We’re delighted to present our finalists for the category of “Best use of digital for improving care pathways”.
Suvera: Proactive recalls in general practice on autopilot
Overview: Planner redesigns the long-term-condition recall pathway around the patient. Instead of list-by-list searches, duplicate texts and repeat blood draws, patients with several conditions get one personalised invite and one combined appointment. Cape Hill expects to free 11 percent of clinical capacity.
What happened? We delivered our Virtual Clinic to over 200,000 patients, and used those learnings to build a workflow automation tool for manual admin in general practice. The recall pathway for long-term conditions is usually a set of separate manual tasks held together by a few experienced staff and a long list of clinical system searches, plus a multi-coloured spreadsheet. People are recalled when the search for their condition happens to be run, not when they most need to be seen. Planner redesigns this pathway from start to finish. The most important change is that it organises recall around the patient, not the disease register. It risk stratifies the whole population so the highest-need and most overdue patients are surfaced first. For the first time, practices can clearly see who is most overdue and work in clinical priority order rather than alphabetically through a list. Patients are offered one multi-condition appointment instead of several. Because the workflow is guided and rule-based, any team member can run it. The practice sets the rules once, and Planner then carries out each recall cycle automatically in the background. At Ashville Surgery, the new pathway cut recall from almost a full day across two staff to smaller daily tasks for one.
NHS England & Chelsea and Westminster NHS Foundation Trust: AI-Assisted Discharge Summarisation (AADS): From partnership pilot to national transformation
Overview: Co-developed by NHS England and Chelsea and Westminster NHS Foundation Trust, the AI-Assisted Discharge Summarisation (AADS) tool uses generative AI to streamline discharge documentation. Now scaling via the NHS Federated Data Platform, it reduces clinician burden, improves care pathways, and accelerates patient flow.
What happened? By combining NHS England’s national AI capability and infrastructure with frontline clinical expertise at Chelsea and Westminster, AADS has been developed as a clinically grounded, real-world solution to one of the NHS’s most persistent operational challenges: delays in patient discharge caused by time-intensive documentation. AADS uses large language models, deployed securely via the NHS Federated Data Platform, to automatically generate structured first drafts of discharge summaries by extracting key information such as diagnoses, treatments, and test results. These drafts are always reviewed, edited, and approved by clinicians prior to finalisation. By automating the drafting of discharge summaries, AADS reduces time spent on repetitive administrative tasks, allows clinicians to focus more on direct patient care, improves consistency and completeness of documentation, and supports workforce sustainability by reducing pressure and cognitive load. By reducing the time required to produce discharge summaries, the solution enables faster discharge, improved patient flow and bed utilisation, more timely communication with GPs and community services, and safer and more consistent transitions of care.
Isla Health: Digital, used well: Improving care pathways from days to minutes
Overview: University Hospitals of Northamptonshire (UHN) and Isla Health improved outpatient care pathways by redesigning them around the condition, not the appointment. An app-free, asynchronous digital pathway now spans 15 specialties, letting 10,620 patients co-manage care from home while clinicians triage in minutes, not days.
What happened? Working with Isla Health, the trust set out to improve care pathways by rebuilding triage, treatment, and monitoring as an asynchronous, digital-first model. Patients submit clinical-grade photos, seizure videos, validated PROMs, and digital forms from home through a secure SMS or email link. Everything sits inside the trust’s existing systems, integrated with the PAS and Mediviewer, so clinicians work from one record. Rather than turning forms into PDFs, the team rebuilt the clinical logic, moving from a synchronous “snapshot” model, where care was triggered by the next available slot, to continuous monitoring that responds to the patient’s actual condition. The improved pathway runs across 15 specialties. These have freed clinical capacity while keeping care safe. UHN has safely deflected 36 percent of face-to-face follow-ups, resolved 75 percent of triaged cases the same day, and lifted clinic capacity 3.8 times without growing headcount. It has returned 5.4 percent of tissue-viability nurses’ working days to direct care and accelerated 18-week RTT performance by up to 85 percent, using patient-initiated follow-up and risk-adjusted triage to fast-track complex cases and safely step down low-risk ones.
The Dudley Group NHS Foundation Trust and Altera Digital Health: A digitally enabled approach to more efficient medication reconciliation
Overview: The Dudley Group and Altera introduced Medicines on Admission (MoA) within the Sunrise EPR. By streamlining previously complex workflows, MoA removes duplicate data entry across ED and wards, reduces manual transcription errors, frees up valuable pharmacy time, and ensures the timely delivery of critical medications.
What happened? The Dudley Group NHS Foundation Trust used Altera’s Sunrise Order Reconciliation Manager (ORM) functionality, designed around a traditional sequential workflow. Partnering closely with Altera, the trust launched a digital module: Meds on Admission (MoA). The system pulls historical prescribing data from prior inpatient visits and displays a comprehensive, arranged picklist of previous TTOs and outpatient prescriptions directly in a dedicated user interface. Clinicians can pick from this history to instantly build an “Admission Home Meds” list without re-keying data. Crucially, MoA enables a seamless persistence of reconciliation status from an ED visit straight into the inpatient visit. Pre-deployment shadowing revealed that manual, blank-slate documentation took an average of 3.0 minutes per drug in ED and 4.6 minutes per drug on inpatient wards. Following MoA deployment, post-implementation data tracking showed that importing a drug item into ORM via the MoA picklist takes an average of just 29.7 seconds per drug. Within the initial 3 months of activation, over 4,000 medication items were successfully imported. This equates to a conservative saving of 1,996 minutes (33.2 hours) of specialised pharmacy time.
Isla Health: Improving care pathways through digital co-design to clear 17,000 waiting list entries and unlock theatre capacity
Overview: Chelsea and Westminster Hospital NHS Foundation Trust improved care pathways by replacing fragmented workflows with Isla’s Digital Pathway Platform. This safely removed 17,000+ waiting list patients in just 9 months, cut theatre cancellations by 57 percent, and unlocked clinical capacity by saving 135 hours of clinical time.
What happened? Chelsea and Westminster Hospital partnered with Isla Health to deploy a Digital Pathway Platform (DPP), establishing a secure, closed-loop infrastructure integrated into existing e-RS and NHS systems. Clinical teams use automated text messages to validate if patients still require surgery, verified patients receive a mobile-first DHQ sent by SMS to capture surgical needs, comorbidities, and short-notice availability. The platform categorises incoming data by health risk to directly assist in improving care pathways. “Green-lighted” healthy patients bypass face-to-face POAs for direct listing, while complex cases are flagged early for immediate specialist review. Within nine months, over 17,000 patients were safely removed from theatre waiting lists. Automated triage recovered 135+ clinical hours and cut face-to-face POAs by 36 percent. On-the-day POA cancellations fell 57 percent, and identifying 7,800+ short-notice patients filled gaps, boosting booked utilisation by 15 percent and overall utilisation by 8 percent. Wound uploads saved 14 minutes per nurse review, saving tissue viability teams 200+ hours annually. Ward managers reclaimed 2.5 to 5 hours weekly from filing. The initiative delivered £731,852 in total efficiency savings.
Oushk Pharmacy: Implementing a GPhC-aligned digital GLP-1 care pathway
Overview: Oushk Pharmacy rebuilt its online GLP-1 service into a GPhC-aligned digital care pathway, embedding structured assessment, live verification, pharmacist review, mandatory follow-up and nutrition support. It supported 90,000+ patients nationwide in 2025, improving safety, clinical oversight and scalable access.
What happened? Following the publication of updated guidance in February 2025, Oushk launched a phased redesign of its systems, workflows and patient journeys. A key achievement was formalising Oushk’s pharmacist-led approach into a structured, continuously monitored digital care pathway. Core standards were embedded into platform architecture so that assessment, verification, prescribing, monitoring and intervention were applied consistently. Simplified intake forms were replaced with multi-step assessments requiring patients to submit detailed medical history, current and previous medication use, BMI data and treatment context before any prescribing decision is made. Verification was strengthened through mandatory live consultation, including a live weigh-in on scales. All submissions are reviewed by a pharmacist in line with GPhC guidance. Patients complete regular reviews to continue treatment, and the platform enforces weight re-verification at defined intervals, including a minimum requirement every six months. Oushk supported more than 90,000 GLP-1 patients in 2025, with 62 percent average retention based on active clinical review rather than automatic renewal.
QCS: Compliance that thinks: Transforming social care through real-time intelligence
Overview: QCS and CareBrain have created a real time care compliance intelligence platform, transforming static policies into live, AI driven guidance at the point of care. By uniting regulatory expertise with sector specific AI, it reduces admin, boosts quality, supports staff, levels the playing field for smaller providers and improves outcomes.
What happened? QCS provides what good looks like: expert policies, best practice and regulatory clarity. CareBrain provides how to deliver it in real time: AI powered workflows, virtual mentoring, dynamic care planning and risk coaching at the point of care. The combined platform turns QCS’s policies and guidance into live, usable tools for frontline teams. Policies become shift prompts, real time guidance, and automated actions. Care plans become living documents, updated and interpreted at the point of care. Supervisions become AI supported, reflective conversations. The Care Plan Audit tool and Risk Management Coach instantly check compliance, quality, and outcomes. An AI Virtual Mentor offers 24/7 real time expert guidance to frontline staff, and analytics dashboards identify knowledge gaps and training needs in real time. Care managers in pilots report nine hours per week saved, and supervisions see up to 75 percent reduction in admin time while improving quality and depth. 173,000 policies are read and shared weekly with 500 policy updates every month, ensuring guidance is always current, and 10,000+ frontline queries have been answered in one year through AI enabled support.
Care Property Hub: Digital matching to accelerate supported living placements and care activation
Overview: Care Property Hub digitises the housing-to-care pathway, connecting CQC-registered providers with suitable properties in real time. By removing information silos between landlords and care providers, we reduce placement delays, enable faster care transitions, and promote better outcomes for vulnerable adults.
What happened? Care Property Hub is a digital platform that connects CQC-registered care providers with landlords, agents, and property sourcers offering suitable accommodation, in real time. Our model works across three housing types: supported living, social housing, and emergency housing. Providers log demand (residents needing placement, care type, location, timeline). Landlords and sourcers list properties (location, bedrooms, rent, accessibility). The platform matches them in real time via an intelligent interface that understands both care and housing requirements. Placement time reduces from weeks to days. Care services activate faster. Crisis accommodation duration shortens. Matches are better because housing is sourced with care requirements (not just rental price) in mind. Accessibility, location, support infrastructure, and tenant vulnerability profiles are all visible before matching. Since its soft launch in late 2025, Care Property Hub now serves 40+ CQC-registered care providers across the UK, with an active pipeline of 80+ properties. Members report an average placement acceleration of 10–14 days. One local authority reported reducing emergency accommodation costs by 6 percent.
Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust: Digital referral redesign for Emergency Department mental health patients
Overview: WWL delivered a nurse led digital redesign of the ED mental health referral pathway, embedding real time digital referral into the Altera Sunrise™ EPR. Referral times reduced by 95 percent, time to be seen by a mental health practitioner reduced by 70 percent, and the solution released the equivalent of 11 WTE nursing time.
What happened? WWL extended the use of Altera’s Sunrise EPR Platform to create a digitally enabled, EPR native mental health referral process. Key features included auto population of ~85 percent of referral data, removing duplication and reducing cognitive load at triage; real time routing of referrals directly to the mental health inbox; referral at arrival, reducing the pathway from five steps to three; and native EPR integration, eliminating the need for scanning, emailing or parallel systems. The solution was developed and configured in house, allowing rapid iteration, strong control of clinical safety and alignment with existing ED workflows. The work was delivered through WWL’s Digital Champions Programme, with frontline nurses, clinical informaticians, ED clinicians and mental health colleagues co designing the pathway end to end. The team mapped existing workflows and time delays in real clinical settings, piloted the digital referral live in ED, and introduced concise, practical training. Audit data demonstrated a 95 percent reduction in referral time, from 68 minutes to 4 minutes; a 70 percent reduction in total time from arrival to being seen by a mental health practitioner (from 148 minutes to 45 minutes); and 11 WTE nursing time released.
Paynela: Accelerating patient access through AI-driven affordability pathways
Overview: Paynela improves care pathways by removing financial friction that delays access to treatment. Using AI-driven solutions, we process claims faster, identify available funds, and deliver payments directly to patients with less manual work and greater transparency. The result is a simpler, faster, more patient-centered affordability journey.
What happened? Our digital innovation improves care pathways by removing one of the most common friction points in the patient journey: the process of managing claims, reviewing documentation, identifying available funds, and getting support into patients’ hands. Paynela addresses this challenge through a suite of AI-powered solutions designed to streamline the affordability pathway from end to end. NelaClaim helps process and extract essential information from large volumes of documents in minutes, dramatically reducing the manual effort required to review explanation of benefits and adverse event monitoring documentation. NelaPay identifies available funds and gives organisations flexible control over how those funds are distributed. NelaView makes fund management simpler for patients by giving them a more direct and user-friendly way to access and apply support. Patients can transfer funds to a debit card, bank account, or payee, including applying them directly to deductibles. Faster processing means reduced turnaround times and less manual work. Simplified fund distribution means patients can get support sooner. Together, these improvements help remove barriers that can slow access to medications, treatment, and care.
Jubail General Hospital: Data-driven transformation in emergency care using interactive performance dashboards
Overview: A data-driven transformation project in the ED implemented interactive dashboards to monitor operational, clinical, and patient experience indicators. Using Agile and PDSA methodologies, the initiative improved patient flow, reduced waiting times, enhanced decision-making, and enabled real-time performance monitoring.
What happened? The project adopted an Agile methodology combined with continuous quality improvement using PDSA cycles. Development progressed through iterative phases, starting with basic reporting, followed by KPI standardisation, expansion of indicators, and the implementation of interactive dashboards using Power BI. These dashboards provided daily, monthly, and annual views of performance, enabling teams to track trends, identify gaps, and monitor the impact of interventions. A key component of improving care pathways was enhancing patient flow through digital visibility of key performance indicators such as door-to-doctor time, decision-to-disposition time, and length of stay. The implementation of the Rapid Assessment Zone (RAZ), supported by data insights, significantly improved patient flow and reduced waiting times. The results demonstrated substantial improvements across multiple domains. The percentage of patients treated and disposed within 4 hours increased from 88 percent to ≥99 percent. The rate of patients leaving without being seen (LWBS) decreased from 4.78 to 2.34 percent, reflecting improved efficiency and reduced overcrowding. Additionally, unscheduled return visits within 72 hours declined significantly.
Portsmouth Hospitals University NHS Trust: Transforming the stable chest pain pathway: Embedding digital Heartflow FFRct to optimise patient care and eliminate backlogs
Overview: Portsmouth Hospital University transformed its stable chest pain pathway, embedding non-invasive FFRct endorsed by NICE. Optimising the pathway transitioned its catheterisation lab from a diagnostic center to an active treatment hub, slashing elective procedure wait times and securing £34k in recurrent monthly savings.
What happened? Our organisation integrated Heartflow FFRct directly into the elective stable chest pain pathway as a digital gating mechanism following initial CCTA screening. Instead of routing patients to an invasive coronary angiogram in a cath lab, clinicians now use this cloud-based AI and CFD digital medical technology to identify clinically significant disease. This digital intervention achieves precise patient stratification without invasive risk, optimised diagnostic confidence, and evidence-based decision-making that shifts acute diagnostics away from invasive hospital spaces. Transforming this clinical pathway required collaboration across cardiology, radiology, cardiac physiologists, operational management, and digital/information teams. We initiated a consultant/nurse-led triage model ensuring that patients with intermediate stenoses on CCTA were automatically and seamlessly routed directly to Heartflow for digital analysis. Elective procedure waiting lists reduced from six months to six weeks. Moving 410 patients annually from FFRct back to standard cardiac catheterisation would cost the trust £664k against an FFRct cost pressure of £258k. Retaining the digital pathway actively prevents an annual financial loss of £406k, a recurrent saving of £34,000 per month.
DHU Healthcare (lead organisation), Doccla: Transforming falls management: Implementing novel pathways in the community virtual ward
Overview: The virtual ward’s digital falls pathway has driven outstanding results, enabling proactive identification and management of frailty in the community. Community VW activity increased from 588 to 1,907 patients, with improved flow, reduced length of stay and higher utilisation.
What happened? DHU Healthcare, working in close collaboration with Doccla and system providers, implemented a new digital pathway for frailty and falls patients, transforming care from reactive to proactive care. At the centre of the model is a simple, scalable digital solution combining a clinician dashboard providing real-time patient oversight, a patient-facing app enabling communication and symptom reporting, and easy-to-use monitoring devices. Patient feedback demonstrated the technology was easy to use, reassuring and enabled patients to remain safely at home while feeling continuously supported. Continuous remote monitoring enabled early identification of deterioration in frail patients at risk of falls. Direct referral enables “call before convey” decisions, reducing unnecessary hospital attendance and improving flow. Patients onboarded increased from 588 to 1,907 year-on-year; referrals increased from 630 to 1,942, and conversion from accepted to onboarded improved from 93.5 to 100 percent. Average length of stay reduced from 8.06 to 7.61 days, and bed utilisation increased from 44.5 to 79.5 percent. Step-up patients (admission avoidance) increased from 580 to 1,317, and step-down patients increased from 8 to 154.
Kensa Health: Using data to shift urgent care closer to home for frail patients in East Kent
Overview: Kensa Health supported East Kent partners to use linked patient data to improve urgent care pathways for frail patients. Through Health Insights, teams identified a frailty proxy cohort and strengthened alternatives to hospital attendance, supporting care closer to home and reducing admissions, bed days and system pressure.
What happened? Health Insights brought together anonymised patient journey data covering A&E attendances, hospital admissions, outpatient activity, discharges, community inpatient activity and wider population trends. The work focused on an agreed frailty proxy cohort, using criteria such as age, diagnosis and patterns of health service use. The key pathway change came in November 2023, when East Kent improved access to Hospital at Home through a Single Point of Access (SPOA). Because many patients in the frailty cohort arrived by ambulance, senior paramedics were also given a route into SPOA after dispatch, reducing avoidable conveyance where a safe community alternative was available. Statistical Process Control charts tracked admissions and helped distinguish meaningful change from normal variation. The team compared actual admissions after 6 November 2023 with the expected trend had the initiative not been introduced. The analysis indicated a reduction of around 16 admissions per week. The same methodology showed a reduction of around 100 bed days per week. A reduction of 100 bed days per week is equivalent to 14 beds. At £350 per bed day, the non-cash releasing equivalent is approximately £1.8m per year.
Aire Innovate: Sheffield Children’s NHS Foundation Trust digital ePROMs transforming paediatric psychological care insights
Overview: We have built an NHS-led implementation of a fully integrated, automated electronic Patient Reported Outcome Measure (ePROMs) system in paediatric mental health. This is significant as demonstrating the effectiveness of psychological interventions is a challenge nationally, due to a lack of standardised, objective data and metrics.
What happened? Using the Aire Innovate platform, we have taken a number of validated PROMs used in paediatric psychology and translated them into a digital format that sits within routine care. From a clinician’s perspective, the process is now much simpler. Patients are added to a list, relevant questionnaires are selected from a pre-configured set, and these are sent electronically via a secure link. Patients and families can complete them on their phone at a time that suits them. Responses are scored automatically in line with clinical standards. Once submitted, results are available within the EPR, meaning clinicians can review them ahead of the appointment. We have applied this across a number of pathways, including RCADS for anxiety and depression (which contains 47 items), the WHEEL tool for young people with cystic fibrosis, and within remote CBT services. Since going live in early 2026, over 30 clinicians have adopted the system and more than 170 questionnaires have been completed. Tasks that previously took around 105 minutes across a group of patients can now be completed in approximately 20 minutes – an 80 percent reduction. In some cases, automated scoring saves up to 25 minutes per assessment.
Consultant Connect LTD: Clinically-led Referral Triage and Validation: Improving pathways and reducing waits
Overview: Clinically-led Referral Triage and Validation has transformed elective care pathways across NHS Trusts by rapidly reviewing referrals, directing patients to the right service first time, initiating diagnostics earlier, and reducing unnecessary hospital appointments. Over 150,000 referrals have been triaged to date.
What happened? Clinically-led Referral Triage and Validation enables NHS consultants from the National Consultant Network (NCN) to work remotely as virtual locums and review referrals securely using digital systems. The service can be deployed rapidly and adjusted in line with local demand. Capacity can be increased, reduced, or paused within 72 hours, allowing trusts to respond to changing pressures. Referrals are clinically reviewed so patients can be routed to the most appropriate service first time, reducing avoidable outpatient appointments and repeat referrals. NCN consultants identify referrals requiring urgent escalation, whilst lower-risk patients can be safely managed through alternative routes. The service has been backed by NHS England, and more than 150,000 referrals have been triaged to date, including more than 40,000 in one quarter alone. On average, 38 percent of referrals have been returned to primary care with detailed management advice, enabling hospital capacity to be focused on patients needing specialist intervention. In North West England, within six weeks 4,500 neurology referrals were triaged, a 20 percent reduction in the waiting list was achieved, and 900 patients avoided an unnecessary hospital appointment.
