News in brief
NHS boss warns of four hard years ahead after health service gets less cash than requested: The head of the NHS has warned of four hard years ahead for the health service – dismissing ministers’ claims that it has been given all the money it needs, reported the Independent. Simon Stevens warned that much of a promised extra £10bn each year has been “back-ended to 2020”, which means promised improvements would be delayed and tough choices inevitable in the interim. Speaking to an inquiry by MPs, Mr Stevens admitted to the looming funding shortfall. He warned: “In the intermediate years, we have got a bigger hill to climb than we first envisaged… there will be controversies along the way.” The statement will severely embarrass ministers who have repeatedly dismissed warnings of a crisis on the basis that the NHS has been “given the money it asked for”. Asked about the funding requested by NHS England for its Five Year Forward View, home secretary Amber Rudd replied: “We’ve delivered on that money.” But Mr Stevens, giving evidence to the Commons Public Accounts Committee, said it was only in 2016-17 that the NHS was getting “broadly what we asked for”. Mr Stevens was read the head of the National Audit Office’s conclusion that, without proper funding and tough efficiencies, “the result will be some combination of worse services, fewer staff, deficits, and restrictions on new treatments”. He replied: “I agree with that entirely. I wasn’t quite sure if that was one of my quotes.” Ministers will point out that, last autumn, Mr Stevens welcomed the £10bn pledge. But a report by the Commons Health Select Committee concluded cuts to public health and training budgets, and the use of capital funding to plug deficits, meant the real figure was much smaller.
Seven-day NHS ‘impossible under current funding levels’: A seven-day NHS is “impossible” to achieve with the current funding and staffing levels, the chief executive of NHS Providers has said, reported the BBC. Chris Hopson said that “something has to give” and there should be a debate about which services to sacrifice “rather than pretend the gap doesn’t exist”. Health secretary Jeremy Hunt has called for a seven-day NHS since 2015 after his department concluded that there was a “clear link between poorer outcomes for patients and uneven service provision at the weekend”. Introducing a seven-day NHS also formed part of the Conservative Party’s manifesto, and it’s based on data which suggests that patients are 16% more likely to die if they are admitted on a Sunday compared with a Wednesday. However, the reasons for this have been contested, and medical professionals agree that people who arrive in hospitals at weekends tend to be sicker than those who do so during the week. NHS Providers, the organisation that represents hospitals in England, said unless urgent funding is provided, it will have to cut staff, bring in charges or introduce “draconian rationing” of treatment, for example, of non-urgent operations. Mr Hopson said: “Jeremy Hunt and others have made a very strong case for seven-day services, but it seems to us it’s impossible on the current level of staff and the current money we have available.”
Care for elderly ‘increasingly rationed’ in England: Government-funded care for older people is being increasingly rationed in England, leaving growing numbers to fend for themselves, a joint report by The King’s Fund and Nuffield Trust has suggested. The BBC reported that the number of over-65s being helped by councils had fallen by a quarter in the four years to 2014. This was despite more people needing help, because of the ageing population. But the government said it was investing in the system to ensure “affordable and dignified care”. Care is means-tested, with only the poorest getting help to pay for services, including help in the home for daily tasks such as washing and dressing, as well as round-the-clock support in care homes and nursing homes. The think tanks carried out interviews with people working in the service and being cared for, as well as analysing existing data during their review. They found that spending on care by councils had fallen by 25% in real terms in the five years to 2015; over 40% of money paid to care homes came from people paying for themselves; and one million people with care needs now receive no formal or informal help – a rise of 10% in a year. The report said the funding outlook for the coming years was “bleak” and ministers needed to reform the system or be honest with the public that government-funded care was extremely limited. Ray James, of the Association of Directors of Adult Social Services, said councils simply did not have enough money. “We’re now at a tipping point where social care is in jeopardy,” he said. The BBC also reported that a sharp rise in waits for care services is piling the pressure on the NHS in England. Data for July showed that waits for care topped 61,000 days for hospital patients.
NHS facing ‘pockets of meltdown’ this winter: Resilience of medical units is being “put to the test like never before”, Dr Mark Holland, president of the Society for Acute Medicine, has said, reported The Guardian. It comes after the chief executive of NHS Providers, Chris Hopson, said the government would fail to achieve its aim of a seven-day NHS without more cash. Holland echoed the warnings about a service under pressure, saying those parts of the NHS where performance was already weak would find the winter months particularly difficult. He also pointed to the “national emergency” of medically fit patients not being discharged home from hospital. He said: “If hospitals cannot discharge patients then the system comes to a halt.”. Figures for July showed the equivalent of 184,188 days were lost due to delayed discharges, the highest on record, with estimates suggesting the figure across a year could be as high as 2.7 million bed days lost. The society published a new report on the performance of acute medical units based on speed of assessment, access to clinical decision-makers within four hours and a consultant review within 14 hours. The audit, which covered 94 units and 4,140 patients, showed 81% of patients were seen by a consultant within the target, 69% by a competent decision-maker within four hours and 69% had an early warning score recorded on arrival. However, only 41% of patients received all three. Holland said it was vital that NHS trusts that were struggling to cope were not “hidden” by better performers who average out the statistics.
NHS watchdog sets out new regulatory regime: Hospital trusts will be able to earn increased autonomy under a new regulatory framework published by NHS Improvement (NHSI), which could also see hospitals outside the special measures regime receiving “mandated support” from the regulator, reported Public Finance. Under the Single Oversight Framework NHS trusts and NHS foundation trusts will be grouped in four segments. These are: providers with maximum autonomy; providers offered targeted support; providers receiving mandated support for significant concerns; and those in special measures. NHSI will provide support to trusts based on their classification, with those in the top tier being reviewed by the watchdog on a quarterly basis. Others will be examined on a monthly basis, but those in special measures may be reviewed weekly. The new system is intended to allow for more tailored support for all hospital trusts, rather than the differing approaches of the previous frameworks, and allow for a more proactive approach to oversight and support for foundation trusts. “There is widespread support among providers for this new approach, which will see us share good practice across the NHS and help providers to learn from each other,” a spokesman for NHSI said. On finance, NHSI highlighted that the assessments would now include an assessment of sector controls such as agency staffing costs.
Nursing workforce levels are not high enough to meet patient demand, report warns: The number of nursing posts in the Welsh NHS still does not reflect the needs of people receiving care, a damning report from The Royal College of Nursing (RCN) has concluded. Wales Online reported that the new study of nursing levels in Wales has claimed the NHS workforce has remained static despite patient demand increasing. The organisation said it has particular worries over the levels of district nurses who care for people in their communities in a bid to reduce hospital admissions. More than 60 nurses across Wales launched a campaign to emphasise that nursing is a fundamental part of healthcare delivery. Tina Donnelly, director of RCN Wales, said: “This campaign highlights some of the real concerns of our members including the need to invest in nursing education. We have also used the campaign to showcase the excellent care given by some of our truly great nurses here in Wales.” The RCN has called on the Welsh government to ensure the numbers of pre-registration student nurses commissioned is maintained at the right level to meet workforce requirements rather than the ‘boom and bust’ cycles previously seen. It also wants the Welsh government to note the high levels of agency nurses being used in the NHS, who provide the equivalent value of an extra 1,062 newly-qualified nurses. Addressing the NHS workforce as a whole, the Welsh Conservatives called on cabinet secretary for health, Vaughan Gething, to bring forward a comprehensive strategy to tackle staff recruitment and retention issues.
Patient safety at risk due to Capita failings, BMA warns: “Multiple failures” in back office support services since they were taken over by outsourcing firm Capita have compromised patient safety, the British Medical Association (BMA) has said, following a qualitative survey of local medical committees, reported GPOnline. The BMA revealed the extent of Capita’s failures, including: practices experiencing prescription pad and syringe shortages, failure to process urgent requests in a timely manner and mistakes in recording NHS pension payments for GP locums. General Practitioners Committee chairman Dr Chaand Nagpaul claimed NHS England was “ultimately responsible for the chaos” by opening up the provision of PCS services to privatisation in an attempt to reduce costs. He said: “Local GPs are reporting to the BMA that they are facing unacceptable delays in patient record transfers and mistakes in maintaining supplies of crucial medical equipment. These mistakes are directly impacting on the ability of many GPs to provide safe, effective care to their patients. They are in some cases being left without the essential information they need to know about a new patient and the tools to treat them.” A Capita spokeswoman said: “We are continuing to work closely with NHS England and our focus remains on delivering these important services at an optimum level.”
32 SMEs win place on DigitalHealth.London accelerator programme: Thirty-two small and medium-sized (SMEs) digital health companies have been selected to take part in DigitalHealth.London’s first accelerator programme, reported Computer Weekly. The programme, launched in March this year, aims to help companies get involved with clinicians to tailor products to the healthcare sector’s needs and navigate the complicated healthcare system. Under the programme, a team of digital health navigators will work with the SMEs to help them “understand and respond to the needs of the market and gain first-hand advice on products in development”. There will be opportunities for the SMEs to showcase their technology to NHS trusts and learn how to deal with sensitive patient data. Tech City News reported that the programme will be part-funded by the European Regional Development Fund. Jenny Thomas, the accelerator programme’s director, commented: “We’re delighted to welcome our very first accelerator cohort and look forward to working with them closely over the next year. This is a completely new and innovative programme – the first of its kind in London – that works by engaging with businesses, the NHS and wider healthcare sector, to close the gap between product development and the uptake of new solutions within hospitals and other healthcare settings.”
NHS organisations warned to sort out their post-N3 connectivity: Healthcare organisations have been urged to start preparing for the end of the N3 network in six months’ time and start speaking to network providers to weigh up their options, reported Government Computing. The existing contract to deliver the N3 network to NHS organisations will come to an end in March 2017, to be replaced by the new Health and Social Care Network (HSCN). Now, a white paper, “Next Generation Connectivity for the NHS”, published by Updata, part of Capita, outlined the key challenges which must be met by both network suppliers and NHS organisations in order to be ready for the new network. The paper said that N3 is “lacking in agility and flexibility” and is “no longer fit for purpose to meet the needs of an evolving healthcare service”. It said that of the limitations of N3 is the N3SP portal, where customers have to pay a premium for extra bandwidth to meet their particular needs. A further issue arising from this lack of flexibility is that the network standards could make it difficult for organisations to deploy and manage their own applications. The paper said that NHS Digital has recognised that the requirements for information sharing and network access have transformed dramatically since its advent and is seeking to address this head-on with the new HSCN.
HIMSS launches international buddy programme to support NHS digital exemplars: HIMSS has launched a new international buddying programme to support NHS digital exemplars in finding a suitable partner to help guide them in delivering innovative approaches to IT-enabled change. Health IT Central reported that the launch follows health secretary Jeremy Hunt’s announcement where he named 12 NHS organisations who would become global exemplars and receive up to £10m in funding. In return they would be expected to help others in the NHS to learn from their experience. The new buddying programme from HIMSS will offer a range of services including working with the exemplars to help them understand their existing level of digital maturity using the globally recognised benchmarking tool – Electronic Medical Record Adoption Model (EMRAM) and Continuity of Care Maturity Model. In addition, HIMSS will work alongside the 12 NHS organisations to help them align and share best practice with the thousands of hospitals across the world who have already shared their data with HIMSS in order to obtain an EMRAM score. John Rayner, regional director of the HIMSS Analytics Health Advisory Services Group, Europe said: “HIMSS works closely with more than 9,000 health and care organisations across the world including those in the UK, Europe, Latin America, Middle East, the US and Asia, so we are uniquely positioned to help match NHS organisations with those who are leading the way in achieving significant benefits through enhanced levels digital maturity and EMR adoption.”
Graphnet plugs wearables into care record: A project to improve the care of patients with epilepsy has led to the launch of a Graphnet product that combines wearable technology, data analysis, and digital care records, reported DigitalHealth.net. MyCareCentric Epilepsy is the outcome of ground-breaking work that set out to use the sensing and geolocation technologies in smartphones to detect seizures and send alerts to clinicians, so they could provide more effective treatment and advice. Dr Rupert Page, the chief clinical information officer of Poole Hospital NHS Foundation Trust, said: “We learned a lot about the accuracy of sensor data, such as heart rate, and we did a lot of work on getting medical quality data. We also learned that battery life is an issue – batteries really get hammered if you are using devices all the time. However, we have got to the point where we can identify 85% of seizures with no false positives, and that is from a relatively small dataset. We believe that as we get a bigger dataset, and start using machine learning, that will improve.” MyCareCentric uses the Microsoft Band in conjunction with other heart-rate monitors and smartphones. These capture data such as sleep patterns, exercise and heartrate. This information is collected into Microsoft HealthVault and analysed using machine learning on the Microsoft Azure platform. It is then combined with patient information from GP, acute and community systems pulled together in the Graphnet CareCentric record. Clinicians are able to see patterns of seizures via a dashboard, while patients have access to a Shearwater Systems patient portal. Page said he was confident the epilepsy solution would not only deliver better clinical care, but generate savings.
Most areas should publish STPs by end of the year, says NHS England: “Most areas” should publish a version of their sustainability and transformation plan (STP) by the end of the year, reported the Health Service Journal (subscription required). NHS England, jointly with other national arm’s length bodies, is publishing a document on “engaging local people” in STPs. This follows prominent media coverage in recent weeks of campaigners’ concerns about secrecy surrounding STPs, and the potential for cuts to services. The new guidance said: “Local proposals for health and care transformation are not expected to have gone through formal local NHS or other organisations’ board approval and/or formal public engagement or consultation at this early stage. We expect that most areas will take a version of their STP to their organisation’s public board meeting for discussion between late October and the end of the year. We would also expect that most areas will publish their plans for wider engagement during this period, building on the engagement they have already done to shape thinking. Every area will be working to a different timeframe, based on its own circumstances and how well progressed its plan is.” National officials’ expectations about whether and when STPs will be published have previously been unclear. The 44 STP areas are required to make their next “full” submission to national bodies by 21 October 2016.
NHS Digital to roll out new CareCERT cyber security services: NHS Digital is to start rolling out its expanded portfolio of Care Computer Emergency Response Team (CareCERT) cyber security services across health and social care, reported DigitalHealth.net. CareCERT, launched in November last year, is a national service from NHS Digital that helps health and care organisations to improve their cyber security defences by providing advice and guidance about digital threats and cyber security best practice. CareCERT currently sends out broadcasts about known cyber threats, and will now be expanded to include three new services, which will start being tested from September. The first is an e-learning portal called CareCERT Knowledge to help all health and care organisations train their staff in cyber security basics. The second is CareCERT Assure, which will help organisations assess their local cyber security measures against industry standards, and provide recommendations on how organisations can improve data security measures and reduce vulnerabilities. The third service, CareCERT React, is designed to help organisations respond to an incident. React will provide professional guidance and advice on the actions to take to reduce the impact of a data security incident. NHS Digital chief executive Andy Williams said: “The security of health information is key to our organisation, and our new CareCERT services will help us to improve digital security across health and care organisations, from frontline doctors and nurses to chief executives. Good digital security is key to all roles in health and care, and we want to give NHS organisations the benefit of our expertise in this area, so that we can promote best practice across the sector.”
Atos spends $275m on a digital healthcare acquisition: French information technology services company, Atos, is spending $275m to acquire a US developer of electronic medical records systems, Anthelio Healthcare Solutions, reported Internet Health Management. The main reason for the acquisition is gaining market share in the $32bn U.S. digital healthcare services market. The all-cash deal is expected to be complete by the end of the month. Atos hosts and maintains the information technology infrastructure for 70 hospitals that are part of NHS Scotland, the country’s publicly funded healthcare system, and manages the doctor and procedure appointment scheduling for hospitals in the UK, a programme which generates 700,000 appointments daily and more than 36 million appointments annually. “With their strong and loyal customer base and our combined commitment to providing a world-class customer experience, our ambition with Anthelio is to reinforce our healthcare footprint in the US and to become the leader in digital healthcare solutions,” said Atos group senior executive vice president and CEO of North American operations Michel-Alain Proch.
New £816m investment in health research: Research into mental health, dementia and antimicrobial resistance are among the projects funded by £816m investment in NHS research, announced the Department of Health. Leading NHS clinicians and universities will benefit from new world class facilities and support services built by the five year funding package totalling £816m – the largest ever investment into health research. More than £28m has been awarded to Greater Manchester’s devolved health service to pay for research into new tests and treatments, reported the BBC. The money will be used to drive forward research into cancer, respiratory disease and other serious conditions. Sir Mike Deegan, chief executive of Central Manchester University Hospitals NHS Foundation Trust, said the £28.5m award would help find “new ways of preventing, predicting and treating some of the major causes of premature death and disability”. Cambridge News also reported that Cambridge University Hospitals NHS Foundation Trust has been awarded £114m investment to make world-first medical breakthroughs. John Bradley, director of the NIHR Cambridge Biomedical Research Centre, said: “We are delighted that our research excellence has been recognised by this massive investment. We look forward to continuing our work to translate Cambridge’s outstanding biomedical research into benefits for patients.”
Opinion
Taunton’s open source success: a new era for electronic patient records
Some might perceive open source software is a risky choice, but NHS CIO Malcolm Senior thinks it can save the NHS significant sums and improve care.
After Taunton and Somerset NHS FT’s recent success of being named a global exemplar for digital excellence by NHS England, Senior, the trust’s chief information officer writes in National Health Executive on the organisation’s future digital health plans:
“Almost one year ago our organisation achieved an important milestone in delivering transformational change in our digital programme: we became the first NHS trust to go live with an open source electronic patient record (EPR). This now means that processes for admission, transfer and discharge of patients are more efficient and coordinated, with the help of real-time bed management and discharge planning.
“We are now moving to completely paperless nursing and outpatients. Alongside IMS MAXIMS (the open source EPR provider), we are developing smartphone apps to record vital signs which will enable our clinical teams to identify and treat deteriorating patients faster and more effectively. We also have plans to implement a medicines management solution, and our app-based solutions will link with openMAXIMS (the open source EPR solution) via open APIs to ensure interoperability is achieved.
“Further down the line, e-prescribing will be introduced, allowing us to link the trust with external GP systems.
“Financially, the cost of moving to openMAXIMS will pay for itself within three years, and is set to save the trust £600,000 a year by 2018.”
Senior concludes other providers could now follow suit: “The open source approach is providing viable technology options for the NHS at a time when financial constraints continue to make the headlines. In my view, there is certainly room in the marketplace for suppliers that are innovative and flexible in how they deliver their software to match the needs of NHS providers.”
Ethics of genetics: More than just designer babies
The advent of genomic information and evolving technology brings a myriad of new ethical considerations and technology challenges, writes Dr Gene Elliott in Laboratory News.
Elliott, a physician executive at InterSystems, says that traditional laboratory IT systems were not designed to cope with rapidly emerging bioinformatics demands now being seen with the advent of genomics.
“The question ‘who will have access and how the data could and should be used?’ is unanswered, but the push to improve the quality and accuracy of health data and the vastly improved computing power will make it more feasible to include genetic information for population analysis.
“Responding to this demand for data with available technologies, also presents another set of challenges that must be addressed in parallel. Some laboratory information management systems (LIMS) currently in use, for instance, will encounter limitations in meeting the exponential rise in demand for secure, increased storage, along with the accessibility of information required for analysis.
“It should be noted that the data for a genomics investigation will require more than 10,000 times the storage of a typical laboratory testing profile today. Simply put, traditional LIMS were not designed to cope with the rapidly emerging bioinformatics demands. A LIMS without a tightly coupled analytics platform will become a solution of the past.”
It’s time for the NHS to realise the benefits of digital
The NHS could make huge savings by replacing paper with digital technology. Health reporter, Jennifer Trueland, asks what the hold-up is.
Trueland says NHS England could save £500,000 to £1m from each trust by eliminating paper records, and gives further insight into how the NHS can benefit from digital technology.
“The NHS still struggles under the weight of paper, from medical notes to referral letters. The new Wachter review on the programme of IT adoption in the NHS describes the government’s target of achieving a paperless NHS by 2020 as ‘unrealistic’, and urges it to put it back to 2023.
“According to NHS England, electronic prescribing systems halve medication errors, but are used only in a minority of trusts. Using digital barcodes on medicines, equipment and even on patients can reduce identification errors and improve supply chain efficiency.
“GPs have embraced digital: One GP practice that saw benefits from moving to a digital system is the Ash Trees Surgery in Lancashire, which replaced its paper-based working processes with the Docman document management system and the Emis Web patient record system. As a result, the surgery has saved seven hours a day of staff time.
“Some hospital trusts have also benefited from the move to digital. In a particularly ambitious project, the West Suffolk NHS foundation trust this year moved to a single integrated electronic patient record and an electronic prescribing system, with a view to improving efficiency and patient safety.”
