Guest Interview
‘Politicians must invest in eHealth to realise Scotland’s NHS ambitions’ – Robin Wright
Former Scottish eHealth leader Robin Wright says Scotland’s NHS deserves the same level of digital investment as other sectors, but doubts whether in the current austere public service funding environment, the political will is there. He speaks to Rob Benson for the Highland Marketing Healthcare Roundup.
News in brief
NHS trusts given two days to bid for digital health funding: NHS trusts were given two days to express interest for investment in digital services, and told the projects would need to be completed by March 2017, reported Health Service Journal (subscription required). In a regional NHS England memo sent out last week, seen by the publication, the national body said it was reviewing the “capital allocation position” with the Department of Health (DH) for the remaining two months of 2016-17. It said funds could be provided “to organisations which urgently need investment in their digital services to support key strategic, operational or patient safety needs”. The digital investment funds would come through the “provider digitisation programme”, which has been allocated £1.3bn over five years. These funds count against the DH capital budget, which has been cut to £3.6bn in 2016-17 after £1.2bn was transferred to the revenue account. Trusts were told that individual proposals should not exceed £1m. The memo added: “Due to the speed of this request and that the project needs to be delivered by March 2017 we expect that your bid will be related to a business case you have already developed.”
Warning of cuts to family doctors in NHS overhaul: GP leaders have warned that local health chiefs are exploiting plans to overhaul the NHS in order to slash the number of family doctors, reported The Telegraph. The Royal College of General Practitioners said the number of GPs proposed for many of the regional re-organisations went “against all common sense”. It also criticised the process for prioritising major hospitals at the expense of local surgeries, despite mounting evidence that shortages of GPs ultimately puts hospitals under more pressure. Two of the sustainability and transformation plans which are being brought in following a record NHS overspend last year, propose to reduce the number of GPs in the local area. However, many other plans are “vague at best”, according to the profession’s leaders, and could be a prelude to more widespread reductions. In November the British Medical Association said that two out of three NHS doctors had not been consulted over plans which could also see bed cuts and closures of accident and emergency departments. It comes as research shows the proposals, being drawn up across the NHS, will mean at least £22bn in cuts. Professor Helen Stokes-Lampard, chair of the royal college, said: “The future of our health service relies on high quality, robust general practice, but it would appear that this may not be the case for vast swathes of the patient population across England. GPs and our teams conduct the vast majority of patient contacts in the NHS for a fraction of the budget. We provide the most cost-effective form of care, keeping our patients safe, in the community, and out of hospitals where care is more expensive.”
British trade deal with US will exclude NHS, May and Fox pledge: Theresa May and Liam Fox have ruled out access to the NHS in a future trade deal between Britain and the US, reported the Financial Times (registration required). The prime minister told MPs that “the NHS is not for sale and it never will be”, while Fox said the idea was “on a par with alligators in the sewers as urban myths”. Officials from the Department for International Trade are due to travel to Washington next week to begin talks about a bilateral trade deal, and Labour, the UK’s opposition party, warned that the government planned to allow US insurers and health companies to provide NHS services. Labour said a rushed trade deal between May and Donald Trump, the US president, could end up being “a Trojan horse for NHS privatisation”. Fox, the international trade secretary, denied that US companies would have access to the NHS: “As the person who will be in charge of negotiating [a deal] that would not be happening on my watch.” He said there had been speculation over the matter when the EU and US were negotiating the now stalled Transatlantic Trade and Investment Partnership (TTIP) deal. However, Fox said: “It is never part of our approach in these multilateral agreements . . . to sacrifice the right of governments to regulate public services. It is what I would want to see continue.”
Watchdog chief says major change key to NHS turnaround: Scotland’s health service will continue to fail to meet targets unless major reforms take place, the head of a watchdog has warned, reported The Scotsman. Dame Denise Coia, chairwoman of Healthcare Improvement Scotland (HIS), said the way services are run across Scotland would need to change. Giving evidence to Holyrood’s Health and Sports Committee, she said: “I think the important thing to get at with targets is if we keep doing the same things that we do at the moment, the way we run acute care and chronic care, we are going to continue failing. We have to change the way we run healthcare in Scotland and I think that’s part of the work we are beginning to do at the moment. The NHS and social care in Scotland has got a finite budget that is really problematic. We’re going to have to decide in Scotland, and it’s a public debate, about how much we are going to spend on state-of-the-art acute care and how much we are going to have to spend on chronic care that shouldn’t be in hospital and should be out in communities. What I would like to see in Scotland is a far more honest debate about do we want to spend the money more on chronic care or do we want to continue to have the seriously hi-tech acute care, because it just gets more and more expensive.” Dame Coia’s comments came as new figures showed that Scotland’s accident and emergency (A&E) recorded their strongest performance so far this year during the week ending 22 January.
Wait times in Ireland for A&E are the worst in Europe: Ireland’s healthcare system last year ranked 21st out of 35 countries and their hospital waiting lists continued to be among the worst in Europe, according to the Euro Health Consumer Index. The Irish Independent reported that the top countries, based on a comparison of key areas, were the Netherlands, Switzerland, Norway, Belgium and Iceland. A&E waiting times in Ireland were again the worst in Europe, followed by Poland, Greece and the UK. The report expressed surprise at the low ambitions of the Health Service Executive and referred to the “target of no more than 18 months’ wait for a specialist appointment”. It warned that “even if and when that target is reached, it will still be the worst waiting-time situation in Europe”. Hospital waiting lists climbed to record levels last year, with more than 530,000 waiting, and will increase again this month due to the trolley crisis. The report also casted doubt on the validity of official HSE statistics and said “as a matter of principle” it uses patient organisation feedback to score Ireland on accessibility. There is also a poor score when it comes to cost efficiency, as Ireland’s healthcare system is the fifth worst country when it comes to “bang for buck”. Only Greece, Hungary, Bulgaria and Romania emerge with worse rankings for value for money.
Glasgow’s NHS ‘facing cuts of £333m over next five years’: Scotland’s largest health board is facing cuts of £333m over the next five years, according to a newly revealed memo which suggested the number of hospital beds in Glasgow will have to be reduced to save money, reported iNews. Senior managers at NHS Greater Glasgow and Clyde are planning to centralise and close acute services outside of the area’s three main hospitals as part of a drive to reduce costs, the document showed. It stated that in the coming years, most specialist acute services offered in the Glasgow area “will be delivered on fewer sites” and that acute care will have to be delivered “with less beds”. Scottish Labour said the “brutal cuts” being contemplated by the health board could lead to further pressure being placed on Glasgow’s struggling A&E departments. The area’s three hospitals – the Queen Elizabeth University Hospital, Royal Alexandra Hospital in Paisley and the Glasgow Royal Infirmary – already have some of the poorest performing A&E wards in Scotland. The report did not name hospitals which could lose services as a result of the changes, but Inverclyde Royal in Greenock and the Vale of Leven in West Dunbartonshire may bear the brunt of the cuts. In the report, obtained under the Freedom of Information Act by The Times newspaper, the board’s managers estimated that £105.9m will have to be saved in 2017-18 alone. They warned that rising numbers of patients will soon be treated in “unaffordable” hospitals.
Social care needs £1bn boost or councils at risk of failing statutory duties: Social care requires £1bn of emergency funding in this year’s Budget in order to stabilise the market, or else some services are at risk of failing, directors of social care have warned. In its representation for the 2017 Budget, the Association of Directors of Adult Social Services (ADASS) said that urgent funds distributed on a needs-based system were required to address the social care shortfall or councils will begin to fail in their statutory duties, reported Public Sector Executive. The current fragility of the adult social care market was demonstrated by the results of a survey of ADASS members last October, which showed that 62% of directors had experienced residential and nursing home closures in the past six months and 57% had care providers hand back contracts. “During this hard winter and throughout next year we will continue see more older and disabled people not getting the care and support they rely upon to survive each day, an even greater toll being placed on those 6.5 million family members and other carers, increasing delays in the NHS, and even more care homes closing and growing gaps and failures in the care market,” read the ADASS’ representation. “We are aware that others ask for more, but emergency assistance of £1bn, distributed on a needs-based formula, to prevent further deterioration whilst working on longer term solution, would go some way towards stabilising the system.” ADASS has stressed that successive governments have failed to fund social care adequately as social care spending as a percentage of GDP continues to fall, while councils project a combined overspend next year of £441m, up from £168m last year.
Problems accessing Google on NHS network: There is an on-going issue with NHS trusts’ ability to access Google, NHS Digital has reportedly confirmed. According to a report on DigitalHealth.net trusts had been presented with a CAPTCHA page when trying to use the search engine. A spokeswoman for NHS Digital said access issues were caused by “sheer numbers”, adding it was “nothing to do with a cyber-attack”, despite some reports suggesting the move was motivated by concerns about a cyber-attack. In a statement to DigitalHealth.net, a spokesman for NHS Digital said: “We are aware of the current issue concerning NHS IP addresses which occasionally results in users being directed to a simple verification form when accessing Google. This would appear to be due to the high number of people using our systems and trying to access Google at peak times. We are currently in discussion with Google as to how we can help them to resolve the issue.”
Half of NHS trusts only scan applications for vulnerabilities once a year – if that: NHS trusts are failing on IT security, with 45% scanning their applications for vulnerabilities just once a year, and only 8% making a systematic effort and scanning every day, reported Computing. That is the claim of security software company, Veracode, in a report based on freedom of information (FoI) requests submitted to 36 NHS trusts across the UK. The responses also indicated that half of NHS trusts only scan perimeter web apps once-a-year as well, leaving patient data at risk of cyber-attacks through insecure legacy websites and third-party plug-ins. Just 12% of the NHS trusts surveyed scan web application perimeters daily. The lack of systematic security practices possibly explains why so many NHS trusts have fallen victim to malware outbreaks, including ransomware. “In light of recent ransomware and other cyber-attacks on healthcare organisations, the industry’s low scores on these application security benchmarks is troubling,” said Paul Farrington, manager of EMEA solution architects at Veracode. He continued: “Our new research certainly raises fresh concerns regarding the safety of patient information here in the UK, as well as across the globe. There appears to be a lack of emphasis on application and web app scanning within the NHS, which could put trusts at an increased risk of losing patient data to hackers.”
Majority of NHS trusts still rely on paper records – but half are looking to AI, research shows: According to figures released following a freedom of information request (FoI) by the communications solutions company Nuance, 93% of the 30 trusts that responded said they handwrite reports, revealed PublicTechnology. The same proportion said they relied on traditional word processing methods to type up electronic patient records. However, the FoI also indicated an increasing interest in AI across the NHS, with 43% of trusts reporting that they were considering how to use AI as a way of allowing patients to “self-help” when accessing health services. In a statement published alongside the FoI responses, Nuance said that such technology included virtual assistants, speech recognition technology and chat-bots. Last year, Enfield Council became one of the first local authorities to use AI assistance, with the introduction of IPSoft’s Amelia systems to help residents carry out online tasks. At the time, the council said that this would allow residents to access services 24 hours a day and reduce pressure on staff. Nuance also noted the potential for this to reduce pressure on staff working in the NHS, pointing to its previous research that 90% of GP practices found their patient documentation systems “burdensome”. The FoI request also showed that 60% of NHS trusts surveyed said their staff had access to speech recognition technologies to create patient reports and diagnostics reports, which Nuance said would speed up processing of documents.
Robots could help solve social care crisis, say academics: Humanoid robots, with cultural awareness and a good bedside manner, could help solve the crisis over care for the elderly, academics said. An international team is working on a £2m project to develop versatile robots to help look after older people in care homes or sheltered accommodation, reported the BBC. The robots will offer support with everyday tasks, like taking tablets, as well as offering companionship. Academics said they could alleviate pressures on care homes and hospitals. Researchers from Middlesex University and the University of Bedfordshire will assist in building personal social robots, known as Pepper Robots, which can be pre-programmed to suit the person they are helping. It is hoped culturally sensitive robots will be developed within three years. The programme is being funded by the EU and the Japanese government. Prof Irena Papadopoulos, expert in trans-cultural nursing, said: “As people live longer, health systems are put under increasing pressure. In the UK alone, 15,000 people are over 100 years of age and this figure will only increase. Assistive, intelligent robots for older people could relieve pressures in hospitals and care homes as well as improving care delivery at home and promoting independent living for the elderly. It is not a question of replacing human support but enhancing and complementing existing care.”
NHS trials teleneurology system: An NHS England vanguard programme is launching a new teleneurology system to speed up communication between patients in acute hospitals and clinicians from The Walton Centre, reported Health IT Central. The technology is currently being trialled at the Countess of Chester Hospital NHS Foundation Trust, developed through Walton Centre’s Neuro Network vanguard, enabling clinicians to expand their reach: “We have built and connected two tele-consultation carts but also developed a web-based referral ‘hub’ where the referring hospital can see available consultation slots and complete the referral electronically. The hub will also act as a repository where the satellite hospital can access a range of Walton clinical pathways and other resources,” said Dr Martin Wilson, consultant neurologist at The Walton Centre. Consultations will take place through Skype via a secure and encrypted portal as a ‘high quality camera’ allows clinicians to examine patients; in case the trial is successful, it will also be extended across other hospitals throughout Cheshire and Merseyside. “We’ve spent the last year delivering an efficiency programme based on the recommendations of Lord Carter, placing a greater emphasis on using transparency of data to inform decision-making that benefits patients. We see this as a flagship project in turning around our approach to patient flow and providing faster, safer care by increasing the responsiveness of our NHS workforce. With the visibility of this data it will put a stop to nurses wasting valuable time searching for equipment, and limit duplication of efforts in clinical admission staff repeatedly chasing updates on patient status to understand bed availability,” added Tony Chambers, chief executive at the trust.
Northern NHS trusts share digital lessons: Hospital patients in North Cumbria will be referred more quickly and efficiently to the right treatment and care following a technology partnership that has learnt vital lessons from a neighbouring NHS trust, reported Building Better Healthcare. North Cumbria University Hospitals NHS Trust has successfully gone live with a new patient administration system which will help more accurately track patients through the care pathway, improve sharing of clinical information, and provide streamlined reporting capabilities. NHS data migration management experts Stalis partnered with established patient administration systems (PAS) provider Silverlink to deliver a new IT system at Northumbria NHS Trust, and the same teams have replicated similar success at north Cumbria. Mark Thomas, director of health informatics at North Cumbria University Hospitals NHS Trust, who worked on both projects, said: “The hospital is going through a big system redesign to change care pathways and improve operational performance. We knew not to underestimate complexity of the project and not to set artificial deadlines.” Andrew Meiner, managing director at Stalis said: “Data migration is a complex and at times high-risk activity. However, by taking on board lessons from the previous project at Northumbria, the team at North Cumbria mitigated that risk through high levels of staff engagement and a pragmatic approach to the resource required to safely transfer vital patient information to the new system.”
NHS Digital is recruiting cyber security specialists: NHS Digital is recruiting cyber security specialists to join the Leeds team, with salaries ranging from £26k to over £68k per year, reported Health IT Central. “NHS Digital’s Data Security Centre has a vision. We want to be at the forefront of information and data security. We want to enable the secure and safe use of information within health and care through the services, guidance and advice we offer. We are the centre for threat intelligence in health and coordinate a system-wide incident management capability,” stated the job advert. The body manages CareCERT, which offers support for healthcare organisations across the country in case of cyber attacks and other types of security breaches; specialists are required to have experience in penetration testing, ethical hacking, cyber security, network analysis and security architecture. Last year, NHS Digital launched three new cyber security services, CareCERT Knowledge, focused on staff training, CareCERT Assure, to assess cyber security measures in place and CareCERT React, to offer professional guidance and advice. “The risks from cyber attacks are ongoing and ever changing across all sectors. Often, cyber attacks on the NHS are not seeking health data specifically, but have targeted a range of sectors with the same attack. But we need to make sure that health and social care information is protected with the highest possible standards of security. If the worst should happen, the service will also help organisations respond as quickly as possible. I would encourage all health and care organisations to sign up to CareCERT and make the most of this valuable resource,” said innovation minister Nicola Blackwood.
Opinions
‘We cannot have another winter like this in the NHS’
Trusts’ ability to provide the right quality of care, safely, is diminishing, warns NHS Providers’ director of policy and strategy Saffron Cordery.
Writing in a blog on the NHS Providers website, Cordery reflects on pressures shown in the BBC Two documentary ‘Hospital’, and the latest data on winter pressures from NHS England.
She says: “NHS staff have responded heroically, treating more people than ever before. The service has, so far, just about managed this year’s winter pressures without a crisis or a meltdown, but it has been a close run thing, and some trusts have failed to cope for short periods of time.
“We cannot carry on trying to manage well known winter pressures in this way. Trusts tell us their resilience and ability to cope with these pressures is diminishing year by year and that their ability to consistently provide the right quality of care, safely, is now being compromised.
“That is why NHS Providers has called for a review of how the health service manages winter pressures. This should be led by NHS Improvement and NHS England. As it is NHS trusts that bear the burden of the current approach, they should have the chance to set out what has worked for them and what needs to change. Experts bodies such as the Royal College of Emergency Medicine should also be consulted.
“The review should look at how effectively the NHS prepared for this winter, including the role of A&E delivery boards. It should also consider whether dedicated winter funding should be reinstated to ensure extra capacity, and the impact of cancelling elective operations.”
Why a tax break for employers is the smart way to improve mental health
Mental ill-health is a huge problem for individuals, businesses and government. Our plan to get workplaces focusing on prevention is a win-win for all concerned, writes Norman Lamb, Liberal Democrat MP, in The Guardian.
He says: “Twenty-two billion pounds: that’s the estimated annual cost to employers and taxpayers of sickness absence. Much of that relates to mental ill-health – which, along with musculoskeletal complaints, causes about 80% of sickness absence – and sick leave seems to be on the rise. A recent survey by the Engineers Employers Federation found that 41% of companies had witnessed an increase in long-term absences over the past two years.
“Simon Stevens, the chief executive of NHS England, highlighted this miserable state of affairs in his Five Year Forward View for the NHS back in 2014. He focused on the role of employers, arguing that incentives should be offered to those ‘who provide effective Nice-recommended workplace health programmes for employees’. Enlightened thinking for an NHS boss: put more effort into prevention and everyone could benefit.
“Now we have an opportunity to test this idea. This week the West Midlands became the first city region to publish an ambitious action plan for mental health. It is the culmination of more than a year’s work by the mental health commission I chaired on behalf of the West Midlands Combined Authority. At its heart is a focus on prevention and early intervention.
“We will also use public procurement to encourage companies tendering for contracts to take action to improve the wellbeing of their workforce. Surely it’s not too much to ask for such companies to demonstrate that they are good employers.”
Nursing associates’ impact on healthcare
The structure and responsibilities of the nursing workforce is set to undergo a change with the introduction of the nursing associate role, writes Professor Lisa Bayliss Pratt, director of nursing at Health Education England.
In an article for Nursing Times, she writes: “It is clear that this decision is in the best interest of patients and the right thing to do for our profession. Our consultation showed that there was strong support for regulation and we have been clear from the outset that we are in favour of regulation. In 2014, when Lord Willis of Knaresborough, chief executive of the Nursing and Midwifery Council Jackie Smith, and I began our work to explore the future education and training needs of the nursing workforce, a key issue reiterated to us was the need for a ‘bridging role’ between the support worker and the graduate level registered nurse.
“Patients told us they want to feel confident in support workers who provide the majority of ‘hands-on’ care, to know that they have been trained to a recognised standard, and that they are accountable to a registered nurse. The decision to regulate the nursing associate will meet these important requirements.
“Support workers tell us that they want to be trained for, and recognised as having, more responsibility. Further education and training and a recognised role with national standards will enhance their ability to provide person-centred care.
“The greater degree of clarity about what the role can do will free registered nurses to take on greater leadership and advanced practice and care for patients with increasingly complex requirements, many of whom may have two or more comorbidities.
“Alongside the nursing associate role, another key piece of the jigsaw to support the development of the profession is the NMC review of pre-registration nurse standards, due to be published this spring. It will define the requirements of the registered nurse for the next decade and probably beyond, making clear the differences between the scope of practice of the registered nurse and the nursing associate.”
Highland Marketing news
This week we welcome two new members to the Highland Marketing team: Becky Mellor as a senior account manager and Dariusz Kasparek as an account executive.
