for the sake of resistance. According to the author, reasoned resistance followers are more likely to be persuaded to engage in change attempts. Furthermore, Gaubatz and Ensminger (2017) discovered that, some members who resist change may be "contentions" and are more likely to derail change efforts due to feelings of resentment or fear of not being recognised for the value they bring to the department or organisation.

For example, "the principal's selfawareness in the functional school demonstrated an understanding of his moral purpose as a principal to the learners in his school" (Dye, 2013.

Leaders cannot expect others to change if they are unwilling to change themselves. Emotionally intelligent leaders demonstrate a willingness and aptitude to change by displaying adaptability, self-confidence, ingenuity, and initiative, as well as serving as change catalysts (Madhivanan and Riasudeen, 2018).

Conclusion Given the issues that leaders face in the twenty-first century, I believe that teaching future leaders to acquire emotional intelligence will go a long way towards appropriately preparing them to offer successful leadership. Furthermore, leaders cannot expect people to change if they are unwilling to change themselves. "Emotional intelligence" was the influencing factor in the difference identified in "the performance of principals of two schools" (Dye, 2013).

References McCann, C. 2012. Further examination of emotional intelligence as a standard intelligence: A latent variable analysis of fluid intelligence, crystallized intelligence, and emotional intelligence. Personality and Individual Differences, 49(5), pp.490–496.

Bourne, P. 2017. Primal Leadership: Realizing the Power of Emotional Intelligence- A Book Review. COJ Nursing & Healthcare, 1(2).

Dye, C. 2013. Healthcare leadership: essential values and skills.

Chicago, Il: Health Administration Press.

Madhivanan, S. and Riasudeen, S. 2018. An analysis of the mediating effect of emotional intelligence between self-evaluation traits with emotional and spiritual well-being. International Journal of Behavioural and Healthcare Research, 6(2), p.149.

Foltin, A., & Keller, R. (2012). Leading change with emotional intelligence. Nursing Management, 43, 20-25. doi:10.1097/01.

NUMA.0000421675.33594.63de Jager, P. (2001). de Jager, P. (2001). Resistance to change: A new view of an old problem. The Futuristic, 35, 24-27.

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Mental health awareness Mental health awareness is of utmost importance in the field of health and social care. It plays a crucial role in promoting overall well-being and ensuring that individuals receive the support they need to maintain good mental health.

Dr Nadia Correia, Clinical Director, Integrated Care Services Group 0012

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In this article, we will explore the significance of mental health awareness in health and social care, focusing on its impact on individuals, families, and society as a whole.

Firstly, mental health awareness is essential for individuals as it helps them understand and recognize their own mental health needs. Many people may not be aware of the signs and symptoms of mental health issues, and as a result, they may not seek help or support. By raising awareness, individuals can become more knowledgeable about mental health conditions, enabling them to identify any potential problems and seek appropriate treatment. This can lead to early intervention, which is crucial in preventing the development of more severe mental health issues.

Furthermore, mental health awareness is vital for families and loved ones of individuals experiencing mental health problems. It helps them understand the challenges their loved ones may be facing and provides them with the knowledge and skills to offer support.

This can include providing emotional support, encouraging individuals to seek professional help, or assisting with practical matters such as medication management or attending therapy sessions. By promoting mental health awareness, families can play an active role in the recovery process and contribute to the overall well-being of their loved ones.

In addition to its impact on individuals and families, mental health awareness is also crucial for society as a

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whole. Mental health issues can have a significant impact on productivity, relationships, and overall quality of life. By raising awareness, society can reduce the stigma surrounding mental health and create a more supportive and inclusive environment for individuals experiencing mental health problems. This can lead to increased acceptance, understanding, and empathy, which are essential for fostering a society that values mental health and well-being.

Moreover, mental health awareness in health and social care can help professionals provide better care and support to individuals with mental health issues. By being aware of the signs and symptoms of mental health conditions, professionals can identify and assess individuals' needs more effectively. This can lead to more accurate diagnoses, appropriate treatment plans, and improved outcomes for individuals.

Additionally, mental health awareness can help professionals develop the necessary skills and knowledge to provide compassionate and personcentered care, ensuring that individuals feel supported and understood throughout their journey to recovery.

In conclusion, mental health awareness is of utmost importance in health and social care. It has a significant impact on individuals, families, and society as a whole. By promoting mental health awareness we are supporting others, advocating for change , promote prevention, reduce stigma, enhance community support and promoting resilience.

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The Silent Struggle: Ignoring the Voices of LGBTQ+ Individuals Living with Dementia 0016

John Angel Bond (He/Him/Fe), PhD Student and Tutor, School of Social Sciences University of Stirling

In the complex landscape of healthcare and advocacy, it is a sad reality that some voices are often drowned out or overlooked.

Among those voices, one group that has been particularly marginalised is LGBTQ+ individuals living with dementia. As society takes steps towards inclusivity and acceptance, it is crucial that we address this issue and ensure that the unique challenges faced by this intersectional community are heard and acted upon.

It is important to acknowledge that the LGBTQ+ community, already facing discrimination and stigmatisation, carries an additional burden when

dementia enters the picture. Dementia can strip individuals of their memories, cognitive abilities, and identity, making it even more challenging for LGBTQ+ individuals to express their authentic selves.

The fear of discrimination, both within healthcare settings and from caregivers, may cause many to remain silent about their sexual orientation or gender identity. This silence can lead to a profound sense of isolation and confusion.

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Furthermore, the lack of culturally competent care for LGBTQ+ individuals with dementia exacerbates the problem. Healthcare providers, who may not be trained to understand the specific needs and experiences of LGBTQ+ patients, can inadvertently perpetuate stereotypes and biases.

This ignorance can manifest in subtle ways, such as misgendering or making assumptions about an individual's sexual orientation, which only deepens the sense of alienation and invisibility felt by these patients.

Healthcare policies and support systems often fail to address the unique challenges that LGBTQ+ individuals with dementia face.

For example, the concept of "chosen family" is paramount within the LGBTQ+ community, yet it is rarely acknowledged in traditional caregiving models. This exclusion can lead to heart-wrenching situations where LGBTQ+ individuals are estranged from their support networks, causing further distress and isolation.

The dearth of research focusing on LGBTQ+ dementia is another alarming issue. Understanding the prevalence and nuances of dementia within this community is vital to crafting effective support and intervention strategies.

Without proper data and research, policymakers and healthcare providers are left ill-equipped to address the unique needs of LGBTQ+ individuals living with dementia.

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To rectify this situation, we must take several steps. First, healthcare providers and caregivers must undergo LGBTQ+ cultural competency training to ensure that LGBTQ+ individuals living with dementia feel safe and respected.

Second, advocacy organisations should work to raise awareness about this issue and push for more research and funding. Finally, policymakers must prioritise the development of policies that address the specific needs of this marginalised community.

Organisations like the LGBTQ+ Dementia Advisory Group Community Interest Company (CIC) can offer advice.

In conclusion, the voices of LGBTQ+ individuals living with dementia are being ignored, and this oversight has severe consequences. It is our moral obligation as a society to recognise and rectify this injustice. By fostering inclusivity, providing culturally competent care, conducting research, and implementing policy changes, we can ensure that no one, regardless of their sexual orientation or gender identity, is left to suffer in silence during their battle with dementia. It's time to give these individuals the support and respect they deserve.

Weblinks: The LGBTQ+ Dementia Advisory Group Community Interest Company (CIC). www.lgbtqdementia.org info@lgbtqdementia.org

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Firestorm to Burnout: The Impact of the Pandemic on Healthcare Professionals During the pandemic, healthcare professionals have demonstrated extraordinary tenacity, resilience, and dedication.

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Although the pandemic is now largely behind us, both healthcare systems and healthcare professionals (HCPs) are currently facing huge stresses, many of which have been exacerbated rather than caused by the pandemic and are unlikely to be resolved soon.

In early 2023, IQVIA conducted a survey of 720 primary care and specialist physicians across six countries to better understand how healthcare providers and their patients are affected by the COVID-19 pandemic and its aftermath, what their expectations for future developments are, and how other healthcare stakeholders can support them.

From their responses, it is clear that the aftermath of the pandemic is still with us and is likely to be so for some time to come.

Many are reporting an increase in patient caseload as a consequence of the COVID-19 pandemic, with patient backlogs and remote management of patients the leading causes of the increase.

The survey confirmed that pharmaceutical companies have a role to play in providing resources and support that will ease the burden COVID-19 at several points in a product's lifecycle, especially during and post-launch.

Key Findings: •

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To ensure the future resilience of healthcare professionals, continuous support is needed from the government, policy makers and employers in providing the resources needed to alleviate the post-COVID-19 burden, especially around improving the work environment and increasing the health workforce.

For pharma, there is considerable scope for engaging with HCPs by providing support throughout the product lifecycle, provided it is tailored to HCPs’ needs and preferences. Expectations of support include a wide range of potential measures, from patient support programs to insights on managing patients and provision of innovative products which reduces time requirements for patient care.

After surveying over 120 hcps in the UK, 66% require an investment in the workforce by increasing staff and improving work conditions in order to manage the burden of COVID-19. Other factors which can contribute to managing the burden of pandemic include, investing in digital infrastructure, recruitment and training of workforce, improving workforce planning, investing in primary and community care or expanding home care. The UK scores higher in these issues than any other country surveyed, including US, Japan, Italy, Spain & France.

Download the White Paper here.

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Hayley Robertshaw Director of Care and Development, St Martins Care

Bridging the gap – hospital to home I am a senior manager working in residential and nursing care in the north east of England. I am passionate about our sector and see first-hand the positive impact good quality care and support can have.

I’d like to share my thoughts on how we can provide solutions to hospital discharge pressures and support admission avoidance strategies. by the redesign of traditional residential and nursing care providers using the lessons from the past to inform the future.

How it was. . .

Convalescent homes were a common aspect of the health care system from the midnineteenth century until the 1980’s. They supported individuals to recuperate, following a stay in hospital. By focusing on nutrition, hydration and general health and well-being they enabled individuals to return home when they were fully rehabilitated.

They were often in locations which could be considered ‘therapeutic’, for example, close to the coast. This was an approach which predates the models of person-centred care we know today, where the link between emotional, physical and mental well-being is now well established.

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It could not be more relevant to the challenges we are experiencing across the whole health and social care system in 2023. We need to be putting the person at the centre of care and focusing on long-term outcomes, rather than short-term fixes.

How it is. . .

We hear every day of unsafe discharges, people entering the system in crisis, reactive rather than proactive service design and a lack of connection between social isolation, low mood and self-neglect.

People are living longer, advances in medical interventions for complex health conditions requiring longer term support models and increased customer expectations. That combined with reduced living standards, health inequalities and the impact of COVID have seen the pressure on the NHS and social care increase past breaking point.

We know that recruitment is a national issue and there are many delayed transfers of care due to domiciliary care shortages. The evidence suggests lack of activity in hospital leads to reduced functional ability, deconditioning, as well as the worsening of cognition, particularly in older people. These are all major factors that can prevent discharge and increase reliance and pressure on social care.

We regularly receive admissions with people who were continent on

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admission and return catheterised, people who were mobile and return requiring hoist transfers and people who had no pressure damage returning with grade 3 pressure sores.

This is not a criticism of health settings; they are not set up to provide holistic outcomes.

How it could be…

A fresh perspective on the ‘convalescent home’ could provide vital short-term care and support interventions to individuals that enable them to return and remain at home.

I am thinking of a ‘social prescribing plus’ model, where short-term stays are commissioned as part of an admission avoidance strategy and support hospital discharge. During a 7 to 14 day period an individual could have a full medication review, maintain good nutrition and hydration, enjoy restful sleep, and encourage daily routines of physical, mental and emotional activity.

An individual could be reconnected or introduced to their community and returned home with a full holistic MOT completed.

We should never underestimate the power of TLC and the positive impact it can have on an individual’s mental, physical, and emotional well-being.

This approach could delay the need for 24/7 care or remove the need completely.

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More full and short qualifications coming in early 2022, including leader and senior leader apprenticeship routes

For more information or to apply please visit arden.ac.uk

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Voror Health Technologies & the Discovery Data Platform What do we do?

The Voror team design, architect, develop, and support an open-source solution designed to aggregate patient data from multiple sources into a common ontology and model for driving better patient outcomes, research, and analytics in one package - patient data from any source, in any format, available at near real-time.

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With more than 34 million patient records, from 3 Integrated Care Systems and 9 Electronic Patient Record Systems (covering primary care, secondary care, unscheduled care, community, and mental health services), we run one of the world’s largest near real-time healthcare databases and provide data and information solutions that improve and support healthcare services. Those services help professionals to access population health and care data across multiple health and care providers.

Publisher to Subscriber data flow Under strict IG, consent, and data sharing/publishing agreements, we can provide you with any number of extracts, reports, dashboards all from one instance of collected/published data.

How do we do it?

We normalise the source data from the publishers, and through data sharing agreements make subsets of that data available in several subscriber databases.

Normalisation Why do we do it?

We take any coded data (SNOMED CT, CTV3, Read2, ICD-10, OPCS-4, or any national/local code system), in any format (CSV, HL7V2...), map it to a single code system, store it in a secure database using a common model, and then make it available to you.

That answer is simple, we put the patient first. All our work is with the patient in mind. Everything we do fulfils one of the following aims and ultimately helps professionals to help their patients.

• Direct Care • Population Health • Proactive Care • Research • Innovation • Planning • Oversight • Service Improvement • Data Analytics • Data Platforms • Core Infrastructure • Productivity Tools How can we help you?

Contact us - info@voror.co.uk - to see how we can increase the power of your patient data or use existing data to provide better insights for your projects.

Or check out our website for more details – voror.co.uk.

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Use us, or lose us: why junior doctors should be involved in decisions about technology Since the much-anticipated unveiling of the NHS Long Term Workforce Plan in June, many healthcare professionals like myself have been questioning if the commitments are fit for purpose.

Ed Hutchison, Clinical Solutions Specialist, Altera Digital Health and NHS doctor 0028

Despite the plan's ambitious and strategic approach, it falls short on many aspects, especially when it comes to digital initiatives.

Burnout, underappreciation, and poor technology are among the many reasons junior doctors decide to leave the UK. This is especially true when you consider the state of the technology within the NHS. Often something as simple as finding a working computer can be a daily struggle.

Undervalued and overlooked Exacerbated by the persistence of paper notes or multiple disjointed systems, it’s certainly not hard to understand why a third of junior doctors plan to leave NHS to work abroad in the next 12 months.

Important decisions, such as about new technology, are usually made by board members and senior leaders, with those that will actually use the tech most marginalised from the decision-making process. So, it comes as no surprise that we as junior doctors often feel undervalued.

The potential ramifications of this are hard to overlook, especially when new technology is introduced, such as EPRs. As such a fundamental aspect of caring for a patient, it needs to function effectively for doctors to be productive and efficient.

However, this is often not the case, and can be a major cause of burnout for staff.

To restore a positive culture with junior doctors, senior leaders need to include them in decisions that will affect them most, like new digital technology and what tools can help them deliver the best care for their patients.

A unique perspective Given the rotational nature of junior doctor training, we work in different hospitals across the country, exposing us to varying degrees of digital maturity and the different EPR solutions available.

This equips us with a unique insight into what works and what (really) doesn’t. This knowledge should be seen as invaluable to decision-makers who often aren’t afforded such a multifaceted view. While input from all clinical staff is needed, it is crucial that junior doctors are included and are afforded protected time away from the wards to offer their expertise.

From my own rotational experience as a doctor, I know that a flexible, highly configurable EPR system is so important.

With an evolving policy landscape and increasing pressures like the surgical backlog, it is imperative. However, with some EPRs, it can take up to three months to make a small change.

With a flexible system, configurations can be completed in under 24 hours, enabling trusts to respond to patient safety issues and policy changes literally overnight.

We’ve seen as much from trusts using Sunrise EPR. Unfortunately, such insight and understanding isn’t always afforded by the board and other traditional decision makers, and organisations are left with inflexible, monolithic systems that work against them.

Without a shadow of a doubt, digital transformation needs a fresh and grassroots approach; otherwise, we’ll risk losing even more valuable NHS staff.

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People, process and technology the steps to an effective virtual ward 0030

Chris Richmond, Principal Clinical Consultant, Answer Digital and previous Head of Delivery, NHS England

NHS waiting lists are at 7.6 million, hospital bed occupancy rates have reached 92 per cent, and one in six patients are in hospital due to delayed discharge.

Virtual wards allow appropriate patients to avoid being admitted to hospital, or to be discharged early, to receive acute-level care at home, while increasing capacity in hospitals.

With 450 virtual wards now launched, data suggests a virtual ward of 50 beds delivers the equivalent of 31 additional secondary care beds and they lead to reduced emergency department presentations and hospital admissions. Virtual wards ease

the pressure on busy hospitals and are better for patients’ mental and physical health as they stay in the comfort of their home.

Delivering a successful virtual ward Based on our experience working with NHS England and system suppliers, virtual wards only deliver benefits if they are created with a focus on people, processes, and technology.

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People

Technology

Firstly, there needs to be buy-in and participation from clinical, operational and transformational teams within the systems and trusts, and participation from patients. Before getting started on delivery, there should be a discovery plan to see what remote care already exists, the technologies being used, and how to connect it into the service.

Effective, scalable virtual wards should be technology-enabled, allowing patient information to be accessed, staff to communicate across systems, and vital signs to be monitored.

Data collected from patients should include both clinical observations and questionnaire responses, to be able to monitor trends and alerts.

With significant demands on their time, staff should have the flexibility to work across pathways, teams and organisations, with clear guidance on clinical responsibilities, and necessary training and appropriate support.

Teams require access to clinical systems, electronic patient records, and remote monitoring platforms that are connected across different hospitals and platforms.

Process Clear processes, supported by user journeys, help teams to identify appropriate patients for virtual care and support referrals, operational tasks, and discharge. There should be a diagnosis and care plan for patients, with defined inclusion and exclusion criteria, and appropriate clinical input as though they are an inpatient.

There should be a clear pathway to recognise deterioration and appropriate escalation processes.

Staff need access to patient data that is integrated between services to support the referral process and facilitate care decisions. Understanding what technologies are required to perform or support key processes, and how they will be integrated, will help to develop a roadmap and identify risks.

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Interoperability between IT systems, devices, and applications is essential to ensure those caring for a patient can access the right information to provide the right treatment and support.

However, greater interoperability between systems isn’t just about accessing clinical data for direct care - it can also help to streamline patient registration processes, medication and prescription management, and discharge processes.

Hospital levels of care being delivered in patients’ own homes could have a significant impact on NHS capacity and patient outcomes, but this can only be done safely and efficiently if the right steps are in place.

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Clinical tech short-termis golden threa To support the digital transformation agenda in the NHS, there has been a push to professionalise the role of clinicians with digital expertise.

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Jacqueline Davis, Chief Nursing Informatics Officer, System C

hnology: sm or the ad?

For example, The Wachter Review and the Topol Review emphasised the need to train clinicians for the digital future of healthcare and the Phillips Ives Nursing & Midwifery Review focused on ensuring nurses and midwives are digitally ready.

However, despite the numerous papers, reviews, and success stories, many NHS organisations still see digital technology as a short-term project rather than a core component of their clinical and nursing

strategies. The appointment of national Chief Clinical Information Officers (CCIOs) and Chief Nursing Information Officers (CNIOs) has been relatively recent, which may explain the slow uptake of these roles among provider organisations.

When transitioning from paper records to EPRs, it is unrealistic to expect a closed-end, fixed-cost program to achieve full digitisation.

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Digitisation fundamentally changes the nature of work and tasks, requiring engagement with end-users and investment in training the digital workforce.

The availability of financial resources for establishing clinical digital teams varies widely among NHS trusts. Smaller providers often rely on short-term funding and assign titles like ‘digital midwife’ or ‘digital physiotherapist’ to professionals involved in supporting digital transformation.

However, the limited duration of funding poses challenges in integrating digital advancements effectively.

Planning, stakeholder engagement, training, testing, configuration, and deployment of the EPR system all require time and resources. Additionally, using the generated data to drive improvements and considering the future of digital advancements are essential. Transforming an entire healthcare provider organisation within a set timeframe often leads to missed milestones, extensions, inefficiencies, burnout, and frustration among clinicians.

Investment in both people and technology is crucial for successful implementation. The presence of digital clinician representation across professions, specialties, and care

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settings greatly contributes to the successful deployment and adoption of EPRs. Deploying and optimising healthcare software is not a finite project but a continuous thread that runs through healthcare.

This ongoing transformation presents an opportunity to fundamentally change the way the NHS operates, enhancing safety and efficiency for both patients and clinicians. By learning from past change projects, embracing technological advances, and investing in people, the NHS can capitalise on the potential benefits of clinical technology.

Our first-hand experience has shown just how important digital clinician representation is across different professional groups, specialties and care settings when successfully deploying and adopting EPRs.

As Topol explains it is an exciting time for the NHS to benefit and capitalise on technological advances but we must learn from previous change projects. Successful implementation will require investment in people as well as technology.

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Unlocking success in cancer care: harnessing the power of digital innovation Over 10,000 people with suspected cancer are currently waiting more than 104 days to see a clinician. This extended waiting period has been consistently reported to cause feelings of anxiety among patients.

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of technology to achieve some of this.

And rightly so but we need a blended approach of physical and digital that works for patients.

Change is desperately needed but many are feeling ‘initiative fatigue’ in the NHS. However, with the Interim Major Conditions Strategy published just last month, there’s new hope for how we deal with long term conditions such as cancer.

The strategy also emphasises the need for taking a person centred approach.

This is something we’re passionate about Careology. We use technology to facilitate easy access to reliable information, providing cancer patients with clarity about next steps in their care and to act as a companion during their treatment.

The strategy aims to improve cancer care by focusing on embedding early diagnosis and treatment in the community, optimising patient pathways and enhancing the overall patient experience through person-centred care and seamless interactions with the healthcare system. The strategy rightly recognises the transformative potential

Our aim is to use patient-facing technology to help people have the best possible experience during their treatment and to make the treatment journey as smooth and hassle-free as possible. With greater control over their healthcare journey, patients and their carers can make informed decisions about their treatment choices.

Paul Landau, CEO, Careology

Right now cancer services across health and care are struggling to deal with backlogs, workforce shortages and escalating costs which are impacting cancer survival rates and the quality of care being delivered.

The major conditions strategy rightly recognises that sustained investment is needed in the cancer workforce, and in diagnostic and treatment capacity.

But we also need to look at how we could potentially reduce the number of appointments needed for various workflows. Through digitalising and streamlining elements of it we can free up capacity and increase speed to treatment.

By reimagining our approach to delivering cancer services, we have the potential to alleviate the burden on our oncology workforce. This can lead to more efficient and effective healthcare outcomes for patients and contribute to the overall improvement of cancer care.

A key example of this is a typical consent process in cancer treatment which requires up to three appointments before consent is obtained. This is expensive, capacity consuming and delays speed to treatment.

If we can digitise this process we can

make it faster through provision of key regimen specific information packs, FAQs, language options and potentially also digital consent itself. This will not only increase clinical capacity but free up consultant time for other clinical duties, as well as reduce the average cost per patient and allow faster commencement of treatment.

As we look to the future of healthcare delivery, its effectiveness and quality will progressively depend on adopting a holistic approach that considers the entire person. Ultimately, we need to create a shift towards digital solutions which enable a greater sense of ownership and engagement for people. Now is the time to push through and embrace technology if we truly want to revolutionise the patient experience.

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Kerry Gardner, Chief Nurse, Doctrin UK and former Group Lead Nurse, Lakeside Healthcare

We need to the convers digital in pri Recently there has been a lot of debate about the rollout of digital telephony in GP practices, given the fast-approaching government deadline for systems to be in place by March 2024.

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o change sation about imary care GP leaders have commented on how this technology alone won’t improve patient access. And they’re right.

However, they’re wrong to only consider telephony in the context of improving access.

Digital encompasses far more than telephony. And whilst it has its benefits, given the national objectives (such as delivering 50 million more appointments in general practice by March 2024), primary care needs to consider more comprehensive solutions.

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Having been involved in the implementation of a digital care navigation platform at Lakeside (a network of eight practices in the East Midlands), I’ve seen firsthand the role technology can have on improving access (and experiences) for patients and transforming operational efficiencies for staff.

Doctrin’s end-to-end navigation solution was rolled out in 2022 across the majority of practices and it has resulted in just 7% of patients needing to see a GP. By using the online triage functionality – which is based on over 800 clinical questionnaires and localised signposting – patients can provide their symptoms at a time that suits them (rather than waiting to speak to a receptionist) and are directed to the most appropriate healthcare professional from the outset.

Most of the time this is a nurse, pharmacist, emergency practitioner and/or self-care, rather than a GP. Patient satisfaction rates have remained consistently high as a result (over 90%), with the feedback including how individuals feel like they are dealt with understanding and compassion.

The redirection of patients has also had a significant impact on staff capacity – there has been a 33% reduction in phone calls, which has helped minimise the 8am telephone queues and free

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up the receptionists to speak to those who don’t have online access.

And GPs have been able to prioritise seeing the patients in greatest need, either digitally using Doctrin’s consultation tool or in person at the surgery.

The data collected from the platform also helps the GP practices understand the demand on different services and to plan its workforce accordingly, in turn avoiding understaffing at times when there is higher demand, but also releasing capacity during less busy times.

The benefits of this type of solution can also easily be scaled-up to meet the needs of Primary Care Networks, and work alongside other technology as part of a digital ecosystem supporting Integrated Care Systems.

The government has taken significant steps in recent months to try and address the intense pressures on the workforce in primary care, and in turn encourage the adoption of digital, which is to be applauded.

However, it is a missed opportunity if care navigation platforms are not considered as part of the solution to patient access and improved clinical capacity in this context.

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Health st at home How social prescribing is combatting fuel poverty, improving health, and reducing pressure on GP services.

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tarts Health conditions that arise from poor housing and fuel poverty cost the NHS upwards of £95m every year, and the wider economy more than £1bn. It also increases individuals’ likelihood of developing long term conditions. As we approach the winter period, these pressures become more intense, as does the risk to individuals’ health and wellbeing.

However, the impact of the home on health is underestimated. When a person goes to their GP because their asthma has become unmanageable, they will likely be asked if they have increased their exercise, are on new medicines, or

have any other respiratory conditions.

However, they are unlikely to be asked if their home is damp or mouldy.

This is despite 50% of people with asthma commenting that their condition worsens when they are in an environment with damp or mould.

Obviously, there is little a GP can do to address these factors. But, if the damp is not resolved, that person could develop further health problems that result in repeat requests to a healthcare professional – most often a GP – creating additional demand on services.

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As winter looms, the likelihood of people living in damp and mouldy conditions will greatly increase. This is often because people are experiencing fuel poverty. In a cost of living crisis, the number of people who are at risk greatly increases.

At Warm Wales, we provide free support and advice to reduce fuel poverty and we have first-hand experience of how social prescribing plays an important role.

For example, we have been able to understand the factors that impact a person’s ability to pay their energy bills, and how not paying them can affect someone’s health. By having more conversations about these interdependencies - which Access Elemental makes it easier to do by enabling robust reporting on community referrals and outcomes we have been able to provide more effective support to help people take control of their situation and improve their wellbeing.

Digital social prescribing’s role Social prescribing enables health and care professionals to connect people with non-clinical interventions to improve health. We’ve been using it since 2020 and it’s had an incredible impact on people’s health outcomes. 93% of our service users reported a reduction in anxiety about their energy bills after accessing our support services through social prescribing. It has enabled us to have more conversations about the home, understand its impact on health and efficiently provide people with the tools they need to tackle fuel poverty.

Our digital social prescribing system - Access Elemental - has radically changed the way we deliver support and made our jobs as link workers far more streamlined. It’s also provided us with reassurance that we’re doing right by the people that need our help.

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Helping in this way, we also reduce the likelihood of GP visits, which eases the burden on stretched healthcare services.

We need to talk about the home Using social prescribing technology helps us to support more people, in a more personalised way. We have made it possible for there to be more conversations about the home and its impact on health, preventing serious problems from developing. Health starts at home, and by enabling these earlier interventions, and encouraging conversations, we can keep people well and away from GP surgeries.

However, it is important to act now, before the pressures of winter firmly take grip.

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Reflection on Support Dignity and Respect Through Ethical Princi Learning is an essential aspect of personal growth and development. Without continuous learning, we limit our potential and miss valuable opportunities to improve ourselves and our lives.

We can unlock new success, happiness, and fulfilment levels by embracing learning as a never-ending process.

During my first year at Arden University, I had to do a module called Supporting Dignity and Respect Through Ethical Principles. I did not have much prior knowledge about LGBTQ people and the real problems they face until I had to do a case study about 16-year-old Jamie, who came out as gay and resulted in homelessness from their parents. It was challenging for me.

However, this module gave me a special message to consider within the areas of morality and ethics. Most importantly, as a person who wants to be involved in the health and social care management 0048

sector. I had to consider my personal core values and supporting diverse individuals. Being LGBTQ is not an issue, a problem, or a choice (LGBT in Britain: Health (2018); they should be treated equally, with dignity and respect. Most certainly, they should have access to healthcare; however, many experience barriers and discrimination that hinder this.

Feelings are important because they depend on ethics, values, and morals. In this module, I realised how the LGBTQ community discriminates against. Jamie was subjected to bullying from their family, forcing them into homelessness. According to Stonewall International (2017), LGBTQ people are more likely to

Lopa Saha, Student, Health and Care Management, Arden University

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iples experience physical violence, sexual abuse, and problems with their physical and mental health, especially young people who will become homeless like Jamie. This frustrates and demoralises them as a human being.

Regrettably, bullying and harassment are everyday experiences for LGBTQ+ in all walks of life, including in healthcare settings (Nieder et al.,2020).

As I managed this module, I consciously tried to comprehend Jamie's predicament and raise awareness of the issues facing LGBTQ individuals. I determined that the LGBTQ community is experiencing numerous forms of misery (LGBTQ in Britain - Hate crime and discrimination, Stonewall,2017).

I emphasised that the Human Rights Act (1998) and other laws (Equality Act, 2010) and government policies may significantly defend LGBTQ individuals; however, do not do enough to protect them.

Since LGBTQ individuals are just like us, they have the right to live as we do, and we cannot make their lives difficult; I believe there should be more knowledge among

the general public in this regard, the healthcare sector.

I am optimistic about changing the situation as the world evolves to meet society's and individuals' needs. It is crucial to speak out against any discrimination faced by LGBTQ+ individuals and urge the government and international organisations to act.

Everyone can play a role in society, and if LGBTQ+ individuals are treated equally, they can make significant contributions, leading to a more equitable community.

Every day, we can create a world filled with dignity and respect. By embracing ethical principles, codes of practice, and standards of practice (Social workers in England,2020), we can positively impact the lives of those around us and help create a better future for everyone.

Let's commit ourselves to treating others with the respect and dignity they deserve and work towards building a brighter tomorrow. I know that I will…

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