News in brief
Jeremy Hunt: NHS needs to go on 10-year diet: The NHS needs to go on a “10-year diet” while the government tries to get on top of the nation’s finances, Jeremy Hunt has said, reported BT. The health secretary said that the most important thing for the NHS was a strong national economy. Speaking at The King’s Fund’s annual leadership and management summit in London, Mr Hunt said that while the government attempts to balance the national budget the NHS needed to “get through this difficult period”. When asked about the impact cuts to social care have on the health service and government attempts to balance the national budget, Mr Hunt said: “We are under a great deal of pressure in the NHS and social care system because of our commitment to eliminate the deficit. In the end the most important thing for the NHS is a strong economy and the biggest risk would be if we were to lose control of our national finances. That means we have got to go on a 10-year diet while we get through this.” Mr Hunt also said that England is lagging behind the US when it comes to technology which is on the cusp of “revolutionising” healthcare. He said Britain and the US are two countries that have done the most thinking about patient safety. But he said America was “streets ahead” with its use of technology. He also said that this decade would be hailed as a transformative period for quality of care and safety for patients in the NHS.
NHS leaders fear negative impact of Brexit, survey says: The majority of NHS leaders think Brexit would have a negative impact on the UK’s health services, according to a survey by NHS Providers, reported Public Finance. The association surveyed a sample of 45 chairs and chief executives working in hospital, ambulance, mental health and community trusts, marking the first time frontline NHS leadership has been asked for collective opinion. Three quarters (75%) of respondents stated that leaving the European Union (EU) would have a negative effect on the NHS as a whole. No respondents felt that leaving the EU would have a positive impact. However, two in five (42%) said there could be beneficial effects on the procurement and competition rules affecting their trusts. NHS Providers chief executive Chris Hopson said that, while the survey is not an exit poll and the association doesn’t claim it to be extensive research, it does “show the strength of feeling on what could be a generation-defining decision”. Hopson added: “Our survey shows the concern NHS leaders have about a range of issues if the UK were to exit the EU. High up on this list is the impact on recruiting staff and access to funding for research and innovation.” Eight out of 10 (80%) respondents felt that leaving the EU would have a negative impact on trusts’ ability to recruit health and social care staff.
Student bursary cut ‘may worsen NHS staff shortages’: Plans to scrap student bursaries and charge nurses and other health staff for their degrees in England could backfire, unions are warning, reported the BBC. Ministers plan to overhaul the funding system in September 2017 and charge those studying to be front-line health workers for their degrees. But the Royal College of Nursing and Unison are warning it could turn people off NHS careers and worsen shortages. Student nurses, midwives and staff such as physiotherapists will be affected. They are currently entitled to bursaries of £4,500 to £5,500 if they live in London – on top of a grant of £1,000 each year during their course. The course fees are also covered. But the government has proposed scrapping these and introducing university fees to bring health staff in line with other students. Ministers argued that the move will lead to an increase in nurse students – of about 10,000 – as applicants for courses currently outnumber the places available by two to one. This is because there is a cap on places. But unions have warned the move could end up putting off prospective students. To strengthen their case, Unison and the National Union of Students commissioned research group London Economics to carry out an analysis of the potential impact. The research, based on modelling, suggested the numbers starting courses could drop by about 6.5% from 31,000 a year to 29,000. Earlier this month, a report by the Public Accounts Committee warned that the NHS was short of about 50,000 front-line staff.
NHS ‘must get a grip on hospital discharge delays’: The NHS in England must get a grip on the delays patients face in being released from hospital, as the problem causes unnecessary harm and wastes money, the National Audit Office (NAO) has said, reported the BBC. A report by the watchdog estimated the delays were costing £820m a year. The NAO also said research shows that for every day spent in hospital an older patient can lose 5% of their muscle strength. There is also the increased risk of infection. The figures showed the number of delays has risen by a third in the past two years to 1.15 million days. But the NAO said this was likely to be an underestimate, the “truer figure” could be nearer 2.7 million days of delay. Waiting for nursing home places or home care were cited as the two fastest growing reasons for delays. It said workforce shortages were likely to be a major cause of this. NAO head Amyas Morse said: “There are currently far too many older people in hospitals who do not need to be there. Without radical action, this problem will worsen and add further strain to the financial sustainability of the NHS and local government.” Simon Bottery, of the Independent Age charity, said the problem was likely to get worse because of the ageing population.
Hunt orders TPP contract discussions be put on hold whilst risk calculator is fixed: Health secretary Jeremy Hunt has ordered that all new contract negotiations with primary and community care IT supplier TPP are put on hold whilst the supplier looks at errors in its QRISK2 calculator, reported Pulse. An alert circulated to NHS organisations stated: “The secretary of state and permanent secretary Una O’Brien have asked that any contracts which may be about to be signed with TPP should be ‘paused’ until the current issue is resolved.” The Medicines and Healthcare products Regulatory Authority (MHRA) is working with TPP to address problems in the QRISK2 calculator in TPP’s SystmOne product. The calculator provides risk scores for patients who may suffer a heart attack or stroke. In some cases it is thought that risk scores have been both underestimated and overestimated, meaning some patients may not have been given preventive treatment, while others may have been treated unnecessarily. This pause does not affect existing contracts, with many CCGs and practices negotiating and re-signing, or changing provider, during the start of 2016. A spokesperson for TPP said: “TPP responded immediately once issues were identified with the QRISK2 calculator, an advisory, third-party tool which was adapted by TPP to be integrated into SystmOne. We are currently working to verify that the QRISK2 calculator is functioning correctly, with the guidance of MHRA and HSCIC.”
Growing financial constraints leave GPs ‘prescribing with handcuffs on’: Three out of four GPs say pressure on prescribing budgets has increased over the past year, with many reporting a negative impact on patient care, a GPonline poll has found. Three quarters of GPs reported that pressure on local prescribing budgets had increased over the past 123 months, according to the poll of over 350 GPs. GP respondents said they felt they had to ‘prescribe with handcuffs on’ to deal with the pressures, while another said the year would mark ‘the first time ever we will fail to meet our budget’. Only 2% of over 350 GP respondents said pressure on their prescribing budget had decreased since April 2015. A quarter said pressure had neither increased nor decreased. Dr Andrew Green, chairman of the GPC’s clinical and prescribing subcommittee, warned that CCGs –many of which are facing ‘significant deficits’ – were ‘becoming increasingly restrictive’ on GP budgets. This is having knock-on effects on patients as GPs are being directed to change patients from one drug to another, potentially causing them distress and piling extra strain on GP workloads, he added. GPonline revealed similar problems two years ago, suggesting the problem has been growing steadily worse. The overall prescribing spend in primary care increased by £414m in 2015, according to prescription cost analysis data from the Health and Social Care Information Centre. This pushed the overall amount spent up to £9.3bn, a rise of 5% on 2014.
Health Secretary: ‘NHS still not trusted on data security’: The NHS has been told that it needs to improve data security from a tech, governance and training perspective ahead of two new reviews set to land in the coming year, reported Infosecurity. Under-fire health secretary, Jeremy Hunt, claimed the NHS hasn’t yet reassured the public it can safely handle data – since he announced the reviews last autumn. The Care Quality Commission is currently reviewing data security standards across the health service, and will report in January 2017. US healthcare expert Robert Wachter is reviewing the digital future of the NHS. NHS organizations continue to be found wanting when it comes to secure data handling. Zak Suleman, healthcare specialist at Smoothwall, argued it is correct that the health secretary is focusing not only on technology but user education and governance. “Ensuring a strong security culture is instilled throughout the NHS workforce is vital to ensure staff are constantly vigilant and aware of the threats. As the proliferation of cyber-attacks becomes more frequent, advanced and sophisticated, it is now not about if an attack happens, but when,” he added
GPs reluctant to use new technology for consultation: GP practices need more evidence to persuade them to adopt new technologies in patient consultations, reported GPonline. Researchers found ‘general reluctance’ among the profession to implement alternatives to face-to-face appointments, with over half saying they had no plans to use email for consultations. The survey, published in the British Journal of General Practice (BJGP), found that two thirds (66%) regularly offer telephone consultations to patients. Only 6% said they implemented email consultations, with 53% indicating that they had no plans to introduce this. None of the practices used services such as Skype to conduct consultations, and none had plans to do so. Professor Chris Salisbury, lead author and GP, said: “The survey results show that, since few people are actually using email or internet video in general practice, views about the pros and cons of alternative forms of consultation are largely speculative and based on anecdote rather than evidence. The general reluctance to adopt alternatives to face-to-face consultations means the situation is unlikely to change soon unless general practices can see clear advantages from introducing new ways of consulting.”
NHS to face new patient safety investigations from autumn: The new Healthcare Safety Investigation Branch (HSIB) will be operating from this autumn with a budget of £3.6m for around 30 investigations, reported HSJ (subscription required). A new chief investigator, tasked with establishing the branch and how it will operate, is expected to be appointed in the next few months. It is understood that although HSIB will be hosted by NHS Improvement, the chief investigator will have full discretion on which cases will be investigated. They will be expected to report to the health secretary and only the secretary of state can appoint or dismiss the chief investigator. A report by an expert advisory group brought together by Jeremy Hunt to advise on the creation of HSIB recommended the government considers creating a new process to tackle historical cases as these will not be looked at by HSIB. National patient safety director Mike Durkin, who chaired the group, said: “I have met many bereaved families and they have not been served well and there are staff members who have equally not been served well after making errors and mistakes. As a whole system we need to reflect on how we are supporting the development of good safety techniques without blame and acrimony. This is a big challenge but also a huge leap forward to have an independent body acting without fear or favour with the support of the whole system.”
CQC shifts focus from inspections to data and feedback: The Care Quality Commission will push ahead with plans to scale down inspections and instead rely more heavily on data and user feedback, DigitalHealth.net reported. The commission’s newly released five-year strategy has stated a shift towards “more targeted, responsive and collaborative approach to regulation”. This was reported to include moving away from regular full inspections, and leaning more on data, user feedback, and self-reporting to spot problems in NHS organisations. In a statement, the commission said the changes were taking place in an environment of “increasing care need combined with financial pressures”. It said: “By using new technology and data to make better use of what people tell us, so that we can use the most up-to-date information to help spot when people might be at risk of poor care. We will improve the processes that underpin our inspections so we can report what we find more quickly.”
CCGs told to decide how to spend PMS savings before cutting practices’ income: NHS England regional teams and CCGs have been told to plan how they will redistribute money made from cuts to personal medical services (PMS) contracts before making the cuts, reported Pulse. Reviews of all PMS contracts were supposed to be concluded across England by 1 April but some have been delayed. Under the terms of the review, agreed by NHS England with the GPC, area teams were told to establish how much of the extra funding given to PMS practices was not linked to extra services. This money would then be redistributed to general practice within the CCG area. But now NHS England has issued a clarification to NHS England regional teams and CCG leaders to say they should prioritise the reinvestment plans before making cuts, in order to offset concerns amongst PMS practices losing funding. In the letter NHS England director of NHS commissioning Rosamund Roughton said PMS practices were ‘understandably’ concerned about their funding reducing where they were not clear on reinvestment proposals. The letter said: “We have been clear on the need to ensure PMS practices can plan for the net impact of these funding changes by ensuring any funding reductions can be set against local proposals for reinvestment. However this communication of new earning opportunities is not happening universally in all areas and PMS practices in those instances will understandably be concerned.” She said NHS England is “therefore requesting that all local commissioners ensure these reinvestment proposals are confirmed locally to PMS practices before any actual reductions to funding are made to PMS practices who are facing reductions in funding.”
CSC announces merger with offshoot of HP: CSC will merge with HP Enterprise Services, the two US-based technology companies have announced, reported DigitalHealth.net. HP Enterprise is a corporate IT solutions company that split off last year from HP; leaving the other half of the company to focus on making PCs and printers. It announced on Tuesday that it would spin off its enterprise services business and merge it with CSC, in what its chief executive, Helen Whitman, described as a ‘spin-merger’ that was part of wider consolidation in the IT industry. The implications for the two companies’ UK arms are unclear, but both have provided technology to NHS trusts around the country. In response to queries from DigitalHealth.net, a CSC UK spokesperson said there were no changes to CSC’s contractual commitments and “it is business as usual”. However, he said the new company would have “more offerings, solutions and capabilities for all clients”; although how these will be offered to the healthcare IT market “has yet to be determined”. In a statement following the announcement in an investor call on HP Enterprise’s latest figures, the US arm of CSC said the merger will “create a new company with substantial scale to serve clients more efficiently and effectively worldwide”. Mike Lawrie, CSC president, chairman and chief executive, said the merger would create a “more powerful and versatile global technology services business”, including its healthcare business.
HSCIC examines info flows for social care: The central informatics organisation for the NHS has begun to look at the information flows needed in the integration of health and social care, reported UKAuthority.com. The Health and Social Care Information Centre (HSCIC) is aiming to create a set of information standards and is working with the Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS) on bringing social care input into the process. It is seen as a necessary step in supporting the integration of health and social care, one of the features of the NHS Five Year Forward View and a long standing aspiration of government. Two of its officials outlined the work at the ADASS Informatics conference. James Palmer, programme head for social care delivery, said: “We’re forming a partnership with the LGA and ADASS to ensure that whatever we are developing we are able to talk to the sector and bring some of the sector intelligence with us. Without that we can’t put together services and products that the sector wants to use.” Mark Nicholas, HSCIC’s social care lead, said it is also raising a research proposal on the use of technology by social care professionals, and plans to release more information soon. “We’re interested in what works and what doesn’t and how it could support their professional role better,” he said.
Surgeons use 3D-printed model of prostate in pioneering operation: Surgeons have for the first time in the NHS used a 3D-printed copy of a patient’s prostate to help them remove the cancerous gland, reported the Evening Standard. They held the replica prostate in their hands as they used a £2m robot to cut it free, ensuring they excised the tumour but minimised the risk of causing impotence and incontinence. The procedure is the latest at Guy’s and St Thomas’ NHS trust using 3D printing. Last November, a team of doctors used the technique during the transplant of a kidney from a father into his three-year-old daughter. Professor Prokar Dasgupta, who performed the prostate operation at Guy’s Hospital, said the technology could prove revolutionary. The hospital’s da Vinci Xi robots perform about 300 such operations a year, but it means surgeons lose their sense of touch. The model revealed the prostate was smooth on one side, allowing Professor Dasgupta to spare a nerve bundle. Dasgupta added: “Using this 3D model, we can plan surgery better, we can counsel the patient better and we hope to be able to remove the cancer successfully. If I didn’t have this, there would be an element of guesswork. It shows you the power of MRI, it shows you the power of this software, it shows you the power of 3D printing. If it proves to be as useful as it seems, I think it has a great future.”
Is Nintendo branching into healthcare?: Nintendo has proposed changes to its articles of incorporation that could see the company begin making medical and health devices, Digital Health Age has reported. The document, said to outline the company’s purpose, was reported to include notice of a partial amendment on the “development, manufacturing and sale of medical devices and health devices”, as well as the addition of “development, manufacturing and sale of computer software” to the company’s portfolio. The amendment proposal will be brought to a shareholder meeting for consideration on June 29. Nintendo was said to be unavailable for comment.
INTEROPen supplier group launched to promote open standards: A supplier-led interoperability group has been launched to promote the exchange of data across healthcare through the adoption of open standards, reported DigitalHealth.net. The INTEROPen group has said it will focus on promoting the development of application programming interfaces, and organise conectathons that will help accelerate the use of open standards such as FHIR [Fast Healthcare Interoperability Resources]. The eight founding members of the interoperability group are: IMS Maxims, Orion Health, Black Pear Software, Cerner, TPP, Endeavour Health Charitable Trust, Emis Health and InterSystems. Paul Cooper, research director IMS MAXIMS, and one of the founders of the new group, told DigitalHealth.net: “This is a new group, created as a sub-group of Code4Health, it is open to all suppliers committed to the promotion of open standards.” Amir Mehrkar, chief clinical information officer for Orion Health, and one of the co-founders of the group added: “Code4Health has a number of sub-groups and suppliers are involved in each of those. Interoperability will only take place if we drive it and we felt we needed our own forum to drive discussions and work together. One of our early priorities will be to collaborate with and help the Professional Records Standards Body and Code4Health. They are both keen to work with us on use cases, developing appropriate FHIR profiles and ensuring that they have the right sort of clinical data.” Cooper said the new INTEROPen industry group will also aim to support the new Code4Health interoperability community, which he described as “the best thing on interoperability for many years in the NHS”.
InterSystems’ Joined-Up Health and Care conference: Integrated information is already allowing better clinical decision making, but technology that is interoperable at scale across whole health systems, will be fundamental in addressing the needs of the future and in delivering better outcomes for patients, InterSystems’ annual Joined-Up Health and Care conference heard this week. In a series of stories, Health IT Central reported on key findings from the event. Gary James, accountable officer for Lincolnshire East Clinical Commissioning Group, revealed how Lincolnshire Health and Care’s (LHAC) Care Portal Programme is now set to deploy and begin realising benefits for patients. James told the conference: “The benefits of this portal are improved clinical decision making, improved patient management, improved quality of care, improved patient experience, improved cost effectiveness and increased time to care through reduction in administrative burden. It has taken us at LHAC two years to get to this point and we are almost there in terms of deployment.” Professor Sarah Harper, of the Oxford Institute of Ageing, detailed findings around increased life expectancy and predictions around rising challenges surrounding frailty. She told the event: “Technology can continue to play a huge role in gaining key data into how the population can live longer and healthier and we believe that life expectancy can keep increasing.” David Liverseidge, director of integrated clinical solutions at Nuffield Health, detailed how the organisation was advancing on a journey to create joined-up records across the not for profit organisation. “At the moment, we aren’t there. We are dealing with it, but we are at the beginning of our journey. We have ambitious plans to transform our approach and enable the strategy for joined up health care and the electronic health record (EHR) is a key element.” And John Rayner, regional director for Europe at HIMSS Analytics spoke on the shift to whole systems leadership: “Transfers of care are key to moving forward. Enablers of integrated care include exchange of information, culture and leadership, procedures, funding, attitude to risk, patient choices, governance, clinical practice and patient engagement,” he said.
Opinion
Mobile tech and the NHS: how to close the skills gap
Does the NHS have the digital skills needed to help deliver new models of care? In an article published by Information Age, Steve Carvell head of healthcare at CommonTime looks at how NHS trusts are developing mobile technology capabilities to meet clinical needs.
Carvell writes: “Technology skills are in higher demand than ever. Look across any vertical and developers who can create mission critical apps and push organisations into the mobile era, are highly sought. NHS trusts tend to only have small teams of developers – but is this enough to cope with the modern and abundant technology needs of the NHS?
“For many NHS trusts, IT developers and IM&T teams are focussed on supporting or delivering traditional clinical systems such as electronic patient records and patient administration systems. These large scale IT implementations, targeted at improving digital maturity and the sharing of information at the point of care, demand and consume significant IT resource.”
There is a way to manage in-house IT resource and respond to real clinical demands, by putting mobile technology first, says Carvell: “Ensuring mobile in-house skills offers the NHS a way to respond to real clinical demands quickly. Gone are the days when it is acceptable for healthcare professionals to queue for access to a PC terminal to find information on their patient.
“Having the ability to create the mobile tools needed to enable this in-house can place the NHS in a position of power, and in the position where it can develop tools to fit the needs of its specific staff and patients, no longer constrained to buy generic off the shelf apps.
“Large clinical ICT systems have been the priority of NHS organisations. But now there is a very real positive energy in every NHS trust that has seen the benefits of embracing mobile technology. Mobile is not the afterthought it used to be.”
Compassion – not bullying – is the path to improving NHS care
A culture of cooperation, compassion and support is crucial for better care, writes Marcus Powell on the Guardian’s healthcare network.
Powell, the director of leadership and organisational development at The King’s Fund, says: “People can’t focus and do good work if they are surrounded by negative emotions. If leaders want people to take committed action and put in a superior performance, they have to connect with their feelings first – and connectivity is compassion in action.
“The changes required to deliver a health system that’s fit for the future are far-reaching. Integrated services that go across traditional organisational boundaries are necessary and a new settlement with patients on what they can expect is emerging. But as global healthcare expert Don Berwick says: ‘Culture change and continual improvement come from what leaders do, through their commitment, encouragement, compassion and modelling of appropriate behaviours.’
“It’s easy to think that in a money-starved environment, where the popular discourse is about failure rather than achievement, we can’t make space for compassion. But I would argue that the opposite is true. Great leaders care about connecting with those they lead. They see connectivity as the conduit for almost everything else they do and compassion is the key. Compassionate leaders inspire people with purpose, hope, optimism and energy because they resonate, empathise and connect.
“Bullying, directive, coercive styles may move people in the short term, but the dissonance it ignites breeds toxic emotions such as anger, anxiety or apathy, and does long-term damage to morale.”
The NHS: Shining a light on digital success stories
Charles Henri Royon, VP EMEA at Tradeshift, writes about technology success stories in the NHS not getting the recognition they deserve.
“In April, the NHS published its digital maturity assessment which evaluated the effectiveness of digital technologies across its 239 trusts. The findings were ‘mixed’, with Paul Rice, the NHS head of technology strategy at NHS England, taking aim at the likes of e-Prescribing. But this doesn’t paint the whole picture. There are tech-based success stories that aren’t receiving the hype they deserve.
“Adopting PEPPOL: In 2014, the NHS announced it would adopt PEPPOL – the Pan-European Public Procurement Online project – and GS1 standards to underpin its e-Procurement strategy, in line with the EU directive for electronic invoicing in public procurement. While PEPPOL was only adopted two years ago, the NHS has already had some great results in areas such as e-Invoicing.
“For example, the NHS Shared Business Services (NHS SBS) grew the number of invoices it electronically processed per month from 5,000 to 50,000 in just over a year. As a result, its accounts payable team has access to payment details and workflow straight away, and can now reduce the approval processing time of invoices from 14 days to just three.
“Going paperless: Then, in February, the UK government announced its latest paperless drive for the NHS. With more than £4bn investment, it plans to boost the use of technology to make patients’ lives more convenient by having access to electronic records and online appointments, prescriptions, and consultations. The hope is that new initiatives will also allow doctors to provide faster diagnoses.
“While the full details are still being ironed out by the Department of Health and NHS England, video-links, health apps, and free WiFi are just some of new investments set to be brought in to remove outdated tech. This investment is set to see the NHS go completely paperless from 2020, with supporters believing that it will greatly improve the health services and deliver better value for money.
“The road to digital isn’t going to happen overnight, but as Paul Rice said, the NHS will continue its push for digital maturity. While there may be headaches to overcome in the process, we have already started to see proven results from initiatives like PEPPOL and GS1 and from digitising processes and partnering with innovative technology providers.”
