News in brief
‘Deeply worrying’ waits for hospital beds: More than one in 10 patients in England face long delays for a hospital bed after emergency admission. BBC analysis of NHS figures showed nearly 475,000 patients waited for more than four hours for a bed on a ward in 2015-16 – almost a five-fold increase since 2010-11. Hospitals reported using side rooms and corridors to cope with the growing number of “trolley waits”. NHS bosses acknowledged problems, blaming “growing demand” on the system. But doctors said hospitals were now dangerously overcrowded, with three quarters of hospitals reporting bed shortages as winter hits. Bed occupancy is not meant to exceed 85% – to give staff time to clean beds, keep infections low and ensure patients who need beds can be found them quickly. However, 130 out of 179 hospital trusts are reporting rates exceeding this for general hospital beds. Dr Chris Moulton, of the Royal College of Emergency Medicine said: “Patients who are delayed like this are still being monitored by staff. But we know that the overcrowding we are seeing is dangerous. It leads to worse outcomes for patients – higher infection rates, patients ending up on the wrong wards and generally a negative experience.”
Sick children moved as NHS intensive care units run out of beds: Seriously sick children are having to be transported long distances to receive intensive care because of a lack of beds in major cities, reported the Guardian. In England, 85% of beds available in paediatric intensive care units were full on Friday night. But some units in cities including London and Leicester have been forced to declare themselves as “at capacity”. Planned operations in some cases have been delayed to prepare for any possible emergencies, as the system shows signs of serious strain as winter starts to bite. It has long been feared that this winter would expose the frailties of the health service. Thousands of non-emergency operations and appointments in the run-up to Christmas have been cancelled to enable doctors to concentrate on discharging patients who can safely be sent home, in an effort to free up beds. Dr Damian Roland, a consultant in paediatrics at University Hospitals of Leicester NHS Trust, said: “We know that at this time of the year children will develop viral or other serious illnesses that cause them to need intensive care. There is some frustration though that the system as a whole doesn’t always have the ability to deal with these predictable issues. This is another symptom of the challenge we are facing in operating a sustainable health system that continues to provide the care that patients expect. All of us in paediatrics and child health would like an honest discussion about how the system is funded.”
Campaigners warn of health and social care ‘crisis’: Scotland must rethink its approach to caring for older and dying people in order to avert a “crisis”, campaigners have said. A new report by a coalition of organisations has made a series of recommendations for improving the delivery of health and social care for people living with a terminal illness and their carers, reported The Herald. Marie Curie, the Association of Palliative Care Social Workers, Hospice UK and MND (Motor Neurone Disease) Scotland say too many people are missing out on specialist end of life care. Creative solutions are needed to tackle the challenge of an ageing population amid increasing pressure on public funds. The report said: “We are concerned that these many challenges cannot be met now, or in the future, solely by finding more money for more statutory services. Scotland faces a crisis in caring for older and dying people.” The organisations want an end to social care charges for people living with any terminal illness, including those under the age of 65 and the fast-tracking of devolved benefits for patients and their carers. Susan Lowes, Marie Curie’s policy and public affairs manager for Scotland, said: “Often, people will go into hospital for a medical reason but it is waiting for the right social care that stops them from leaving again. When people have a terminal illness, time is short and many don’t have the time to wait for delayed care packages. Good social care support can prevent unnecessary admissions, prevent people dying in hospital and prevent delayed discharges.”
NHS unprepared for winter pressure, say doctors: The NHS is unprepared for winter pressures, the British Medical Association (BMA) has warned, reported OnMedica. A new BMA survey of 457 doctors reveals that 78% believe that the ability of the NHS to cope during this winter is worse compared with the last three years. Doctors said that a lack of beds, delayed discharges and the general demand for primary care services were going to pose the greatest challenges over the winter period. Unmanageable workload has hampered doctors’ ability to provide high quality patient care during previous winter periods. Commenting on the findings, Dr Mark Porter, BMA chair of council, said: “These figures are cause for serious concern as, while there is an ever increasing demand for health services across the NHS, this is hugely exacerbated during the winter months.” He added: “Front-line staff are working flat-out but the system can’t cope with the number of patients needing to move through acute care, as the entire system is congested. It is vital that there is sufficient capacity across the entire health and social care system, including in accident and emergency departments, general practice and social and community care.”
Patient waiting lists hit new high despite pledge: The number of public patients on hospital waiting lists in Ireland has reached a new high of 538,209 – a jump of more than 2,500 in just a month, reported the Irish Independent. The upward trend continued despite the Health Service Executive (HSE) saying 8,000 patients have come off the waiting list since August. While some of these have been treated, others have just been given an appointment for their procedure and in other cases names of people who died were removed. The HSE said the total number of patients awaiting a routine endoscopy procedure continued to decrease – down 672 in total from last month. The promise was to have nobody waiting more than a year for an endoscopy at the end of 2016, but 419 were still facing this delay at the end of November. It will be the New Year before the full €20m, allocated in the budget to outsource some patients to private and other hospitals, comes through. Health minister Simon Harris recently released the first €5m of this to fund day-care procedures and around 2,500 of the longest waiters will be treated. However, substantial numbers of new patients are joining waiting lists. An average of 1,200 new patients a week are coming on to outpatient lists alone. The HSE said work is underway to put sustainable solutions in place to address general access times for patients who need to see a specialist.
Board appointed to oversee implementation of healthcare plan: The Northern Ireland health minister has appointed two expert panels to oversee the implementation of her 10-year plan for healthcare, reported the BBC. Michelle O’Neill has said ‘Health and Wellbeing 2026, Delivering Together’ is a “wholesale transformation” of Northern Ireland’s health service. The board overseeing the transition includes Professor Rafael Bengoa. In October, Professor Bengoa published a report recommending widespread change to the healthcare system. A transformation advisory board will oversee the direction and speed of reform, while a transformation implementation group will manage its execution. Announcing the two boards, O’Neill said: “Given the size and scale of the challenge ahead, we need to start now to properly plan, implement and embed the whole system transformation. That begins with the leadership and structure to drive change, with the involvement of service providers and users. I am committed to playing my part in making change happen and will chair the transformation advisory board, whose membership will be drawn from the field of independent experts, trade unions, service users and community and voluntary sector representatives, along with the permanent secretary of the Department of Health.”
NHS and social care leaders urged to embrace ‘whole system flow’: Improving the flow of patients, information and resources within and between NHS and social care organisations can drive up service quality and productivity, a new report has argued. The challenge and potential of whole system flow, written by the Health Foundation and the Advancing Quality Alliance (AQuA), aims to help NHS and social care leaders to reduce delays and duplication, two things it said should be given added impetus in the context of sustainability and transformation plans and current financial challenges, reported the National Health Executive. The report encouraged leaders to embrace ‘whole system flow’, a co-ordinated approach across organisations which focuses on improving the pathway that patients take through the NHS and social care system. David Fillingham CBE, chief executive of AQuA and one of the authors of the report, said: “Understanding and improving the flow of people and resources should be a major priority, not just for colleagues working in the NHS, but also those across the wider health and social care landscape.” The joint report found that poor flow is not only wasteful but can also cause harm to patients and staff. It cited common examples of this such as ambulances queuing outside hospitals, stretched accident and emergency and mental health departments, and delays in patients getting referred to hospital by GPs.
Global Digital Exemplars expected to match £10m funding: Global Digital Exemplars will each be expected to match £10m in funding received from NHS England for digital infrastructure developments required by the programme, reported Health IT Central. A spokesperson for the Department of Health confirmed that it is down to the individual sites to decide how they will match the funding, either through revenue or clinician time and other possibilities. Commenting on the story in an interview for British Journal of Healthcare Computing (BJ-HC), Ben Maruthappu, co-founder of Cera and the NHS Innovation Accelerator, agreed that ‘local and national alignment’ is essential to shaping the right pathways for the digitisation of the NHS system. “It is evident the benefits of investing in and optimising use of digital technology to improve efficiency and enhance care is more widely understood but we are not yet realising these benefits at scale or sufficiently quickly. We need to move faster in getting clinicians real-time access to accurate information and joining up healthcare systems to improve outcomes for patients and reduce workload for doctors, nurses and other NHS staff. Our aim here is to create a national movement in which the centres of global digital excellence will be core,” said NHS England’s chief clinical information officer Keith McNeil regarding NHS England’s initiative.
Nine in 10 NHS trusts still use Windows XP: Windows XP is still in widespread use throughout the NHS, two-and-a-half years after Microsoft dropped support, according to a new survey. Citrix, which commissioned the survey, sent freedom of information act (FoI) requests to 63 NHS trusts in the UK, 42 of which responded, reported ITPro. The information gathered revealed Windows XP was in use in 90% of trusts questioned – albeit on a small percentage of overall devices in some cases. The data also revealed that 24 trusts are still unsure as to when they will migrate from Windows XP to a newer operating system. Windows XP, introduced in 2001, hasn’t received official security updates since April 2014, but remains in use – even in large deployments – despite a significant effort from Microsoft to persuade organisations to move to Windows 7, 8 or 10. Around one in seven (14%) trusts indicated that they would be transitioning to a new operating system by the end of this year, with nearly a third (29%) claiming they will make the move some time next year. The latest findings did reveal that nearly one in four (23%) trusts are deploying desktop virtualisation technology to address the issue of migrating from Windows XP, up 18% from July 2014. Jon Cook, director of sales in UK & Ireland at Citrix, said that prolonged austerity and Brexit has meant the NHS has had to do more with less. “Whilst many authorities now only use a small number of devices that run Windows XP, the transition to a newer operating system needs to happen as a matter of urgency,” he said.
Aggressive ransomware blamed for NHS cyber attack: The Globe2 ransomware virus has been singled out as the culprit in the cyber attack that took down a northern NHS trust’s systems for four days, reported DigitalHealth.net. Northern Lincolnshire and Goole NHS Foundation Trust confirmed in a statement that the shutdown, which led to cancellations of 2,800 appointments, was due to a variant of ransomeware called Globe2. Globe2 works similarly to other ramsomware viruses, but uses a Blowfish data encryption, by encrypting files and demanding money to release them. It has been described by security experts as very aggressive. Pam Clipson, director of strategy and planning at the trust, said: “Any potentially encrypted servers were checked and cleansed both prior to switching off and before returning to ‘live’ status”. The latest board papers from the trust show the 30th October attack infected the systems through a “remote intruder”, and that “data elements on a number of trust servers were encrypted”. When it hit, most operations and appointments were cancelled for four days, and patients were urged to only visit the emergency departments “if you absolutely need to”. The outage affected all three of the trust’s major hospitals; Scunthorpe General, Diana Princess of Wales Hospital in Grimsby, and Goole and District Hospital. This ransomware attack will add to the growing concern within the NHS of cyber attacks, where there is a big base of legacy IT systems that are particularly vulnerable.
Virgin Care to take over GP out-of-hours services in multi-million contract win: Virgin Care has clinched contracts worth £65m to provide urgent care services – including out-of-hours GP services – and community services in one region of England, reported Pulse. The company will take over the five-year contracts for NHS community health services, worth £45m, and urgent care services, worth £20m, for West Lancashire on 1 April 2017. The services include district nurses, community matrons, IV therapy, end of life teams, GP out of hours and walk-in centres. In February 2016, NHS West Lancashire CCG announced that two private companies, Optum Health Solutions (UK) and Virgin Care Services, would go forward to compete to provide urgent care services. The same two private companies were also in the running for the community health services contract, along with two NHS foundation trusts, Lancashire Care and Bridgewater Community Healthcare. The current provider, Southport and Ormskirk Hospital NHS Trust, was not shortlisted for the contracts. The trust was rated as ‘requires improvement’ by the CQC inspection on 15th November and received the same rating in April this year. Claire Heneghan, chief nurse of NHS West Lancashire clinical commissioning group, said: “The aim is to develop and enhance community and local walk-in and out of hours services, helping to prevent avoidable acute hospital attendance, relieving pressure on such a vital resource.”
Digital roadmaps weak on ‘how’ – review: At least a quarter of the country’s local digital roadmaps (LDR) are weak on explaining how they will deliver on a paperless vision, a regional NHS England review team has found, reported DigitalHealth.net. The analysis by regional review teams is revealed in board papers published by North Bristol NHS Trust. NHS England, which is leading the LDR process, refused to comment on the findings. However there has been no formal national level feedback on all LDRs. The comments raised concerns about the LDR process, which is meant to outline how local areas will digitally transform to achieve the NHS goal to be paperless at the point of care by 2020. The findings detailed in the board paper said overall there was “a general lack of articulation as to how the elements of the LDR would lead to improved outcomes and benefits and how these would be measured”. While there was an understanding that the LDRs needed to be linked to the broader sustainability and transformation plans (STPs), it was not always clear that roadmaps would make a “big difference” to the STP goals. Overall many LDRs were also still developing a governance arrangement and there was a “huge variety in detail” about how they would use information sharing and interoperability to meet their goals. Funding was a key issue in the publication’s review of the publicly available draft LDRs. Without outside help, many footprints believe that NHS England’s paperless goal is locally unachievable.
NHS England announces cancer services boost: NHS England’s chief executive Simon Stevens has unveiled the first tranche of hospitals that will benefit from a major national investment in NHS radiotherapy machines, reported The Pharma Times. Fifteen hospitals in areas where there is greatest need have now been selected to receive new LINAC linear (accelerator) machines, as part of a £130m investment in radiotherapy technology upgrades. Recent advances in radiotherapy using cutting-edge imaging and computing technology have helped target radiation doses at cancer cells more precisely, improving both treatment outcomes and reducing NHS costs. Also announced was funding of £200m over two years to boost local cancer services. Speaking at the Britain Against Cancer conference in London, Stevens said: “Across the country, the NHS is now making great strides in upgrading modern cancer radiotherapy equipment and ensuring faster access to the most promising new cancer drugs.” He added: “Because the quality of NHS cancer care has improved so much over the past year, an extra two thousand families will be able to celebrate the Christmas holiday with a loved one who has successfully survived cancer. It’s an enormous tribute to dedicated nurses, doctors, scientists and patients’ organisations that we are on track to save 30,000 more lives a year from cancer.”
NHS Digital vindicated in patient data confidentiality row: The information watchdog has ruled NHS Digital has complied with its code of practice when releasing hospital record data, following a row over the sharing of 1.2 million patient records, reported Health Service Journal (HSJ – subscription required). The Information Commissioner’s Office’s (ICO) verdict, published last week, was welcomed by NHS Digital and researchers, who said it showed “robust” processes were in place when data was anonymised or pseudonymised for sharing outside the NHS. The data is seen as crucial for vital research projects. However, privacy campaigners said patients’ right to opt out of their data being shared was being ignored. There are also concerns because the code of practice is not statutory, and the ICO warned earlier this year that it may not be robust enough. The ruling comes as the NHS waits for the government’s response to Dame Fiona Caldicott’s review of patient data sharing. An ICO statement to HSJ said: “We’ve looked at NHS Digital’s process for anonymising hospital episode statistics data and found the organisation has followed our anonymisation code of practice.”
New clinical IT framework launched: A northern trust has developed a new clinical IT framework that it hopes will compete nationally in what is already a crowded market, reported DigitalHealth.net. Gateshead Health NHS Foundation Trust, through its spin-off company QE Facilities, released the broad framework last month. David Burns, frameworks manager at QE Facilities, said it was probably the broadest clinical IT framework in market. “We’re trying to capture as much of a view of what IT the community in a hospital needs as we possibly can.” There are 49 suppliers on the framework, covering 52 products, including electronic patient records, patient administration systems, picture archiving and communications systems, radiology information systems, e-prescribing and specialist departmental systems. Suppliers include big names such as Cerner, System C and Agfa, as well as SMEs seeking to disrupt the market, Burns said. NHS IT frameworks are designed to standardise procurement of systems, in theory reducing costs and improving quality for trusts, and providing a more assured commercial pathway for suppliers into the NHS. Burns said there were currently 13 “active opportunities” with trust interested in buying IT through the framework, including document management, e-prescribing and EPR products. Ideally the framework business would generate income for the trust while at the same time making the acquisition of IT cheaper, he said.
Opinions
How to keep clinicians happy with IT: don’t mess up a data project
The NHS is evolving. As technology improves, across the system organisations are increasingly embracing the opportunities. Dermot O’Riordan, chief clinical information officer at West Suffolk Foundation Trust, discusses what it is like to transfer over to new systems, and why it is so vital that it is done correctly.
In an article to the Health Service Journal (subscription required) he said: “In May this year, at West Suffolk, we pushed the button on a massive transfer of our patient administration system and referral to treatment (RTT) data from our existing legacy system to a new electronic patient record (EPR).
“We all understood the risk of getting this wrong. Data supports our hospital staff in managing patients through their care pathways as safely and efficiently as possible. If we can’t track patients through pathways, we might miss them.
“Moving to a new IT system is a little bit like moving home. You want to ensure that everything great about your old home is kept and transfers to the new one, and is roughly in the same place. At West Suffolk we were moving much more than a house, we were transferring a huge amount of sensitive data from over 250,000 of our patients seamlessly from our 20-year-old system to a new implementation.
“This information needed to be packaged, processed and cleansed before it could be moved. Once moved, it needed to be immediately accessible for our clinicians and administrative staff, whenever and wherever they needed it. And we didn’t need clinicians to tell us that this had to be done with as little downtime or interruption as possible.
“Accurate scoping helps to reduce threats. With a clear understanding of the challenge, plans can be drawn up, risks mitigated and fears allayed.”
What have we learnt about keeping people safer?
At a recent event, the Sign up to Safety campaign and NHS Improvement, people gathered to explore how the NHS can keep patients safer. David Naylor, senior consultant, leadership development at The King’s Fund discusses what they learnt from the day.
In an article to the Kings Fund, he said: “Recently, 90 people from across the health and care system came together for an event run by The King’s Fund.
“To state the obvious, keeping people safer is not simple or straightforward. ‘Safety’ is a combination of knowhow: resources, patient situations, and the regulatory environment. Keeping sight of how this complex chain of interactions and events works is part of how we keep people safe, but keeping this complexity in mind when trying to understand why we fall short is a challenge.
“There was a strength expressed in the stories we heard on the day – people’s willingness to shoulder a significant level of personal responsibility for keeping people safer. This attitude will get things done, but the serious downside is an unreasonable level of personal scrutiny and accountability when things go wrong. People spoke of feeling embattled and isolated working ‘in the implementation gap’ – and of the personal sense of shame when things go wrong.
“This in turn leads to self-silencing and a consequent lack of open conversation that could help to identify and tackle problems in the wider system.
“If one assumes that most care is characterised by complexity, then just focusing on individual behaviour is simplistic, unethical and part of the reason why there is an implementation gap in the first place.
“We think this sort of conversation contributes to keeping people safer because more of what is really going on – unintentionally shaped by people’s assumptions and behaviours – can be surfaced and evaluated, alongside the question: how does this way of thinking, behaving and organising keep people safer?”
What is wrong with the NHS?
The NHS does a great job when it comes to keeping the UK population alive, treating chronic long term illnesses and providing thousands of jobs for hardworking doctors, nurses and staff. However, in Dr Seth Rankin’s, London Doctors Clinic founder and senior NHS GP opinion, when it comes to customer service and convenience the NHS does not do so well, not just in the UK but across the world.
“According to The King’s Fund, NHS quality standards have slipped to their lowest level in more than a decade. This is hardly shocking as we have become accustomed to reading doom and gloom headlines in the media, but clearly the situation needs to be improved.
“The reasons for NHS customer service challenges are wide and varied, however, I believe many issues stem from it being a public service. History has shown that public service is not always the most efficient way to deliver productivity. In particular, there are three key areas to consider:
“1) Committees: There is a plethora of committees at every level of the NHS. These committees have often been given tasks that are unintentionally mutually incompatible. One example of this is with sharing patient information to those who need it.
“2) Employment contracts: Believe it or not there are some positions in the NHS that have 6 months fully paid sick leave starting from day one. A newly employed staff member can (and occasionally does) leave work half-way through their first day and stay away for 6 months on full pay – only to reappear jauntily as soon as the sick pay runs out.
“3) Activity and reward: The final nail in the coffin of productivity in the NHS is that no staff get paid in proportion to the effort they put in. At every level of the NHS staff are generally paid the same whether they process 100 patients or sitting chatting amongst themselves in an empty out-patient department.
“How do you fix the NHS? I think leaving it alone is the best idea. Having worked in it as a clinician and a commissioner I truly don’t think it can be ‘fixed’. Universal healthcare, free at the point of care is an amazing achievement and is the envy of governments around the world. While many people complain bitterly about access and customer service this is not the only consideration in a public health service. The health of the people of the UK is favourably comparable to the best in the world. The cost of the NHS is one of the lowest percentages of GDP and many thousands of people are employed on good salaries to deliver this service to us. So be proud of it in sickness and in health.”
Highland Marketing blog
How technology can help improve the patient experience
What is patient experience and why is it so important to health organisations?, asks Ellie Ratcliffe.
