News in brief
Number waiting more than 18 weeks for NHS surgery ‘set to double’: The number of patients waiting longer than 18 weeks for surgery is set to double in the next three years, the health service has been warned. The new analysis, based on official NHS figures, suggests the total number waiting for operations will reach almost 5 million in 2020 – an increase of almost 2 million since 2015, reported The Telegraph. On current trends, that will include more than 800,000 patients waiting more than 18 weeks for treatment – a rise from 360,000 today, the research showed. The analysis was carried out by the NHS Partners Network, which represents independent providers of NHS care. It urged patients to be more “sharp elbowed” about getting the treatment needed. The organisation said too few patients were aware of a legal right to choose where to have NHS treatment. Last month the head of the NHS admitted that times for routine operations are likely to grow longer, as cash-strapped hospitals prioritise emergency and cancer care. Senior doctors said an NHS target to carry out 92% of non-urgent operations within 18 weeks of referral had been “jettisoned in all but name” as the health service struggles to meet demand.
NHS Improvement to seek approval for hedge fund borrowing: The NHS is already in talks to borrow the cash to repair NHS infrastructure and help provide specialist care at GP surgeries, an article in The Times has revealed, according to Public Finance. Jim Mackey, chief executive of the NHS’s financial regulator, told the newspaper that the health service currently has a “golden opportunity” to borrow at low interest rates. “Historically low interest rates are a golden opportunity for the NHS, but we are constrained by rigid rules around borrowing that prevent us from taking action,” Mackey said. “An NHS fund could power the improvement needed to sort out problems at our hospitals and to drive the change required to get the NHS ready for future challenges.” The Times said the NHS’s maintenance backlog was £5bn and that health officials have reached an outline agreement with one or two hedge funds as well as other investment companies. But no deal can go ahead without Treasury approval. Mackey also told The Times the NHS had “to be realistic” as it was not likely to get a “£10bn cheque to pay for all the transformation under way and the massive maintenance backlog”. The health service needed to “think long and hard about another way”. Simon Stevens, head of NHS England, has apparently agreed not to ask for more day-to-day funding.
Almost half of GPs plan to quit NHS due to ‘perilously’ low morale, survey suggests: Two in every five GPs are planning to quit the NHS, a new survey has suggested, amid warnings that “perilously” low morale among family doctors is fuelling an “enormous crisis” in frontline healthcare, reported The Independent. Jeremy Hunt has said GP surgeries should be open seven days a week, from 8am to 8pm, and has announced plans to place doctor generalists in A&E departments to help ease overwhelming pressures faced by NHS hospitals. However, the British Medical Association said GPs across the country were already “struggling to cope with rising patient demand, stagnating budgets and widespread staff shortages” – and warned this could get worse if Brexit results in an exodus of doctors from overseas. Academics at Exeter Medical School surveyed more than 2,000 GPs, with over half reporting low morale. The researchers said the government “needs to take robust action more swiftly and urgently than previously thought” to avert a crisis if their results were echoed in other regions. Helen Stokes-Lampard, chair of the Royal College of GPs, said the NHS is “haemorrhaging highly trained, experienced GPs at an alarming rate”.
Health service overhaul ‘has been limited,’ says report: A lack of planning and funding has meant the biggest overhaul of the health service in Northern Ireland for decades has not had the expected impact, reported the BBC. Transforming Your Care (TYC) was a plan to change how services are delivered. However, the programme has only realised £28m of the £130m savings anticipated. In a report the auditor general, Kieran Donnelly, said the pace of change was not what was envisaged. This was the first time officials have commented on the management and delivery of the programme, which was published in 2011. While acknowledging it was an ambitious shared vision, Donnelly said: “The impact of TYC has been much more limited than expected and the hoped-for shift of services from hospitals into people’s own homes has not happened as rapidly as had been intended.” The message “could do better” rings loud and clear from the report. It is the first official confirmation of what many health professionals have been saying for some time about TYC. According to Donnelly, that is because there was no action plan, funding or leadership to help deliver it.
Social care system ‘beginning to collapse’ as 900 carers quit every day: More than 900 adult social care workers a day quit their job in England last year, new figures have revealed. Service providers warned that growing staff shortages mean vulnerable people are receiving poorer levels of care, reported the BBC. In a letter to the prime minister, the chairman of the UK Homecare Association said the adult social care system – which applies to those over the age of 18 – has begun to collapse. An ageing population means demand is increasing for adult social care services. Those who provide care to people directly in their own homes, or in nursing homes, say a growing shortage of staff means people face receiving deteriorating levels of care. The figures show that social care providers are struggling to retain their staff, with the industry having a staff turnover rate of 27% – nearly twice the average for other professions in the UK. The government has recently committed to spending an extra £2bn on the social care system, and allowed local authorities to raise council tax bills in order to fund social care services. The number of people aged over 75 is expected to double by the year 2040, according to the Office for National Statistics.
Treasury belatedly approves £160m tech funding: The Treasury has approved £160m of funding for 16 flagship digital trusts, but concerns remain about delays in accessing the money, reported the Health Service Journal (HSJ, subscription required). HSJ understands that the 16 acute global digital exemplar trusts have been sent a letter by NHS Digital saying the Treasury has approved their exemplar funding, but it also says “obstacles and conditions” remain before this will be released to trusts. An NHS England spokesman confirmed that the funding, of up to £10m per trust, had been approved and would start being released in the first half of 2017-18. A separate funding announcement on the seven mental health digital exemplars has been made. If that funding is approved, it would take total central funding for the exemplars to £195m. While the letter was welcomed, several senior figures involved in the programme told HSJ they would continue to be wary until the funding arrived.
NHS England names seven global digital exemplars for mental health: NHS England has named the seven mental health trusts that are to spend £70m on digital mental health services and act as exemplars for how the rest of the health service can make better use of technology, reported Public Technology. The trusts, which will match the government’s funding of £35m for the scheme, are to improve online access to patient records, develop ways for staff to work remotely and boost the use of apps to help patients while they wait for face-to-face treatments. Schemes under development include a system that will allow all the main healthcare professionals working with a particular patient to have access to real-time records, from triage and initial assessment, through admissions and referrals to follow-up care. The NHS’s chief clinical information officer, Keith McNeil, said that clinicians “must embrace technology to help us deliver the best care to our service users” and that the investment would help to provide both “improved experience and outcomes for service users across the country”. The seven trusts are: Berkshire Healthcare NHS Foundation Trust, Birmingham and Solihull Mental Health NHS Foundation Trust, Mersey Care NHS Foundation Trust, Northumberland, Tyne and Wear NHS Foundation Trust, Oxford Health NHS Foundation Trust, South London and Maudsley NHS Foundation Trust and Worcestershire Health and Care NHS Trust.
NHS Digital launches app library and health developer space: NHS Digital has launched an apps library and a mobile health space for developers on developer.nhs.uk, reported the Health Technology Newspaper. The vision is for NHS.UK to host leading healthcare apps so they are accessible and trusted by the public. Juliet Bauer, director of digital experience at NHS England, and Rachel Murphy, delivery director at NHS Digital, said: “Our vision is to transform the way people experience the NHS, by designing digital health tools and services that connect them to the information and services they need, when they need them. We want to enable people to access care in a convenient and coordinated way, through the digital tools that all of us are now familiar with in other areas of our lives. The new digital tools pages on NHS.UK have been designed to showcase a selected number of apps while we test our thinking. Each tool has been through an assessment and is safe to use. Over time, people will start to see more apps appearing that are labelled ‘being tested in the NHS’ or ‘NHS approved’. These products have been built on a solid evidence base and are part of an NHS programme; monitoring and collecting data and evidence of effectiveness towards positive patient outcomes. Developer.nhs.uk now has an exciting mobile health space that is aimed at the developer market that is rich with talent and striving to create digital products that will offer valuable healthcare benefits to patients.”
NHS invests £2.1m to drive new tech developments in primary care: The NHS has given its backing to a programme led by SBRI Healthcare that will see £2.1m invested into innovative technologies to improve general practice. A total of 22 companies have been given awards of up to £100,000 to develop and commercialise novel technologies that will improve GP services and primary care, reported National Health Executive. The awards cover three key areas of GP practice: self-care; diagnostics and earlier triage; and workload and demand management. Dr Liz Mear, chair of the AHSN Network, said: “There are few areas of our daily lives that remain untouched by technological advancement. Through the SBRI Healthcare programme, the AHSN Network is working with industry partners to develop solutions that will help deliver high quality GP services to a growing and ageing population, and ensure patients across the country benefit from new and innovative technologies.” Professor Helen Stokes-Lampard, chair of the Royal College of GPs, stated that general practice had always been a “trailblazer” for innovations, and that the new scheme was an exciting way of addressing increasing pressures on GPs. “At a time when our profession is under intense resource and workforce pressures, it is important that we continue to encourage and support new ideas that can benefit the care we deliver to patients.”
Data sharing agreements signed across Bradford’s health and social care: New city-wide data sharing agreements, covering key NHS and social care organisations, have been signed in Bradford allowing researchers to see pseudonymised patient information across health and care. In Bradford, all 88 GPs, three clinical commissioning groups, two trusts, the council and a palliative care charity have all agreed to share de-identified data on childhood obesity and frailty in the elderly. The initiative forms part of Connected Health Cities (CHC), a £20m three-year project to improve health care across the north of England by giving academics working in Bradford access to health data. Stefan Williams, a neurology doctor and clinical leadership fellow on the CHC’s Yorkshire programme, told DigitalHealth.net that the data produced as a “natural by-product” of health and social care is a “really rich resource for improving patient’s pathways of care”. The data will be stored and analysed at Bradford Teaching Hospitals NHS Foundation Trust, and Williams said that patient identifiable details are removed at source. The information shared could include all routine care for the two projects such as event logs, diagnosis codes and prescription codes, said Williams. Bradford has a population of 1.5 million, and all patients are automatically opted into the data sharing initiative, with an opt-out option available at local GPs. Williams stressed that all patients’ data was pseudonymised, and that patient confidentiality was maintained through the de-identification process. “We’re not building a big database,” he said.
Technology in the home is helping to ease the NHS beds crisis: Technology installed in the home to help elderly people live independently is being introduced in some parts of the country to ease the growing problem of bed blocking, reported Digital Health Age. Latest figures from NHS England show bed blocking has risen by around 25% in a year, mainly due to the NHS financial crisis, huge deficits in social care budgets and an ageing population. In January 2017, there were 197,100 bed blocking days nationwide. The proportion of delays attributable to social care has grown with the main reason for these delays in January 2017 being “patients awaiting care package in their own home”. In a bid to tackle this issue, NHS West Sussex and West Sussex County Council have joined forces to provide a telecare service with the aim of enabling older people to live safely at home for longer and stay out of hospital. Independent living specialist Welbeing will provide a telecare service free for 13 weeks for eligible service users, who will receive a lifeline home unit and wireless pendant to wear around their neck which is radio-linked to a 24/7 contact centre where expertly trained staff will decide upon an appropriate response. Steve Smith, CEO of Welbeing, said: “The West Sussex model has significant benefits to health and social care as well as to service users and their families. Our aim is to work in partnership with our customers to generate even better outcomes for each pound spent, and help to increase quality of life for some of the more vulnerable people living in the communities in which we work.”
Wellcome Trust launches Understanding Patient Data site: The Wellcome Trust has launched a new website that provides a range of resources meant to tackle challenges surrounding patient data sharing, reported Health IT Central. Entitled Understanding Patient Data, the website has been set up in response to the recommendations set out in last year’s Caldicott report, offering a wide array of “comprehensive, and searchable, bank of case studies”. “By talking clearly and openly about the benefits and risks, we want to help people make informed decisions when they have options about how their data might be used,” Nicola Perrin, the charity’s head of policy and lead of the new initiative, explained. The website also focuses on data-driven technologies, which are set to have “significant implications for public confidence”. “We want to find out more about public attitudes now, so that we can develop appropriate governance frameworks to ensure new technologies are introduced in a responsible way,” Perrin added. The initiative is expected to run for two years, funded by the Medical Research Council, the Department of Health, Public Health England and the Economic and Social Research Council; however, it is reportedly run ‘independently’ of funders by a London team at the Wellcome Trust.
Allscripts announces dbMotionTM Solution now available through cloud on Microsoft Azure: Allscripts has announced that its community interoperability platform, dbMotion Solution, is now available through the cloud via Microsoft Azure, reported eHealthNews.eu. The cloud-based solution offers the same capabilities as the on-premise version, but the subscription model will enable faster implementation of the interoperability service and lower annual upgrade cost, helping organisations to leverage the technology with less dependence on internal IT resources. The value extends to population health as well since Allscripts will also offer its Population Health Analytics solution, powered by dbMotion, via Azure. “Providers desire a platform that enables them to meaningfully integrate and act on their patients’ health information,” said Allscripts senior vice president and general manager of population health, Martha Thorne. “By offering access to dbMotion features through the cloud, it will help lower the barrier to entry for health systems and physician groups looking for true interoperability and empower them to make more informed decisions for safer, more efficient care.”
Opinions
How clinical IT will underpin proposed Five Year Forward View transformation
The Five Year Forward View (FYFV), when published in 2014, set out a suitably courageous strategy for the NHS to deliver the triple aim of better health, better care and better value, in the context of overcoming a £22 billion funding gap by 2020, writes Shane Tickell, IMS MAXIMS chief executive officer, in the Health Technology Newspaper.
“Three years on much has been achieved in planning the redesign of services, with the new models of care (NMC) vanguards showing promise. However, it now leaves just two years for delivery, which given the continued funding constraints and resource challenges placed on the NHS, is too ambitious.
“It’s right, therefore, to have a pragmatic plan focused on realistic goals, as set out by NHS England chief executive Simon Stevens last month in his update to the FYFV. Turning its attention to what is achievable in the time available, the document prioritises improved access for patients and better performance in urgent and emergency care, mental health and cancer services. With technology, NMC and sustainability and transformation partnerships (STPs) underpin delivery.
“Clinical IT systems empower organisations to work quicker and smarter, and crucially, in partnership with each other. Moreover, with STPs giving digital planning a new focus – with greater emphasis on area-wide requirements rather than a single enterprise – this infrastructure, or what I consider to be the ‘digital fabric’, is fundamental to the success of the FYFV.
“The global digital exemplars are primed to lead the delivery of the much-needed digital fabric. The priority now is funding for implementation. The government’s commitment to invest £100m into the programme is applauded, but for it to be successful, the funds must swiftly flow down to the trusts. Without it, the programme is at risk of being derailed.”
How NHS worshippers copy the worst habits of economists
Those who praise the NHS copy the worst habits of economists in that they do not think that resources for the public good can be provided privately, according to Kristian Niemitz, head of health and welfare at the free market think tank the Institute of Economic Affairs.
“Lighthouses are a clear example of a public good,” he says. “They cannot selectively shine their light only for those boatmen who have paid towards their upkeep. Thus, the boatmen will try to freeride, making use of the lighthouse, but preferring somebody else to pay for it. But if everybody tries to do that, the lighthouse will not be provided in the first place.
“It sounds perfectly plausible. It is also wrong. There are plenty of historical examples of privately financed lighthouses. True: the light was free at the point of use. But there was a way around this problem, which seems obvious once somebody spells it out: Lighthouses were often provided by port operators, and financed through landing charges.
“Economists assume that just because they don’t spot the mistake in the picture, there could not possibly be any.
“But it is not just economists. In my experience, NHS worshippers make a similar mistake. They come up with elaborate explanations of why market mechanisms in healthcare could not possibly work, and then close the case. They never look at actual market-based healthcare systems, of which there are plenty; they do not inform themselves about how such systems actually work.
“There are plenty of market-based and mixed systems that work just fine, including in France, a country not generally known for its exaggerated faith in free markets and private entrepreneurship. Nor is there a continuous drift towards greater marketisation (or, for that matter, in the opposite direction) over time. All kinds of mixtures can be stable in the long term.
“If you want to get an idea about how market-based systems work, you need to look at actual examples of such systems in action, not just project your own worst fears. NHS worshippers need to look at healthcare systems other than the NHS more often.”
Don’t panic: what healthcare leaders need to know about cybersecurity
In the past few months there have been high profile instances of cyber-attacks affecting the functioning of healthcare providers. Three IT experts give Claire Read at the Health Service Journal the rundown on everything from cyber-attacks to the dangers of human error.
Dan Taylor, head of security at NHS Digital’s data security centre argues: “Board members do not need to have specialist expertise in data or cybersecurity. What they do need to understand is the questions they should be asking their organisation to ensure security of patient data.”
Gary Colman, head of IT audit and assurance services at the Information Security and Assurance Service (ISAS) said: “Consider cybersecurity as part of your standard risk management procedures. As long as your risk management framework and procedures are robust, then your IT-related risks should filter through that and filter up to the board where necessary.”
Colman goes on to warn that the most sophisticated anti-virus software can be rendered worthless by carelessness, adding: “You’ve got to train users and make them aware of how to keep things safe.” And taking this one step further, Taylor advises that support must be given to those people who do speak up if they have made a mistake.
Dr. Saif Abed founding partner at healthcare IT and risk consultancy AbedGraham argues: “You have to take the concept of cyber security and remove it from the silo of IT. We’re seeing examples of IT systems going down, and elective operations being cancelled, and clinic appointments being postponed, and that affects the quality of care. So cybersecurity ties into the bigger agenda of care quality, safety, risk.”
Abed also reinforces that data security isn’t a one-off tick box and it should be viewed as part of a long-term agenda.
Taylor concludes with a reminder of new online training courses on information security being launched next quarter for all NHS staff: “Make the most of the support that is out there.”
Highland Marketing blog
Lords call for a long-term plan for the NHS and action to drive its take-up of technology
Highland Marketing’s Dariusz Kasparek summarises the implications for the technology market from last week’s hard-hitting report on NHS sustainability from the House of Lords.
