The year opened as it was to go on with the government in turmoil over Brexit and think-tanks issuing dire warnings about the state of the NHS. Prime minister Theresa May was pushed into an early Cabinet reshuffle, in which health secretary Jeremy Hunt was tipped for a sideways move to business. But he emerged with his NHS lapel pin in place and social care added to his remit.
While all this was going on, a letter was “leaked” from NHS Providers warning that the NHS was “at a watershed moment” and could “no longer deliver what is required of it within current funding” (HCRU 12 January). Then builder and outsourcer Carillion collapsed, leaving two hospital construction projects in limbo.
NHS Digital relaxed its rules on using cloud and offshore data services. NHS England announced fast followers for the mental health trusts in the global digital exemplar programme. Less positively, it was reported that Paperless 2020 funding was being diverted to the aftermath of the WannaCry attack and shoring-up cyber security (HCRU 26 January).
NHS England and NHS Improvement issued the NHS’ annual planning guidance for 2018-19, setting out measures to boost financial support for trusts, contain deficits and restore target performance. Within days, official figures showed that the NHS acute sector was on course for an annual deficit of £1 billion and A&E performance was the worst since records began.
Despite this, a tweet from US President Donald Trump, claiming that the NHS was “going broke and not working”, caused uproar (HCRU 9 February). The planning guidance also set out ideas for progressing the Five Year Forward View’s integrated care and population health management agenda; quietly renaming ‘accountable care organisations’ as ‘integrated care services’ in the process.
Dr Simon Eccles, an emergency medicine consultant at Guy’s and St Thomas’ NHS Foundation Trust, became the NHS’ second chief clinical information officer. The first students were recruited to the NHS Digital Academy. And NHS Digital announced that it was looking for apps to add to the revamped NHS Apps Library that it was running in beta (HCRU 23 February).
Snow fell over many parts of Britain. As the weather worsened, the annual British Social Attitudes Survey reported that public satisfaction with health services was at its lowest level for 30 years (HCRU 2 March). The Nuffield Trust urged Hunt to “sit up” and find more money for additional capacity.
As it did so, the Institute for Fiscal studies urged Hunt to get to grips with the even more severe crisis in social care. In response, Hunt said a much-delayed green paper would be published in the “summer”. More cheerfully, thoughts started to turn towards the NHS 70th anniversary in July. NHS England launched an NHS70 recruitment campaign; just in time for the annual pay round to abandon the NHS pay cap.
Hunt did find £75 million for e-prescribing; and claimed that this would “eliminate around half of [medication] errors.” GP at Hand, an NHS service using the Babylon Health platform, faced controversy after it emerged that local commissioners were facing a huge bill for out-of-area patients; and GPs accused it of “cherry picking” (HCRU 23 March).
At the start of the month, hints were made on political TV shows that the government was going to find a “birthday present” for the NHS; as NHS Providers argued the British Social Attitudes survey had revealed support for increased taxes to fund health and social care (HCRU 13 April).
The Academy of Medical Sciences turned its attention to one of the issues underlying the relentless rise in demand in a report that called for research into the growing number of patients living with multiple, serious conditions.
As the first anniversary of the WannaCry attack came into view, the Commons’ public accounts committee warned there had been no assessment of its financial impact on the NHS – and no plan to implement ‘lessons learned’ (HCRU 20 April). NHS England and NHS Improvement issued a patient safety alert to support the roll-out of the NEWS2 early warning score. And NHS Digital announced that it was going to extend the Electronic Prescription Service to out of hours and urgent care settings.
In a Health Service Journal interview, Hunt said he wanted to create a ‘long-term plan’ for NHS70. He added that he would like to see“full integration of the health and social care system” and a ten-year programme to “get the NHS massively more teched up” (HCRU 11 May).
Matthew Swindells, NHS England director of operations and information, responded by telling e-Health Week that trusts should first sort out their “bog standard” IT and RTT reporting. However, chief information officer Will Smart predicted there would be a HIMSS 7 trust out of the GDE programme “by the end of the year” (HCRU 18 May).
In Scotland, a financial crisis at NHS Tayside led to it being put into special measures; and all NHS boards being told to publish their financial positions monthly. Then the Institute for Fiscal Studies upped the ante by suggesting that UK healthcare spending would need to rise by 3.3% a year “to maintain NHS provision at current levels” and 4% a year “if services are to be improved” (HCRU 25 May).
Jeremy Hunt became the longest-serving health secretary at the start of the month. The milestone prompted assessments of his time in office; with commentators praising his commitment to patient safety and IT while noting that he had fallen out with staff in general and junior doctors in particular (HCRU 8 June).
The dangers of a no-deal Brexit featured in sessions at the NHS Confederation’s annual conference; but all delegates really wanted to hear was the size of the “birthday present.” This was finally unwrapped a week later, when May told TV politics shows the NHS would receive a funding boost of£20 billion a year by 2023-4.
Think-tanks calculated this was 3.4% a year; or rather less than the IFS and others had been calling for. Meanwhile, it emerged that the social care green paper would not be out in the summer (HCRU 22 June). However, the GDE programme did announce the last of five new local health and care record exemplars to test out integrated care records and population health analytics for 23.5 million people (HCRU 29 June).
As Britain sweltered in a heatwave, the NHS finally mark edits 70th anniversary on 5 July with church services and tea parties. As the celebrations continued, spending and policy experts continued to debate the impact of May’s “birthday present.”
The National Audit Office said it would be “enough to sustain current service levels” but not enough to meet the needs of the ageing population, while the NHS Confederation called for a “national conversation” on what should be in the long-term plan (HCRU 6 July). A week later, another bout of government turmoil over Brexit saw Hunt become foreign secretary and Matt Hancock move from culture to the Department for Health and Social Care.
The Royal College of Surgeons published a report saying the NHS was “stubbornly attached to fax machines” and needed to introduce modern working methods (HCRU 13 July). In his first speech in his new job, Hancock said his first three priorities were going to be workforce, technology and prevention. More controversially, he also backed the Babylon Health GP at Hand app.
With the NHS70 out of the way, attention turned to the impact of Brexit on the health service. Matt Hancock told the Commons health and social care committee that his department was looking to stockpile drugs; and airlift treatments if ports collapsed (HCRU 3 August).
Some members of the Brexit Health Alliance, which was setup to keep reciprocal health arrangements, public health, staff issues, medicines supply, and research on negotiators’ agenda, backed a ‘people’s vote’ on the final deal. Thoughts also turned towards the coming winter; as official figures showed the heatwave had put the NHS under huge pressure.
NHS Digital announced a major restructuring programme; and published a prior information notice for the Digital Care Service Framework that will replace GPSoC. Manchester published the one, big electronic patient record tender of the year (HCRU 24 August). In a Facebook post reflecting on a night-shift in London, Hancock called for “interoperable data standards” for NHS IT systems. An official announcement directed £412 million of tech funding secured by Hunt to sustainability and transformation partnerships (HCRU 31 August).
The Health and Social Care Expo took place in Manchester.NHS England asked for public input into the long-term plan, Hancock reiterated his call for “interoperable data standards”, NHS England chief executive Simon Stevens worried about social media and gambling, and Swindells said there would be a HIMSS 7 GDE exemplar “within six months” (HCRU 7 September).
The week after the show, Hancock launched a TalkHealthandCare app to let staff feedback on their experiences and submit ideas for improvement. Confirmation that the NHS could be facing a staffing crisis to match its demand/funding crisis came in the form of official figures showing that there are now 108,000 unfilled posts across the service; 10% of the total (HCRU 14 September).
With winter getting closer, the DHSC announced £145 million of winter funding and £240 million to prop-up social care. The NHS App moved into private beta testing in three areas using the Citizen Identity Service; now renamed NHS Login.
There was financial news of a different kind from Scotland, when the devolved government announced that it was going to write-off NHS board debts. Health secretary Jeane Freeman, who took up the job amid political fall-out from NHS Tayside’s problems, said this would allow the health service to start a new, three-year budgetary cycle in 2019-20 with “a clean sheet.”
The move prompted debate in England about how much, if any, of the “birthday present” should go on bailing out an acute sector (HCRU 5 October). The Care Quality Commission published its annual ‘State of Care’ report, warning that in some areas, hospitals, community care and care homes were all poor, causing “injustice” for local people.
The European Investment Bank announced that it was going to support Ireland’s eHealth programme to the tune of 225 million Euros; as Hancock published a ‘tech vision’ for England that focused on cloud-first and internet-first technologies, open standards and APIs, and a push on security and skills. NHS Digital followed up with a detailed core standards document (HCRU 19 October).
At the very end of October, chancellor Philip Hammond unveiled his Budget. This confirmed the “birthday present”; but failed to reveal the long-term plan. Hammond was able to announce that mental health’s share of the money, £2 billion a year, would go on crisis services (HCRU 2 November).
Then, May revealed that primary and community care’s £3.5billion a year would be channelled towards rapid response teams and care homes; suggesting a lot of the new money might be spent on press-friendly programmes to plug gaps in existing services. The Royal College of Physicians published a report calling for a new, tech-enabled approach to outpatient care.
But Wales’ once admired approach to NHS IT was criticised by the country’s public accounts committee for leaving it with “archaic and fragile IT systems” (HCRU 9 November). In a bid to avoid the same fate, Hancock set up a Healthtech Advisory Board, led by Dr Ben Goldacre; but a survey for the IPPR think-tank suggested the public would rather see money go on staff and cancer (HCRU 23 November).
As Brexit turmoil reached a peak, rumours surfaced in the press that the long-term plan had become stuck in rows between the NHS and the Treasury and civil servants and ministers about what the NHS should be expected to deliver for its cash. There was no speculation on what had happened to the social care green paper.
Despite the lack of stated policy, NHS England, NHS Improvement and Public Health England started a covert re-organisation of the NHS, by announcing a new regional structure. Shortly afterwards, clinical commissioning groups were told their administration budgets would be cut by 20%, and one CCG per ICS might be plenty (HCRU 30 November).
In a speech on leadership, Hancock said he wanted to see a chief information officer on every trust board. NHS Digital launched the National Record Locator Service, which enables clinicians to find and view records wherever they are held. Thirteen trusts were given money from Hunt’s e-prescribing fund. The 100,000 Genomes Project reached its target (HCRU 7 December). And, as the year ended, Hancock banned faxes but started buying fridges to stockpile medicines in case there was no-deal in March (HCRU 21 December).
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