News in brief
Winter pressure ‘busts NHS budget’: Winter pressures have caused the NHS to overspend as hospitals and other services have struggled to keep up with demand in England, finance chiefs have said. A deficit of nearly £900m was racked up by NHS trusts in the first nine months of the 2016-17 financial year, reported the BBC. It comes despite the health service being given extra money to help it get on top of its finances after the record £2.45bn overspend in 2015-16. Hospitals were seeing more patients than budgeted for, they reported. They also said problems discharging patients because of a lack of community services had cost them, said the regulator, NHS Improvement. The figures for April to December cover ambulances, mental health units and community services as well as hospitals – although most of the deficit has been accrued by the latter. Between them they account for £80bn of funding, about two-thirds of the health budget, because spending on GPs, training, drugs and public health are accounted for separately. NHS Improvement, which released the accounts, said it had been a “challenging winter”. Waiting times have reached their worst-ever levels in accident and emergency, while nine out of 10 hospitals have spent the winter months overcrowded with unsafe numbers of patients on wards. The NHS is in the middle of the tightest financial settlement since it was created. Since 2010 the budget has been rising by a little more than 1% on average compared to more than 4% during the rest of its history.
NHS reforms: cuts proposed across most of England: Cuts to hospital services are being proposed in nearly two-thirds of England, BBC analysis of proposed NHS reforms has found. The broadcaster found that there was some mention of cuts to hospitals in 28 of the 44 sustainability and transformation plans (STPs), reported iNews. These include plans to reduce the number of acute hospital sites from three to two in Leicester, Leicestershire and Rutland, and the closure of a major hospital in south-west London. The findings back up a series of investigations into the plans, drawn up to prevent a £22bn funding gap from occurring by 2021, which revealed dozens of hospital and A&E closures as well as closure or maternity units, and how technology will transform the health service. Among the findings were maternity and children’s services being “centralised” on to one site in Lincolnshire, a £700m funding gap in the Black Country meaning one hospital may have to be closed, and the downgrading of two out of three A&Es in Mid and South Essex, with only one retaining specialist emergency care. NHS England argued patients will receive better care in the community to compensate for the hospital cuts. They have also said centralised services, for stroke patients for example, where a group of specialists are concentrated in one area rather than being spread across a wider region, will improve healthcare. The analysis followed a report on STPs published by The King’s Fund. The think tank said the proposals were the best option for the future of the NHS and urged the government to support the plans. A £1.8bn pot set aside this year for funding transformation has already been used to shore up NHS trust finances as they struggle to balance their books.
Invest in social care before closing beds, says think tank: Hospital beds should not be closed until money has been invested in improving community services, The King’s Fund think tank has argued in a frank assessment of plans to better integrate health and social care, reported The Financial Times (subscription required). The report could add to pressure on chancellor Philip Hammond to find extra money in the Budget to ease the strains on the NHS. It said investment is needed if sustainability and transformation plans are to work. The plans intend to help solve the service’s dire financial predicament by ensuring closer working between the NHS and local authorities, which bear much of the responsibility for providing social care to the elderly and disabled. They have already sparked controversy for suggesting cuts in the number of hospital beds, and the closure of some acute hospitals. In the past such shake ups have generally been bitterly resisted by MPs, including those of the governing party, as well as local councillors. The King’s Fund warned, however, that the government must be prepared to back these radical changes to secure the future of the NHS. The think tank said proposals to reconfigure hospitals could improve the quality and safety of care. However, reducing capacity will be credible only if there are robust plans to provide alternatives in the community before the number of beds is cut.
NHS breaking point now ‘the norm’ as 15,000 beds are cut in six years: Breaking point is becoming “the norm” for the NHS, with 15,000 beds cut from hospitals in the space of six years, reported The Telegraph. The fall amounts to one in ten beds being lost, and has prompted warnings about patient safety amid rising pressure on the health service. The British Medical Association (BMA) said that the decrease in beds was directly contributing to long waits in crowded accident and emergency departments. The warning comes after three quarters of hospitals last month reported dangerously high occupancy rates of 95%, even though managers are told to aim for a rate of 85% to leave a safe margin of beds to cope with surges of patient demand. In the first quarter of 2010-11 there were 144,455 available beds, but in the same period in 2016-17 the figure was 130,774 – a fall of almost 9.5%. The loss is comparable to 24 hospitals being closed down. The BMA report also pointed to a steep rise in the rate of emergency re-admissions, which the organisation said indicated that patients are being discharged from hospital too quickly. The report found pressure on mental health services is especially acute, with the number of beds nearly halving since 2000, causing an average of 726 patients a month to be treated in “out of area” units during the period March to October last year.
Difficult for hospitals to balance books ‘while social care under pressure’: NHS hospitals will not be able to balance their books until problems in social care are addressed, health experts have warned. The Health Foundation said the gap in social care funding should be addressed in next month’s Budget, reported Care Appointments. The charity said failure to invest in social care is a “false economy” which is resulting in inefficiency in the NHS. The comments come as NHS hospitals in England reported a deficit of £886m in the first nine months of the financial year. Anita Charlesworth, director of research and economics at The Health Foundation, said: “More than half of NHS providers can’t balance their books. The NHS is locked in a vicious cycle of financial deficits, cost-cutting and inefficiency. Hospitals will find it very difficult to balance their books while social care remains under such intense pressure. Days lost to social care-related delayed transfers have risen sharply, which detrimentally impacts on patients, staff and budgets. There is very little prospect of turning round hospital finances this year, but lessons must be learnt. The failure to invest in social care is a false economy, resulting in avoidable waste and inefficiency in the NHS.” Sally Gainsbury, senior policy analyst at the Nuffield Trust, added: “This massive deficit comes even though NHS trusts have delivered very high levels of cost cutting: £2.9bn in the first nine months of this financial year alone.” However, according to findings by Health Service Journal, social care funding is set to increase reported Care Appointments. It comes after council chiefs warned that social care services would still be cut despite ministers’ confirmation that the sector would get £900m extra in the local government finance settlement for 2017-18.
NHS’s non-emergency phone line sending rising number of patients to A&E: The Nuffield Trust think tank has said the proportion of people transferred to ambulances after dialling 111 has ‘crept up’ over the last three years from 150,000 to 200,000, reported The Independent. The NHS’s non-emergency phone line is sending a rising proportion of patients for emergency care, new analysis has shown. However, researchers concluded the phone line had also prevented millions from seeking emergency care. The report examined data from the phone line which was rolled out across England by the end of 2013. The phone line is “widely used”, taking more than one million calls every month. The largest number of patients are sent to primary care, their GP or other community services. The researchers found the proportion of patients sent to emergency services has also risen. In its first year, 18-19% of patients were sent to emergency care, a figure which has now increased to 20-22%. The think tank estimated this means 20,000 more people a month are sent to emergency services than would be if NHS 111 kept to its original pattern. Labour’s shadow health secretary Jonathan Ashworth said: “The decision to scrap NHS Direct and replace it with the NHS 111 was strongly criticised by health professionals, and today we have learned that NHS 111 is sending more callers, and a higher proportion, to A&E than in previous years, with great variations in performance across different regions.”
Patience required for STPs to bring about change, says NHS Confed boss: Patience with sustainability and transformation plans (STPs) is needed if they are going to be successful, the NHS Confederation chief has said in response to a major report from The King’s Fund on STPs. The report had analysed England’s 44 STPs and found that, whilst they are the best chance for reform, they also require additional funding and support from central government to be successful, reported National Health Executive. Responding to the findings in a statement, Niall Dickson, chief executive of the NHS Confederation, said: “The good news is that this timely report recognises that the NHS and social care services have begun to work together in new ways to change the way care and treatment is delivered. But it also shows that this takes time and yet again provides more evidence, if it were needed, that social care urgently needs more funding.” The coalition of health and care charities, National Voices, described the findings of the think tank’s report as “not acceptable or tenable”. Its chief executive, Jeremy Taylor, added: “The STP process is not without flaws, but it has the potential to create sustainable health and care services that meet 21st century needs. This will only work if there is proper engagement of the people who rely on NHS and social care services, and adequate funding to deliver the much needed changes.”
NHS ‘rapped’ over leaks of A&E data: NHS leaders in England have been asked by the statistics watchdog to rethink current policies that delay publishing official data on accident and emergency (A&E) waiting times. This follows two separate leaks to the BBC of A&E data for January, which suggested the worst performance by hospitals since records began. NHS England, and the regulator NHS Improvement have been told by the UK Statistics Authority to review the practice of publishing the data six weeks after collecting it. Their leaders have been asked to “to determine how you could reduce the time lag in publication”. The call for a review comes in a letter from Ed Humpherson, director general for regulation at the authority, to those who chair the organisations. At the time the leaked data, obtained by the BBC was dismissed as incomplete by NHS sources. Humpherson described the leaks of management information as “a disorderly release of data”, which had created “a confused picture”. However, in what amounted to a rap over the knuckles, he went on to urge the NHS organisations to “undertake the appropriate reviews of how this management information is used and shared”.
Sepsis costing NHS ‘billions’ more than thought due to ‘crippling’ lack of data: The scale of the deadly blood poisoning disease sepsis is “far worse” than previously thought as a “crippling” lack of data meant previous estimates were wide of the mark, a major study has revealed, reported ITV News. The research by the York Health Economics Consortium found there are at least 260,000 cases of sepsis in the UK each year – at least 100,000 more than previously thought. Sepsis, which kills more than 44,000 people across the country every year, can lead to rapid organ failure if not identified and treated quickly, leaving thousands of survivors with life-changing disabilities. The chief executive of the UK Sepsis Trust said the findings unveil a “shocking new indication of the gravity and sheer scale of the problem”. Dr Ron Daniels said: “It’s sobering to learn that the issue is so much greater than previously estimated. Equally sobering, though, is the dearth of reliable data recorded for a condition that carries such an overwhelming costs in human and economic terms.” Health secretary Jeremy Hunt said: “We need to get far better at spotting sepsis across the NHS, which is why we are rolling out a lifesaving campaign to raise awareness and improve clinical practice. Already a million leaflets and posters have been distributed to GP clinics, hospitals and other public places – another step in our fight against this devastating condition.” The study, which was commissioned by the UK Sepsis Trust, found that sepsis is likely to cost £15.6bn a year, rather than the previous estimate of £2.5bn.
Genomics to hit mainstream with AI and $100 genome: The dramatic drop in the cost of genome sequencing, combined with rapidly evolving artificial intelligence (AI), is moving precision medicine into mainstream healthcare, reported DigitalHealth.net. Sanjay Chikarmane, senior vice president at Illumina, told a briefing at HIMSS17 in Orlando that the US$100 genome is now in sight. Illumina is a US company focused on genetics sequencing and analysing big data for biological insights. The company is also the major partner for the UK government’s 100k Genome project, providing most of the infrastructure through a £78m partnership with Genomics England. During the briefing, Illumina announced a new partnership with Philips. Illumina will use Philips new genomics AI platform to analyse genomics data, identify key mutations and provide the data into clinical workflows. In the NHS, genomics sequencing has been supported through the 100k Genome project. In 2014 the government announced £300m funding to support 11 genome centres, which would be expected to sequence 100,000 genomes by 2017. That target was later pushed back to 2018.
NHS England to scrutinise suppliers of personalised healthcare IT systems: Suppliers offering IT systems for personalised healthcare need to gain approval from NHS England, as the body aims to ensure healthcare providers are using high quality solutions that offer good value for money, reported PublicTechnology.net. An increase in personalisation of healthcare – offering people more choice and control over their care – is one of the main aims of the NHS’ Five Year Forward View. As part of this, NHS England the Local Government Association are working on a partnership programme called Integrated Personal Commissioning. A trial is being carried out by 13 clinical commissioning groups (CCGs), which are focusing on offering people with complex needs personalised health and social care support plans. NHS England said that these CCGs are in the early stages of considering and procuring IT systems to offer more personalised healthcare, but that “there is a risk that these solutions are of varying quality”. These solutions, it said, must be based on people’s needs, rather than being designed to meet the needs of the system. The body has published a set of requirements for IT solutions and suppliers are being asked to demonstrate that they comply with these requirements before 7th April. NHS England will then publish a list of those that are compliant to help commissioners choose the most appropriate IT solution for their circumstances, in line with their normal procurement and governance processes. NHS England stressed that it “is not, at this stage, procuring any solutions or contracts or setting up any form of purchasing framework”.
Interoperability more than ‘technical challenge’, says new study: Interoperability is considered more than a ‘technical challenge’ when it comes to large-scale implementation of digital health programmes, a new study led by the University of Glasgow has shown, reported Health IT Central. “Commercial companies often perceive standards and interoperability as a threat to their business model, since it was not a priority in comparison with efforts to increase their own individual market share as the market develops and matures,” the authors wrote. The paper, published in the Journal of Medical Internet Research, examines the deployment of a £37m national digital health programme called ‘Delivering Assisted Living Lifestyles at Scale’ in the UK, identifying three levels of factors that had an impact on its progress, ‘micro, meso and macro’. “Factors hindering implementation included: lack of information technology (IT) infrastructure, uncertainty around information governance, lack of incentives to prioritise interoperability, lack of precedence on accountability within the commercial sector, and a market perceived as difficult to navigate. Factors enabling implementation were: clinical endorsement, champions who promoted digital health, and public and professional willingness,” the study revealed.
NHS Digital will not face ‘regulatory action’ from ICO: NHS Digital has avoided regulatory action from the Information Commissioner’s Office (ICO) over its treatment of patient data, reported DigitalHealth.net. The ICO announced on 10th February that, after an assessment into NHS Digital and the organisation agreeing to the recommendations, “regulatory action will not be necessary at this stage”. In April last year, the ICO criticised NHS Digital, then called the Health and Social Care Information Centre, for not honouring the wishes of patients who had opted out of sharing their records beyond direct care. The ICO published an undertaking requiring NHS Digital to make changes to how it shared patient data. NHS Digital was obliged to honour all these opt-outs, known as “type 2”, by 19th October, 2016. In a statement, an ICO spokesperson said: “A formal assessment by ICO good practice auditors in December identified a small amount of work to do, but the team was satisfied that the requirements of the undertaking were being met. NHS Digital has agreed to the ICO’s final recommendations and, as a result, the ICO is satisfied that regulatory action will not be necessary at this stage”. The report recommended that the wording on NHS websites is changed to clarify that NHS Digital was not honouring opt outs from January 2014 to 29th April 2016. The ICO also said NHS Digital should review educational material for organisations, to place greater emphasis on honouring opt-outs. An NHS Digital spokeswoman said the organisation was “respecting type 2 opt-outs robustly and consistently across all our disseminations”.
King’s Fund puts emphasis on shared EPR system ambitions: The report from The King’s Fund has placed an emphasis on shared electronic patient record (EPR) system ambitions outlined in the 44 sustainability and transformation plans (STPs), essential for the digital transformation of the NHS, reported Health IT Central. The report underlines that each STP has a ‘range of enablers’ meant to support the delivery of the changes needed, such as IT or estates, with most of them supporting the development of a shared EPR system that could be accessed by different organisations: “Norfolk and Waveney proposes a digital platform that allows all providers of out-of-hospital care access to the same records, as well as developing a shared electronic patient record system – ‘e-hospital’ – linking the three acute hospitals,” the authors give as an example. Some of the benefits expected from having this EPR would be improved ‘integrated working’, along with ‘higher-quality’ and ‘more efficient care’ or increased ‘patient safety’ and better mobility, especially in rural parts of the country.
Opinions
Lean laboratories: the prerequisite to survive rising pressure?
InterSystems’ Dr Gene Elliott asks if decades-old car manufacturing ideas could now help laboratories (registration required) support better patient outcomes, lower costs and meet hugely rising demand.
Writing in the latest edition of Pathology in Practice, Dr Elliott, a physician executive at InterSystems, reflects on media headlines describing mounting pressures for pathology services and asks if lean principles could be an answer.
“Laboratories across the UK are facing never before seen pressure. Cancer Research UK warned as recently as last November that the UK’s pathology services are now at tipping point, struggling to cope with the number of patient samples that need to be tested, with potentially serious implications for cancer survival.
“Pathology pressures are now the material of national newspaper headlines, and rising demand will only accelerate. Concurrent to warnings from charities, other pressures are mounting. An endless evolution of social and digital media is driving greater public awareness of new technology and treatment options that are currently or imminently available. Healthcare professionals are now faced with new service delivery demands from an increasingly complex landscape of rising co-morbidities and better-informed customers.
“Laboratories are certainly feeling the knock-on effects. Healthcare growth areas range from genetic profiles, through to new techniques in screening for diseases and monitoring chronic conditions, as well as point-of-care and personal device testing. Each one invariably depends on some form of supportive traditional laboratory testing.
“To meet the shifting demand in work type and service, laboratories have had to adapt and become more efficient.
“Healthcare systems across the world are pursuing consolidation strategies to improve efficiency.
“Beyond consolidation, even greater efficiency gains are possible with an ongoing improvement programme.
“Recently, there has been a surge in the number of healthcare initiatives utilising lean principles that centre on continuous improvement but maintain respect for the rights of individual consumers.”
‘When it comes to healthcare, political inertia can be truly harmful’
GPs, community services, NHS 111, ambulances, A&E departments, and hospital services are under intense pressure. The problems are complex but must be – and are now being – addressed urgently, writes Professor Keith Willett, NHS England’s medical director for acute care, in The Yorkshire Post.
“Every industry needs to adapt, and the NHS – at the forefront of innovation and technology – is no different. As a population, we have changed considerably. Our health and care needs are greatest in the later decades of life as we accumulate multiple ageing disorders that can affect our independence as much as our wellness.
“Right now our health and social care system has an in-built default mechanism. When society cannot meet our personal care needs at home, we are moved, often distressingly for us, to a hospital medical setting, the only way to provide that care. The NHS has around 100,000 beds, which is enough for the medical treatment of our patients. But what we are increasingly facing is using a large proportion for ‘personal care’ – dormitories of older people.
“Now what we need in every part of England is evidence-based debate about what our local authority, community and health and care leaders are suggesting. I am sure those ideas can be improved, but they deserve a fair hearing. We cannot just ignore what we now know, or how needs are changing. When it comes to healthcare, inertia can be truly harmful. It is no longer realistic to say ‘if it’s not broke don’t fix it’ – believe me it is breaking. What I most fear is an overly-politicised conversation that seeks to damn every proposal as a ‘cut’ and paralyses progress.”
Addressing the challenges of new technologies in the NHS
Former neurosurgeon and ophthalmic surgeon Dr Guy Wood-Gush, CEO of artificial intelligence healthcare company Deontics, welcomes positive moves to bring digital health into the frontline of care delivery, but fears the NHS may get left behind if it does not look beyond the basics.
“Digital transformation is rife across many markets,” he says in Digital Health Age. “In health, similar transformation is underway. Doctors and care givers can come direct to your home using ‘Uber’-style apps. Patients and practitioners are engaging directly online and providing data that informs clinical research. Artificial intelligence and machine learning are developing at such a rate that the traditional face-to-face doctor-patient relationship is likely to change significantly in the next few years.
“Yet despite the NHS’ strong history of innovation, it remains behind the times in terms of technology adoption, with pockets of development in evidence. The focus is on steady, linear development that will see hospitals prioritised for digital investment.
“Clinicians and support staff should be able to access 21st century tools to work smarter, quicker and safer,” he continues. Electronic patient records are a start, but technologies such as clinical decision support should also be considered.
“It is time go beyond just having the basics in place. We need to think now about what we want to achieve with health technology.”
Highland Marketing blog
Brexit and NHS data protection: How will GDPR affect healthcare?
As the new General Data Protection Regulation (GDPR) comes into force next year, Dariusz Kasparek asks if the added pressure that this puts on NHS organisations will help or hinder the safe and secure processing of patient data.
