News in brief
NHS England forecasting first ever overspend: The overall NHS England budget is forecast to be overspent for the first time in 2016-17, and 45 clinical commissioning groups (CCGs) are performing worse than planned, reported Health Service Journal (subscription required). In its finance report for the three months to July, the national body forecasts an overspend of £83m against the core financial performance measure. This incorporates the performance of CCGs. In 2015-16, NHS England recorded an underspend of £599m, much of which was achieved through one-off measures. It helped the Department of Health (DH) avoid a formal parliamentary process to ask for more money. NHS England has reported an underspend to the DH in each of the three years since it was formed. In 2015-16, an overspend was also forecast in the first half of the year. A number measures were subsequently taken to boost the position to a £599m underspend, but many of these were one-off actions and will not be available this year. The report says CCGs reported a combined £57m overspend for the first three months of the financial year, but adds that many are expecting to recover their positions. The year-end forecast is for a combined £10m overspend. A spokesman for NHS England said: “NHS England will be taking action to address its very marginal forecast overspend (less than 0.1% of allocation) as at month three, so that despite the significant risks, we achieve a balanced year end position. We are working with NHS Improvement to stabilise finances this year and to kick-start the wider changes needed to improve services, as set out in last week’s financial ‘reset’ document.”
Hospitals’ premium-rate overtime payments soar: Spending on premium-rate overtime by hospitals across the UK has risen by more than a third in the past two years, reported The Guardian. Hospitals can pay consultants a higher-than-normal rate for extra shifts. Some hospitals have paid up to £1,000 for four hours’ work, research by the BBC found, while rates of £600 a shift are common – three or four times consultants’ normal rate of pay. The average amount paid in high-cost overtime last year was £13,356 per consultant. One doctor at Lancashire Teaching Hospitals NHS Foundation Trust made £375,000 on top of their salary from the shifts. Figures from 114 of the 186 trusts and health boards show the amount hospitals spend on high-cost overtime is increasing. In 2015-16, £168m was spent, up from £125m in 2013-14. Not all hospitals pay overtime at higher rates. Wrightington, Wigan and Leigh NHS Foundation Trust stopped paying premium rates in 2010. Andrew Foster, the trust’s chief executive, told the BBC: “I don’t think it is very defensible to pay a huge premium to one group of staff and not to other groups of staff.” Danny Mortimer, chief executive of NHS Employers, conceded that the figures revealed “challenges in some parts of the country” where trusts are “finding it difficult to recruit doctors to certain specialities”. The British Medical Association (BMA) said the payments were a sign of doctor shortages. Keith Brent, the BMA consultants’ leader, said: “These payments are made because there simply are not enough doctors and hospitals are under pressure to meet waiting time targets.” The BBC also reported figures in Scotland show that additional payments have risen from £14.27m in 2013-14 to £20.92m in 2015-16.
Ministers told to ‘get a grip’ after increase in bed blocking: The Scottish Government has been urged to “get a grip” on bed blocking after new figures showed more patients were kept in hospital when they were medically well enough to leave, reported Herald Scotland. A census across Scotland’s hospitals carried out in June revealed 1,159 patients whose discharge had been delayed – including 175 who had been waiting six weeks or more. Across the NHS in May, patients spent a total of 44,305 days in hospital when they were medically well enough to leave, a rise from 43,980 the previous month. Health secretary Shona Robison said the latest figures showed a 6% fall in the number of bed days lost compared to the same month last year, and a drop of 14% compared to two years ago. Opposition parties highlighted the increase in bed blocking – which happens when patients are clinically ready to leave hospital but are waiting for the necessary care, support and accommodation arrangements to be put in place. In April 2015 the Scottish Government introduced the target that nobody should have to wait more than two weeks to be discharged. The total of 1,159 delayed discharges in June’s research is up by 3% from May’s census and includes 338 patients with specific, complex care needs. Labour health spokesman Anas Sarwar said: “Yet another increase in delayed discharges, yet another broken promise from the SNP [Scottish National Party] who promised to eradicate it a year ago. Our NHS staff are doing the best they can under the circumstances but they are over-worked, undervalued and under-resourced. The lack of funding to health boards and social care from the SNP government will only make this worse.”
NHS unveils first phase of GP resilience funding, indemnity deal and MCP contract: Struggling practices across England will receive a share of £16m in funding in 2016-17 – the first tranche of a £40m practice resilience programme to be released over four years, reported GPOnline. NHS regions across England will receive between around £600,000 and more than £1m each to support practices in the current financial year. The first wave of a £30m, three-year general practice development programme, which will “give every practice in the country the opportunity to receive training and development support” will also be rolled out under the package announced by NHS England. NHS chiefs will also release funding “to fully offset the rising cost of GP indemnity” as part of wider plans to reform primary care indemnity. Simon Stevens, NHS England chief executive said: “We meant it when we said we would take concrete action to help relieve pressure on GP practices, and this funding is just the first instalment. Practices need support, now, and a few weeks on from the GP Forward View we’re getting on with practical action to do so.” Dr Arvind Madan, a GP and NHS England director of primary care, said: “We understand the pressure on GP practices and today’s announcement shows how we’re getting on with immediate practical steps to deliver GPs much-needed support.”
More than one in ten GPs have closed their lists over the past year: Relentless pressure on GP practices has led to more than one in ten GPs closing their list to new patients at some point over the past year, reported Pulse. Some 12% of 508 GP partners responding to a recent Pulse survey said they had either formally or informally closed their patient list in the past year. Further, several GPs who had not closed their lists said this was because NHS England or the clinical commissioning group (CCG) had declined their requests to do so. A Pulse investigation revealed that area team managers refused almost a third of all requests from practices wishing to close their lists. Dr Rebecca Hardy, a GP in Calderdale whose list has been informally closed, said that in her 30 years in the job she has never faced this level of demand. She said: “We have been told we must continue to register patients even though we do not have enough staff in our team and are constantly relying on locum GPs and nurses. This has never happened at my practice before, but it is now the norm in the last 12 months.” Family Doctor Association chair Dr Peter Swinyard said: “We are all under great pressure and we have the facility under our contracts to close lists if we cannot provide a service which is safe to those patients who are already on our list. That is the situation that many practices now find themselves in and that is very sad.”
Stevens: Most STPs ready by October as ‘substantial’ progress made: The sustainability and transformation plans (STPs) are on track to be agreed by autumn, the chief executive of NHS England has said, reported National Health Executive. Simon Stevens told the NHS England board meeting this week that progress on the STPs, which were submitted at the end of June, had been “very substantial” and that they were ready to develop their financial propositions by September and agree the final sign off of most STPs by October. Stevens admitted that there was variety between the 44 STPs, but said: “It’s fair to say that the size of the challenge and the degree people have collectively mobilised were at different places when this project first kicked off, but most people have moved a very long way in a very short time.” An investigation by Public Sector Executive found that ‘Locality Plans’ in Greater Manchester are providing greater local authority involvement in integrating care than STPs in other areas. They have also been watered down from their original goal, with the then life sciences minister George Freeman admitting in June that they have no legal basis and health secretary Jeremy Hunt saying they were “very simply” about reducing hospital bed days. A survey of NHS finance directors also found that only 16% believe STPs will succeed in delivering sustainable care by 2021. Stevens also said that NHS England had responded to providers’ concerns by bringing forward the annual contracting rounds for 2017-18 and 2018-19. These will now be finished by December in order to allow providers more time to redesign services.
Creeping privatisation of healthcare is damaging the NHS, study finds: The creeping privatisation of healthcare under the guise of “patient choice” could be damaging a central concept of the NHS, leading to worse treatment for the old, the poor and the sick, a new study by Queen Mary University of London (QMUL) suggested. The Independent reported that the researchers warned that the government’s sudden shift to the widespread use of private healthcare firms in England was a “radical” experiment that could go “catastrophically wrong”. They investigated what happened in Scotland after the Labour-Liberal Democrat coalition passed a law in 2003 enabling people to have their treatment in a private hospital but paid for by the NHS. Similar legislation was introduced elsewhere in the UK. The move was designed to cut waiting lists, but the study, which looked at hip surgery, found the level of NHS provision declined as the number of private operations increased. And there was also a rise in inequality, with the poorest and oldest sections of society less likely to get an artificial hip than the rest. According to the founding principles of the NHS, it is supposed to meet the needs of everyone, regardless of their circumstances. Researcher Graham Kirkwood of QMUL said previous research had found evidence that private healthcare firms given NHS contracts were allowed to discriminate against patients who are probably going to spend too long in hospital. “They don’t want patients who are going to be hanging around in hospital because they are expensive,” he said.
Forward View ‘guarantee’ needed to stop crisis in general practice: Reforms designed to make general practice sustainable must be delivered by the new government, the Royal College of GPs (RCGP) has said, as it warned that cases of patients having to wait more than a week to see a GP could reach almost 100 million in five years. National Health Executive reported that new analysis by the RCGP shows that the number of incidents where patients had to wait over a week was at 69 million in 2015-16 and could reach 98 million in 2020-21 if the GP Forward View isn’t introduced – with 52 million cases of patients not seeing a GP at all. The GP Forward View was published to tackle the growing problems besetting the sector, with the UK topping an international table in terms of stress and care co-ordination problems for GPs, and 10% of surgeries currently in unsustainable financial positions. Dr Maureen Baker, chair of the RCGP, called the figures “frankly flabbergasting”. She added: “All the evidence shows that general practice is in crisis, and that crisis is worsening. However, having recognised the scale of the meltdown, the government, under David Cameron, announced plans to save general practice and help pay for a service that could consistently meet the needs of our patients. We now need a guarantee from the new prime minister, the new chancellor and the health secretary that the NHS England General Practice Forward View will be delivered in full. This is an especially pressing issue given that so many voters in the EU referendum were swayed in their opinion by concerns about the NHS and particularly by worsening GP waiting times.”
CQC to launch security review after losing personal data: The Care Quality Commission (CQC) is to launch an independent review of its security arrangements after losing sensitive personal data, reported Health Service Journal (subscription required). Up to 500 disclosure and barring service (DBS) certificates have been lost after a locked filing cabinet was wrongly marked for removal and destruction during a refurbishment of the regulator’s Newcastle office earlier this month. The certificates include information about people who had applied to become “registered managers and providers.” The forms include their full name, date and place of birth, name of employer and position applied for, and in some cases could include information about previous criminal convictions and cautions. In a statement the CQC said as soon as it became aware of the breach it carried out a “thorough and comprehensive investigation.” It has written to those affected and has reported the incident to the Disclosure and Barring Service Authority, the Department of Health and the Information Commissioner’s Office. The CQC believes the records have all been destroyed but was unable to confirm this definitively. David Behan, the CQC’s chief executive, said: “I would like to apologise to the individuals whose DBS certificates have been lost… and for any distress this may cause. I deeply regret that this has happened. I intend to commission an independent, external review of CQC’s security arrangements in case wider lessons can be learned and so that we can be confident that something like this does not happen again.”
Final three take Lorenzo deal: Three trusts have been granted central funding to deploy Lorenzo as an electronic patient record system (EPR), as part of the deal agreed between the Department of Health and CSC in 2012. The Health and Social Care Information Centre (HSCIC) confirmed to DigitalHealth.net that Mid Essex Hospital Services, East and North Hertfordshire NHS Trust and Papworth Hospital NHS Foundation Trust have all been given approval to take the system. The HSCIC did not say how much funding the trusts would receive, but the maximum on offer to the other 12 trusts that taken the deal was £3.1m. East and North Hertfordshire confirmed it would receive £3.09m over two years. No further trusts can now access the central funding. Responding to questions from DigitalHealth.net, East and North Hertfordshire said: “Lorenzo represented the best value and timely solution for the trust to replace its current system”. A CSC spokesman said the new planned deployments were further evidence that Lorenzo “was earning its place as a leading EPR. We’re committed to working with all our Lorenzo customers to help them use technology to deliver better, safer care.”
Short-term RTT fix unlikely as nearly 1,000 patients wait over a year for referral: NHS waiting times for referral to treatment (RTT) are growing and are unlikely to improve in the short-term, according to the latest report to NHS Improvement. National Health Executive reported that papers that were published ahead of the regulator’s board meeting showed that 996 patients had been waiting over a year for referral in May 2016, a significant increase from 133 in May 2015. There were 196 patients waiting for over a year at King’s College Hospital NHS Foundation Trust and 134 at University Hospitals of Leicester NHS Trust. In addition, eight providers did not submit figures, meaning the true amount could be even higher. A report to the NHS England board said: “It will be challenging to recover RTT performance in the short term.”
MP to discuss tech firm’s ‘innovative’ health products with ministers: Andrew Jones, the Conservative MP for Harrogate and Knaresborough, has visited constituency business Inhealthcare to learn about the tech firm’s work in digital health, reported Digital Health Age. The company specialises in self-testing services which are designed to help patients take greater control over their healthcare and ease the pressure on the NHS. Mr Jones said: “We all know that demand for our NHS services is going through the roof and also that people want more help and support managing any condition they have. New technology is part of the answer here and it was great to see innovative products from a local company that address these two challenges.” Entrepreneur Mr Wilkinson passionately believes that Inhealthcare’s unique technology can save hundreds of millions of routine hospital appointments and transform the NHS. Mr Sage said: “Our digital health services give freedom and independence to patients and enable doctors and nurses to focus their care on those in greatest need. We have tried-and-tested solutions that can help to solve the NHS’ biggest challenges and look forward to sharing these with government ministers.” Inhealthcare is working with the NHS to digitise care services across the UK. These include self-testing for warfarin patients, chronic pain management, undernutrition and vital signs monitoring. Inhealthcare has also been selected to work on NHS England’s “healthy towns” initiative in Darlington.
Mid Yorkshire Hospitals NHS Trust uses new platform to access patient record: The Mid Yorkshire Hospitals NHS Trust (MYHNT) will move to the next generation with a digital healthcare platform that will improve processes, freeing up approximately 19,000 hours of trust staff time each year, which will allow staff to focus on improving patient care, reported Health IT Central. MYHNT has used the help of a health and social care tool to launch its new system, following the successful movement of the trust’s 19.5 million paper records online. The digital records for new MYHNT staff are now hosted in a new system which allows medical staff to access 360 million pages of patient documents at the click of a button. Due to the programme’s success, MYHNT has now decided to invest in a new solution which builds on Civica’s WinDIP capability to enhance the speed of accessing patient information via a single sign-on and integrated interface. Debbie Bentley, head of IT clinical systems at MYHNT, said: “Digitising our patient records was just the first step in our journey to becoming an efficient and paper-light organisation. With Civica’s proven and continued support, we’re now ready to take the next step in our digital transformation.”
Twelve million records shared in Merseyside: More than 12 million records have been shared across Merseyside, as an increasing number of health and social services sign-up to share information, reported DigitalHealth.net. Nearly 6 million records were shared in 12 months to July, compared to 5.5 million the year before. The drive to share is part of the region’s iLinks transformation programme, which aims to improve patient pathways and outcomes through improved use of technology. The programme operates over three clinical commissioning groups (CCGs) in Liverpool, South Sefton and Southport and Formby, covering about 750,000 people. Dr Rob Caudwell, chair and clinical IM&T lead at NHS Southport and Formby CCG, said the assumption was now that information would be shared. “Share has to be a default position. If we are not sharing, we have to ask ourselves what the very, very good reason is we are not sharing; not the other way around,” he said. There have been several projects that have accelerated the volume of information shared, he added. These include the development of a single information sharing framework, to which all health and social care organisation have agreed. This will reduce the more than 2,000 information sharing agreements across the region to just one. Dr Simon Bowers, vice chair and clinical IM&T lead at Liverpool CCG, said that while the region was sharing more information than ever it was also introducing new audit tools, or “safety valve”, this winter to ensure this information was handled appropriately.
Hospital patients are costing the NHS millions by missing five or more appointments last year: Nearly 700 people failed to turn up for five or more appointments at Coventry and Warwickshire hospitals last year – costing the local NHS millions of pounds, reported the Coventry Telegraph. A total of 648 patients did not attend five or more arranged appointments at University Hospitals Coventry and Warwickshire NHS Trust in 2015-16, up from 597 in 2014-15. The trust runs University Hospital in Coventry and St Cross in Rugby. Overall 51,212 patients across the area failed to attend at least one appointment in 2015-16, up 7% from 47,847 in 2014-15. Overall 5.63 million people across Britain failed to attend at least one hospital appointment in 2015-16, up from 5.6 million in 2014-15. The figures come from Freedom of Information requests to hospital trusts and health boards across Britain. Five hospital trusts or health boards failed to answer the request.
Mother of sepsis death baby welcomes government-backed awareness campaign: A mother whose young son died from sepsis has convinced the health secretary to start an awareness campaign about the illness, reported ITV News. William Mead was just 12 months old when he died after a string of NHS failures in 2014 led to his case of sepsis not being properly recognised. His mother Melissa said she is “delighted” by Jeremy Hunt’s decision, who she said “acts like any other father” in wanting to know if his child has sepsis. The decision came after Mr Hunt met members of the UK Sepsis Trust, including Mrs Mead, at the Department of Health. Leaflets, posters and a 90-second social media video campaign aimed at both doctors and the public will appear at A&Es, walk-in centres and doctor’s surgeries on World Sepsis Day on September 13. Mrs Mead said: “With the work of The Sepsis Trust, we can save so many more thousands of lives.” The campaign comes after the National Institute for Health and Care Excellence (NICE) updated its guidelines so that sepsis is treated by doctors and nurses as an emergency on the same level as heart attacks.
Opinion
Hunt’s task is to focus on population health now
The headlines usually focus on deficiencies of NHS funding but Jeremy Hunt’s focus must equally be on the way we live, writes Emily Crawford in Health Service Journal (subscription required).
Crawford says, following his re-appointment as health secretary, Hunt should take on ‘a more positive and preventative approach to health policy’: “The need for preventative population health has long moved out of the niche world of policy wonks and health economists. Indeed, the Five Year Forward View, which is guiding the transformation of the UK health and care landscape over the next five years, explicitly places prevention at the heart of the strategy.
“A healthy population is central to contributing to the productivity of the nation – too much potential is lost due to early exit from working life, time off sick costs the UK economy £100bn a year, and for those people who are signed off as long term sick, they are more likely to die than return to work. At the same time, it is crucial to tackle the onset of avoidable ill health in order to reduce demand on a stretched health and care system.
“Good health is more than the absence of illness. Social isolation is a huge cause of mental distress – cost £70-100bn according to the Mental Health Foundation – and supporting voluntary and community groups who provide crucial community links is part of ensuring wellbeing.
“Yet it is fair to say population health has not been given the same resources, attention, status or political clout as more visible parts of the health system. Threaten a local hospital at your peril minister, but cut the public health budget by £200m and there is barely awareness, let alone objection.”
Kate Granger inspired all of us in the NHS to be more compassionate
Rachel Clarke, a junior doctor in Oxford, writes about how recently passed Kate Granger, who was a consultant geriatrician, unleashed a quiet revolution for better care in the NHS.
Clarke recalls a ward round that lacked compassion: “He’d been rushed the day before to our surgical emergency unit. An elderly man, crying out in pain, he’d looked haggard, gaunt and frightened as we wheeled him straight to the CT scanner. Without so much as an introduction, this experienced doctor broke the news to the patient of his terminal illness by turning to the bedside entourage and muttering, perfectly audibly: “Get a palliative care nurse to come and see him.” No one had even told “him” he had cancer.
“For the past five years, one woman has unleashed a quiet revolution to banish such casual brutality from our NHS. My fellow doctor Kate Granger died on 23 July from a rare and aggressive form of sarcoma. Three years ago – without introducing himself or even looking her in the eye – a doctor issued her with a death sentence by telling her that her cancer was inoperable. She told delegates at the annual NHS Confederation conference in 2014: “Without any warning or asking if I wanted anyone with me, he just said, “Your cancer has spread.” He then could not leave the room quickly enough and I was left in deep psychological distress. I never saw him again.”
“Aged 29, Kate harnessed the inhumanity of her treatment that day to become a tireless campaigner for kindness and compassion in the NHS. Her idea was simple but brilliant. She wanted NHS staff to build vital, caring relationships with their patients by – at the very least – introducing themselves by name. Her #hellomynameis campaign, launched with a single tweet, turned into a nationwide NHS movement, with more than 400,000 frontline NHS staff and innumerable hospital trusts backing it.
“Perhaps more than anything, the enemy of compassion in today’s NHS is understaffing. When doctors and nurses are too few on the ground we are left scrabbling, exhausted and demoralised, merely to keep our patients safe. Taking time to connect with our patients as fellow human beings is all too often squeezed out.
“Kate reminded us all that kindness, though freely dispensed, is priceless. If we lose our humanity, we are shadows of the doctors we should be. I like to believe that her legacy in part will be that every one of your doctors and nurses might sometimes, thanks to her, intone the same silent plea: “When you lie before me in your hospital bed, distressed, frightened, in pain, vulnerable, may the day never come that I cease to see an individual, a human being in front of me.”
Doctors and nurses will work with AI
Danny Buckland, health journalist, writes about how medical artificial intelligence could save the NHS from a looming shortfall of £20bn and the demands of an ageing population, with 30% over the age of 60 by 2039.
“A wave of innovation driven by artificial intelligence (AI) is being hailed as both a saviour of traditional healthcare and the dawn of a new era in the public’s engagement with their own health. Dan Housman, chief technology officer at ConvergeHEALTH by Deloitte, said: “Healthcare is complex as an industry and is generating vast volumes of data from imaging, genomics, sensors, daily care and scientific research. AI can generate insights from this data that people can’t easily do, so again it makes healthcare a good fit for the technology.
“Dr Ali Parsa, the pioneering health guru behind Babylon, the online service that fuses clinical expertise with the latest technology to provide symptom checks and increasingly diagnostics, says: “There is not an area in our lives where AI is not already doing a big job – it is all around us. Using AI will free up doctors and nurse time. There are so many combinations that no human brain can compute all of them and that is why one in eight of NHS diagnoses are wrong. It is not that the doctors are bad, it is just that it is mathematically impossible to configure all these in your head.
“The statistics underscore his point: there are 10,000 known human diseases and the British National Formulary, the Royal Pharmaceutical Society’s pharmacology reference book, runs to 1,349 pages of detailed information from asthma to zinc adhesive tape.
“The NHS is certainly keen to take advantage with its chief executive Simon Stevens proclaiming that smartphones are “one of the most powerful diagnostic tools available”. NHS funding is being reformed to allow hospitals and GPs to apply for reimbursement for apps and devices on an approved list.
“NHS England’s Small Business Research Initiative awarded £42m of funds for NHS innovations in 2015 which have the potential to save £1.5bn.
“The mechanics are in place, but the public still needs to learn to trust computers and have confidence their records will remain private. Bleddyn Rees, digital health consultant at Osborne Clarke, also cautions that, although the NHS is data rich, a lot of work needs to be done to collate it into meaningful data sets.”
