News in brief
Some NHS boards ‘may not balance books’: Some Scottish NHS boards may not be able to balance their books this year, Audit Scotland has warned. According to the BBC, the public spending watchdog said the health service needed to make unprecedented savings in 2016-17. NHS funding was not keeping pace with increasing demand on the service. It also said NHS Scotland met only one of its eight key waiting time targets last year, with performance also reportedly declining in six of the eight targets over the past four years. The watchdog did however stress that some improvements had been made despite an “extremely challenging financial position” facing the health service. Caroline Gardner, the auditor general for Scotland, said: “The Scottish government has had a policy to shift the balance of care for over a decade, but despite multiple strategies for reform, NHS funding has not changed course. Before that shift can occur, there needs to be a clear and detailed plan for change, setting out what the future of the NHS looks like, what it will cost to deliver and the workforce numbers and skills needed to make it a reality.” According to The Telegraph, Donald Cameron, the Scottish Conservative shadow health secretary, said: “This is a damning report, and shows the dire state that our NHS is currently in. It paints a picture of an NHS in crisis, with short staffing leading to worsening patient care and budgets becoming increasingly under pressure.” Anas Sarwar, Scottish Labour’s health spokesman, was also quoted as saying: “The scale of mismanagement in our health service revealed by this report is utterly staggering.” Scotland’s health secretary Shona Robison, said: “Under this government there have been significant improvements in the performance of the NHS, the safety of patients, overall life expectancy and survival rates for conditions such as heart disease, supported by a real terms increase in spending on our NHS.”
Bengoa review: Ambitious shake-up unveiled for Northern Ireland health and care: An ambitious plan to make Northern Ireland’s health and social care system fit for the 21st century has been unveiled, reported the BBC. Health minister Michelle O’Neill said the 10-year plan, known as the Bengoa review after panel chair Professor Rafael Bengoa, would improve a system at “breaking point”. Its 18 time-specific action points are based on recommendations from a government-appointed panel. Hospital closures are not mentioned, but services will have to meet criteria to prove they are viable, she said. “If we continue as we are now, the system in 10 years would need 90% of the entire executive budget,” said O’Neill. Opposition politicians have questioned the lack of details in the plan, which is not costed. Her plan sets out a range of priorities, including a focus on keeping people healthy in the first place, and a new model of care involving a team of professionals based around GP surgeries. The proposals set out in the report, Delivering Together, include:
A short-term plan to tackle waiting lists to be drawn up by January; by spring, every GP practice will have a named district nurse, health visitor and social worker; and further support for looked-after children will be in place by late 2017.
Draft sustainability and transformation plans call for digital investment amid mounting criticism: Draft sustainability and transformation plans (STPs) submitted to NHS England are calling for significant investment in digital strategy amidst mounting criticism over the lack of focus in STPs on social care and public engagement. Computer Weekly reported that the North Central London (NCL) health and social care economy claims it needs £180m to be able to realise its digital strategy of becoming paperless at the point of care, and published its STP against the advice of NHS England, which asked local health economies not to publish their STPs until independent scrutiny of the plans has taken place. Camden Council is one of the four local authorities involved in the NCL plan. Council leader Sarah Hayward said the decision to publish the plan was due to a lack of “political oversight and minimal public and patient engagement”. NCL is one of 44 local health and care economies that have had to submit STPs, of which the local digital roadmaps form part, to NHS England. The London Borough of Sutton has also published the South West London STP, saying that “we are concerned the NHS centrally has not allowed the publication of our STP and that this is raising worries about its content,” reported DigitalHealth.Net. The South West London plan proposes cutting the number of acute sites from five to four, although a reduction to just three has also been modelled. It identified technology as a “critical enabler” of its recommendations, which include greater self-care, use of mobile, analytics, and information sharing at the point of care. Birmingham and Solihull has also published its STP, with aims to expand its shared care record, citywide wi-fi, a structured data transfer system, and an integrated universal patient administration system. Mark Rogers – Birmingham and Solihull STP lead and city council chief – said that the “sort out the NHS first” approach adopted by NHS England and NHS Improvement towards STPs has made it difficult for areas to balance health and care, reported the Health Service Journal (HSJ, subscription required). NHS England chief executive Simon Stevens said any judgements on shifting funds from the NHS could and should be made by local STP partners and that the process was “never designed” to address the fall in social care financing.
Survey finds few local leaders confident STPs will deliver: Very few local NHS leaders believe Sustainability and Transformation Plan (STPs) are likely to deliver the intended improvements to finance and performance in the next 18 months, a Health Service Journal (HSJ, subscription required) survey has suggested. Ninety-nine clinical commissioning group (CCG) chairs and accountable officers responded to the survey, covering around 47% of the total 209 CCGs. The survey also reveals the changes to services being planned in STPs, including sensitive closures, but dominated by expansion and potential improvements to services. The result will be concerning, as STPs are the major national process for coming up with actions to address the current major failures in finance and service performance in coming years. John Rooke, head of healthcare commissioning at PA Consulting Group, said: “The critical issue for STPs is a lack of clarity about the future intentions of those involved. In the impending contracting round, leaders may benefit from recognising this tension and focusing on the creation of the explicit terms and known implications of their new coalition agreement.”
Government review reveals plan to speed NHS innovations uptake: The Health Service Journal (HSJ, subscription required) reported that patient access to some innovative drugs and other interventions could be brought forward by up to four years by restructuring the NHS’ approval and adoption process, a government-commissioned review has concluded. The long awaited Accelerated Access Review’s conclusion is a damning indictment of existing processes, and the report emphasises that improving them would require investment. It currently takes up to around 12 years to get interventions through the NHS’ approval and adoption process, but the review estimates this could be cut to around eight years by streamlining the pathway. It calls for up to an additional £30m per year to go into “new, strengthened” academic health science networks, among other investments to spearhead the process. DigitalHealth.net reported the review recommended that NHS app assessments should be extended to all digital health products. Jeremy Farrar, director of the Wellcome Trust, said: “The review is a first step towards building the right environment and infrastructure within the NHS. It sets out an achievable strategy for getting the most promising drugs, devices, digital products and diagnostics to patients quickly, and transforming lives. Its success will depend on the close involvement of all stakeholders, and will need dedicated funding from the government to support implementation.” The government set up the review, independently chaired by Sir Hugh Taylor, in November 2014 to find ways of speeding up NHS access to innovation in digital technology, innovative drugs, devices, and diagnostics.
Lack of funding could jeopardise Five Year Forward View: The King’s Fund has warned that funding problems could derail the Five Year Forward View’s aspirations to transform NHS services, reported PharmaTimes. In a report on the progress of the Forward View, the healthcare thinktank said that almost all of the additional funds available to the NHS in 2016-17 had been used to sustain existing services, specifically to reduce deficits in NHS acute providers, rather than on new experimental endeavours. “NHS leaders both nationally and locally have been preoccupied with sustainability because of the growing pressures on health and social care and evidence that NHS organisations are missing key targets for patient care,” the report said. It added: “This matters because the pressures on health and social care will not be tackled simply by additional funding, staff working harder, and patching up existing services through ‘sticking plaster’ solutions. These pressures result from a growing and ageing population placing ever greater demands on a system already under huge strain. This is evident in year-on-year increases in A&E attendances and emergency admissions to hospital, high bed occupancy rates, and rising delayed transfers of care. The rationale for new care models is precisely that they hold out the prospect of moderating rising demands for care by focusing on prevention, early intervention, admission avoidance, and support for people to remain independent in their own homes. The challenge is that developing alternatives to care in hospitals and care homes requires investment, which is currently in short supply.”
‘State of unease’ in NHS risks affecting patients: A growing pressure on health services is leading to a “state of unease” among NHS staff and this risks affecting patients, a leading regulator has warned, reported ITV. There was a “dangerous level of alienation” felt by doctors in training which had increased because of industrial action, a new report by the General Medical Council (GMC) found. It highlighted the “intense pressure” of £2bn in hospital deficits alongside falling performance figures for access to A&E, planned operations and ambulance response times as having a corrosive effect on morale. The sixth annual report, The State of Medical Education and Practice in the UK, was released this week. Despite some bleak findings, it stressed UK healthcare “remains among the best in the world” and the vast majority of doctors were not complained about to the GMC. Additionally, figures show women are edging closer to comprising half of all registered doctors, and medicine is becoming more ethnically diverse as a profession.
Better care integration could stop a quarter of hospital admissions, LGA says: Better integration of health and social care could prevent over a quarter of hospital admissions, the Local Government Association (LGA) has said. The LGA commissioned consultants Newton Europe to conduct a review of health and social care in five areas (Kent, Pennine Lancashire, Greenwich, Swindon and Sunderland), which found that 26% of hospital admissions had missed opportunities for other forms of care that would have prevented the need for an admission, reported Public Sector Executive. It also found that better integration of care would have saved 7 to 10% of the areas’ budgets, saving over £1bn nationally. Councillor Izzi Seccombe, chair of the LGA community wellbeing board, said: “Our analysis shows the sheer scale of the funding crisis we face in social care, both now and in the near future, as well as the damage done from the historic underfunding of adult social care. Councils, care providers, charities and the NHS are all united around the need for central government to fully fund adult social care. This is essential if we are to move away from just trying to keep people alive to ensuring they can live independent, fulfilling lives, as well as alleviating the pressure on the NHS. The care provider market cannot carry on as it is and there is a real danger of more widespread market failure. Either care is properly funded or providers will pull out of council contracts or, in worst case scenarios, go bust. The market for publicly-funded care is simply not sustainable as it stands.” She noted that the reforms recommended in the report should be achieved by transferring funding from acute care to community and social care, for instance through the Better Care Fund.
NHS England turns to digital for mental healthcare: Innovators of digital technology which improves people’s mental health can now apply for a share of a £400k fund to speed up the adoption of their product by the NHS, reported Digital by Default News. Six to eight innovations will be chosen to take part in the NHS England-funded Digital Development Lab being delivered by mHabitat. Over seven months the innovators will have the chance to accelerate their technology towards potentially becoming endorsed and nationally promoted within the NHS. One in four people experience a mental health problem in their lifetime. The cost of mental ill health to the economy, NHS and society is £105bn a year. The recent Mental Health Five Year Forward View forecast a pivotal role for digital technology in driving major changes to mental health services over the next five years. There are already good examples of its use by NHS Choices, and there are a number of apps with a mental health theme. The recent Wachter review also said that successfully digitising the NHS was essential to achieve the triple aim of better health, better healthcare and lower cost. Juliet Bauer, director of digital experience at NHS England, said: “There are lots of digital technologies claiming to help people manage their mental health, but it is hard for practitioners to assess their effectiveness and their safety for use. Using this fund, we can rapidly develop and scale currently available, evidence-based tools. The lab’s successes will mean more people can manage and care for their mental health using a set of high quality, evidence-based and safe digital tools with NHS endorsement.”
NHS to spend £130m upgrading or replacing radiotherapy machines: Cancer treatment is to get its biggest boost in 15 years, according to NHS England, which has said it will spend £130m upgrading or replacing radiotherapy machines to improve the survival chances of hundreds of thousands of patients, reported the Guardian. The upgrade of at least 100 linear accelerator (Linac) machines across the country will ensure more patients get state-of-the-art treatment called intensity-modulated radiotherapy, which can target the tumour very precisely without damaging surrounding healthy tissue. New machines are more accurate and can deliver a higher dose to the cancer cells, which will reduce the amount of time a patient has to spend in radiotherapy and hopefully increase cure rates. Radiotherapy is an important part of cancer treatment, after surgery to remove the tumour, and cures more people than cancer drugs. The Linac machines used to deliver it are supposed to be replaced after 10 years, but 20% of them in England are older than that. The machines installed in the last decade need a software upgrade, according to Harpal Kumar, chief executive of Cancer Research UK. Kumar headed the Independent Cancer Taskforce, which drew up the NHS cancer strategy and recommended the investment in radiotherapy machines. “One of the things we were quite clear about in the strategy was that, if you look at the proportion of treatment that is delivered as intensity-modulated radiotherapy across the country, it varies quite widely,” said Kumar. “Uptake varies two to three-fold across the country. About half the machines in the country are going to be upgraded in the next two years.” About four in 10 cancer patients – all those who receive radiotherapy – will get improved treatment, said NHS England, which amounts to around 130,000 people a year.
Addenbrooke’s £140m IT contract hangs in balance: Cambridge University Hospitals NHS Foundation Trust could ditch the main IT provider of its high profile eHospital programme, Health Service Journal (HSJ, subscription required) reported. The publication said it understood the programme was making a significant contribution to the trust’s deficit. Bids were said to have been invited for a range of “outsourced commodity IT services” valued at £140m – despite Hewlett Packard Enterprise’s (HPE) contract of the same value and for similar services not being due to expire until after 2020. The trust reportedly said the move was part of a “market testing” exercise to drive value for money out of the programme. The trust’s contract notice in the Official Journal of the EU published last month invited bids for two contracts: one for infrastructure, end user computing and service desk; and one for networks and security. Multiple sources told HSJ that the cost of the HPE contract is exceeding the trust’s original expectations, and is a significant contributor to the trust’s deficit. A trust spokesman said: “We are unable to comment on the costs of the original tender during the current market testing, as it would impact on the potential bids and is commercially confidential. Almost four years into the eHospital programme [the trust] has exponentially increased the use of its electronic patient records and seen a growing demand in the size and types of commodity IT services needed by the trust. As such we are market testing to ensure best value for public money to meet these needs, whilst recognising our partners, HPE, have and continue to meet their contractual obligations.”
Pharmacy access to GP summary records slashes admin by 80%: Granting local pharmacists access to summary information from GP patient records alleviates strain on GP practices and cuts admin time dealing with pharmacists up to 80%, NHS Digital has said, reported GPOnline. One pharmacist cut down on calls to their local GP practice from 200 to just 30 a month after being given access to the practice’s summary care records (SCRs), according to Harpreet Shergill, NHS Digital’s lead for rolling the scheme out across community pharmacy. Speaking at an event hosted by The King’s Fund on emerging models in primary care, Shergill said: “Having access to this information empowers me as a pharmacist to provide care back to patients.” He said it allowed his pharmacy to sort “92% of cases” with patients on-site, without having to direct them back to their GP. To access the system, a pharmacist must use an NHS smartcard to see the patient’s information. This action is logged to show when the SCR is accessed and by whom, and requires the patient’s verbal consent. Around 41% of pharmacies are enabled to use SCRs so far, with plans for them all to be live in 2017. Having access to the SCR means pharmacists can see information about any medicines prescribed, the strength and quantity of treatment and the date they were issued. This enables them to deal with patient queries about their treatment or prescriptions. “The second benefit is because we’re solving this in-pharmacy, there’s a reduction in unplanned patient visits and footfall into GP practices,” said Shergill.
Private company expands ‘GPs to your door’ service: A private GP service that delivers a ‘GP to your door’ for £120 has launched in Birmingham after proving popular in London, reported Pulse. GP Delivered Quick (GPDQ) said it was the first of the new online GP services’ apps to offer on-demand home GP visits. North London GP Dr Anshumen Bhagat set up the service and is already employing around 40 GPs who cover most of central London, where he said it had proved “a great success”. The company has started with 20 GPs in Birmingham but plans to take on more doctors as it grows the business. The service allows patients to book an appointment with a private GP – at a location of their choice – between the hours of 8am and 11pm, seven days a week. They can track their GPs’ progress and estimated arrival time on their smartphone, with an average wait of “within 90 minutes”. The cost starts at £120 for a 25-minute weekday consultation, rising to £150 for a 25-minute weekend consultation. Dr Bhagat said: “The feedback from both our patients and our doctors in London has been fantastic. Now we feel the time is right to bring GPDQ to more UK locations, starting with Birmingham.” Dr Bhagat said the service is “digitising the home visit – it really is that simple”. He added that: “Patients benefit from speed and flexibility, with the ability to see a doctor when and where it suits them, booking and tracking their GP through their smartphone. This should help cut down the NHS waiting times.”
End-of-life shared systems face ‘immense challenges’ – paper: Attempts to set-up end-of-life electronic care systems are falling short, with many failing to reach the dying patients that need them, a new paper said, reported DigitalHealth.net. The paper, published in the quarterly BMJ Supportive and Palliative Care, reviewed the development and use of electronic palliative care coordination systems (EPaCCS) in England. The government has committed to rolling out EPaCCS or equivalent shared end of life digital records across England by 2020. The researchers found there was little guidance about what an EPaCCS should look like, and weak evidence that the systems that were operating were delivering benefits for patients. An EPaCCS is a shared electronic record outlining healthcare information and end of life preferences for a dying patient, which is accessible to any health staff likely to be involved in that patient’s care. They are aimed to reduce the number of people who die in hospital, contrary to their wish to die at home with their families, and cutting unnecessary hospital admissions. One of the researchers, Cambridge University’s Dr Mila Petrova, said to reach the 2020 goal, greater transparency was needed around existing EPaCCS to make sure public money was being spent appropriately. “To me, we are just getting into trouble by not recognising these challenges, wasting money and not getting anywhere,” she said. “The evidence is so weak that it is very problematic.”
New NHS data reveals extent of weekend patient mortality: The first NHS Digital report into seven-day service provision across the NHS has found worse outcomes for patients who are admitted at the weekend, with over 50% of trusts having significantly higher odds of mortality, reported National Health Executive. The ‘Seven-Day Services’ statistics, based on experimental data, found that the national odds ratio of mortality within 30 days of admission on Saturday or Sunday compared to Tuesday to Thursday is 1.15, “suggesting an increased likelihood of mortality”. Of the 137 trusts included in the indicator, 58% of trusts had a significantly higher odds ratio of mortality at the weekend. The research was commissioned after health secretary Jeremy Hunt made his commitment to a ‘seven-day NHS’. The proposals have proven fiercely controversial, with a separate study suggesting that the belief that death rates are higher at the weekend may instead reflect the fact that fewer patients are admitted.
Top speaker line-up for health CIO and CCIO conferences next week: Leading healthcare influencers are speaking in chief information officer (CIO) and chief clinical information officer (CCIO) conference streams as part of EHI Live 2016, which takes place on the 1st and 2nd November at the NEC in Birmingham. At the Health CIO National Conference, which takes place on 1st November and will be hosted by DigitalHealth.net, NHS Digital chief executive, Andy Williams will expand on NHS Digital’s role in service delivery through supporting local digital transformation, rather than forcing change from the centre. Andy Kinnear, chief information officer (CIO) at the Central and West Commissioning Support Unit, will also speak on CIO professionalism and core common qualifications in advance of a debate on this concept. On the 2nd November, NHS England CCIO and National Information Board chair, Keith McNeil will lead the programme at the CCIO National Conference. Joe McDonald, a practising NHS consultant psychiatrist and CCIO at Northumberland, Tyne and Wear NHS Foundation Trust will chair two panels and the EHI Award-winning CCIO and GP Masood Nazir will be discussing the development of CCIOs in primary care.
Healthcare Computing to update on latest developments at EHI Live: NHS IT provider Healthcare Computing will use the EHI Live conference at Birmingham NEC on 1st and 2nd November to update customers and visitors on latest developments, reported Building Better Healthcare. The EHI Live conference and exhibition will focus on frontline use of healthcare technology and will give visitors the chance to see the best that NHS IT providers have to offer the health service. The conference is a key event for NHS care providers, public health and local authorities. Nuria Sanchez, head of marketing at Healthcare Computing said: “We are looking forward to showcasing our success stories and demonstrating how our solutions can make a difference to service delivery.”
Opinions
Nick Hopkinson, chief information officer at Devon Partnership NHS Trust, discusses the role of the CIO and the CCIO in relation to the recent Watcher report.
In an article in Health IT Central, he says: “Whilst increasing numbers of NHS organisations have a chief clinical information officer (CCIO) this role is set to achieve a new prominence. The review recognises that at present very few CCIOs have prior informatics experience or qualifications for this part of their role, and that often protected time is for just one day a week.
“The recommendation that trusts should have an almost full-time CCIO supported by a wider group of ‘clinician-informaticians’ demonstrates the scale of the task in hand. The rise of the clinician-informatician is potentially a pivotal moment in the development of health IT and the levels outlined by Wachter seem the minimum necessary to achieve such a fundamental change.
“So as the CCIO rises, where is the CIO? The CIO is curiously absent from the Wachter review.
“In fact the role of CIO is mentioned just once, in reference to strengthening and growing the CCIO field and health IT workforce. The roles of CCIO and CIO have always had to work in partnership and the truth is that neither can really operate effectively without the other.
“The desire is undoubtedly there to professionalise both the CCIO and CIO roles, and as part of that function we need to work out new ways of working together to deliver exceptional digital services.”
Two years on from the forward view, is there hope for sustainability and transformation in the NHS?
In the two years since the NHS Five Year Forward View was published, the need for change within the NHS has become more urgent, writes Tom Buckley, NHS management trainee.
In a blog for The King’s Fund, he says that pressures on health and social care are continuing to grow, with providers in deficit and targets being missed.
“Given enough time to develop, new care models set out in the forward view may well hold the answer to these rising pressures, with their focus on prevention, early intervention, avoiding unnecessary hospital admissions and supporting people to stay well at home. Local innovations in how care is delivered are beginning to show promise.
“However, despite these developments, new care models are still a work in progress. Putting in place new organisational forms and associated contracting and governance arrangements to support this is proving challenging. There are legal uncertainties about procurement and tendering that have yet to be clarified, with even the most advanced vanguards yet to issue any contracts. Despite guidance issued by national bodies on payment approaches and key issues, local leaders are still unclear on some of the technical aspects of how new approaches to payment systems will work, such as how to determine the size of the budget and how risks and rewards can be shared.”
‘It’s time to articulate the value of registered nurses’:
Jenni Middleton, editor at the Nursing Times, argues the new ‘nursing associate’ role may put safety and quality of care at risk.
In an article this week, she says: “A new role is to join the nursing family. The nursing associate position has been given the rubber stamp by the chief nursing officer for England, who publicly approved its introduction on the NHS England website last week.
Middleton quotes the chief nursing officer for England as saying: “The role is designed to enhance the quality of personalised care, strengthening the support available to registered nursing staff and reducing the reliance and dependency on registered nurses to undertake elements of care that others can be trained to understand and do.”
The editor continues: “Much of the argument against the role has arisen through fear that it will be used to substitute graduate nurses. I can sympathise her view.
“But isn’t that a moot point right now? While many directors of nursing are crying out for registered nurses to fill their vacancies and struggling to provide care safely, you can’t really substitute what isn’t there.
“And right now there aren’t enough nurses, and safety and quality are being put at risk. A solution, call it a quick fix if you like, was needed. Now it’s time to make sure it isn’t used to erode the graduate profession.
“What this profession and its leaders must do is keep a careful eye on what happens now. If the government starts hoodwinking the public into thinking nursing associates are registered nurses, then we have a problem. If trust finance directors start pushing for more nursing associates and fewer registered nurses to keep the pay bill low, then we have a problem.
“There has never been a more important time to articulate the value of the registered nurse. And all those in the profession – and definitely those leading it – must do that to protect and preserve the graduate role.”
Blog
Should you use Snapchat for B2B health marketing?
The proliferation of social media channels can make it difficult for healthcare marketers to decide which ones to choose from to have the most impact. In this blog, Highland Marketing’s PR apprentice Ellie Ratcliffe explores Snapchat as a potential channel for B2B healthcare marketing.
