News in brief
Manchester asks for extra £214m to cover social care costs: Former health secretary Andy Burnham has said a shortfall in social care funding threatens the NHS devolution deal, reported the Financial Times. Greater Manchester has appealed to the Treasury for an extra £214m to cover social care, in the latest example of how local authorities are finding it difficult to cope with the rising cost of looking after disabled and elderly people in a time of budget cuts. Burnham revealed the details of the request quoting the official submission made by the 10-council Greater Manchester Combined Authority (GMCA) to chancellor Philip Hammond. The document said the “financial pressures in social care pose a real threat” to Manchester’s ability to deliver devolution because of the resulting strain on the city’s NHS budget. Local authorities must provide support for children, elderly and disabled people, which now consumes up to 70% of the budget in some cities. A lack of beds means many patients stay in hospital longer than needed, with a knock-on effect on the NHS. The document said there is a funding gap of £81m in social care in 2016-17 but that will grow to £214m by 2020-21. The GMCA said the measures were “too little too late” and £1bn was needed nationally by 2021. Burnham said: “The Tories have played a dangerous game on social care funding for six years – cutting budgets to the bone and taking support away from half a million people. If this carries on, and social care is allowed to collapse, it will bring down the NHS with it.”
Ambulances ‘too slow to reach 999 calls’: Ambulance services are struggling to reach seriously ill and injured patients quickly enough after rising demand has left the system over-stretched, a BBC investigation has found. Patients with life-threatening conditions, like cardiac arrests, are meant to be reached in eight minutes. But only one of the UK’s 13 ambulance trusts is currently meeting the target. Ambulance bosses are blaming rising demand and pressure in the system. Freedom of information requests by the BBC to ambulance trusts showed over 500,000 hours of ambulance crews’ time in England, Wales and Northern Ireland was lost last year waiting for A&E staff to be free to hand over their patients to – a rise of 52% in two years. Senior paramedics said the situation had become so critical that it was not uncommon to run out of ambulances at peak times. The Welsh ambulance service is the only one that is hitting its targets to respond to life-threatening calls – and that is only after it reduced the number of cases it classed as an emergency from a third to about 5% so it could prioritise the most critical calls. Scotland adopted a similar system to help it cope, while services in Northern Ireland and England are also looking to follow suit. It comes after average response times for life-threatening calls topped 10 minutes in Northern Ireland. College of Paramedics chair Andrew Newton said the situation was of “great concern”.
NHS trust leaders warn of ‘much higher level of risk’: The NHS is facing a “much higher level of risk” than it can sustain, NHS Providers has warned after it published a new report which revealed widespread fears about service quality, funding and workforce levels, reported National Health Executive. The trust leaders surveyed (the survey covered 172 chairs and chief executives from 136 hospital, mental health, community and ambulance trusts) warned that they could not maintain services at their current levels for much longer, with only 30% saying they expected performance against key targets to improve in the next six months and only 10% saying they were confident they could maintain their current quality of services. Chris Hopson, chief executive of NHS Providers, said: “We need to listen carefully to frontline leaders when they say that the NHS is now running a much higher level of risk. We need greater honesty and realism about what can be delivered for the funding and staff capacity that is available. We need a smaller set of key priorities, more support for staff, and a better relationship between trusts, the government and its arm’s length bodies to develop solutions to these challenges. Above all, we need a clear plan on how to close the gap between what the NHS is being asked to deliver and the funding available.” Many trusts reported that concerns about staff levels were an even bigger worry than concerns over finances. Only one in four respondents thought they had the right staff numbers, quality and skills mix, and more expected this to deteriorate.
Over half of mental health trusts cut crisis beds despite government £1bn funding pledge: Over half of mental health trusts in England have cut the number of beds for patients in crisis, despite the government promising extra funding, reported ITV News. ITV News sent a freedom of information request to all of the country’s 58 mental health trusts. Thirty-two of them responded. They found that despite a government pledge to invest an extra £1bn into mental health services in England, 60% of trusts have cut the number of beds available for mental health patients. The figures offered little evidence of savings being put into community-based services designed to reduce the need for inpatient treatment. Instead they painted a picture of a desperately overstretched system struggling to meet demand. When hospitals find themselves with no beds, they face a difficult choice of either paying private hospitals to take their patients or sending them hundreds of miles from home for an NHS bed. The government has pledged that by 2021 no patient should ever face a long journey for mental health treatment. Barnet Mental Health Trust in North London, for example, cut 21 beds this year. But it spent £2m on private beds – £700,000 more than last year.
Hospitals won’t cope, warns HSE chief: With emergency admissions increasing every year, hospitals in Ireland will be unable to deal with planned surgery in the future unless something changes, Health and Safety Executive (HSE) chief Tony O’Brien has warned, reported the Irish Examiner. “In fact, if these trends continue, all work will be emergency work, and we will be unable to accommodate elective work,” said O’Brien. The country’s health service had to change because of the country’s ageing population. “Unless we plan for the changes now we are going to run into significant difficulties in 10 years’ time,” O’Brien told the Oireachtas committee on the future of healthcare. The HSE was already facing those challenges – there was a 5%-6% increase in presentations to emergency departments year on year, and this was affecting the number of beds available to do elective work. O’Brien also told the committee he was “greatly concerned” that there was not enough money provided to replace ageing ambulances, X-ray machines, MRIs and other equipment. Seven hospital groups, nine community healthcare organisations and a national ambulance service had been established. He said the new bodies should be given at least five to seven years to properly bed down before evaluating them and considering any further changes and that a “very substantial” amount of money was spent on health and the realignment of services allowed an opportunity to make “better” use of it.
HFMA survey reveals divided loyalties for NHS finance chiefs implementing STPs: Finance chiefs in charge of implementing NHS sustainability and transformation plans (STPs) are struggling with a “club versus country” dichotomy, according to the Healthcare Financial Management Association (HFMA), reported Public Finance. Meanwhile, 52% of trusts and 21% of clinical commissioning groups (CCGs) are forecasting a deficit in 2016/17. These were the findings of the latest NHS Financial Temperature Check undertaken by the HFMA, which represents NHS finance directors and finance staff working in healthcare. It draws on responses to a survey of over 200 finance directors and chief finance officers from 128 provider trusts and 72 CCGs across England. Feedback indicated that 22% of trusts and 35% of CCGs are forecasting a worse position than predicted in their financial plan for the year. The most common causes of deficits were under-achieving savings plans (61%), increased agency costs (34%) and an increase in non-pay costs (24%). Most respondents do view the STPs as a cornerstone in plans to reduce deficits. However, an overwhelming majority also voiced concerns about the structure of the plans, with almost three-quarters (72%) concerned about their governance. There was a degree of positive sentiment, however, around STP leadership, with 58% of finance directors seeing “clear and effective leadership in place within STPs”. Meanwhile, 46% believe relations between commissioners and providers had improved. Responding to the HFMA’s NHS Financial Temperature Check report, Stephen Dalton, chief executive of the NHS Confederation, said: “The survey highlights the financial impact of unprecedented demand for emergency care, and much of this is stemming from a lack of social care services in the community.”
Jeremy Hunt: Doctors and nurses should be put in charge of hospitals: Doctors and nurses should be put in charge of hospitals, the health secretary has said, as he announced new plans to put more clinicians in charge, reported the Telegraph. Jeremy Hunt suggested the creation of an NHS management class in the 1980s was a “mistake” which should now be reversed, with frontline staff trained up to run hospitals. Just one in three NHS hospital chief executives are currently former practising doctors and nurses. Speaking to the NHS Providers conference in Birmingham, Hunt announced new plans to fast-track doctors and nurses into management, and to expand the number of graduates entering the field. Hunt said: “Given that one of the most important roles of a chief executive is to motivate a large number of able, smart but – let’s be honest – often quite headstrong clinicians we should today ask whether the NHS made a historic mistake in the 1980s by deliberately creating a manager class who were not clinicians rather than making more effort to nurture and develop the management skills of those who are.” The plans will see 1,000 more graduates recruited to become managers, along with a fast-track programme to train up doctors and nurses with an interest in management. Doctors and nurses will be sent to universities, including Yale University, to prepare for management positions, starting next year, with a new MBA being created so clinicians can study leadership.
STPs ‘will meet opposition’ due to lack of council involvement: The controversial sustainability and transformation plans (STPs) would be more likely to succeed if there was proper engagement with local councils and communities, the chief executive of the Local Government Association has claimed. In a communities and local government hearing, Mark Lloyd said there was a “spectrum” of STPs, from areas of “outstanding practice” to areas where councils were “refusing to support the plans”. A recent report from the Chartered Institute of Public Finance and Accountancy revealed that the STPs lack robust plans to deliver savings and should make more use of councils’ involvement, reported National Health Executive. Lloyd added that the principle of integrated care “could make a big difference”, but that draft STPs so far had a mixed record in delivering them. “Where they’ve not worked are where plans have been introduced in secret,” he said. “Where they’ve not worked are where communities have not been engaged. Where they’ve not worked are where politicians are not at the table and, in some areas, as a consequence of those failures, plans will meet opposition as they’ve been made public. In areas where councils have been inside, communities have been involved, plans have been evolved in a way that’s right for local circumstance, it will make a big difference in solving the dilemmas we face in social care, health and wellbeing more generally.”
‘Carer on demand’ service launched: A new service that provides social care on demand has been launched, contributing to a growing trend for private health and care services to launch on digital platforms, reported DigitalHealth.net. Cera enables people to book online and see a carer within four hours, providing they live within the M25 commuter belt. However, the precedent for setting up Uber-style models in the health and social care sector suggests that winning over the public may not be plain sailing. The media has been quick to question whether companies providing private GP services via digital devices are undermining the NHS. Ben Maruthappu, co-founder of Cera and a junior doctor, said his company was certainly looking to work with councils to provide social care. The company’s carers can help the elderly, those recovering from an operation, or others that need assistance. The service costs about £16 per hour and it can be accessed from outside London – but on a longer time frame. Maruthappu said the company has applied to be registered by the Care Quality Commission, “so that we can make our technology available to everyone”. This would enable it to work with councils as a provider, instead of being classed as an introductory agency.
Northern NHS group builds shared care record: A group of healthcare organisations in the north of England is rolling out a shared electronic patient record as part of a broader initiative to make better use of data and technology in care, reported UKAuthority. The Great North Care Record is being developed under the Connected Health Cities programme, which is encouraging local services to work together and emphasising the better use of healthcare data. A spokesperson told UKAuthority it is already live in some parts of the North East, and will be implemented in stages around the rest of the region over the coming months. It will be available to NHS providers including hospitals, mental health services, out-of-hours doctors and the ambulance service. The record will include information that is currently shared through phone calls and letters, and could include details of medical conditions, medication, operations, treatment, tests and next of kin or carers. Speaking at the launch in September, health and innovation minister Nicola Blackwood said: “This project could set an exciting precedent of working collaboratively across regions, with the potential to be replicated right across the country.”
Mixed digital ambitions for STPs: The publication of further sustainability and transformation plans (STPs) has revealed varying ambitions for the digital transformation of health services across England, reported DigitalHealth.net. The non-London plans include a “digital” section that mentions the need for better analytics, shared care records, better public access to transactional services such as appointment booking. However, they vary greatly in the emphasis that they place on them. Bedford, Luton and Milton Keynes STP, which is one of the most advanced documents, prioritises investment in analytics to underpin its ambition for local organisations to adopt an accountable care approach. Durham, Darlington, Teeside, Hambleton, Richmondshire and Whitby STP puts more emphasis on shared care records, giving a prominent role to the implementation of the Great North Care Record as a vehicle to “make information more widely available and accessible to support frontline care, individual self-management, planning and research”. Lancashire and South Cumbria STP, which has invested heavily in “air traffic control” to streamline referrals and information sharing, said it will continue to focus on this as it reconfigures its acute hospitals, while investing in self-care and “technology-enabled care to support independence”. The STPs are being drawn up to address immediate financial challenges in the health service, and to take forward the Five Year Forward View, which has said that without action a gap between NHS funding, demand and costs could reach £30bn by 2020-21.
Government tells trusts to embrace e-rostering technology: Health secretary Jeremy Hunt has “set expectations” for trusts to boost their use of e-rostering technology in order to better manage ward staffing levels, reported the Nursing Times. He told a conference that working conditions for staff will be improved by setting expectations about the use of e-rostering in trusts. “Matching the right mix of staff to a shift or rota is a central organising principle,” said Hunt. He also told delegates that trusts would be expected to comply with a best practice guide on e-rostering, which was published earlier this year by NHS Improvement, by the end of 2017. The policy will be supported by up to £200,000, so trusts can manage staff rotas and staffing levels on wards, he said. The technology will also allow nursing staff to check rotas online and make requests, simplifying the process for many, Hunt said at the NHS Providers annual conference in Birmingham. The health secretary made the announcement as part of a series of measures to “improve the working lives” of staff, including policy on nursing degree apprenticeships and nursing associates. He said the NHS was “not doing enough, particularly when it comes to e-rostering”.
Cancer Research UK calls for investment in digital pathology: Investment in digital pathology and data collection will be essential if diagnostic services are to be able to cope in the future, according to a leading charity’s report, reported DigitalHealth.net. Cancer Research UK’s investigation into pathology, has nine recommendations that include funding the infrastructure required for digital pathology and investing in technology so data can be sent to the Cancer Outcomes and Services Dataset. Otherwise, the report painted a bleak picture of the future of the sector, with overstretched and overworked pathologists, issues with the recruitment and retention of staff, and a health service “struggling” to cope with increasing demand. Suzy Lishman, president of the Royal College of Pathologists, said in a statement that digital pathology is still in its early stages: “In short, while digital pathology is an exciting and rapidly developing area with significant potential to improve several aspects of the diagnostic process, there is not yet sufficient evidence to support its wholesale adoption.” More recently, digital pathology, in which glass slides are replaced by a digital image that can be read anywhere, anytime, has been developed. Again, though, it is in use at just a handful of centres internationally. The Cancer Research UK report said digital pathology is one route to “future-proof pathology”, but notes that “large parts of the cellular pathology process have so far not pursued digitalisation”.
High profile NHS ‘cyber attack’ may have ‘come from USB stick’: A high profile ‘cyber attack’ on a foundation trust appears to have been the consequence of poor practice, rather than an intentional attack on the organisation, the director of a neighbouring trust has suggested, reported Health Service Journal (subscription required). Martyn Smith, director of IT and innovation at Hull and East Yorkshire Hospitals Trust, told a board meeting that it appeared the source of the virus that affected Northern Lincolnshire and Goole Foundation Trust at the end of October was a USB stick, or an NHS employee working remotely. If this was the case, it is likely that following good practice on use of technology may have avoided the security breach. The virus is not thought to have been from a targeted attack. Northern Lincolnshire said it could not comment on Smith’s claims because “the police investigation is still continuing”. The trust was forced to cancel thousands of operations after what it called a “cyber-attack” affected its IT network, prompting it to close down the majority of its systems. The cyber security team at NHS Digital warned all NHS providers last month of a “potential threat to your organisation” as a result. A North Lincolnshire spokeswoman said it “has a policy on removable media and a policy on information technology security”. She said: “Only sanctioned, corporate encrypted USB sticks provided by the IT department are allowed to be written to. All trust laptops and tablets are encrypted.”
NHS Digital proposes analytics service to disrupt market: NHS Digital is proposing to create a “clear, baseline analytical service”, according to a paper with significant implications for the business intelligence market, reported DigitalHealth.net. The data and information strategy paper said the baseline service will “raise the bar for analytics across the system” and do away with the need for local organisations to buy basic business intelligence (BI) and analytics services. Although this will have implications for companies that sell these services, the paper argued that the move will encourage “investments in innovation”. The data and information strategy, drawn up by Daniel Ray, NHS Digital’s director of data science, fits with this direction of travel. It said the baseline service “will shift the focus more to the use of information to drive improvement in quality, efficiency and outcomes”. Specifically, the paper, which was discussed at NHS Digital’s board meeting, said the organisation will develop an “enhanced, interactive, web-based analytics service” for the data it holds from the health and care system. It said its new service catalogue will cover services it is directed or commissioned to provide, that can be cost-effectively delivered across a large population, or that are needed to support an indicator or statutory service. “We recognise that our analytical service offering can (and indeed should) have an impact on the market of business intelligence analytical providers,” the paper said in an ‘engaging with the market’ section. “By making standard, baseline data analytics that are easily available and easy to be interpreted, we expect to shift the market into adding greater value and innovation for the health system and taxpayer.”
Opinions
The squeezed NHS is responding to difficult times by innovating
There are great examples of NHS trusts dealing with today’s funding and workforce challenges, writes Saffron Cordery, director of policy and strategy at NHS Providers, in the Guardian Healthcare Network.
“The NHS is seven years into the longest and deepest financial squeeze in its near-70-year history. But amid fears over staffing and funding, it is important not to overlook the work trusts are doing to deal with these challenges, sometimes with great success. In pulling together this [The State of the Provider Sector] report, we have been struck by examples of innovation and improvement. This has spurred us to search for the kernel of gold in this situation.
“The key to finding that kernel is to think about patients and service users: they should be at the heart of NHS reform. So whether it’s delayed transfers of care, A&E admissions, or mental health crisis care, it is the combination of improving an individual’s experience and making the system work better that can prove a successful approach.”
In one example, Cordery points to Oxford University Hospitals, which, under new leadership and new approaches, has gone from having one of the worst rates of delayed transfers of care, to halving its delays.
“It did this firstly through better collaboration with social care providers and secondly by creating its own social care workforce and capacity. This means people can be discharged straight into the community. This not only provides a better and safer experience for patients but also frees up hospital beds, which improves the flow of patients and generates capacity for planned elective work.
“…With these and other projects, services and programmes that consider the quality of individual experiences and the needs of the wider system together, NHS trusts are innovating, improving care and driving efficiencies. These are the kernels of gold.”
Ewan Davis: Time to be brave, minister
The NHS needs a digital transformation, yet current plans are unambitious and there is little or no money for them, writes Ewan Davis in an article for DigitalHealth.net.
Davis, a digital health strategist at Woodcote Consulting and former chair of the Primary Health Care Group of the BCS, says: “Politicians have succeeded in presenting an image to the electorate of NHS funding that is ‘protected’. Whereas, in reality, total expenditure on healthcare has been squeezed.
“From a peak in 2009, when we spent nearly 10% of GDP of healthcare, we are now down to less than 9%. Our healthcare spending also compares badly with comparable nations including France and Germany, which spend around 11% of GDP.
“Politicians have also managed to present the NHS as poorly performing. If I ask my friends from outside of healthcare where they think the NHS rates compared to comparable systems, they are typically amazed to learn that we are at the top of most rankings.
“Anyone who works in or with the NHS knows there are opportunities for savings through more efficient processes and redesigned care pathways. But given that we are already the most cost efficient of any major healthcare system in the developed world, it seems unlikely that these savings are going to be easily won.
“They certainly won’t be won by doing what we currently do a bit better (we have already been successful at squeezing out these efficiencies). If we are going to achieve the next level of efficiency improvements, we have to radically redesign the processes of care, and this is where digital is so important.”
Would you swap your local doctor for one on a computer?
Jack Torrance, associate web editor at Management Today, looks at the “Uber-style” health apps of today, and explains how this system could help the NHS.
He writes: “We British are understandably attached to our National Health Service. But it’s hard to argue that the NHS is not an impediment to innovation in healthcare.
“The likes of Doctor Care Anywhere, Babylon Health and Push Doctor provide consultations via a Skype-like video call for as little as between £4.99 and £20 per month. That saves patients having to trudge along to spend ages in waiting rooms full of other ill people and also means they can get appointments out-of-hours.
“Of course there are some things that can only be diagnosed with an in-person examination or blood or urine tests. But the NHS itself says experienced doctors can deal with 60-70% of consultations just over the phone – and that’s without the added benefit of a video feed. Kate Newhouse, CEO of Doctor Care Anywhere, says just 10% of her patients’ consultations require further attention from a doctor in the real world.
“There are clear parallels with the ride-hailing app Uber, whose business practices have been emulated by many an entrepreneur over the last few years, though few Uber drivers can claim to make the £45-£65 per hour that Doctor Care Anywhere’s clinicians make.
“Of course in an ideal world the NHS would already be providing this kind of service itself. Perhaps in the future it could develop its own online service that connects patients with doctors in a time and place that’s convenient to them.”
This is how we get the measure of patient safety
We must continue seeking the most effective set of indicators if we are to obtain a more accurate picture of patient safety, writes Lord Ara Darzi, in Health Service Journal.
He says: “How do you know your local hospital or GP surgery is safe? It turns out there are multiple ways – depending where in the world you live. While health organisations in many countries record errors, monitor staff reports and gather patient complaints, there is no consistency among them. Without consistency, there can be no common understanding of what it means to say a healthcare organisation is safe.
“This is not mere semantics. One in 10 patients are harmed when receiving hospital care, seven to 10% of patients acquire a healthcare-associated infection and there are 400,000 deaths a year in the US alone from potentially avoidable errors. We cannot begin to reduce this toll if we cannot agree how to measure it.
“Assessing whether a healthcare organisation provides safe care is not a simple task. There is a patchwork of measures. Most hospitals rely on staff reporting incidents where things go wrong. These can provide useful patterns but they are beset by problems of under-reporting.
“A study of 34 hospitals in the US found only 14 per cent of incidents were captured by incident reporting systems. In the UK a similar review found only 5 per cent of incidents were reported.”
Highland Marketing blog
Charging overseas visitors: identify the patient, identify the solution
With charges for overseas patients again in the headlines, healthcare technology veteran and Highland Marketing industry advisor Jeremy Nettle says we have the technology and systems in place to address this issue; it is defining who should receive NHS services that is the biggest challenge.
