Guest Blog: Democratising diagnostics
Democratisation of healthcare access is a significant development in the arena of medicine. Dr Mark Davies, European medical director at MedeAnalytics, considers some of the professional and ethical implications in this compelling blog.
News in brief
Summer 2016 ‘worse than most winters for A&E’: Waiting times in A&E units in England this summer have been worse than every winter for the past 12 years bar one, figures have shown. The colder months have traditionally been the most difficult for hospitals, reported the BBC. However, pressures have grown so much that this summer saw one in 10 patients wait for over four hours in A&E during June, July and August. Only last winter saw a worse performance since the target started in 2004, figures from NHS England showed. During the summer months 90.6% of patients were seen in four hours. Hospitals are meant to deal with 95% in four hours. The data also showed hospitals are missing a number of other key targets for cancer, routine operations and ambulance response times. And the delays hospitals experienced in August discharging patients reached a record high. There were over 188,000 days of delays – a 30% rise on the same month the year before. These delays occur when there are no services available in the community to care for frail patients on release. Dr Mark Holland, president of the Society for Acute Medicine, said the figures once again showed the NHS was locked in an “eternal winter”.
Leaders call for major rethink on NHS: A fundamental shift of provision of care from hospitals to the community is central to a radical new vision for how the NHS should be run, says a manifesto published in The Lancet. OnMedica reported that the manifesto, written by a leading group of clinicians, scientists, social entrepreneurs and peers including Professor Maureen Baker, chair of the Royal College of General Practitioners, Lord Nigel Crisp, the former chief executive of the NHS, and Professor Dame Sue Bailey, chair of the Academy of Medical Royal Colleges, said the UK’s approach to health needs radical rethinking. Brexit and the “troubled state” of the NHS meant it was time for a rethink on the UK’s approach to health, said the authors. “The EU referendum vote reveals deep social divisions as well as presenting the country with important decisions and negotiations about the future,” says the manifesto. “At the same time, health problems are growing; the NHS faces severe financial constraints and appears to lurch from crisis to crisis, with leaving the European Union likely to exacerbate many problems including staffing issues across the whole sector.” Despite this, new scientific developments and digital technology offered large and unprecedented opportunities for improving health, they argued.
NHS Wales: £700m ‘black hole’ fear as pressures rise: The NHS in Wales could face a £700m black hole in its finances in just three years’ time according to new research by leading experts. The health service was said to be “currently facing the most financially challenging period in its history”, according to the Health Foundation think tank. The shortfall would be equivalent to more than 10% of what NHS Wales currently spends in an entire year, reported the BBC. The think tank also warned the costs of social care might nearly double by 2030-31. Analysis suggested NHS Wales could end up spending more than it gets because of increasing pressure caused by a growing and ageing population. This results in significant increases in the number of patients living with long-term serious health conditions.
Social care cuts take English service to tipping point, regulator warns: Accident and emergency (A&E) units are struggling to cope because social care services that help elderly people have been cut so much that they are reaching a “tipping point”, England’s care regulator has warned, reported The Guardian. The State of Care report from the Care Quality Commission (CQC) has said underfunding of council care services was causing overcrowding in hospitals, with emergency care one of the poorest performing parts of the system, the BBC. According to the report, while the majority of England’s health and adult social providers were delivering “safe, high quality and compassionate care”, strong leadership and improved interoperability between different organisations were seen as vital to maintaining standards, reported Government Computing. CQC chairman David Behan said that although high quality care was largely being delivered despite challenging circumstances in delivering care, there was already variation in regards to standards between different providers. Behan warned of a potential tipping point in the future for adult social care, with an ageing UK population and increased numbers of long-term conditions leading to an increased need for, but reduced access to services. The report was released as hospital leaders accused ministers of living in a “fantasy world” and failing to face up to the scale of the challenges facing Britain’s health and social care system, reported The Telegraph. Chris Hopson, chief executive of NHS Providers told MPs it was now “impossible” for the health service to meet the expectations on it. He called for extra funding for social care, in order to ensure better care outside hospitals. “We actually think where the pressure is greatest in the system, it’s social care… if there’s more money to be spent, that’s where we say it should be spent,” he said. The CQC report also plays up need for better service integration through technology. It accepted that in line with longer-term strategies such as the NHS Five Year Forward View plan that aimed to set out blue prints for closer integration of health and social care, providers were adopting new technologies as part of efforts to find implement new means of delivering services. “Some are engaging their own staff, other local care providers, local stakeholders such as Healthwatch, and the public to think differently about how they can deliver services together,” said the findings. “[This includes] moving services closer to people’s homes, exploring the relationship with local care partners to improve hospital discharge rates, and supporting more people to manage their own care through the use of technology.”
Huge shifts in power and influence emerge from the 2016 HSJ100: The 2016 HSJ100 has revealed huge changes in the people with the greatest influence over the English NHS, reported the Health Service Journal (subscription required). There are 31 new entries, while 19 people saw their positions in the ranking drop by 10 places or more and 11 saw a similar rise. The HSJ100 was launched in 2005 and has become the benchmark by which to gauge the changing fortunes of the leading figures in the NHS and health policy. It is judged by a group of experienced health service leaders and attempts to paint as accurate picture as possible of who will exercise most power over the English NHS and health policy until September 2017. NHS England chief executive Simon Stevens has retained his number one spot, but only narrowly pips the resurgent health secretary Jeremy Hunt. There are significant shifts in the power balance between and within the leading NHS agencies and a notable rise of local leaders – especially those associated with the sustainability and transformation plans. New entrants include: chief secretary to the Treasury David Gauke, Brexit secretary David Davis, the chief inspector of the NHS’ new patient safety arm Keith Conradi, the Labour chair of the Public Accounts Committee Meg Hillier, Health Foundation chief economist Anita Charlesworth and learning disability rights campaigner Sara Ryan. Two thirds of the 100 are white men; 29 of the 100 are women, an increase of three on the previous year; and four have a BME background, one less than in 2015.
NHS 24 IT system delayed until December 2017: NHS 24’s plan for a replacement IT system has once again been revised, and will now be deployed in stages with the final roll-out not complete until December 2017, reported Computer Weekly. Costs have also spiralled out of control for the system. A report by Audit Scotland said the project was originally estimated to cost £75.8m and generate savings of £10m over 10 years, however the total cost is now estimated to be £131.2m – a whopping 73% over the original budget. The report said every month the system “is not operational, NHS 24 incurs around £0.5m in additional costs”. According to the report: “NHS 24 previously attempted full implementation of the new system on a national basis, to avoid any potential problems of return callers who may access the service across different geographical boundaries. However, NHS boards had expressed concern about this approach. NHS 24 has since done further work to assess the scale of this potential problem and has now determined that it is possible to introduce the new IT system through a single health board for a period of time.” The first stage of the implementation process will be planned care services in autumn 2016, followed by unscheduled care services in a single NHS board by March 2017, and a full roll out of unscheduled care services by December 2017.
Wales invests £11m in NHS devices and security: A multi-million pound government funding package for the NHS Wales’ IT systems and infrastructure has been launched by Welsh health secretary, Vaughan Gething, reported DigitalHealth.net. Over £11m will be used to replace ageing equipment, boost systems’ resilience to cyber-attacks and improve infrastructure. However, the move has been criticised as not going far enough by the British Medical Association (BMA). Philip Banfield, the BMA Welsh council chair, said the BMA Cymru Wales has a long-standing view that Welsh health IT is lagging behind, and the proposed investment did not sound like a lot of money. However, he told the BMA’s own news service that: “If this funding was used to make new solutions more secure, there may be some exciting possibilities in changing the way we use IT in the delivery of high-quality patient care.” He added: “This investment is in response to what NHS organisations tell us they need to ensure that their IT infrastructure remains safe, secure and fit for purpose into the future.” Powys is a rural health board covering around a quarter of Wales and 133,000 people, and the money will support the roll out of the Welsh Community Care Information System. The government said last June that it would invest £6.7m to link health and social care services across the country. The move followed the publication of the ‘Informed Health and Care: a digital health and social care strategy’ for Wales. The five-year plan aims to build on the work that the NHS Wales Information Service has already undertaken to create healthcare IT systems for the country, or to place national contracts for core IT.
Software ‘freeze’ after network failure at St George’s: A south London trust has “frozen” all software deployment as it continues to recover from trust-wide IT crash in June, reported DigitalHealth.net. St George’s University Hospitals NHS Foundation Trust suffered a “network failure” that shut down computer systems for several hours on 6th June, which was further exacerbated when the disaster recovery system did not work. However, the crash also appears to have exposed a range of IT issues in need of improvement to prevent future failures, including “inadequately supported” software such as Windows XP, ageing computers, and insufficient data storage capacity. In a report to the trust’s board this month, chief information officer Larry Murphy said the trust was still working on “stabilisation and recovery of ICT” but a new long-term solution was needed to reduce the risk of future failure. Deployment of new clinical systems, such as the roll-out of Cerner Millennium to the neo-natal unit, had also been “frozen” until the underlying IT infrastructure was no longer an “unstable platform”. “In reality this freeze is a formal recognition of what has already happened as the main programmes are neither properly funded nor resourced,” said the report. The St George’s report comes amid increasingly central scrutiny of obsolete technology, particularly around Windows XP. The operating system has not been supported since April 2014, but remains in widespread use within the NHS.
Cyber-blackmailers increasingly target NHS trusts with ransoms for patient data, figures reveal: NHS IT systems are increasingly vulnerable to attacks by cyber-blackmailers trying to extort ransoms from hospitals, according to reports. The Telegraph reported that at least 28 NHS trusts in England have been victims of ransomware incursions in the last 12 months. NHS Digital, the body which oversees cyber-security for the health service, admitted there has been an increase in attacks but said that no ransom was paid and no data was lost. It said patient records had not been affected and added that other organisations have been targeted in the attacks. Ollie Whitehouse, technical director of NCC Group, the internet security company which obtained the data, said: “Ransomware has become the bottom line of cyber-crime – if hackers break into a system and can’t find any other way to monetise what they find, they encrypt the data and demand a ransom. We have seen a 400% increase in these attacks. NHS trusts are being increasingly targeted and any loss of patient data would be a nightmare scenario. Like everyone else, they need to be applying robust controls.”
Brexit timescale means NHS should plan for EU data laws: It is looking increasingly likely that the NHS will need to comply with new, European data protection laws, as the Brexit timetable becomes clearer, reported DigitalhHealth.net. Prime minister Theresa May announced on 2nd October that the government will incorporate all existing EU laws into UK law and then trigger Article 50 by April 2017. Once Article 50 is triggered, the UK will have two years to exit the EU, during which time the General Data Protection Regulation (GDPR) will have to be applied, since it is due to come into effect on 25th May 2018. Sarah Collen, senior policy manager for the NHS Confederation’s European Office, said it is hard to predict the politics but she mused that the GDPR would be similar in UK law. “I think the regulation reflects some of the main concerns of the UK government,” she commented. “My personal opinion is that it will probably be rolled over into national law”. The GDPR includes a greater focus on accountability and enhanced processes around consent. Infringements will carry a maximum charge of €20m, or 4% of a company or organisation’s yearly turnover. It would also mean mandatory data privacy assessments at the start of any relevant activity, obligatory data protection officers in public authorities and changes to the legal basis upon which the public sector can use personal data. Andrew Harvey, head of information governance at Western Sussex Hospitals NHS Foundation Trust, said May’s announcement might not affect the situation significantly, as “we’ll either need to enact what is already out there, or create something that is almost exactly the same anyway.” He continued: “I think it’s going to make very little difference, because we’ve got to have that parity with the rest of Europe.”
HIMSS and Elsevier launch new digital healthcare award in Europe: Healthcare Information and Management Systems Society (HIMSS) and Elsevier, a world leading provider of scientific, technical and medical information products and services, have launched the HIMSS-Elsevier Digital Healthcare Award in Europe, reported eHealthNews.eu. The award recognises outstanding achievements in the usage of information and technology to successfully advance patient care and safety. Nominations for the ‘Outstanding ICT Achievement Award’ category are now open to all public and private healthcare providers based in Europe. Jeremy Bonfini, executive vice president, HIMSS International said: “Having witnessed a high number of submissions and outstanding quality of winners during the Asia Pacific and Middle East awards, we are excited to recognise exemplar projects from our European colleagues. The HIMSS-Elsevier Digital Healthcare Award strives to encourage its participants to showcase best practices in health and care, where the results have ultimately improved patient outcomes.” Interested applicants can submit their case study here. The submission deadline is 20th October.
NHS Shared Business Service wins more business: NHS Shared Business Service (NHS SBS) has signed three-year contracts with University College London Hospitals NHS Foundation Trust (UCLH) and the Royal National Orthopaedic Hospital NHS Trust to support payroll and pension services, reported Health IT Central. Under the terms of the contract, current payroll and pensions services have been migrated to the NHS SBS Southampton Centre of Excellence, going live at the start of the month. “We’re delighted to enter into this strategic partnership with NHS SBS,” confirmed Tim Jaggard, director of finance at UCLH. Jaggard predicted that savings made from outsourcing UCLH’s payroll and pension services will be reinvested into patient services and “contribute towards our objective to deliver financial sustainability”. “There is a great benefit in taking this step to support the NHS by consolidating back office functions, as per the Lord Carter Review,” added NHS SBS managing director David Morris. Morris said he and his team were looking forward to sharing expertise and capability, as well as delivering efficiency benefits and innovation, with the two NHS bodies.
Kent and Medway consortium suffers week long RIS failure: A troubled radiology information system (RIS) that is used by a consortium of trusts covering over two million people failed for over a week, reported DigitalHealth.net. The Kent and Medway consortium, which includes four trusts, suffered a hardware failure to its RIS following an upgrade. The September board papers for Dartford and Gravesham NHS Trust, include a radiology report that said the RIS system has “not been fully functional” for a fortnight and that a “significant reporting backlog” has developed. This has led to complaints from clinics as patients have attended without their imaging report being available. In a statement, the trust said: “The failure of the RIS system was of great concern to the trust.” Dartford and Gravesham added that “patient care was not compromised, all appointments went ahead and no patients were cancelled”. A spokesperson said a contingency plan was enacted, and the trust is now up to date with referrals and requests. GE Healthcare provides the RIS to the whole of Kent and Medway. Many trusts have been reluctant to replace a RIS. The board papers detailing the recent RIS outage also say that “in the longer term the trust plans to give notice on the RIS contract”, which runs for seven years. However, the papers say it wants to extend the PACS used on site at Queen Mary’s to Darent Valley Hospital. In its statement, the trust said: “We will not be pulling out of the GE contract, which is a Kent and Medway wide agreement.”
Former DH director joins Google artificial intelligence company: A former senior director at the Department of Health (DH) has joined DeepMind, the artificial intelligence company known for its data sharing work with the Royal Free London Foundation Trust, reported Health Service Journal (subscription required). Will Cavendish, former DH director general of innovation, growth and technology, is to become head of strategy at the company, which is a subsidiary of Alphabet – Google’s parent company. In February he was seconded to the Cabinet Office. DeepMind featured in the news earlier this year when the New Scientist obtained a copy of a data sharing agreement between the company and the Royal Free. The revelation raised concerns about companies’ access to medical data without patient consent. Cavendish’s achievements include leading the move to GP online booking and prescription services in the NHS, and negotiating deals that “made new drugs and vaccines available to NHS patients for the first time”, DeepMind said in a statement. Cavendish is the latest senior health policy figure to join a digital health company. Paul Bate left his role as Care Quality Commission strategy director to join Babylon Health, a company which allows patients to consult with doctors using a mobile app. DeepMind says its goal is to “support clinicians by providing the technical expertise needed to build and scale technologies that help them provide the best possible care to their patients”.
Siemens, IBM Watson join forces on population health management: Two leading healthcare players are launching a unique joint population health management (PHM) alliance to support healthcare providers in the critical transition towards value-based healthcare models, reported HealthManagement.org. Siemens Healthineers and IBM have just announced the launch of the new global alliance. Bringing together the use of technologies and IT applications, the collaboration is scheduled to run for five years and represents Siemens’ major step into the PHM sector. The partnership is the companies’ response to current trends in global healthcare, including the growing availability of big data and digitalisation, as well as the increased prevalence of chronic diseases and an ageing global population. While PHM is widely discussed in the US, the subject is also becoming more prevalent in Europe, where a transition into value-based healthcare models is also emerging. With that shift, the demands of hospitals for value-based analytics and reporting are evolving. By joining Siemens’s technologies with healthcare offerings for PHM, such as IBM Watson Health, their aim is to gather and analyse previously siloed information, such as imaging and lab results with patient demographic details. Dr Arthur Kaindl, head of digital health services for Siemens Healthineers said: “We strongly believe that digitalisation and population health management is a mission critical offering in order to address the challenges that customers have already today.”
Deontics adds board member: Clinically-led artificial intelligence (AI) company Deontics has announced Nick Beard as a non-executive director, reported The Health Technology Newspaper. Beard is a physician and former hospital chief information officer. Over a 30-year career, he has held numerous senior executive positions at leading electronic health records and clinical guidelines companies in both the US and UK. The company provides pioneering AI technology which acts as a clinical ‘sat nav’ by integrating evidence-based guidelines with individual patient data, providing dynamic, personalised treatment recommendations at the point of care. “I believe Deontics can become the technology of choice for organisations that work to disseminate clinical best practice in a way that fully leverages the spread of electronic health records,” said Beard. “UK and US health industries share the challenge of producing high quality, affordable care. Delivering clinical best practice while managing cost is often seen as a dichotomy. However, by putting evidence-based clinical guidance into the hands of clinicians, costs of care are often lower while outcomes are improved. This is what Deontics can support, for clinicians and patients,” he added. This appointment is the latest milestone for the company since it spun-out of the University of Oxford, University College London and Cancer Research UK just two years ago. Deontics is already delivering new pathways for large NHS trusts, has built a lung cancer system for a global pharmaceutical company, and is supplying technology to several leading international IT companies.
Opinions
Moving beyond consultation to genuine public engagement is key to STPs
Old school methods of consultation won’t cut it if the changes brought in by sustainability and transformation plans (STPs) are to succeed, writes Daniel Reynolds in Health Service Journal.
Reynolds, the director of communications for NHS Providers, said that even if there were major benefits to be had from sustainability and transformation plans (STPs), people will go to great lengths to preserve the status quo.
“So far, the STPs have largely been off the public’s radar. But they are about to hit our consciousness in ways that will have profound consequences for their success or failure. While it is unfair to say that STPs have been shrouded in secrecy, an unhelpful narrative of a ‘stealth’ cuts agenda is already being fuelled by campaign groups, opposition politicians and sections of the media who are thirsty for emerging insights from the plans.
“The chances of successful engagement will be enhanced if trusts and their STPs go beyond standard approaches to consultation. These are often divisive, come too late in the process and rarely deliver the kind of mandate that is needed for transformational change. Consultation is a legal requirement but it should follow public engagement, which needs to start early and run throughout the process.
“The rapid timescales of the STP process make this tough but trusts and their STPs should attempt to foster ‘genuine co-production’ to ensure local communities are engaged in decisions.”
Don’t let big data drive big business through the rear view mirror
The traditional model of basing decisions on meticulously gathered and refined historical data is no longer fit for purpose, writes Julie Lockner, global data platform product marketing lead of InterSystems.
In an article on Business Computing World, she says: “Looking over one’s shoulder is no way to make positive decisions; basing choices on information that is hours, days and event months old is the equivalent of driving through the rear view mirror.
“Equally, what lies ahead can never be known. Events such as Brexit show that nothing is certain, and organisations across the public and private sectors need to adapt quickly to move forward. Rapid access to data to drive decisions is essential, as is the ability to sense and respond to that data. And technology is emerging that will enable businesses to do just that, and change as the world changes.
“Take retail, for example. The products you choose for your weekly shop provide data on your likes and dislikes, which in turn can inform the deals you are offered when you pay. In turn, this triggers the supply chain to order more of the products you want and have them in store in time for your next visit.
“Such personalisation also can benefit health. The mass of data held on a patient at a hospital can be used to recommend not just the correct treatment to a doctor, but also the right care package that ensures the patient stays out of hospital and enjoys a much greater quality of life.
“With our genomes mapped, for example, and wearables linking to health records, we have the potential for personalised medicine that will revolutionise healthcare – but only if that data and decision support is placed in the hands of those delivering frontline care.”
Julie Lockner will be discussing these ideas at the InterSystems UK Technology Summit on 19th October 2016.
Time for hard choices in the NHS
Stephen Dorrell, chair of the NHS Confederation and former health secretary, outlines three basic errors with the plans for further significant increases in funding for both health and social care towards the end of parliament.
In an article for Health Service Journal, he writes: “First, the immediate cash did no more than cover historic deficits; it made no allowance for current and continuing increases in demand for NHS services;
“Second, planned reductions in spending in other public services were always going to stoke demand for NHS services. This is most obviously true in social care, where reductions result in more demand in GPs’ surgeries, more hospital admissions and more delayed discharges from hospital. It is also true that reduced spending on other local services including social housing, schools and public health all have the same effect of increasing demands on the NHS;
“Third, even if the arithmetic did add up by 2020, the next two years presented an implausible scenario of continuously rising demand and virtually flat real resources.”
Dorrell concludes: “Public services work most efficiently when they work together. The NHS must be a fully engaged partner with other local public services, and increasingly local people, through their councillors – and sometimes their directly elected mayors – must have a voice in the way its services develop.”
