December 21, 2023

“We’ve got to be committed to the long term”: How Medinet are placing sustainable partnerships at the heart of their work with the NHS

Distilled Post sat down with Chris Adams and Oliver Bailey of Medinet Clinical Services, a leading clinical services provider to the NHS, to talk sustainable solutions and the key to positive partnerships. The NHS Executive Strategy Summit was an opportunity to hear problems and develop solutions to issues that abound across the NHS, and the conversation started with a discussion on what Medinet’s solution entails. Medinet is a clinical services provider, a role that has historically involved insourcing - providing clinical teams to NHS Trusts that are struggling to cope with demand, and working out of un-used space on site (such as empty rooms or theatres) “that represent a cost rather than a benefit to the Trust”. However, “as a business, we’ve always operated by asking the question - what is the barrier to you being able to see more patients? And how can we pivot and adjust our offering to fill that gap?” Chris offered. 

In recent years for Medinet this has led to the introduction of modular facilities. These environmentally sustainable units are constructed on-site for when Trusts require the insourcing of staff to deal with demand but don’t have the capacity to allow for additional clinicians to operate. The introduction of the modular units has been a huge success: “we’ve got state of the art endoscopy suites in car parks that have been used to see hundreds of patients who wouldn’t otherwise be seen”, Chris said.

With the onset of winter pressures never far from the headlines, the benefits of the NHS working with private healthcare companies is clear to see. But Oliver saw the forming of a positive relationship with Trusts as key to the success of initiatives like these. “As a private provider, we’ve always been universally welcomed into the NHS with open arms… But there’s a distinction between private healthcare companies and what we do - we’re all private companies, but our only customer is the NHS. We’re not charging the maximum rate for an endoscopy, we’re working under a tariff”. Chris concurred, adding that “we approach events like the NESS (NHS Executive Strategy Summit) as a partner, not a vendor”. For Medinet, this spirit of partnership and collaboration is key. 

Indeed, Oliver observed that often there is a perception in the private health provider sector that NHS operational managers “know exactly what they want, how they want to do it, and they’re just looking for a company to push the button for them.” But Medinet operate under the assumption that actually, it’s extremely difficult to commission the service you need (from an operational perspective) without thoughtful collaboration between the private provider and the host Trust. “We’re not just offering a menu of services, we’re trying to listen, really understand the challenges for that specific Trust, and come up with innovative ways of delivering those services at the right price point and in the right way.” 

The conversation turned to the question of sustainability, and how companies like Medinet can be sustainable when a key function of their job is ‘fire-fighting’ in times of crisis for the NHS. “We can’t just run in, thrash out a load of activity and run out. We’ve got to be committed to the long term, asking questions like do we understand how the Trust views that whole care pathway?”, Chris asserted. Medinet have adopted a raft of initiatives to ensure that their insourcing has a lasting beneficial impact on the Trust they are supporting.  This has led to initiatives like training programmes for Trust staff and the implementation of A.I. tools to increase diagnostic accuracy. The logic being that Medinet are not only supporting the NHS as it is, but nurturing and developing the individuals who will be its custodians in the future too.  In a more literal sense, sustainability is achieved through multiple means: the modular facilities are constructed using sustainable building materials and methods, and when insourcing, Medinet ensure that clinicians are sent to Trusts local to them, reducing extended periods of travel. 

The conversation concluded with a reflection on the NHS Executive Strategy Summit. Both Oliver and Chris agreed that there was huge value in hearing directly from operational leadership teams at the event, particularly with regards to their collaborative partner-led ethos. They are used to hearing about the pressures facing the NHS, “but what was really powerful about the event specifically was that it created a context where we were able to find out about the layer below the headlines. What do these problems look like on a day to day basis?” For Oliver and Chris, understanding the minutiae of the problems facing NHS staff is the foundation of a positive and collaborative partnership, and the basis for finding the solutions to those problems. 

December 5, 2023

“People’s stories make a difference”: Angela Hillery CBE on how good communication leads to cultural transformation

The NHS Executive Strategy Summit took place in London on 7th November, organised by Meet Health Events and Proud2bOps.  Distilled Post sat down with some of the operational leadership teams present at the event, including Angela Hillery CBE. Earlier in 2023, Angela was named the number one NHS Chief Executive in the country by the Health Service Journal.

Angela is in the unusual position of having operational oversight of two different NHS Trusts: the Northamptonshire Healthcare NHS Trust and the Leicestershire Partnership NHS Trust. At the NHS Executive Strategy Summit, a common theme that emerged in discussions was the complaint that across the NHS, different parts of the system are not ‘talking’ to each other to a sufficient degree, leading to worsening outcomes. Angela has a unique perspective on intersectional communication across the NHS: “we often contain ourselves within sectors or organisations… In my experience, the more we reach out and connect, the better. Often we use different language in different areas to describe the same thing.” 

She referenced conversations surrounding discharge, which is relevant in the mental health, acute and community sectors; however these different areas separate out the conversation and report on it differently. Angela saw this as a key issue to address in solving wider problems facing the NHS; “If we can get people together across operations and acknowledge that often these are the same issues just manifested differently - the more we can get that understood in operational terms, the more we’ll get staff presenting solutions and crossing sectors.”

Complementing this aim for a greater sense of connectedness across systems is the burgeoning role that technology can play in achieving efficiency and better outcomes in healthcare. “I’m absolutely certain it’s going to be pivotal in terms of what the future looks like”, Angela said. An oft-mentioned topic at the Summit was the prospect of greater care in the community alleviating some of the burdens placed on the shoulders of NHS staff, and Angela was quick to acknowledge that technology was a vital component of implementing innovations such as virtual wards and intermediate care services. 

However, she conceded that “people often underestimate the clinical behaviour change that’s needed and the change in integrated care pathways that’s required to really maximise the potential of those ideas”. She also saw communicating the mutual benefits of care in the community as essential: while there is a benefit to the NHS in terms of bed occupancy, less discussed is the potential for patients to benefit from being cared for from their own home, and empowering them to manage their own care. A huge part of all of this, Angela assessed, was convincing people of the “art of the possible”. From an operational leadership perspective, Angela wants to communicate these new ideas through visible promotion of success stories - “people’s stories make a difference to behaviour. It allows for emotional connection”. 

Angela saw the NHS Executive Strategy as equally vital in improving the culture of operational leadership in the NHS. “It was really, really valuable… Often in the operations sector people are so busy that they’re not connecting as much as might be beneficial”. She identified that taking the time out of a busy schedule to reflect can lead to feelings of guilt amongst leadership teams, but that the act of doing so was invaluable. As she summarised, “operational colleagues need to plan for these moments. They need to plan time to connect with colleagues… They are drawn to the busyness of the day to day, but by taking the time out, I genuinely think they will improve their problem solving abilities and they’ll feel more supported.”

December 4, 2023

“We end up being reactive rather than responsive”: Professor Kiran Patel on how integrated visioning can help to address some of the challenges facing the NHS this winter.

Distilled Post sat down with Professor Kiran Patel to discuss solutions to some of the most pressing issues the NHS is confronting this winter.

Meet Health Events and Proud2bOps are joining forces to deliver the NHS Executive Strategy Summit on the 7th of November in London. Following straight on from the NHS’s first official day of winter, 1st November, the Summit represents a vital opportunity for operational leaders from across the Health Service to make connections and share knowledge and experiences in a supportive environment. In doing so, the Summit will direct leaders to collaborative solutions to some of the most pressing issues facing the NHS, including patient flow, workforce challenges, digital strategies and winter resilience.

As we focus on operational leaders in the buildup to the event, Distilled Post recently sat down with Professor Kiran Patel. Kiran spent 6 years as Medical Director for NHS England (West Midlands), and since 2019 has been a Chief Medical Officer, Deputy CEO and Consultant cardiologist at University Hospitals of Coventry and Warwickshire. Internationally, Kiran has lectured extensively and advised the Thai and Indonesian governments on health system strengthening. 

Winter pressures are looming large from an operational standpoint, with demand for services set to increase with the onset of colder weather. Kiran articulated what resilience should look like, in the face of these pressures: “It’s being able to cope with the multiple challenges that are thrown upon us”. Indeed, following a summer of disruption stemming from strikes across the workforce, Kiran believes that “this winter, we have many mare challenges than usual, to take into context the industrial action we’ve seen”. 

And how do we meet these challenges, including improving patient flow sustainably? Kiran observed that “we tend to think having meetings is the answer… but I think we need to have better structural design, better collaboration, better peer review”. The prospect of integrated, joined-up care is a much-touted goal by operational leaders across the NHS, and Kiran is an ardent advocate: “we need better integration to make sure we see the world from each other's eyes, so that we can appreciate the challenges across primary care, secondary care, public health and social care. I think we need much more integrated visioning, instead of meetings”. 

The challenge, of course, is how that integrative visioning is achieved. The implementation of digital solutions is a promising avenue, but Kiran believes it is still a matter of potential: “I don’t think anybody’s cracked it yet… But the potential  “is more integrated digital sharing, rather than using digital for escalation”. He referenced his site management board at the hospital, which contains a ‘rich data set’ containing information on bed state and patient flow. However, he has no indication of real-time data coming from primary or social care, and doubts that they in turn have access to his data-sets. The consequences of this lack of integration? “We end up being reactive rather than responsive… And we could become responsive with good digital sharing”. 

While he acknowledges that integrative sharing requires a balance - “you clearly want local autonomy with commonality in there as well” - he’s adamant that sharing information across a wide range of stakeholders is key to providing joined-up care, improving flow and alleviating some of the pressures facing the NHS this winter. These issues and more will be brought to the table at the NHS Executive Strategy Summit. Kiran sees clearly the benefits of bringing operational leaders together in this way: “the value is to share solutions and to share challenges. I think if you can share challenges, you can generate collective solutions”. 

The NHS Executive Strategy Summit is on the 7th of November in London, organised by Meet Health Events and Proud2bOps.

To learn more about the event, visit: https://www.meethealthevents.com/nhs-executive-strategy-summit-ness-2023

To learn more about Proud2bOps, visit: https://www.proud2bops.org

November 30, 2023

“Humans are messy, and therefore data about humans is itself  messy” – A conversation with MBI Healthcare Technologies on the  importance of quality data and data management systems in healthcare

Reflecting on the success of the NHS Executive Strategy Summit in early November, Distilled  Post spoke with Barry Mulholland and Jason Roberts. Barry is a partner at MBI Healthcare  Technologies with experience of operational roles within the NHS previously, and Jason is the  Director of Sales and Business Development at MBI. Both were present at the Summit with  MBI, who deploy cutting-edge technology to ensure the quality of healthcare data and  have collaborated frequently with the NHS. 

Barry began by offering a commentary on the critical challenges facing the NHS this winter,  from a data perspective. “We’re in a situation where we’ve got stretched resources  everywhere”, he began. “One of the biggest challenges in terms of the workforce is a  shortage of analysts… if your data is not what we might call healthy, you're always going to  struggle to make the right decisions - especially when resources are tight, and every decision  counts from a financial point of view.” 

He alluded to other disruptions exacerbating workforce shortages, including the elective  care backlog, the ambiguity surrounding the incoming centrally procured data platform  (known as the Federated Data Platform or FDP) and increased demand in Emergency  Departments over the winter months. In the light of these additional disruptions, Barry  surmised that “NHS operations colleagues haven’t really got the time for piloting things and  trying out new solutions”. In order to meet these critical challenges in the short term, he  emphasised the need for experience in the NHS environment and particularly in healthcare data - “we have to wrap expertise round an already stretched resource”. 

The conversation shifted to the obstacles standing in the way of high quality health data.  Jason saw one key problem as being the method by which waiting lists are constructed, with  data derived from EPR (Electronic Patient Record) systems. However, clinicians rarely look at  EPR data when establishing a context for a patient - they are far more likely to go to the last  patient letter or clinical documentation. This kind of data is not reflected in waiting lists, as these clinical sources tend to be unstructured.  

The problem is underscored by what Jason identified as “a partial view of demand”, with  uneven coverage of data: while certain areas such as cancer waiting lists or Referral to  Treatment (RTT) waiting lists are measured, “there’s a lot of it that isn’t measured and isn’t  properly understood. And that hampers plans all the time.” Barry added that invariably,  health data can be messy - “because humans are messy, and therefore the data about  humans is itself messy”. Messy data is further compounded by the number of disparate  systems over which information is supposed to be shared, all of which talk to each other to  wildly varying degrees. Additionally, he referenced EPR implementations as adding a burden  to staff workloads of entering extra data, with no clearly defined roles to do this. 

The discussion made it abundantly clear that solutions are desperately needed to some of  these pressing issues surrounding data management and insights. As Barry said, “it’s almost  impossible to fix unless you can see the full picture - and very few organisations have got that  full picture at the moment”. MBI Healthcare Technologies’ array of digital solutions enables  clinicians greater insights and ultimately leads to better decision making. In a word, it’s  “safety”, as Barry said. He referenced numerous incidents of certain groups of patients  receiving attention at the expense of other groups. “The first thing our solution brings is an  overview of everybody who's waiting and what the risk is around those patients. That allows  you to prioritise better which patients to see and when”. Flowing from improved safety standards is an increased ability to plan well: “Once you’re able to know and see all of the various competing demands for your finite capacity, you can start to plan it better”. He  pointed towards the significant financial benefits too, with huge amounts of time and money  currently being spent on “armies of people” who search through patient records to ascertain  what is going on with a particular patient. By supporting this process, MBI are also relieving  the pressure on staff by shaving the time required to work out what patients need. 

The conversation ended with some reflections from Barry and Jason on the success of  November’s NHS Executive Strategy Summit event, organised by Meet Health Events and  Proud2bOps. “There is so much common ground”, Jason commented. “The challenge of  getting a full picture, that’s universal across the system… And the idea that we should be  doing things manually, I think there was a widespread recognition that the time is up on that  perspective”. “And I think everybody recognised at the event that simply putting fancy  technology on top of data that isn’t accurate will just provide expensive and ineffective  solutions… We need to do something about all the data that’s going into this new  technology”, Barry added. “You have to give full credit to the Summit, for creating a space  where people feel safe to raise those concerns”. 

The NHS Executive Strategy Summit was held on the 7th of November in London, organised  by Meet Health Events and Proud2bOps. 

To learn more about the event, visit: https://www.meethealthevents.com/nhs-executive strategy-summit-ness-2023

November 27, 2023

“A space to reflect”: Salma Yasmeen on the potential of care in the community and the value of collaborating with partners in the third sector.

After a summer of industrial action and with winter just around the corner, operational leaders from across the NHS are facing a series of significant and sustained challenges. In response to the current situation, Meet Health Events and Proud2bOps organised the NHS Executive Strategy Summit, which took place in London on the 7th of November. The Summit offered operational leaders a rare and vital space to come together and share experiences and practice, with the overall goal of finding solutions to some of these problems through collaborative problem-solving. 

Distilled Post spoke to Salma Yasmeen, the Chief Executive of Sheffield Health and Social Care NHS Foundation Trust. Prior to her appointment in July of this year, Salma was the Deputy Chief Executive and Executive Director of Strategy and Change at South West Yorkshire Partnership NHS Foundation Trust. She was also the Chief Executive of Sharing Voices, an award-winning mental health community development charity that she developed from a pilot project. 

One solution to the sustained pressure the NHS is facing - much-touted at the Summit - was the prospect of greater care in the community. Salma appreciates the potential of an increased role for community care, but was keen to observe that “We haven’t had investment in social care for a decade now… And that means that there’s reduced capacity and capability in our communities to soak up some of that need”. Clearly, if the NHS is to rely to a greater extent on support from communities, significant investment is needed outside of the scope of the NHS. 

Salma suggested that one exciting pathway to community care might involve the development of new roles for community connectors and navigators. Particularly in a mental health context, she has observed high levels of people that need secondary support or crisis pathways. “However, if you ask our liaison teams, there’s a large number of people that have issues around housing and other areas that contribute to their distress… They’re emotionally distressed, but don’t necessarily need specialist input - but they present there because they have anxiety, depression or thoughts of self harm”. Salma would advocate for new community-facing roles that can support people to address what those core issues are. Dialogues with stakeholders outside of the system are vital; as Salma said, “the  people that helped join the dots between the different bits of the system are no longer there”. 

At such a trying time, Salma welcomed the concept of events such as the NHS Executive Strategy Summit. “It’s incredibly important… It gives operational leaders space to reflect, take a step back from the pressure of the day to day, to reflect on our own internal approach and learn from others, and to then come back affirmed that we’re as ready as we could be”. Monitoring and maintaining the wellbeing of staff across the NHS will be vital to withstanding winter pressures, and spaces such as the NHS Executive Strategy Summit help operational leaders such as Salma support themselves to then go and support their own staff. 

The conversation ended with a discussion of what resilience means this winter. “Resiliency is having joined up integrated approach which everybody understands across the system, with additional escalation points”. From her perspective as the leader of a mental health, disabilities and autism provider, Salma believes that her beds are filled nearly 20% with people who are “clinically fit to be discharged, but have got incredibly complex needs with ongoing, high levels of risk”. Managing these complex situations has required innovation, and Salma has focused on working closely with social care partners. Additionally,  “we’ve been working to strengthen the front end of services, liaison services, and we’ve invested in a clinical decision support unit”. Evidently, a joined-up approach that collaborates with partners outside of the system is key to building sustainable resilience.

To learn more about the NHS Executive Strategy Summit, visit: https://www.meethealthevents.com/nhs-executive-strategy-summit-ness-2023

November 21, 2023

“There’s no single silver bullet” – Paul Tambeau of Induction Healthcare on how Technology can Support the NHS

Following the NHS Executive Strategy Summit on 7th November, Distilled Post spoke to Paul Tambeau, the CEO of Induction Healthcare. Induction were a key vendor at this year’s event, and specialise in providing technology solutions that transform interactions between patients and clinicians, with a video consultation platform, the Zesty patient portal and a bespoke platform to assist in the creation and publication of local guidance for medical organisations. Paul has previously worked with Induction as their COO and Chief Growth Officer, and previous to this he was the Chief Commercial Officer for Doctor Care Anywhere.

Paul began by reflecting on the Summit, which he attended earlier in November.  He saw the benefit of the event in simple but striking terms: the space the Summit provided for “just listening, and hearing.” While he is well-versed in conversing with customers, “having that intimate setting where you can really talk through issues in a space place - it’s just really helpful, hearing experiences and what are the pain points and potential opportunities”. Traditionally, Induction Healthcare have been more focused on the acute sector, and Paul was impressed by the strong presence from other areas such as mental health - Claire Murdoch (the Director of Mental Health for NHS England) was one of the keynote speakers. Paul was able to speak to a number of executives from community mental health Trusts and was excited by the prospect of opening up new areas where Induction might be able to support the NHS. 

Support is a buzzword surrounding the NHS in the present moment as the seasonal surges and pressures brought on by winter begin to take their toll. Paul was well apprised of the challenges facing the Health Service: “Waiting lists for elective procedures are growing to possibly north of 8 million patients next year… Labour actions over the summer are just compounded by the usual winter pressures.” The Summit aimed to generate collaborative solutions, but as Paul put it, “There’s no single silver bullet that’s going to solve any of these problems. What there is is lots of different partners and providers coming together and playing a supporting role”. Induction have been working to alleviate pressure by supporting the NHS with wait list validation. Often patients on waiting lists either find that their condition improves or opt for private treatment in the interim, and by mass contacting those on waiting lists to validate that they still require an appointment, “We’re able to take 5, 10% of those people off a waiting list, and prioritise those who actually need this kind of support in the shorter term.” 

Induction is further optimising waiting lists through their Zesty patient portal, which places appointment details in patients’ hands, with the ability for patients to cancel, reschedule or validate their appointments. Paul referenced Induction’s Attend Anywhere platform, which further empowers patients by allowing them to access treatment remotely via a video consultation (often sparing patients long distances to travel). From a clinical perspective, the advantages are clearly apparent: “you get to see more patients, in a more timely way”. The discussion of remote consultations led to a wider conversation surrounding the role of care in the community. Paul was adamant that in many cases attendance at a hospital or medical organisation is a necessity, but observed that from a capacity perspective there were certain scenarios - perhaps a pre-surgery check-in - where bringing people into hospital might be an unnecessary burden on capacity that digital consultations can alleviate. “It supports the creation of efficiencies in how care is delivered.” And the Attend Anywhere platform is flexible in its uses: a group consultation function allows for numerous possibilities, including holding clinics or education sessions, or perhaps group counselling sessions within Mental Health Trusts. Remote consultations also hold significant advantages for those living in isolated or rural areas. Paul concluded by reiterating that the benefits of video consultations, and more widely the implementation of technology in healthcare settings, are clear to see for patients and clinicians alike.

November 20, 2023

Helping Frontline Teams to “Make the Change They Really Want”: Jenny Panes on implementing continuous quality improvement and empowering NHS staff in their work.

The NHS Executive Strategy Summit was an opportunity for operational leadership teams from across the NHS to come together and explore new ways to reduce pressure on the NHS and improve outcomes. The implementation of new strategies for NHS Trusts includes, in some instances, collaborations with vendors such as KPMG. To highlight the role that companies like KPMG can play, Distilled Post spoke to Jenny Panes. Jenny is a partner at KPMG, specialising in Provider Improvement and Urgent and Emergency Care. She has extensive experience of management in the NHS and is a proud graduate of the NHS Management Training Scheme.

KPMG have worked with 20 NHS Trusts to co-design and roll out continuous quality improvement (CQI) systems. The conversation began with a discussion concerning what it is that Trusts need to do to implement CQI and ultimately deliver the best service to patients. “The NHS is really good at putting quality at the heart of everything it does”, Jenny was first keen to point out. But she acknowledged that the service is facing “even greater operational pressures” than usual: the continuing ramifications of a period of sustained industrial action over the summer, the fallout from COVID and a challenging financial landscape to name but a few. As Jenny asserted, “being able to keep quality at the heart of everything we do against that backdrop of competing priorities is the number one challenge for the NHS”. In working with 20 NHS organisations to set up a CQI system, she observed how each organisation placed patient safety, access, and outcomes at the heart of their strategy and vision. Quality outcomes for patients have to be “baked in” to any vision for CQI implementation. 

Jenny also identified the value of evidence-based planning and the benefits of using data to understand the challenges facing the NHS, as well as the things that each respective organisation are doing well. “We need to be using data and information management in a really proactive way, to understand our challenges and their true root causes and also to prioritise where resources are directed”. In the quest for improving practice, she also pointed towards the importance of learning and best practice. “Every time I visit any NHS organisation, there’s always something that I’m blown away by”. Despite this, Jenny conceded that “best practice examples aren’t always shared nationally, or even across a given region”. Some of the best work that KPMG has done recently with the NHS, Jenny surmised, involved sharing regional best practice for any given care pathway. In doing so, similar organisations facing similar challenges don’t need to start from scratch in devising a combative strategy; indeed often “80% of the thinking has already been done by someone else, and the energy can go on tailoring the intervention to a given population, workforce or trust”. This sharing of knowledge is something Jenny is keen to see more of.

The NHS Executive Strategy Summit on Tuesday 7th November was another space where sharing best practice, knowledge and experience came to the fore. Jenny was enthusiastic about the value of such an event: “the minute you bring colleagues together from different trusts and different regions, automatically, there is benefit in the shared learning; peer support, new ideas, old ideas that you can often make even better. So I think just by virtue of putting experienced colleagues together, we always become greater than the sum of our parts”. The value of collaboration is embedded in KPMG’s approach to working with NHS clients – improvement / management systems are co-designed with Trusts to maximise ownership and engagement. Jenny reiterated that vendors like KPMG  serve to empower the job that NHS staff do -  “The phrase that our NHS clients often use is that we help them to “remove the rocks from their shoes”, so frontline teams can really make the change that they want and that patients deserve”. 

November 20, 2023

“It gives you the opportunity to build those richer, more dynamic, more responsive, more patient focused pathways”: Nick Barlow on the Transformative Potential of Technology in Healthcare

Digital solutions were a hot topic at this year’s NHS Executive Strategy Summit, co-organised by Meet Health Events and Proud2bOps. The event, held on 7th November, provided a valuable space for discussion for a large number of NHS operational leadership teams. With the onset of winter, leaders from across the Service came together to share experiences, learnings, and work together to develop collaborative solutions to some of the most pertinent problems facing the NHS. Invariably, any discussion of solutions has to involve the advent of new and innovative technologies and their potential role in supporting the NHS and its staff. Present at the Summit were a number of companies offering such digital solutions, including DrDoctor. DrDoctor has developed a number of tools, designed to create a system that works for everyone – patients, clinicians and providers. Its technology centres on their cutting-edge Patient Engagement Platform, which enables patients to take more control over their own care, using  services such as digital booking tools, direct 2-way messaging, forms and assessments for waiting list validation and digital PIFU and a video consultation platform. Distilled Post spoke with Nick Barlow, the Executive Director for Transformation at DrDoctor. Nick has considerable experience from within the NHS, previously holding roles including Chief Digital Transformation Officer at University Hospitals Birmingham NHS Foundation Trust.

The conversation began with a discussion around what resilience looks like for the NHS this winter. “For me, the balance between winter and summer is probably more about the focus and bias between urgent and emergency care in the winter, and elective care in the summer”, Nick began. “Resilience, for me, is the ability to keep both shows on the road every twelve months”. Nick acknowledged that while this might be easy to say, it represents a number of huge challenges. But he was also keen to draw attention to some of the solutions the NHS is already developing to combat winter pressures: he cited on a national level the implementation of rapid response and support services into the community, and ‘care traffic control’ centres that are used to assess the whole system to identify potential pressure points, with a view to ensuring that no individual or provider is struggling under the pressure more than another. He was clear that “staff are our most precious resource at the moment” - staff shortages abound across the NHS, with the cost of living crisis contributing further to low levels of staff retention as portions of the workforce move to more financially rewarding sectors such as retail or hospitality. 

While Nick was quick to acknowledge the fantastic initiatives already implemented to support NHS staff and patients, he also saw a need to layer new ways of thinking and new models of care on top of existing structures. He described this strategy as “a hybrid model of healthcare, where you get the right mix of in-person care where it’s appropriate, blended with digital care where it is appropriate - particularly with regards to high-volume, lower complexity work”. He observed that the debate surrounding digital versus in-person care can be misleading; the solution lies in balancing both, “on a patient by patient, pathway by pathway, condition by condition basis”. Nick identified huge opportunities for digital solutions to help with particular issues, and cited patient initiated follow-ups as an example: instead of booking in patients for follow ups six months down the line, they are given information that instruct them to book in for another appointment if their symptoms flare up again. As Nick summarised, “it gives patients the opportunity for a better experience and it also gives the NHS back precious capacity”. But as always, Nick saw balance as key. He cited a case study involving DrDoctor and University Hospitals Birmingham Foundation Trust, where 2.3 million digital appointment letters have been sent out since 2020. 71% of these letters were opened by a “big, fantastically diverse population”. But Nick was focused on ensuring that the remaining 29% of patients were just as supported: “whenever we implement these technologies, we're really clear that this has to coexist alongside a more traditional method of communication too”. 

The hybrid model of technological and in-person support is at the heart of DrDoctor’s work. “The big prerequisite to make that hybrid model work is we need patients to be fully involved in their own care pathways. And we need to be able to empower them to actually get involved, have control of their own care.” In advance of an appointment, utilising digital services that allow patients to give clinicians more information on their condition can then allow clinical teams to save time by directing the patient to the right healthcare professional, or indeed opting to send the patient for a test first. Collaboration with healthcare professionals is key in the technology’s implementation: “when you switch the technology on, it doesn’t just work out the box, there’s process – behavioural and pathway changes that need to be made… So we put teams in alongside them to coach support, facilitate, provide the tools, the frameworks, the information, the experience, to help navigate that process and go through that process in as quick and efficient and effective a way as possible”. 

It’s clear to Nick that technology represents a potent solution to some of the issues facing the NHS. And DrDoctor wants to be part of that support system to the NHS, to patients, and to providers. The proof of their capability is in the work they’ve done so far. To date, DrDoctor have managed more than 103 million appointments across more than 50 healthcare providers. The benefit? Within the last 12 months alone, there have been 257,000+ fewer missed appointments and 128,000+ unnecessary appointments avoided, creating more than £50 million in value to local health systems and releasing more than 1,000 additional days to be spent with patients.

As Nick said, “technology gives you the opportunity to build those richer, more dynamic, more responsive, more patient focused pathways”. 

November 20, 2023

Edwin Ndlovu: “It’s really important the mental health conversation is held in these spaces” – The Pitfalls and Potential of Digital Solutions and the Importance of Community Provision

The spaces for operational leadership figures in the NHS to come together and reflect are few and far between. The NHS Executive Strategy Summit on 7th November provided one such space, and the day brought together a diverse range of experiences and practices in the spirit of collaboration and learning best practice. As we reflect upon the event, Distilled Post is speaking to NHS leaders about some of the issues the Summit covered, including winter pressures and the potential for digital innovation to navigate these pressures. We sat down with Edwin Ndlovu, the COO of the East London NHS Foundation Trust. Edwin’s background is as a mental health nurse - he was the Borough Lead Nurse and Associate Clinical Director for Newham adult mental health services from 2009 - 2015 before becoming the Borough Director for Tower Hamlets in 2016. Edwin is a recipient of the Nye Bevan Healthcare Leadership Programme award. 

The conversation began with some reflections on the event. “I recognise the importance of every so often taking a moment to just stop and think together”, Edwin said. He is well aware of the importance of being part of a community, as a nurse and as a member of the Jabali Men’s Network, a group that brings together senior men in nursing leadership from across the NHS. Edwin was impressed by the number of mental health representatives present at the event - Claire Murdoch, the National Mental Health Director for NHS England, delivered one of the keynote speeches. “I think historically, these events mainly focus on the physical health or the acute care side of things… it’s really important that the mental health conversation is held at this level in these spaces. A lot of the time, it’s when things have gone wrong that people start to talk about mental health.” He welcomed the opportunity to talk about mental health in the broadest sense of that service and on par with physical health care and using spaces like the NSS to focus on improving quality and the patient experience. Ultimately, Edwin assessed the value of such events as being in “that we can bring learning, new ideas back into our own part of the world and test them out”. I would like to see more explicit service user or people participation involvement at these forums in a more active way because without them then we are not really going to have sustainable improvement.

The Summit gave leaders an opportunity to discuss pressing issues, including patient flow. “We are seeing an increasing number of patients who are stranded in our beds, and these are patients whom we struggle to place beyond the episodes of care”, Edwin commented. He pointed towards a greater emphasis placed on community care provision to help remedy this, but acknowledged that often people are not able to access community care in time and therefore end up being admitted. He also highlighted how family connections, charities and the wider fabric of community support have been eroded in the wake of the pandemic, observing, “People don’t have that natural safety cushion that allows them to manage some of life's challenging events or help them to be quickly moved out of hospitals”. He also saw preventative measures as an inherent part of the solution to fixing patient flow: “There’s a lot of conversation around people who are waiting longer in Emergency Departments (EDs), but I try to say ‘no’ - let’s focus on what we can do to stop people rocking up to EDs in the first place”, this take collective efforts and events such as NSS are really helpful and providing platforms to learn together, design together and deliver together. 

The potential of digital strategies to alleviate some of the aforementioned issues was a hot topic at the Summit, and Edwin saw clearly the possibilities of technology. He was mindful of considering all the variables when it comes to digital implementation: “there’s an equity conversation that needs to be always had, front and center, when we start talking about digital solutions”. He was keen to make it clear that “some of the people we’re talking about here don’t even have access to food or other basic things needed in living. So if somebody cannot eat, then they’re not going to be thinking about Wi-Fi or a smartphone”. Despite this, he recognised that the potential is abundant: he referenced significant opportunities in the field of talking therapies, and in terms of back office functions to free up staff to do necessary work. Ultimately, digital solutions can empower the workforce while giving patients flexibility and choice in their care. There was still, Edwin acknowledged, “a challenge in that we focus a lot of diagnosis using digital platforms. But when it comes to the treatment part there are fewer digital solutions”. But the possibility of technology, Edwin summarised, is “an opportunity to repurpose ourselves as human beings to do other things”.

November 20, 2023

“Only every so often we come together as a system” – Chinyama Okunuga on the importance of sharing experiences

The NHS Executive Strategy Summit, organised by Meet Health and Proud2bOps, will bring together Chief Operating Officers (COOs) from across the NHS to discuss and find solutions to urgent issues including winter pressures on the NHS and patient flow. 

In advance of the event on 7th November, Distilled Post spoke to Chinyama Okunuga, the COO of Whittington Health NHS Trust. The conversation covered the challenge of building resilience in winter, the shifting expectations and needs of patients post-pandemic, and the potential of technology to free up beds in hospitals.

Chin opened by expressing the need for collaboration across different systems and partners within the NHS in building resilience: “Only every so often we come together as a system”, she noted, despite the fact that patients are moving more frequently outside local authority boundaries. Whole-system conversations about primary care and the strain on the ambulance service are rarely had, and so it proves challenging to share resources for emergency care and strengthen community services. Chin noted that these obstacles are faced within an immensely tough financial climate: her Trust had just been told that they would receive no additional funding this winter, regardless of their need to open surge beds in hospitals to cope with increasing demand. 

The conversation then turned to how patient flow could be improved in the long term. Chin expressed that it was essential for patients to shift their expectations and “own their own health”, an attitude that had begun to exist before the pandemic, which then transformed “how people want to be cared for, and how quickly”. She described how patients were quick to use resources and services for very urgent emergency care, even when their needs might not necessitate such a decision. She added that the NHS should, in turn, take into account how much the demographics of service users have changed, citing the ageing population with increasingly complex needs, and the phenomenal increase in patients suffering from mental ill-health: “the next pandemic”, according to Chin, as services struggle to manage the acute mental health episodes occurring within the population. 

Chin elaborated on her assertion that whole-system thinking was essential to managing pressure on the NHS, explaining that the NHS must begin to take a holistic approach to patient care. “How do we look after the whole of the patient?” she asked. The active and real integration of health and social care would facilitate such a holistic approach, allow professionals to look after patients with multiple and long-term issues, and ensure the onward care of those leaving services. Understanding the whole picture, or the “patient’s pathway right up to outside a hospital”, is crucial, Chin stressed. 

The conversation concluded with Chin stressing the importance of an event like the NHS Executive Strategy Summit. Professionals can learn from each other, and see good practice at all levels of the NHS, guiding those who may be struggling. “The real value”, she noted, “is for the people who attend knowing that they’re not alone in what they’re going through”. 

The NESS, organised by Meethealth and Proud2bOps, is on the 7th November in London.

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