News in brief
NHS standing on burning platform, inspectors warn: Safety at four in five hospital trusts in England is not good enough, a leading hospital inspector has warned. Professor Sir Mike Richards said that the NHS stands on a “burning platform” and that the need for change is clear, reported the BBC. His warning followed a review which said staffing and overcrowding were major concerns and that unprecedented pressures on hospitals were putting patients at risk. Ministers said the findings should be used to root out poor practices. The Care Quality Commission review also highlighted delays getting tests and treatments, and poor care for life-threatening conditions such as sepsis. But inspectors warned some of the problems were beyond the control of hospitals because of rising demands being placed on them. The review of all 136 hospital trusts in the country found 11% were rated as inadequate on safety and 70% required improvement. The Department of Health said carrying out the inspections was essential to make the NHS the “safest and most transparent healthcare system in the world” and would “shine a spotlight” on poor practice.
Thousands of hospital beds ‘must not be slashed’ orders head of NHS: Swingeing hospital bed closures must be halted, the head of the NHS has warned as he said slashing thousands of places amid a “sharp rise” in crowding levels was too risky, reported The Telegraph. Simon Stevens made the intervention as NHS authorities draw up plans to attempt to save £22bn while coping with unprecedented demand. Many of the draft proposals included sweeping bed cuts, as well as the closure or downgrading of up to 24 accident and emergency (A&E) departments, 11 maternity units and 19 hospitals. But they were drawn up before the worst winter crisis in the history of the NHS, with almost half of trusts declaring emergency warnings amid record occupancy levels. Now Stevens has ordered officials to scale back bed cuts – ordering each area to draw up “credible implementation plans” which take proper account of current levels of strain. He told a conference of NHS leaders: “More older patients inevitably means more emergency admissions, and the pressures on A&E are being compounded by the sharp rise in patients stuck in beds awaiting home care and care home places. So there can no longer be an automatic assumption that it’s OK to slash many thousands of extra hospital beds – unless and until there really are better alternatives in place for patients. That’s why before major service changes are given the green light, they’ll now need to prove there are still going to be sufficient hospital beds to provide safe, modern and efficient care locally.”
NHS finances facing ‘nasty hangover’ after bid to avert winter crisis: The NHS’s already precarious finances are facing a “nasty hangover” after hospitals cancelled tens of thousands of operations recently in a bid to avert a full-blown winter crisis, experts have said. Handing large numbers of operations over to private providers and hiring extra staff to cope with extra demand during December and January has also dealt a big blow to NHS trusts’ efforts to balance their books, The King’s Fund said, reported The Guardian. The backlog of patients needing non-urgent surgery as a result of the widespread postponement of procedures this winter will also force patients to wait even longer for their operation, Richard Murray, its director of policy, said. The service’s finances are deteriorating so sharply there is a real risk the Department of Health could bust its budget for 2016-17, according to the think-tank’s new analysis of NHS performance. Its latest quarterly monitoring report on how the NHS in England is faring predicts that it is facing several more years of finding it impossible to live within its budget, despite government orders to do so. Hospital trusts ran up a deficit of £2.45bn last year and are on course to overspend by over £1bn again this year. NHS England said: “NHS frontline services have come under real pressure this winter but it is a tribute to the professionalism and dedication of GPs, nurses and other staff in accident and emergency (A&E) who continued to see, treat, admit or discharge the vast majority of patients within four hours.”
Opposition parties on attack over ‘missed NHS waiting times’: Opposition parties have accused the Scottish government of failing to manage the NHS properly after new figures revealed a number of key waiting time targets have been missed, reported The Scotsman. NHS Scotland health statistics show a target to treat 90% of patients within 18 weeks was not met in the final quarter of 2016 and a legal obligation for patients’ treatment to start within 12 weeks of it being agreed by a specialist was also missed. The proportion of people waiting longer than 12 weeks for an outpatient appointment or a key diagnostic test was also up in December. The Scottish Conservatives said ministers must explain the “disastrous slump” in waiting times. Waiting times statistics show that in December 2016, 83.8% of people waited less than 18 weeks for treatment from the point they were referred by their doctor. That was down from 84.7% in September 2016 and 87.1% in December 2015. Meanwhile, 75.8% of patients waiting for a new outpatient appointment at 31st December had been waiting 12 weeks or less, down from 79.2% at 30th September and 87.6% at 31st December 2015. A total of 86.1% of patients waiting for a key diagnostic test at 31st December had been waiting less than six weeks. Health secretary Shona Robison said: “We’re investing substantially in social care and community care, with a view to keeping people healthy at home for as long as possible. This will, in time, help prevent the need for many people to go to hospital.”
Brexit: NHS faces crisis unless government guarantees right of remain for 145,000 EU workers, TUC says: NHS and adult social care services are facing a further crisis after Brexit unless the government guarantees the rights of EU workers to remain in the UK, new analysis has shown. More than 140,000 NHS and adult social care workers in England are EU migrants, with London, the South East and the East of England the most vulnerable to losing vital staff, the TUC found. London would be the worst hit, with 13% of adult social care workers and 9.8% of the NHS workforce made up of non-UK nationals from the EU, reported the Independent. Across the country, 7% of adult social workers and 4.5% of those in NHS jobs could be affected, numbers which already overstretched services can ill-afford to lose. “The government is creating appalling uncertainty for thousands of NHS workers and care workers. It’s a terrible way to treat dedicated public servants. And if Brexit means they have to leave, our health and social care services will struggle to cope,” TUC general secretary Frances O’Grady said. Earlier this month MPs resoundingly voted down an amendment to the Brexit bill unilaterally guaranteeing the right of around 3 million EU nationals already in the UK the right to stay after the country exits the EU. O’Grady called on prime minister Theresa May to immediately guarantee the right to remain before Brexit negotiations officially begin. “It’s the right thing to do. And it will regain some of the goodwill Britain needs to negotiate the best possible Brexit deal,” O’Grady said.
‘OBR for public spending’ needed to improve finance planning in struggling sectors: A report published by the Institute for Government and the Chartered Institute of Public Finance and Accountancy looking into the pressures being placed on public services has concluded that adult social care is being pushed to “breaking point” – and recommended the creation of an independent body to scrutinise spending and drive efficiency in the public sector, reported Public Sector Executive. The independent body, which would act as an “Office for Budget Responsibility for public spending”, would ease pressure by scrutinising government tax and benefit spending forecasts and prevent “wishful thinking” from unrealistic budgets being set in Whitehall. The findings analysed government data to examine the UK’s key public services including social care, and found that, despite growing demand that has seen the number of people aged over 65 in England jump by 16% since 2009, adult social care funding had actually dropped by 6% since 2009-10. There has also been a 70% reduction in people receiving “meals on wheels”. It also warned of the difficulties local councils are facing trying to stretch budgets to meet social care needs. The report alluded to a King’s Fund review that also pointed to the problem arising from the disparity in funding between different authorities, as social care funding fell by at least 20% in 25 local authorities, but actually rose in a separate 36 authorities.
Scotland to appoint first chief clinical information officer: Scotland will appoint the country’s first chief clinical information officer (CCIO), the Scottish government’s cabinet secretary for health and sport, Shona Robison, said earlier this week at a conference in Edinburgh, reported the British Journal of Healthcare Computing. “I can announce that the Scottish government will be looking to shortly recruit a national chief clinical information officer to work closely with civil servants as well as health and care professionals throughout Scotland to provide essential leadership in digital,” Robison told the audience. The minister emphasised the CCIO will play a key role in the ‘successful implementation’ of the digital health and social care strategy that will be published later this year. “We will be looking to see how we can ignite and harness the enthusiasm of clinicians and other professionals for digital transformation,” Robison added. The government is expected to ‘build’ on different initiatives such as the NMAHP Leadership and Technology-Enabled Workforce programmes in order to make sure staff will receive the training needed to maximise an efficient use of digital tools and ‘provide a world class’ service. Pieter van de Graaf, eHealth clinical strategy team leader at the Scottish government, underlined the new eHealth strategy will be focused on improving decision-making processes through data and patient involvement: “The current eHealth Strategy is more focused on systems, whereas the new strategy will be more centred around data. As part of our current eHealth Strategy, delivered by NHS Scotland and the Scottish government, we have been putting core IT systems in place and going forward we will be building on this as we are moving towards much more explicit transformations for the delivery of care,” van de Graaf added.
London councils urged to develop ‘full narrative’ for health and social care integration: Devolution of health powers could be the key to improving care outcomes for London authorities, but councils must do more to present and explain local integration initiatives to the capital’s population, a new report has revealed. The London Councils report, detailing how devolution could be used as an enabler for driving health and social care integration, said that councils would benefit from a “full narrative” that would set out how integration could be used to drive health and social care reform for the public, reported Public Sector Executive. It added that subject to the health devolution memorandum of understanding with national partners being agreed, the roll-out of “devolution as an enabler of deep and successful integration and reform will require strong political leadership underpinned by a coherent narrative around which borough leaders wish to join together”. The report added: “This would not imply a single London system, but a narrative which captures the rich variety of local models of integration of health and care which political leaders are willing to advocate for across London and which clearly demonstrate the powerful role of devolution in the objectives underpinning the narrative. This narrative is more urgent because of the pressures in social care and the likelihood that they will continue because of an absence of additional funding to the sector.” It was noted that the new powers that may be gained through devolution can provide a platform for accelerating the development of borough-led integration models and so reforming the health and care system locally.
STPs will end the purchaser-provider split, says Stevens: Speaking at a Commons public accounts committee hearing this week, the NHS England chief executive said between six and 10 sustainability and transformation plan (STP) areas were set to become “accountable care organisations or systems, which will for the first time since 1990 effectively end the purchaser provider split, bringing about integrated funding and delivery for a given geographical population”, reported the Health Service Journal (HSJ, subscription required). HSJ understands NHS England is in discussions with several STP areas around the country with a view to them being listed in the Forward View “delivery plan” to be published next month. These are thought to include Frimley Health, Lancashire and South Yorkshire. Stevens has over the past year suggested that North Central London and Frimley Health would see this type of development, but no detailed proposals have been brought forward. The NHS England chief executive also told the committee: “We are going to formally appoint leads to [all 44] STPs, going to give them a range of governance rights over the organisations in their areas; including the ability to marshal the forces of the local [clinical commissioning groups] and the local NHS England staff.” Stevens added that “there are a number of parts of the country where we will be looking to [local authority] leadership to take on more decision rights”. He said STPs would have to achieve their plans within the confines of current legislation and that formal lines of accountability would remain the same.
Pickup: Huge scope of social care duties means BCF is not enough: The Local Government Association (LGA) has called on the government to not forget that adult social care does not only cater for elderly people – in fact, more than 40% of the budget is spent on adults aged between 18-64, with 35% being spent on people with learning disabilities alone. During a public accounts committee (PAC) hearing earlier this week about the integration of health and social care, Sarah Pickup, deputy chief executive of the LGA, revealed these figures in the latest call to government for fresh funding for adult social care – and reminded the committee that adults with complex needs and learning disabilities should not be left out of the social care provision debate, reported Public Sector Executive. Health and social care integration has long been touted as a way of easing pressure on the waning adult social care budget. But NHS England has consistently emphasised that while integration has the potential to be successful, new funds are also required rather than a reallocation of funds from pots such as the Better Care Fund (BCF). Its chief executive, Simon Stevens, said during the PAC inquiry: “We are conflating integration with social care funding and availability. You need a properly resourced social care system, and you need proper joint working at all the hand-off points and for key client groups that are doing health and social care. Just doing one is not a substitute for the other.”
Every hospital ordered to change its logo by NHS “identity managers” in move which prompts ridicule: Every hospital in the country has been ordered to alter its logo by NHS “identity managers” in a measure which has prompted fury and ridicule, reported The Telegraph. A diktat from NHS England means hundreds of organisations will have to rework all their publicity materials, moving the NHS logo so it is above the name of each trust, instead of beside it. The measure has been introduced by the “NHS identity team” following 1,000 interviews and 28 focus groups with members of the public. It follows a two-year review of the health service logo with nine workshops involving 100 communications officials. NHS England said it would reduce “confusion and concern” among the public – claiming that current inconsistencies in current use of the format could be fuelling pressures on accident and emergency units. The new guidance advises every NHS organisation to comply with new brand rules and has been introduced by the NHS identity team. Every organisation has been told to make changes to online publications within a year and to make changes to physical signs when practical. NHS trust managers condemned the move as a waste of time at a time when services are under major strain. It comes as organisations across the country have been asked to draw up plans to save £22bn by 2020, while meeting increased demand.
InterSystems wins multi-million pound Liverpool joint-EPR tender: Three Liverpool trusts have picked InterSystems as their preferred electronic patient record supplier, potentially winning the US company its first global digital exemplar customer, reported DigitalHealth.net. In what could be a £70 million deal, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool Women’s NHS Foundation Trust and Aintree University Hospital NHS Foundation Trust, have chosen InterSystems’ TrakCare for their joint EPR project. While Royal Liverpool has yet to formally sign on with InterSystems, that partnership is likely to be particularly significant. Royal Liverpool trust is one of 16 global digital exemplar sites, which are being centrally funded to provide digital transformation blueprints for other trusts to follow. TrakCare is nearly ubiquitous in the NHS in Scotland but does not have a long history in England. In May 2014, the system was also chosen in a joint tender by three southern acute trusts; Gloucestershire Hospitals NHS Foundation Trust, Northern Devon Healthcare NHS Trust and Yeovil District Hospital NHS Foundation Trust. Known collectively as the Smartcare trusts, Yeovil was the first to deploy TrakCare in June 2016, followed by Gloucestershire in December. Apart from the southern trio, North Tees and Hartlepool NHS Foundation Trust is the only other English trust to deploy TrakCare.
Leicestershire NHS body connects local email to NHSmail2: NHS Leicestershire Health Informatics Service (LHIS) has become the first public sector organisation in the country to be able connect its local email system to NHSmail2, reported UKAuthority. The provider of IT services to healthcare organisations primarily in Leicester, Leicestershire and Rutland, and to other organisations across the country, has received the relevant ISB 1596 accreditation after working with NHS Digital and using an in-house team rather than a consultancy. The accreditation enables it to connect its own secure email system to hundreds of thousands of NHSmail2 users across the UK. This followed a decision that, due to local factors, it was not yet right for the service to migrate to NHSmail2 – a Department of Health approved service used by healthcare providers in England and Scotland for sharing patient identifiable and sensitive information. Ian Wakeford, head of service at LHIS, said: “The configuration of our email system in Leicester, Leicestershire and Rutland is vital for effective workflows and business processes, already allowing secure communication between community providers, local authorities and our local acute trust through private data links. The time was not yet right for us to move to NHSmail2 but we did want to take advantage of securely communicating with NHSmail2 users and beyond. Accreditation from NHS Digital to connect to NHSmail2 is allowing us to achieve the best of both worlds, not losing the local benefits we have developed over years, but combining that with being able to securely communicate with all of the NHS and government secure domains that NHSmail2 has connectivity to.”
Orion Health secures place on NHS digital health plan: Population health and precision medicine company Orion Health has been awarded five lots by the NHS London Procurement Partnership for its Clinical & Digital Information Systems framework (CDIS), reported Digital Health Age. The CDIS Systems framework was developed to help health and social care organisations become fully compliant with the government’s digital health ambitions. The framework attributes £1.3bn to resource suppliers that can help healthcare organisations meet the government’s Personalised Health and Care 2020 plan. NHS London Procurement Partnership launched the framework in December 2016 to help streamline the procurement of technology, such as electronic health record systems, integration and interoperable digital tools. Orion Health’s five lots include interoperability and interfacing, clinical and patient portal, informatics and reporting, medication management and patient workflow. The company met 100% of the evaluation criteria. Gary Birks, general manager UK and Ireland at Orion Health, said: “By supporting more accurate and more efficient sharing of clinical information, we can enable healthcare providers and their partner organisations to reduce unnecessary duplication of clinical effort and save precious time for frontline staff to help meet today’s clinical safety and efficiency challenges.”
Cyber security in the NHS… time to pull the plug on obsolete operating systems and legacy applications: Healthcare is facing the most cyber-attacks since records began, with the sector accounting for the largest number of data security incidents, according to recent figures from the Information Commissioners Office (ICO), reported Information Age. According to the latest quarterly review from the ICO, the healthcare sector accounted for the highest number of data security incidents for the quarter, with 239 cases reported in Q3 2016. Cyber incidents accounted for 74 of these reports. Recent results of a Freedom of Information request revealed that 90% of NHS trusts are still running Windows XP, exposing hospitals to threats designed to exploit vulnerabilities for which Microsoft no longer issues patches. But it’s not just obsolete operating systems that pose a risk – anecdotal evidence suggests that healthcare organisations are running hundreds of legacy applications in the background. Older technologies, whether hardware or software, are more prone to security loopholes, as well as corruptions, failures and outages, making trusts an easy target for ransomware attacks. Despite the risks, not to mention the huge costs and drain on resources associated with running these obsolete systems, the practice is still worryingly commonplace across the healthcare sector.
Open innovation exemplar fund gets 48 bids: An independent campaign to develop a new open digital platform for health and care has received 48 open innovation exemplar bids from across the UK and Ireland, totalling more than £60m, reported DigitalHealth.net. The campaign group is now calling on NHS England to commit £40m, equivalent to 1% of national NHS IT investment, to fund the diverse range of open platform projects and applications. The 48 bids include commitments of £25m of match funding. The initiative was developed by industry thought leaders Dr Tony Shannon, director of open source shared records initiative Ripple, and Digital Health columnist Ewan Davis. Both have called for the symbolic 1% of health IT investment – £40m of the £4bn investment promised for health IT – to be channelled into the development of an open platform and open applications to support personalised health and care. The ‘One Per Cent Campaign’ argues that investment in an open platform and applications is vital to harness future innovation, enable SMEs to enter the health market and reduce the daunting current regulatory, technical and financial barriers to market entry. NHS England’s acute Global Digital Exemplar (GDE) programme is investing £160m in 16 acute GDEs and a further £100m in 20 fast followers, and up to £30m in six mental health GDEs. A grand total of £290m, with further waves of exemplars due in areas including ambulance trusts, community and population health management. Dr Tony Shannon, told DigitalHealth.net that while last year’s Wachter Review and subsequent GDE programme focused on a small number of existing ‘elite’ digital leaders and current big EPR suppliers, the One Per Cent Campaign aims to be more forward looking and broadly based.
NHS Improvement rejects Leicester’s multi-million pound EPR bid: A Midlands trust has reined in its paperless ambitions after NHS Improvement declined to fund its multi-million-pound electronic patient record (EPR) bid. University Hospitals of Leicester NHS Trust wanted to deploy a £26.3m integrated EPR plan, a DigitalHealth.net review of recent trust board papers revealed. The board papers also showed that NHS Improvement (NHSI) refused to fund the plan. “NHSI have confirmed that they are not in a position to support the proposal and their proposed cost envelope would mean that an integrated solution, UHLs preferred option, is no longer achievable,” the papers said. Tellingly, the board papers suggested that NHSI did not reject the bid because of any concerns about the proposal itself but because there was no money available. “The trust’s EPR scheme as it currently stands would have an unaffordable impact on the national capital resource limit and, therefore, would not be recommended for approval.” The trust will now propose “an alternative proposal for the delivery of a ‘best of breed’ paper lite solution”. The papers showed that the trust was working with EPR supplier Cerner on its original bid. That work would be now revisited to find a cheaper solution. The trust declined to comment further on their EPR plans when approached by DigitalHealth.net but said it “will be announcing further details later in the year”. All NHS trusts are nationally required to become fully digital and “paperless at the point of care” by 2020 with national funds available, in theory, to help them meet this goal. However, that target had come under increasing pressure as funds set aside for digital transformation are instead diverted to keep the financially struggling acute sector running.
Opinions
Will shifting the balance of care balance the books?
Results from the Nuffield Trust’s review of the community based models of care relied on by STPs are a warning against setting expectations too high, says Candace Imison, director of policy at the Nuffield Trust, in HSJ.
“Many believe that a more community based model of care would be more cost effective. Nationally, £4bn, nearly a fifth of the £22bn savings required by 2020-21 are anticipated to come from “new models of care”. Many of the STPs assume that they will significantly reduce hospital activity, in some cases by up to a third in the next three years, and at the same time deliver savings.
“At the Nuffield Trust, we have undertaken a considerable number of evaluations of community based models of care, including the early evaluations of the integrated care pioneers and virtual wards. While these have often found positive outcomes for patients, they frequently show disappointing results with respect to cost and reductions in hospital activity. So we thought it timely to undertake a more comprehensive review of the initiatives that STPs are relying on, to see how the evidence for demand reduction and cost savings stacks up against expectations.
“The results stand as a warning against setting our expectations too high. While seven of the 27 initiatives showed relatively good evidence of a potential to reduce hospital activity and deliver savings, the majority had mixed evidence for their capacity to reduce cost.
“Nobody can argue against the principle of better, more appropriate care closer to home. But sadly we cannot assume that this will save money, especially in the short term. Instead, to succeed, we need a relentless focus on what works, and, crucially, to admit when the funding envelope simply isn’t big enough to deliver the transformation.”
Comment: Building cross-border healthcare networks
One of the greatest challenges faced by those working to treat rare diseases is that the expertise and the very small groups of patients are scattered across the world. Even within Europe, it is very difficult to connect the right knowledge, treatment and research with the people who need it most, says Yann Le Cam, chief executive of Eurordis — Rare Diseases Europe, in The Financial Times (subscription required).
“Late last year, the European Commission made a move to change this. It approved 24 networks of experts and healthcare providers, organised across borders under the framework of an EU directive on patients’ rights in cross-border healthcare. These “European Reference Networks” (ERNs) will be able to share and implement existing knowledge on diagnosis, treatment and care and will generate new knowledge.
“To make sure each of the thousands of rare diseases that exist is covered by an ERN, the networks are organised according to disease groups. The networks are embedded into national healthcare systems and share common missions. The expertise will travel, rather than the patient. If a doctor does not have specific knowledge about the disease in question, the system will connect that doctor to clinician who does. This happens primarily through the use of a common virtual clinical board for the exchange of patient information (which will remain confidential).
“We must try to integrate existing research infrastructures in Europe across these networks. This would radically change how research is carried out and data are collected. Rather than focusing on one disease, data will be collected for many, meeting the same standards, using the same tools and helping to recruit patients to clinical trials. Ultimately, ERNs will improve the health and wellbeing of millions of people living with a rare disease, leaving no one behind.”
Mental health is a public sector comms issue
One in four experience mental illness each year, but more than half of communications professionals are more afraid to speak up about mental than physical health, writes Ashley Toon, communications officer at Derbyshire Healthcare NHS Foundation Trust, in PRWeek (subscription required).
“Us comms professionals love nothing more than a decent conversation, so why are 57% of us more afraid to speak up about our mental health than our physical health. Despite mental illness being better understood, both medically and socially, the prejudice and stigma attached to certain conditions remains rife.
“As many as 16% of adults in England still believe that someone with a history of mental problems should be excluded from taking public office. As PR people who tend to speak more about others rather than ourselves, we keep our feelings and emotions under wraps in embarrassment that we’ll appear weak.
“In the increasingly demanding environment of the public sector, targets, objectives and deadlines are a daily occurrence. Efficiency savings continue to strip back-office functions to the bare bones, increasing the risk of isolation.
“Comms teams are not immune to these issues. Those of us who remain are under greater pressure than ever. PR is one of the only organisational functions with a ‘boundary spanning’ characteristic and in large, highly regulated public sector organisations this means there’s a vast amount of people to keep happy and informed.
“As individuals we have to take a step back to understand how these challenges are impacting on our job satisfaction and wellbeing. And as communicators, we have a privileged role to play in cultivating a culture of openness within our workplace so that colleagues, and ourselves, feel able to speak freely about mental illness in a safe environment.”
Highland Marketing blog
Can Scotland’s NHS avoid a state funeral?
Listening at Edinburgh’s Digital Health and Care conference, Matthew D’Arcy writes ‘Scotland cannot afford failure for its new Digital Health and Social Care strategy’
