News in brief
Patients ‘will suffer unless NHS budget rises’: Patients in England will see rising waiting times, rationing and cuts in the number of staff unless the NHS gets more money, health bosses have said. A five-year plan to increase the budget by £8bn a year by 2020 was only set out last year, but now hospital bosses have warned that is not enough, reported the BBC. Chris Hopson, of NHS Providers, said the settlement needed to be redrawn. However, the Department of Health said “tough economic decisions” had allowed it “to invest in our NHS”. It comes ahead of the Autumn Statement next week when ministers will set out their spending plans. This will be the first time the government under Theresa May’s leadership has outlined its priorities. Hopson criticised the way the current spending plans had been structured. He pointed out the rise in spending was actually £4.5bn rather than £8bn when cuts to other budgets, including those for training staff and money for public health schemes such as stop smoking services, was taken into account. He also said the extra demands being placed on hospitals, GPs and council-run care services had been underestimated, while the target to save £22bn in efficiencies by 2020 was “too ambitious”. “If there are no changes to the money available we will need to set out what the NHS stops doing. Right now the service cannot deliver what is being asked of it on the current budget,” Hopson said.
MPs gain a vote on NHS budget: MPs will be able to debate and vote on the budget of each government department, beginning with the NHS, under a plan that will come into force next year, reported the Financial Times (registration required). Meg Hillier, the chair of the Public Accounts Committee, said she was pressing for a vote on the NHS budget to force the government to be more “realistic”. The votes would be non-binding and, in practice, the government is unlikely to be defeated on its spending proposals. However, the debates could cause embarrassment and will put pressure on ministers to explain how they have allocated public funds. David Gauke, chief secretary to the Treasury, said last month he “certainly would not want to object” to the plans, and one person close to the process said the new arrangements were likely to be in place by June or July next year. Hillier said the first vote should tackle the NHS “because it is at such a crisis point”. She added that she hoped that stop-start financing arrangements – such as an extra £1.8bn given to the NHS by health secretary Jeremy Hunt – were replaced with more predictable and stable funding. At present, the House of Commons votes to approve so-called spending estimates in their entirety, spending little time scrutinising the plans for each individual department.
Half of hospital trusts miss reduced waiting targets: More than half of England’s hospital trusts have missed their elective waiting time targets set by NHS Improvement. Health Service Journal’s (subscription required) analysis of the 18 week referral to treatment time data for the second quarter of 2016-17 showed 66 trusts missed targets set for them by the regulator. The national target is for trusts to have no more than 8% of their patients waiting more than 18 weeks for elective treatment, but in July NHS Improvement set different, usually lower, “reset” targets that trusts must hit to access sustainability and transformation funding. Of the 120 trusts that signed up for reset targets from July, 42 missed them in each of the three months of quarter two. Another 24 missed in aggregate over the quarter. The worst performing trust over quarter two overall was Brighton and Sussex University Hospitals NHS Trust, where 76% of patients on the waiting list had waited less than 18 weeks. This meant the trust hit its reset target of 72%. Waiting time’s data released last week for September showed a record high overall waiting list for treatment. The total waiting list hit 3.7 million but is likely to be closer to 4 million when the patients at trusts that are not reporting waiting times are included. A spokesman for NHS Improvement said: “The NHS is dealing with a significant and sustained increase in demand for services, at the same time as working to become more efficient and effective. Patients rightly expect to be seen as quickly as possible and we are already working hard with providers to find ways to better manage the challenges presented by this increase in demand.”
The King’s Fund: If STPs do not work ‘then there is no plan B’: Despite being plagued by problems in their infancy, sustainability and transformation plans (STPs) offer the best chance of improving health and care services, a new report by The King’s Fund has revealed. STPs have faced strong criticism by politicians, local authority leaders and patient groups, reported the National Health Executive. The think tank’s new report, based on interviews with senior leaders in four STP areas, echoes many of these criticisms, especially for the scant engagement with local government, clinical staff and patients and a lack of governance for STP leaders. “It is clear from our research that STPs have been developed at significant speed and without the meaningful involvement of frontline staff or the patients they serve,” the report concluded. While supporting the principle of STPs, The King’s Fund’s report made clear suggestions for patients and all parts of the health and care system to be involved in the STP consultation process, along with improved governance supported by changes in NHS regulation. Chris Ham, chief executive of The King’s Fund, accepted that the introduction of STPs had been “frustrating” for many in the health service, but stressed that it was vital to stick to them. “For all the difficulties over the last few months, their focus on organisations in each area working together is the right approach for improving care and meeting the needs of an ageing population,” Ham explained.
STPs subject to ‘full consultation’ with patients, says Jeremy Hunt: Sustainability and transformation plans (STPs) will be subject to “full consultation” with patient groups, the health secretary has suggested, appearing to go further than commitments in NHS England guidance, reported GPonline. Responding to health questions in the House of Commons, Hunt gave an assurance that patients would be fully consulted on STP proposals, which could include service reconfigurations, closures and mergers. Asked by Tory backbencher Sir Henry Bellingham to “confirm that there will be full consultation with different patient groups on the STP”, the health secretary replied: “I can absolutely give that assurance.” Previously, NHS England, which is running the STP process alongside the five other national NHS bodies, has said that full public consultation would only be required where significant service changes are proposed.
Elderly failed by ‘shameful’ care system: The way older people are being cared for in England is “shameful” and “scandalous”, charities have said. Age UK and the Alzheimer’s Society criticised both the quality of care and the way it was rationed as they published fresh evidence on the state of the care sector. It included figures that suggest the number of older people not getting help has risen by nearly 50% since 2010. However, ministers insisted plans were in place to support the market. Care is funded by either councils or individuals themselves – although growing numbers are also relying on family and friends to support them. The two charities published reports on the same day that the BBC released an analysis of how councils had handled requests for help. The research showed there are now an estimated 1.2 million over-65s going without help for care – nearly one in eight of all older people. Where home care was provided, “serious problems” were identified in the way dementia patients were treated. Caroline Abrahams, of Age UK, said she was “extremely worried” about the “shameful” state of the care system. “The sad irony is that it would be far more effective as well as infinitely more humane to give older people the care and support they need,” she said.
NHS Wales ‘well prepared’ for winter – Vaughan Gething: The NHS in Wales is as “well prepared as it can be” to face the pressures of winter, according to the health secretary. But Vaughan Gething told assembly members the health service was not in “perfect shape”, reported the BBC. He told the assembly’s health committee there would be “extremely difficult days” over the next few months. Gething was giving evidence to its inquiry into the NHS’s readiness for the winter months. He said while he was confident the NHS “is better prepared than last winter and the winter before” he said it still faced challenges in terms of staffing levels and reducing delays in transferring or discharging patients when they are well enough to leave hospitals. Conservative health spokeswoman Angela Burns asked about concerns that elderly patients were being delayed from being discharged from hospital because of issues in arranging follow-up care. Gething said there had been “a downward trend and a levelling off” in recent years in those types of delays but added he “was not happy with the current rate of progress” and conceded delayed transfers would be a “real challenge this winter”.
NHS patients being put ‘at risk’ because of cybersecurity flaws: A Sky News investigation has discovered that NHS trusts were putting patients at risk by not protecting their data online. Seven NHS trusts, serving more than two million people, spent nothing on cybersecurity in 2015. Working with security experts Sky News found serious flaws in their cybersecurity, including misconfigured email servers, outdated software and security certificates, along with NHS trusts’ emails and passwords, through public searches. Jennifer Arcuri, co-founder of Hacker House,l told Sky News: “I would have to say that the security across the board was weak for many factors. Out of date SSLs [secure socket layers], out of date software, it was very clear that you could bypass any number of these trusts just by doing the right recon online. So if I was an adversary looking to get into any of these trusts or take advantage or change, manipulate or send communications on behalf of a doctor, I could, just because the information was already there.” The investigation also revealed that trusts are suffering an increasing amount of personal data breaches, from 3,133 in 2014 to 4,177 last year, and that cyber incidents are accounting for more breaches, from eight in 2014 to 60 last year. A Department of Health spokesman said: “We expect all parts of the NHS to take the threat of cybersecurity extremely seriously so that patient data is protected. We already have in place cybersecurity support services such as careCERT, and are continuing to take action with NHS Digital to enable hospital trusts to drive forward improvements in security where needed.”
Digital patient tech may not save money – Nuffield report: Politicians and policy makers should not assume that digital patient technologies will produce big savings, particularly in the short-term, the Nuffield Trust has warned. In a review of technologies including wearables, symptom checkers, remote consultations, access to records, and apps, the think-tank said “technologies that patients can use offer some of the brightest hopes on the NHS horizon”, reported DigitalHealth.net. However, the report’s lead author, Sophie Castle-Clarke, added: “There is still a lot we don’t know. Without regulation, and a careful look at the evidence – not all of which is compelling – these digital tools could compromise the quality of care and disrupt the way care is provided.” Politicians have shown great enthusiasm for digital patient tech since New Labour launched the first NHS website to coincide with the 50th anniversary of the service in 1998. It went on to create the NHS Direct service (now NHS Choices, morphing into NHS.uk). However, the Nuffield Trust noted: “At the moment, we are lacking robust evidence about the impact that many technologies will have, and in what context. In particular, the potential impact on health outcomes, and to a less extent demand, remains somewhat unclear from a range of technologies.” The think-tank said research effort should be put into particularly promising areas, such as self-triage, online access to records, and remote consultations.
Brexit hits IT costs for NHS: Brexit is starting to hit trusts already stretched IT budgets, with prices jumping in a matter of days as the currency remains volatile, reported DigitalHealth.net. Several big US tech suppliers, including Apple and Microsoft, announced their price rises after the UK voted to leave the EU. Microsoft announced that as of 2017, the price on its enterprise software and most cloud services will increase by 13% and 22% respectively. It has been reported that Apple will increase its prices on hardware by up 25%, although neither tech giant explicitly acknowledged Brexit as the cause of the rise. Senior NHS IT staff said other suppliers had also been bumping up prices or offering quotes that were valid for as little as 24 hours. One IT source reported the cost of data storage had increased by £15,000, while there were also reports that a trust had been forced to pay an extra £150,000 for a new radiology system after a post-Brexit price rise. Quoted prices changed so quickly that it was often difficult to get approval before they had risen. “All of this has happened because of the instability of the currency post-Brexit,” one source said. A senior NHS IT source said his trust had thousands of iPads, all of which would need to be replaced in the next few years.
NHS Digital chief to retire: NHS Digital chief executive Andy Williams has announced he will retire in March 2017, reported Health Service Journal (subscription required). He told NHS Digital staff: “Whilst this was a very difficult decision for me to make, I’m confident that NHS Digital will successfully deliver the personalised health and care agenda under its new leadership. Making effective use of information, technology and data across the health and care system is an enormously important endeavour. We now have a strong portfolio of programmes at national and local level that will play their part in helping to change the way health and care is delivered for the benefit of patients and clinicians. Between now and the end of March, I want to make sure that I do everything to ensure we deliver against our objectives and that NHS Digital is in good shape for my successor.” Health secretary Jeremy Hunt said: “I want to thank Andy for his leadership of NHS Digital and his tireless commitment to improving the quality of health and social care for patients through the power of data and technology. He has made a decisive contribution to setting the NHS on course to be far better digitally integrated and advanced, and I want to wish him all the best for the future.” Recruitment for a new chief executive has begun with public advertisement of the role to follow. In the event of there being a delay in recruitment, NHS Digital chief operating officer Rob Shaw will act as interim chief executive from 1st April 2017.
NHS send-to-all email causes turmoil: An email that was accidentally sent to all the NHS’s staff in England has caused havoc, reported the BBC. One of the health system’s employees fired off the message on Monday morning without realising they had copied in 840,000 of their colleagues. The action quickly clogged up the system and was exacerbated by users hitting “reply all” to complain. The secure email system is used by NHS staff and other approved organisations to discuss healthcare and related activities. “It’s driving me bananas,” one doctor – who asked not to be identified – said. “The thing is hundreds of people have been replying to all. My NHS email is very important to me because it’s the only secure way I can send and receive anything safely about my patients. So, this is a major problem [and] potentially a risk to patients.” A spokeswoman for NHS Digital said it was not a member of its IT team who had sent the message, but declined to identify the culprit, saying they were not to blame. “A number of email accounts have been operating slowly,” said NHS Digital in a statement. “This was due to an NHS Mail user setting up an email distribution list which, because of a bug in the supplier’s system, inadvertently included everyone on the NHS Mail list. As soon as we became aware of the issue, we deleted the distribution list, so that no-one else could respond to it.”
NHS England selects eight projects for second tranche of healthcare innovators: Eight new healthcare innovators are to join NHS England’s NHS Innovation Accelerator scheme, reported Computer Weekly. The programme, established last year, supports local innovations to be adopted across the health service. The scheme is focused on challenges around prevention, early intervention and long-term condition management in healthcare. NHS England’s national medical director, Bruce Keogh, who founded the programme last year, said the innovations “have the potential to deliver better value for the taxpayer”, while also ensuring patient interactions with the NHS are safer and “more personal”. He added: “With rising demand and escalating costs, innovation is not an option but a necessity if we are to build a sustainable NHS.” The programme is part of the NHS’s Five Year Forward View strategy, which aims to invest in technology to improve patient care and close gaps in service provision. The eight new products are: Sore Throat Test and Treat, a walk-in community pharmacy service; EpSMon, an epilepsy self-management tool; Serenity Integrated Mentoring, a collaborative model of care scheme; DrDoctor, an online and text-based service that allows patients to confirm, cancel, and change bookings digitally; OBH Outcomes Platform, which enables commissioners and providers to identify baselines for their selected outcomes, set improvement trajectories and monitor outcomes specific to their local populations; Coordinate My Care, a web-based IT platform enabling digital, multidisciplinary urgent care planning for end of life care; ArtemusICS, a data driven population health intelligence platform; and Enhanced Recovery After Surgery + (ERAS+), which works to reduce the risk of post-operative pulmonary complication.
DH looks for digital strategy and transformation leader: The Department of Health (DH) will be recruiting a digital strategy and transformation leader – a “digital evangelist” – to help shape innovative digital services across the UK health sector, reported Government Computing. The deputy director, digital and technology strategy role, based at the DH, carries a £100K salary. He or she will work with the Government Digital Service (GDS) to “transform the Department of Health into a Digital First department with the tools, capability and confidence it requires to operate effectively, and to lead digital strategy for the health and care system”. The role, which reports to the director of digital and data, will also involve ensuring that the Department of Health and its arms’ length bodies comply with the Cabinet Office digital spend controls and the GDS Digital by Default Service Standard. In addition to shaping the future digital landscape for health, the successful candidate will be expected to build the digital and technology strategy for the health and care system, sponsor digital transformation across key partner organisations in health, advise on best practice and build a network of digital advocates and key allies. Interviews for the position will take place in January 2017.
Remote heart failure monitoring tested in Buckinghamshire: A portal aggregating heart failure data for more than a hundred patients will be deployed in Buckinghamshire, reported DigitalHealth.net. Care4Today is a technology that also allows patients to input their vital signs for remote monitoring and to see a limited view of their record. The study, led by Jansssen Healthcare Innovation and in collaboration with Buckinghamshire Healthcare NHS Trust, Graphnet, and Chiltern and Aylesbury Vale clinical commissioning groups (CCGs), will involve 175 patients using the technology and 175 as a control group. The year-long trial is expected to start in January 2017, with 20 participating GP practices in the two CCGs. Jack Turner, co-lead of the project along with Marc Phippen at Janssen Healthcare Innovation, said the solution was created as there were “lots of silos working”. He added: “One of the things we’ve done is integrate all that data into one record. We’re not generating new data but putting all the existing data feeds into one place. If you have a heart failure patient you can see all the data on that patient in real time.” Alongside being a portal, patients can input into Care4Today to answer symptomatic questions about their condition and monitor signs such as blood pressure and heart rate. The aim, for Turner, through a combination of pooled data viewing and remote monitoring, is to identify patients that become symptomatic earlier, ensure medicine is taken effectively, and enable quicker clinical intervention.
Opinions
A review of the AAR
The government’s Accelerated Access Review is a good start on shortening the time from bench to bedside innovation. But there’s more still to do, argues Michael Thick, IMS MAXIMS chief clinical information officer and chief medical officer, in DigitalHealth.net this week.
“[The review is] an encouraging step for technology adoption. The review shows promise and offers valid solutions. It makes a strong case for collaboration between suppliers and the NHS, to enable end user design from the outset, which in the past has been a challenge.
“The AAR is right to highlight that innovations such as patient-facing apps should be encouraged, but we need to address how this fits into the broader transformation agenda for healthcare providers.
“It is now widely accepted that the adoption of mobile working is part of the future, but standalone, patient-facing apps that do not share data and knowledge with an enterprise solution presents a significant challenge for managing the care pathway.
“It’s also important not to omit apps developed for healthcare professionals, which, when integrated into an enterprise-wide solution deliver significant benefits to the patient, professional and hospital.
“Getting value from apps in the delivery of care requires a highly coordinated view, both in clinical and organisational terms. A myriad of self-contained, non-reporting apps makes holistic and informed care, nigh on impossible.
“How does the AAR fit in with these national and local priorities, particularly as there is increasing uncertainty around capital funding? Where will investment come from for the plans set out in the AAR?
“It’s clear that the digital paradox remains: to save money and transform services, the NHS must be ‘digital by default’; but in order to deploy digital services, organisations must invest.”
Community mental health survey shows results falling short of ambitions
Results from the latest 2016 mental health survey indicate that the ‘No Health Without Mental Health’ strategy has a long way to go, and indicates some worrying findings.
Nick Pothecary, a senior research associate at Picker says in the Health Service Journal: “It is, perhaps, unsurprising that the promise of a more progressive approach to mental health has not yet been realised. In the years since the government published its strategy, the NHS has faced unprecedented financial pressures and staff shortages, all the while coping with the increasing workload of serving an ageing, and growing, population.
“Results for crisis care are cause for concern, with too many users reporting a lack of effective crisis care.
“Of those who had tried to contact the team in a crisis, 3% reported that they were not able to reach them. As in 2015, one in four who did get through, said they didn’t get the help they had needed (24%, up from 21% in 2014).
“If anything demonstrates the gulf between physical and mental health services, it is this; what if 3% of ‘999’ callers were unable to get through, or if 24% of callers were told that there wasn’t an ambulance available.
“Despite worrying trends, there is evidence that service providers are finding more effective ways of using their dwindling resources. NHS mental health services can act as a hub for directing people to other services or groups that may be available in the community.
“Taken together, these findings show a mixed picture and point to services needing to be more creative in addressing the challenges they face. In particular, it is vital to maintain fundamental standards: responsive crisis care teams and wide access to services more generally.”
Do the right thing on social care, Mr Hammond
The chancellor must pledge serious investment in social and primary care in his Autumn Statement, writes Saffron Cordery in Health Service Journal.
Cordery, the director of policy and strategy at NHS Providers, writes: “At the end of November the chancellor, Phillip Hammond, will set out spending intentions for the coming financial year, including for the NHS. All eyes on him, then, but given his recent letter to the Commons Health Select Committee chair we perhaps shouldn’t expect too much for the NHS, or even social care.
“We need to invest any additional resources in those areas of greatest need, which can be a real challenge. Health and care is a mosaic of organisations, with different approaches and aims, which broadly fit together to create the current system. So we must look across them all to understand why demand is increasing and how can we curb it, why A&E is the default destination, and how can we tackle the delays in transferring medically fit patients out of hospital.
“In our submission to the Treasury for the Autumn Statement, we have emphasised the need to invest in the care side of the equation – both social and primary care. Unusual perhaps for an organisation representing hospitals and other secondary care providers?
“However, we know that social care is struggling. Funding cuts have limited the scope of services, eligibility criteria are narrowing and private care providers are exiting the market. Together with the capacity gap in community and mental health services, this translates into the largest number of delayed transfers of care on record.”
