News in brief
BMA urges trust CEOs to pause junior doctor contract as roll-out kicks off: The British Medical Association (BMA) has written to all NHS trust chief executives in a last-ditch effort to pause the introduction of the new junior doctor contract, set to be rolled out for obstetrics and gynaecology ST3 doctors, reported National Health Executive. The union’s junior doctor committee chair, Dr Ellen McCourt, this was a “watershed moment” for the health service, with doctors being moved onto contracts “which they have rejected”. She added: “It couldn’t come at a worse time, as a recent BMA study found that almost half of junior doctors are looking to move overseas, given their morale is at an all-time low. A great deal of preparation is required for the new contract to be put in place, but very little time has been allowed for this, due to the government’s politically imposed deadline.” According to Dr McCourt, a “number of trusts” have decided not to start using the contract in October. The BMA is therefore calling on all other trusts to hold off on the roll-out “if any of the required arrangements are not in place”. Dr McCourt has led the junior doctor workforce through the long-running dispute with the government and promised to “continue to fight” contract imposition.
NHS safety determined by leadership not money, says Jeremy Hunt: Quality healthcare is not determined by funding, health secretary Jeremy Hunt has told the Conservative Party conference, reported GPOnline. Hunt said that quality care costs the NHS less, not more. While the government had given the NHS “the most generous increase of any government department last year”, the health secretary said, “just writing a cheque doesn’t raise standards”. The safest public services, he said were those with the best leadership that “supports doctors and nurses to learn from mistakes”. Hunt also called on junior doctors to abandon any industrial action against the new contract. Welcoming the decision by the BMA’s junior doctor committee last month to suspend a series of planned five-day strikes, he said: “Let’s not argue about statistics or whether we can do more to raise standards for patients. The NHS that you believe in is the NHS we are building. So call off the strikes for good and start working with us to deliver safer care, seven days a week, for patients and their families.” The health secretary has also suggested that GPs should learn from the banking industry and get patients to do more of the work to cut costs. He told a Royal College of General Practice (RCGP) fringe meeting that the transformation of new technology would be a win for doctors and a win for patients, reported GPOnline. Hunt said: “There is a deal with consumers that you get a better service but we are asking more from you in return, I think in the NHS we haven’t thought about what more we can ask from our patients as we enable these new facilities to be made possible.”
Student doctor numbers to rise by 25%: The number of medical school places will increase by 25% from 2018 under plans to make England “self-sufficient” in training doctors, reported the BBC. The government’s plan will see an expansion in training places from 6,000 to 7,500 a year. Ministers believe that increasing the number of home-grown doctors is essential given the ageing population. There is also concern it will become more difficult to recruit doctors trained abroad in the future. About a quarter of the medical workforce is trained outside the UK, but the impact of Brexit and a global shortage of doctors could make it harder to recruit so many in the future. Prime minister Theresa May said: “We want to see more British doctors in the NHS.” Health secretary Jeremy Hunt told the Conservative Party conference: “We need to prepare the NHS for the future, which means doing something we have never done properly before – training enough doctors.” He said the steps would mean that by the end of the next parliament the health service in England would be “self-sufficient” when it comes to training doctors.
Scotland’s NHS services face £143m cost overruns: Vital NHS services in Scotland are facing £143m in cost overruns and may need a bailout to plug a funding black hole, Audit Scotland has warned. The Scotsman reported on findings from the public spending watchdog. NHS Tayside was said to be facing an £11.6m funding shortfall this year with no plans in place to “fully address this gap”. And an under-fire IT system at NHS 24 had seen its overrun increase to £131.2m (more than 70% above the original budget), jeopardising future financial targets. STV News reported that auditor general for Scotland, Caroline Gardner, said: “Each of these health boards is experiencing prolonged and considerable challenges which continue to have an impact on the way they operate and deliver services. While action is under way to try to address these issues, there’s no quick fix available and recovery will take time. It’s important that the Scottish parliament and the Scottish government closely monitor progress to ensure circumstances do not worsen, to the detriment of staff and service users.”
Health watchdog: Overhaul healthcare system which is “disjointed and reactionary”: Ireland’s health watchdog has recommended an overhaul of the country’s “disjointed and reactionary” healthcare system, reported the Irish Examiner. In its submission to the Oireachtas Committee on the Future of Healthcare, the Health Information and Quality Authority (HIQA) said the Irish health system needed to provide for better decisions, safer services and improved care for patients. The HIQA said: “The disjointed and reactionary approach to health service reform is leading to increasing instability in the system. There is a failure to assess current requirements and plan for the future health and social care needs of the population. There is also a reticence to recalibrate the current focus on acute hospital services to an integrated health and social care model.” The authority added: “We believe that now is the time to introduce safeguarding legislation to protect at-risk adults from abuse and neglect.” It said existing national safeguarding protocols did not go far enough and statutory regulation should be extended to cover all domiciliary care services.
Operational plans timetable “extremely challenging” for providers: NHS Improvement has warned that it will be “extremely challenging” for trusts to complete operational plans to support their sustainability and transformation plans (STPs) for March 2017, reported National Health Executive. Trusts are required to submit their draft plans on 24th November for them to be approved in time for the national deadline for signing contracts on 23rd December. A report from an NHS Improvement board meeting noted a significantly shorter timeline than allowed for a previous lot of plans. NHS Improvement is now developing a streamlined process for plan assurance to help ensure the plans are delivered on time. NHS England recently published its first two-year operational planning guidance to try to make the planning process easier for trusts. Dr Graham Jackson, co-chair of NHS Clinical Commissioners and chair of NHS Aylesbury Vale Clinical Commissioning Group, warned at the time that the timescale was challenging, and that the two-year contracts would create a risk of “unsatisfactory results” if the decision-making process was “rushed”. The board papers also said that all STPs have now produced two-page plans for implementing the recommendations in the Carter Review regarding pathology and back-office consolidation. However, the regulator warns that detail in the plans is “variable” and few mention “financial benefits and timescales”.
NHS Digital to change how it collects and publishes health stats: NHS Digital has confirmed it is making changes to some of its health statistics, but has rowed back on plans to stop a number of datasets, reported PublicTechnology.net. The body consulted on the changes between April and June this year, and received 257 responses. It said the aim was to help it prioritise its work, make better use of resources and ensure the statistics it produces are useful and understandable. In a report on the consultation process, NHS Digital said there was a “strong message” that users supported the body’s direction of travel, which it defined as ensuring that statistics and publications were up-to-date, relevant and add value. However, the body said that there were a number of proposals that were not accepted by users, and so it would not be making those changes. “The majority of respondents said it would have a high impact on them and their work, prohibiting them from performing their statutory function or completing crucial research,” it said in response to the proposal about plans for GP data. NHS Digital also said it would continue to publish provisional accident and emergency quality indicators, but only until a replacement has been developed as part of the ongoing Urgent and Emergency Care Review.
HSE says reforms to key areas of Ireland’s primary care system are needed: The Health Service Executive (HSE) has said there are more than a dozen areas within Ireland’s primary care services that require further development and reform, reported the Irish Times. It said that greater clarity was needed in relation to access to services and eligibility for access. The HSE also said that “inconsistent coverage” by GP out-of-hours services represented “a significant deficit that can lead to inappropriate attendance at hospital emergency departments”. A “lack of standardised GP access to diagnostics” was also identified, resulting in inappropriate presentation to hospital out-patient departments and emergency departments. “There is a need to develop a clear set of statutory provisions to ensure ease of access and transparency and to bring the system up to date with developments in service delivery and technology since the Health Act 1970,” said the HSE. The submission notes that GPs were core members of primary care teams, but “there can be difficulties experienced in integration between the team and the GPs”. Also the HSE maintained that “a significant deficit that can lead to inappropriate attendance at emergency departments is inconsistent coverage of GP out of hours services”.
Number of hospital beds in Scotland drops by 600 in a year: Hundreds of beds have been cut from hospitals in Scotland with more than 600 disappearing in a year, reported The Herald. Official figures have revealed the squeeze on hospital capacity at a time when the number of patients who need to be admitted to wards continues to rise. Across Scotland there was on average 22,284 hospital beds in 2015-16, down from 22,955 the year before. Since 2006, 5,000 hospital beds have been dropped. Policy makers justify the decrease by pointing to changes in the way patients are treated. People now spend less time in hospital before and after planned operations and some areas of treatment – such as mental health – are now delivered more in the community and less on hospital wards. However, there are signs that hospital capacity in Scotland is under pressure. Anas Sarwar, Scottish Labour spokesman, said: “Scots will wonder why we are cutting so many beds whilst we still have such a problem with delayed discharge. This can’t go on – the SNP is cutting beds without delivering the necessary resources into social care.” Scottish Liberal Democrat health spokesman Alex Cole-Hamilton called on Scottish ministers to give health boards the support they need. He said: “There are any number of medical reasons why an operation may have to be delayed but the hard fact is that the NHS is sending hundreds of patients home before they have their operation because of capacity issues. It often seems that there is no part of our NHS that is not under real strain. GPs are struggling, nurses are overstretched and cancer targets have been missed. This is a picture of a health service under enormous pressure.”
Brexit could speed up NHS commissioning process, says health minister: Speaking at the Conservative Party conference, health minister Philip Dunne said that that leaving the EU would create scope for a “British approach” to procurement currently governed by European directives, reported GPOnline. Dunne said his previous department, the Ministry of Defence, estimated that tendering for services under EU rules took at least 18 months. “I’m quite sure we could do things quicker in the future if we are not subject to that directive,” he said. “But whether that will lead to UK public bodies looking to shortcut procedures is hard to tell at this point. I think many would like to. We have a habit of adopting best practice and gold standards in this country which tend to gold-plate directives coming out of Europe. I would hope in this area we could undermine, we could reduce it a bit in terms of timing,” he added.
50 suppliers on updated NHS Supply Chain imaging framework: A new national framework contract for clinical systems has been released, covering more than 50 suppliers with a focus on imaging, reported DigitalHealth.net. NHS Supply Chain, the NHS logistics service run by DHL, has developed the framework to replace its existing picture and archiving and communications systems (PACS) framework. Matthew Johnson, from NHS Supply Chain, said hundreds of contracts had been signed using the previous framework, which was created to help trusts exit their National PACS Programme contracts as this part of the National Programme for IT came to an end. However, feedback from trusts indicated that they wanted a wider range of products to complement their core PACS and radiology information systems. “It stays within scope, but it is across many more departments,” he said of the new framework. The government’s “paperless 2020” goal had also stimulated interest among trusts in adopting a wider range of digital solutions, he said. “The digital marketplace has matured to the point where everyone wants to be part of this.” The framework now covers digital solutions for: image management, departmental information systems, clinical information systems, vendor neutral archiving, document management, specialist apps, e-prescribing and genomics. The number of suppliers has more than doubled from 24 to 52.
CCGs using new online marketplace to support personalisation and take-up of personal health budgets: Chiltern Clinical Commissioning Group (CCG) and Aylesbury Vale CCG are working with one of the UK’s largest commissioning support units to pioneer the use of a new simple and easy-to-use tool that delivers a seamless, end-to-end process for the delivery of personal health budgets. eHealthNews.eu reported that the CCGs are using PHBChoices, the new online marketplace that connects health and care suppliers with personal health budget (PHB) holders. PHBChoices has been developed and delivered by NHS Shared Business Services (NHS SBS) using the cloudBuy eCommerce platform. “Put at its simplest, this is an online marketplace with the look and feel of major online retailers,” said Benjamyn Damazer, head of commissioning at NHS SBS. “It is set up for the CCG to enable budget provision and patient management with an ease and simplicity of use for the patient. Control of what is bought and how it is used is with the patient. But the CCG can retain cash until the patient ‘spends’ their budget by buying goods or services,” he added. Lyn Duncan, cloudBuy CEO said: “We are pleased that the momentum is building around PHBChoices with more CCGs and suppliers coming on board.”
Chelsea and Westminster picks Cerner, and Jarrold as CIO: Chelsea and Westminster Hospital NHS Foundation Trust is switching to Cerner, and creating a single shared electronic patient record (EPR) with a neighbouring trust. The London trust will share the Millennium EPR with the adjoining Imperial College Healthcare NHS Trust. The trust will not only share an EPR but a chief information officer (CIO), with Imperial’s Kevin Jarrold assuming the role across both trusts. Jarrold is best known as the former CIO and programme director of the NHS London Programme for IT but more recently he has led the deployment of Cerner at Imperial. Speaking to DigitalHealth.net, Jarrold said the decision to share a single instance had arisen “quite recently” after Chelsea and Westminster had selected Cerner as its preferred supplier through a competitive tender. While the two trusts would have separate contracts, by sharing the same domain Chelsea and Westminster had obtained a discount on the EPR purchase, which was being funded without central support. “I think this is going to become an increasingly popular model,” he said. Together the Cerner joint-system will cover seven hospitals that service about two million patients across central London. Clinical information held within one trust should be accessible from the other, and the trusts will work jointly to integrate the technology with other health and social care systems.
National Cyber Security Centre to help tackle NHS threats: The new National Cyber Security Centre has become operational, and some of its first goals will be improving security practices in the NHS, reported DigitalHealth.net. The centre has been working closely with NHS Digital, and particularly with its CareCERT unit, which was set up last year to protect, detect and respond to cyber security threats. Speaking at the UK Health Show in London, the centre’s new health lead, Alison Whitney, said the sheer scale and complexity of the NHS meant it needed to be approached differently. The centre will work primarily with national organisations, rather than with trusts, and particularly with the Department of Health, NHS England, NHS Digital and the Care Quality Commission. The big focus will be on ensuring the integrity of large scale systems and networks, Whitney said. This will include offering expert advice about the upcoming Health and Social Care Network, and helping to embed the recommendations of Dame Fiona Caldicott’s third review into data security and patient opt-outs into the NHS. At the UK Health Show, NHS Digital operations director Rob Shaw outlined how the work of the CareCert unit had uncovered frequent cyber-attacks on the NHS, from bedroom hackers to potentially state-sponsored attacks. NHS Digital has recently expanded its CareCERT programmes to offer new services to help trusts defend against cyber-attacks and a support team to help them respond to a successful attack.
EHI Awards 2016 reflect innovation and progress of health IT in NHS: The tenth anniversary EHI Awards, organised by Informa Global Exhibitions, has paid tribute to an extraordinary array of talent in the NHS who are attempting to bolster efficiency and patient care with state-of-the-art IT initiatives, reported Building Better Healthcare. The health industry’s only dedicated IT awards provided a snapshot of what is happening across the UK and helped drive forward changes in the industry through a healthy dose of competition. The CCIO award for clinical informatics leadership was won by Dr Masood Nazir, GP and chief clinical information officer (CCIO) at NHS Birmingham CrossCity Clinical Commissioning Group. Picking up the award for best use of IT to support integrated healthcare services was King’s Health Partners and Lambeth and Southwark NHS Clinical Commissioning Groups. South West London Pathology and Orion Health were victorious in the best use of IT to support healthcare business efficiency and the best use of IT to promote patient safety award was handed to NHS Fife for its work with Patientrack. The chairman of the judges, Charles Gutteridge the former national clinical director of the National Programme for IT, said: “The awards are a great way of bringing people together, both judges and competitors, and enabling them to make connections. They share ideas and talk and obviously there is a healthy element of competition that helps to drive change.”
New oversight for remote GP digital services: GP video subscription apps will come under increased regulatory scrutiny next year, as the number of companies offering remote consultation continues to grow, reported DigitalHealth.net. In a statement the Care Quality Commission (CQC) said it was looking a setting up a “comprehensive inspection programme” for these digital primary care service by next April. GP video subscription services, such as Dr Now and Babylon, provide users with on demand video consultations with GPs for a flat subscription or pay-per-appointment fee. Some people have expressed concern that the services represented a backdoor privatisation of parts of the NHS, or at the very least a cherry picking of the healthiest patients, while leaving the NHS to care for the sickest. However, others have argued the services, or an NHS version of them, could dramatically cut health service demand while providing a more convenient service for patients. During a presentation at the UK Health Show, Public Health England’s deputy director of digital, Diarmaid Crean, said he had already been approached by digital GP service Babylon about an app library endorsement. Crean said because apps like Babylon were a service, they would more difficult to assess than apps with narrower function, such as a smoking cessation app. He added: “We understand that CQC specifically are best placed to do a service assessment when we get to that stage.” For apps that were considered particularly useful within the NHS, they might be bought from the developer or be NHS branded, he said.
Events
NHS Digital to host industry briefings in October: NHS Digital has partnered with techUK to host two industry briefings in October for digital health and care suppliers across the UK. NHS Digital’s director of digital transformation, Beverley Bryant, and her team, will provide information on NHS Digital’s current priorities and plans to support an integrated, paper free health and care system. The events will also focus on how industry partners can support NHS Digital’s work and the organisation’s role in delivering programmes on behalf of the National Informatics Board. Formerly the Health and Social Care Information Centre, the newly branded NHS Digital was launched in July this year with the aim of building public recognition, confidence and trust. The two events, which will each carry the same agenda, will take place on the 18th October 2016 in London and the 21st October 2016 in Leeds. Individuals wishing to attend can register here.
Opinion
Can a digital revolution save the NHS?
Funding, stakeholder engagement, removing silos, and patience, are four key elements to embracing advances in technology to answer the health service’s financial crisis, writes Professor Bob Hudson, from the Centre for Public Policy and Health at Durham University.
In an article on the Guardian, Hudson explains the key debate now is not so much about what can be done with technology, but about how to put it into practice.
“Funding: There is thought to be about £1.3bn earmarked for the ‘paperless NHS’ but little clarity over when it will be made available and whether it will be ringfenced. The size of the pot is also small for the shift from analogue to digital. Arguably the jam needs to be spread more thinly.
“Stakeholder engagement: There are two main groups whose engagement needs to be secured – frontline staff and end users. Failure to convince them (frontline staff) of the virtue of change can lead to all manner of resistance strategies arising from inadequate understanding, lack of time, challenges to established routines and fears around job security. Users also have to be convinced of the value of using new devices. Technology varies in the ways in which it requires engagement and action on the part of users.
“Systems not silos: Any solution for the incompatibility between IT systems used by all the different parts of the NHS is generally only focused on communication between hospitals or, at best, between hospitals and GPs. The reality for growing numbers of patients is that their ‘journey’ traverses all of these sectors and more. A more ambitious, system-wide approach is needed.
“Patience: The danger with all this digital razzmatazz is that too much is expected too quickly. It is up to NHS England to construct a more realistic timeline for investment and change.”
What intelligence can hospitals gain from diagnostics?
Radiology could represent a far more important part of a hospital’s business intelligence, argues Sectra’s Chris Scarisbrick, who explores a goldmine that hospitals must look to unearth.
In an article published in the latest Digital Health Intelligence special report, Scarisbrick says that providing diagnostics with the right intelligence can benefit the entire enterprise.
He writes: “Could greater intelligence within our diagnostic departments, and greater use of a rich source of information held within the ‘ologies’, now be about to make a serious difference to the effectiveness and efficiency of the wider hospital enterprise? Are hospitals taking full advantage of diagnostic information? And is enough being done to provide disciplines like radiology with the departmental intelligence needed?
“Real effective intelligence is about far more than only enabling departmental managers to drive their own efficiencies.
“Ensuring it can be lifted out of the confines of a traditional radiology solution, and made useful at the trust or enterprise level, is key.
“From an administrative point of view, this can mean understanding the time taken for patients to receive an appointment, a report, or a follow up and actions that can be taken at the enterprise level to solve these challenges.
“But at the same time there is a revolution on its way in the clinical and research side of big data. Vendor neutral archives, which have served as image repositories, offer a goldmine of data to the NHS, that is only set to grown.”
Hunt: Speech to the Conservative Party conference 2016
Money matters for the NHS, but just writing a cheque will not raise standards, Jeremy Hunt has said.
Addressing the Conservative Party conference, the health secretary said that safer care doesn’t cost more, in fact it costs less.
“Every time a patient has a fall, or picks up a bedsore or catches an infection they stay in hospital for longer, costing the NHS more.
“Serious errors cost us £1.5bn in litigation fees every year. That’s £1.5bn spent not on medicines, doctors or nurses – but on picking up the pieces when things go wrong.
“When you look at our safest hospitals, our best schools and our top police forces and you see it’s not about the level of funding, but the quality of leadership.
“Leadership that supports doctors and nurses to learn from mistakes. Leadership that makes a complex system seamless for patients, by joining up the health and social care systems.
“Leadership that says simply the care I’d want for my mum or dad is the care I’m going to give to my patients with a more efficient, safer, higher quality NHS for you and your family.”
