News in brief
Junior doctors lose High Court case: Health secretary Jeremy Hunt has won a High Court fight with junior doctors in England over a new contract, reported the BBC. The group, Justice for Health, mounted a legal bid arguing the contract was “unsafe and unsustainable” and Hunt did not have the power to impose it. However, the Hon. Justice Green ruled the health secretary had acted “squarely” within his powers in what he did. He clarified this as pushing for NHS trusts to introduce the contract, rather than compelling them. The judge said “in principle” trusts had the freedom as employers to decide whether they did force the contract on doctors. This prompted Justice for Health to claim the judgement had freed the profession from the “shackles” of Hunt’s timeline. The new terms and conditions are due to start being rolled out next week – and there is no indication hospitals will not do this. Justice Green also considered whether the health secretary’s actions lacked clarity and transparency and whether he acted irrationally in pursuing the new contract on the basis he believed it would help improve the quality of care at weekends. On both counts, Justice Green sided with the government. He said Hunt was entitled to believe changing staffing at weekends would have “some, material” impact. Responding to the verdict, a Department of Health spokeswoman said: “We must now move on from this dispute to the crucial job of making sure patients get the same high standards of urgent and emergency care every day of the week, which involves more than the junior doctors’ contract.”
New frameworks to increase integrated health and social care launched: A new framework to help local areas establish a single primary and acute care system (PACS) has been published by NHS England, as well as another for improving the lives of care home residents. Under a PACS, hospital, primary, community, mental health and social care services align their goals and incentives to improve the health and wellbeing of the population, reported National Health Executive. The announcement comes following the publication in July of a framework for the multispecialty community provider (MCP) model. The framework said that the PACS and MCP vanguards, which currently cover about 8% of the country, show that PACS models need five factors to succeed: partnership working between local providers; a data-driven care model; integrated neighbourhood health and care teams; flexible and innovative use of workforce and technology; and a population-based contracting, funding and organisational model. Samantha Jones, director of the New Care Models Programme, said: “Practical implementation of care redesign is now well under way across 50 areas of England. Learning about what has and hasn’t worked in these vanguards means we can now set out for the rest of the NHS with greater precision what needs to happen in order to get concrete results – improving the quality of care, preventing ill-health and saving money.” Key focuses for the PACS model include prevention, population health management, co-ordinated and community-based care for people with ongoing conditions, and reducing emergency and unplanned interventions.
Simon Stevens: There’s no new reform plan for the NHS: The government wants the NHS to “get on with the task” of overhauling services in line with the Five Year Forward View and there is “no new reform plan” for the health service, Simon Stevens has said, reported Health Service Journal (HSJ, subscription required). The NHS England chief executive was asked about the approach of the government under a new prime minister, to service changes which may prove controversial. Stevens, speaking at the HSJ Commissioning Summit, said: “People want us to get on with the task we’ve set ourselves. There’s no new reform plan for the NHS.” Discussing the potential reconfiguration of acute services, which are being considered in many areas as part of sustainability and transformation planning (STP), Stevens said he was “not one of those people who thinks that the right answer for this country is that we have 10 mega hospitals and everybody has to travel 100 miles to get there”. However, he said that “changes in clinical staffing patterns in hospitals such as reductions in junior doctors’ working times”, meant that the minimum efficient scale of some acute services has probably increased over the last decade. Asked about the future of STP footprints, Stevens said there might be “some modest adjustments” to the current configuration of 44. He said: “Some places will decide they’re either a bit big for the task now in hand or the geography isn’t quite right.” Last week’s planning guidance said some STPs areas would be able to apply to split into “subdivisions” with separate financial control totals. Stevens also acknowledged some STPs were likely to change their leader.
Data breaches ongoing as NHS Digital pushes opt-outs: Some patients who opted out of sharing their data beyond direct care have not yet had their wishes respected, as NHS Digital chases up organisations to destroy data, reported DigitalHealth.net. The Information Commissioner’s Office gave the organisation until 19th October to honour the “type 2” opt-outs, claiming it failure to do so years afterward opt-outs have been introduced was “unfair”. NHS Digital has been processing type-2 opt-outs centrally and removing them from datasets but some opt-outs at the fringe are still not being honoured. NHS Digital has contacted 151 customers which have received data since 2014 on patients that have since exercised a type 2 opt-out, to request that the bodies destroy this data. As of August, 58 organisations had yet to respond. It showed 54 GP practices had not yet told NHS Digital whether their patients had requested a type 2 opt-out and some data flows had been stopped until patient’s wishes could be respected. So far, NHS Digital has processed more than 2.6 billion records and removed 61.7 million to honour type 2 opt-outs. Patients have been able to use the type 2 opt-out since 2013, with about 700,000 people requesting their health data not be shared beyond direct care. In a statement an NHS Digital spokeswoman said: “We take seriously our responsibilities to uphold patient’s choices about how their data is used. We remain on schedule to complete this work within the timescales outlined.”
Public health must be embedded in all government policies to deliver Five Year Forward View: Better public health can only be delivered with a full government approach, the Academy of Medical Sciences has said. In a new report, ‘Improving the health of the public by 2040’, the academy recommended that each government department reviews how it obtains evidence and advice on health and health equity, in order to ensure that consideration of the health impact is included in new policies reported National Health Executive. It argued that this approach is needed to address the increasingly complex challenges of a society with both increasing life expectancy and increasing health inequality. Professor Dame Anne Johnson, academy fellow and chair, said: “Public health measures such as smoke-free and clean air legislation, safer food and workplaces, and vaccination have resulted in major advances in the health of the public. However, society is evolving rapidly and new challenges are emerging that require a change in our understanding of public health. We need a public health system, and the research to support it, that takes account of the wide range of interacting factors that affect health to develop effective prevention measures that result in a healthier, fairer future for all.” The academy said that taking a whole-government approach to public health was the only way to “deliver the focus on prevention and build on the efficient and effective use of resources identified in the NHS’ Five Year Forward View”. Margaret Johnson, vice president of the Royal College of Physicians, said that physicians would need “time, funding and support” to engage in public health research.
Less than a third of trusts hitting revised A&E targets: Less than a third of trusts have achieved the new, lower accident and emergency (A&E) targets for July, which they were set by regulators in the NHS “reset” document, Health Service Journal (subscription required) analysis has revealed. The A&E results for July showed 89 trusts had missed the individual targets set for them by NHS Improvement. Thirty six met their targets, and a further 11 don’t have revised “trajectory” targets as they had not accepted sustainability and transformation funding (STF). Organisations must hit the trajectory targets in order to receive their full STF payments. Many trusts will be relying on these payments to stay out of, or reduce, their financial deficits. NHS Improvement chief executive Jim Mackey said the performance in July showed a “very clear link in some parts of the country to school holidays. In some parts of the country it looks like a very clear link to primary care access issues, which was a big issue in January. The system has changed and we don’t fully understand how it has changed. The dynamics and the drivers have changed really dramatically.” Referring to the performance for the first two months of the year, finance director Elizabeth O’Mahony said the sector had faced “sustained operational challenges”. She added: “At previous boards we have talked about this being a bit of a blip but it’s now becoming more of a trend.”
Hospital overcrowding caused by ‘political maladministration’, say MPs: Hospitals have become dangerously full and are discharging patients too soon as a direct result of “political maladministration” by successive governments, according to a report by the Commons Public Administration and Constitutional Affairs Select Committee (PACAC), reported The Guardian. So-called bed blocking costs the NHS in England £820m a year, according to National Audit Office estimates. “At a structural level, the historic split between health and social care means that interdependent services are being managed and funded separately. We consider this to be political maladministration,” the committee said in a report about unsafe patient discharges from hospital. “Hospital staff seem to feel pressured to discharge patients before it is safe to do so,” said Bernard Jenkin, the Conservative MP who chairs the committee. “Hospital leadership must reassure their staff that organisational pressures never take priority over person-centred care,” he added. A Department of Health spokeswoman insisted that the current government was spending large sums integrating health and social care. “Patients should only be discharged from hospital when it’s clinically appropriate and safe for them and their families, and the best way to ensure that is to meaningfully integrate health and social care. We are investing billions to do so over the course of this parliament to improve the experience of patients, many of whom will be vulnerable.”
Fragmented system is failing older people, say experts: Older people are being let down by the current health and social care system, which is “inadequate” and “fragmented”, according to the ‘Growing Older in the UK’ report published by the British Medical Association, reported OnMedica. The report stated that additional resources for general practice and more training in geriatrics for GPs will be vital to help improve the care being provided for this part of the population. It is estimated that four in 10 people aged over 65 years old and seven in 10 over 85 year olds have long-term illnesses. Out of 16 million adults admitted to hospital in England in 2014-2015, almost half (47%) were aged over 65. The report called for more to be done to support and improve people’s health and wellbeing as they grow older in the UK, including tackling the under-diagnosis and under-treatment of mental health conditions in older adults. Developing primary care would be central to efforts to improve the situation, said the authors. The report said: “GPs have a unique role in coordinating the care of older adults with physical and mental health problems: continuity of care and advance care planning are two areas that are key to providing better care. Resources and investment will need to reflect the key roles of general practice, the need for rapid supported discharge from hospital, and for responsive integrated community services.”
Improving patient outcomes through digital innovation: Dr Harpreet Sood, a senior fellow to the chairman and chief executive’s office at NHS England, who will speak at EHI Live 1-2 November, is calling for increased adoption of digital and technological solutions to bring about change and improve health and care services for patients, reported Building Better Healthcare. Improving patient outcomes is at the heart of the 10 free-to-attend conferences, which run alongside the exhibition at the digital health event, taking place at the Birmingham NEC. Dr Sood’s work focuses on two main aspects at NHS England. One priority is prevention, for example, looking at how digitisation can be used in the fight to prevent diabetes. The other is around digitising secondary care as part of the wider transformation agenda in local geographies and getting all levels of the workforce enthused and engaged about it. He said: “It is important to say for innovators and SMEs that we are at a time where resources are challenging and we are going through a period of transformation and innovation. We need to see some quick wins, but we also need to get leadership across the system about why the investment in innovation and its uptake is important.” Visitors will find out more about the opportunities presented by NHS England setting up centres of global digital excellence with a £100m-plus funding pot. Dr Sood said: “The NHS Innovation and Technology Tariff will allow those organisations that are ready to secure services across the system to tap into this tariff and apply for it. If we can identify a whole host of applications that are ready to scale up, the next question is how do we help them from a financial reimbursement perspective.”
NHS to have new central digital leadership body: NHS England is setting up a new “Digital Delivery Board” to better co-ordinate health IT investment, reported Health IT Central. The new body is expected to lead the roll-out of the £4.2bn health secretary Jeremy Hunt has committed from government for greater use of technology and digital in the health service. That will be done, it is understood, by a consolidation of funding approval processes currently undertaken by NHS England, the Department of Health (DH), and NHS Digital Funding. The idea, published as part of new guidance explaining governance structures for planning right across the NHS, is to provide a central resource to help NHS organisations meet their new requirements for digital services like e-referrals. The Digital Delivery Board is to be led by newly appointed NHS England chief clinical information officer Keith McNeil, and replaces the existing DH informatics portfolio management board. McNeil will be looking for regular updates from NHS Digital, on progress to things like a paperless NHS, which is now expected for 2023, not 2020, after the recent Watcher Review. McNeil will be aided by other senior NHS IT leaders, such as NHS England chief information officer Will Smart, NHS Digital’s Beverley Bryant and NHS England’s Matthew Swindells.
More than 100 patients affected by Leeds pathology IT systems crash: Leeds Teaching Hospitals NHS Foundation Trust has postponed a number of patients’ operations after its pathology IT systems crashed, reported Computer Weekly. The trust’s pathology IT systems, which is used to report and process test results, began experiencing problems in September, which are still ongoing. The trust said it is working hard to resolve the issues, which were caused by a hardware failure, and has made “good progress” addressing the issues with the system, but that it is continuing to experience problems with the pathology IT systems. “Unfortunately, we have had to postpone 113 patients, and operations as a result of the issue with the pathology IT system,” the trust said. “We recognise that it is taking a significant time to restore the IT system, but this is a very complex issue. The blood transfusion system is now “operating as normal”, but the blood sciences systems are still not functioning, the trust added. The trust has also put in place “temporary arrangements” for alternative testing. “We hope to have full functionality restored and back to normal clinical practice by the end of the week,” the trust said.
Hunt for three million “ghost” patients: As many as three million “ghost” patients registered with GP practices in England should be removed from doctors’ lists, reported the BBC. As of March 2016, there were just over 57 million patients on GPs’ books. But official census data suggested that the correct figure should be about 54 million. NHS Digital said some of the discrepancy is because patients who have died or left the country have not been removed from GP lists. NHS England has already announced new rules to find and remove these “ghost” patients. It is unclear how many patients are incorrectly registered – some “ghosts” may be genuine patients who did not fill out the 2011 Census, for example. But any true “ghosts” divert NHS cash inequitably. GPs are paid a basic amount for each patient they have registered on their list, even if they do not see them. In 2013-14 it was worth £136 per patient on average. Private company, Capita, has been hired by the NHS to carry out the checks and list cleansing. Patients will be sent letters when they have not seen their GP for five years. If they fail to respond, a second letter will be sent. If that letter is unanswered, the patient will be deregistered. A patient then wanting to get back on a list would have to reapply through the normal process. Some doctors have expressed concerns about the plan, saying the letters could anger patients, who might feel punished for being well.
European award for Orion Health’s population health management technology: Orion Health has been awarded the 2016 European Frost & Sullivan Award for Product Leadership, recognising the company’s pioneering approach to population health management (PHM), supporting its vision for delivering precision medicine. Global research and consulting organisation Frost & Sullivan conducted a recent analysis of the PHM solutions market and praised Orion Health for the “unmatched reliability and quality” of its technology, compared to other electronic health record (EHR) vendors, reported eHealthNews.eu. “While most EHR vendors focus on care coordination and patient engagement, Orion Health focuses on a host of factors ranging from data acquisition and aggregation to the adoption of PHM and consulting services,” said Frost & Sullivan Industry Analyst Srikanth Venkataraman. “These functions are vital for change management among healthcare providers to facilitate shifts in roles and responsibilities.” The award recognises companies for developing products with innovative features and functionality, which are gaining rapid acceptance in the market. Orion Health was singled out for its end-to-end PHM solution, including its array of applications, and for meeting customers’ demand for quality, functionality, and price-performance. The solution provides seamless data integration and visualisation, whilst components can be deployed in groups or as standalone solutions. Colin Henderson, VP EMEA strategy and solutions at Orion Health, said: “The Frost & Sullivan award reflects many years of investment and dedication towards our vision to make precision medicine a reality.”
Isle of Man hospital aims to be paperless by 2018: The Isle of Man government has launched the latest strand of its five year, public services digitisation project at the Noble’s Hospital, reported DigitalHealth.net. Health and social care minister, Howard Quayle unveiled a “Digital Future” programme for the hospital that builds on its use of System C’s Medway patient administration system. The hospital will now add an electronic document management (EDM) system, with 100,000 paper-based medical and maternity records scanned into IMMJ System’s EDM, MediViewer, which will be fully integrated into Medway. It will also roll out Medway’s clinical noting and implement order communications, e-prescribing, and e-discharge planning. Quayle said: “Digital platforms ensure that those who need information have access to it, with patients themselves increasingly in charge of their own information.” Richard Wild, the chief information and digital officer at Noble’s Hospital, said: “This is a major commitment, building on the work already undertaken across many parts of the hospital. Many UK trusts have struggled to do this, but I am confident that we will achieve our goal of removing paper records by the end of 2018.” Markus Bolton, the joint chief executive of System C, said: “The full integration of MediViewer has been a very successful project, and it has provided an excellent addition to our product portfolio.”
The UK Health Show 2016 news roundup
The UK Health Show 2016, hosted in London this week, featured five healthcare conferences, with the established Healthcare Efficiency Through Technology (HETT) show and Commissioning in Healthcare (CIH), now combined with new programmes around cyber security, estates and procurement in health. Andy Williams, chief executive at NHS Digital and ‘digital doctor’ Professor Robert Wachter were just two high profile individuals to lead a strong speaker line-up.
From HETT DigitalHealth.net reported on Robert Wachter who spoke to the audience via a Skype call from Texas. Wachter called for a “three-point IT implementation plan” including a successful implementation strategy, a network of clinical information professionals, and interoperable systems. He also added that there needed to be “quick wins with immediate benefits being realised in records becoming digitalised and saving clinicians time, or through prescribing becoming less arduous”. The focus for Keith McNeil, NHS England’s new chief clinical information officer, was also on technology commenting on the fact that the “NHS needed to move quickly on IT and take risks, and move beyond the slow pace of government and deploy fast digitisation across the board”.
Computer Weekly focused on cyber security and the announcement of the launch of the National Cyber Security Centre (NCSC) on 1 October this year. Speaking on the launch Alison Whitney from NCSC, said: “The primary goal of the NCSC is to simplify the complicated (cyber security) picture across government that made it difficult for organisations to know who to talk to. It brings together all the key organisations under a single organisational umbrella to provide better support and bridge the gaps between government, industry and critical national infrastructure.” The publication also reported on a panel discussion where Nicola Perrin, head of policy at the Wellcome Trust and Professor Martin Severs, Caldicott guardian, discussed the need for the government to build public trust around sharing of anonymised patient data.
Business Cloud picked NHS Digital’s pledge to foster a cyber security-oriented culture in healthcare as hospitals come under increasing attacks from cyber criminals. Rob Shaw, chief operating officer at NHS Digital’s Data Security Centre, said: “We will be working with the NCSC to provide access to specialists, access help on how to handle security incidents, and share information with and from other organisations.” He added: “We need a better culture (around cyber security) because it cannot just be something that is added on at the end.”
GPOnline reported from a CIH stream, where Julia Simon, former head of commissioning policy at NHS England, said the timescale imposed by NHS England for developing sustainability and transformation plans (STPs) is “ridiculous” and “shameful”. Up against tight deadlines, organisations were likely to make unrealistic financial forecasts and claims about benefits to patient care, she warned. “Everyone will submit a plan, because they have to,” she said. Hastily drawn-up plans would lead to financial problems, she said. “Ultimately it means bankruptcy in some areas,” she said.
Awards
EHI award winners announced: Salford Royal NHS Foundation Trust emerged as trust of the year at the 10th annual EHI Awards last night. Dr Masood Nazir, Birmingham GP and national clinical lead for the Patient Online programme, received the CCIO award for clinical informatics leadership. The trust and the CCIO were unveiled alongside eight other award winners at a black tie dinner at the Lancaster Hotel in London, hosted by comedian Ruby Wax. The full list of winners is available here.
Opinion
The planning guidance: Christmas come early or winter of discontent?
While early publication of the planning guidance is helpful, there is much to be done about meeting expectations and fulfilling demands with stretched resources, writes Tim Gardner, senior policy fellow at the Health Foundation.
In an article for HSJ, he likens the recent publication of the planning guidance to an early Christmas present for the NHS. “promises of a newly streamlined and simplified process and a two-year planning and contracting round for greater local stability”
He writes: “There are also, much trumpeted, incentives for mental health in the form of new commissioning for quality and innovations, which undoubtedly reflect considerable work behind the scenes”.
“The new measures should focus more efforts on improving liaison and community services, even if CQUIN as a general policy lever doesn’t seem to have had as much impact on quality as originally intended.
“The guidance rightly stresses the importance of changing behaviours and building better relationships, both within the health service and beyond it to local government, the third sector – important, but too often overlooked – and other local partners.
“Actually making it happen will take a substantial amount of time and effort locally, and the parts of the country that have had more continuity in terms of people, organisations and boundaries arguably start from a much better place than others.
“The same goes for the aspiration to create new relationships with patients and communities – briefly mentioned, but with little elaboration about new support or guidance to help localities make it happen – as well as delivering effective public engagement.
“If there’s a basis for concluding that the NHS’s 2020 to do list has been made considerably easier, I haven’t seen it yet. Early publication of the planning guidance is helpful, but the deadline for agreeing contracts has also been brought forward and so there’s little respite there.”
What if people had to pay £10 to see a GP?
John Appleby, director of research and chief economist at the Nuffield Trust asks what would happen if we were to pay for our doctor’s appointments.
In an article from the think tank, Appleby expresses his concerns.
“A simple back-of-the-envelope calculation would suggest that with around 350 to 450 million visits a year to GPs, a £10 charge would raise between £3.5bn and £4.5bn a year.
“This back-of-the-envelope calculation is just that, a crude multiplication that takes no account of the dynamic effects of introducing the charge. While for many people £10 may seem a small sum, for others it will be a significant cost.
“Indeed, if the argument that a new charge would help reduce unnecessary visits to the GP is true, then it is no surprise that it will have a deterrent effect.
“Added to this is the effect that paying to visit their GP would have on the behaviour of patients. There is every likelihood that forking out real money at the time of a visit will encourage previously passive patients to become more galvanised consumers of primary care – to be more, not less demanding.
“If ‘frivolous’ demand is a problem then there are more effective and less inefficient and unfair ways of dealing with it – for example, educating the public about appropriate use of primary care, and also supporting GPs’ to deal more efficiently with less appropriate visits by some patients.
“And if raising money for the NHS is the aim of charging for visits to a GP, it should be remembered that we have already invented a solution to the problems of exemptions and variations based on ability to pay – it’s called taxation.”
Glasgow technology entrepreneur applies lessons learned from electronic warfare to care business
Healthcare, and specifically telecare, can share parallels with the Royal Navy, explains Communicare247 CEO Tom Morton.
In an interview with The Herald, Morton details how his experiences in the armed forces fuelled inspiration for his healthcare business.
He says: “I served as an electronics engineer in the Royal Navy. My job in electronic warfare was to maintain the equipment used for finding other ships and potential threats, and to ensure the secure transfer of accurate information between multiple ships and decision makers.
“So I knew that the reliable transfer of information was essential to help keep people safe. People receiving care at home rely on the provider’s ability to share information with others, including other providers, next of kin and health professionals.
“I saw an opportunity to apply the knowledge and experience I gained within the space and defence sectors to provide a robust and efficient personal security service for people in potentially vulnerable situations.
“I believed digital home care systems could offer more capacity and flexibility than those that relied on traditional analogue telephone communications networks.”
Steven Bloor, the chief information officer at Blackpool Teaching Hospitals NHS Foundation Trust, outlines the risks that his trust has faced and overcome in implementing the IMS MAXIMS open source electronic patient record, openMAXIMS.
In an interview with DigitalHealth.net, Bloor says: “We have developed a portal, it has been in place for a couple of years, it has thousands of users, there is wrap-around with other systems, and we have got the presence and so on in place.
“So one risk is you could do all that, and then lose it (if a subsequent decision is taken to go down the single supplier route). At the same time, we have been offering this to other trusts.
“We’re giving it away – although we would need paying to help implement it – but most people don’t seem to want to do it. It’s almost like ‘if the NHS has done it, it can’t be any good’.” In other words, another risk is doing a lot of work “and nobody takes it up”.
“You still have to do your project management, and your data migration, and your staff training. So if you are not careful, you can end up with a deployment for which the cost is as high as a proprietary deployment – or higher.”
Highland Marketing blog
In this week’s blog Highland Marketing reviews this year’s UK Health Show which saw five conference themes central to the future of the NHS brought together at London’s Olympia.
