Healthcare Roundup – 10th February 2017

Jeremy Hunt

News in brief

NHS Health Check: Hunt says NHS problems ‘unacceptable’: Health secretary Jeremy Hunt has conceded the NHS in England is facing “completely unacceptable” problems. He said there was “no excuse” for some of the difficulties highlighted during the BBC’s NHS week, and the government had a plan to help hospitals cope. A series of reports have revealed lengthening waits in A&E and patients being left for hours on trolleys. Sir Robert Francis QC, who investigated failings in Mid Staffordshire, said the NHS was facing an “existential crisis”. However, in an exclusive interview with the BBC, Hunt said the key was to treat more people “at home and in the community” to ease the burden on hard-pressed hospitals. He said: “It is incredibly frustrating for me. I am doing this job because I want NHS care to be the safest and best in the world. That kind of care is completely unacceptable. No-one would want it for members of their own family.” Hunt was speaking at the end of a week in which the BBC has revealed that the numbers waiting longer than they should for routine operations has risen by 163% in four years; nine in 10 hospitals have had unsafe numbers of patients on their wards this winter; record numbers of patients have waited more than four hours for A&E care; the plight of patients left stranded in hospital for months because no community care can be found for them and broadcast footage from the Royal Blackburn Hospital showing long waits in A&E and a doctor close to tears because she could not provide the care she wanted to.

One in six A&Es faces threat of closure or downgrade despite mounting strain: One in six A&E departments are under threat of closure despite record overcrowding, in the worst ever crisis facing the NHS, new plans revealed. A total of 33 casualty units could face closure or being replaced with minor injuries units, according to documents drawn up across the country, reported The Telegraph. The plans are part of efforts to close a £22bn hole in the health service budget by 2021. Health officials insist the changes will come alongside efforts to modernise services, and bring more care closer to home. In seven cases, proposals have been drawn up, and in some cases issued for local consultation. However a further 26 hospitals are now considering plans to close or downgrade services, according to research by Health Service Journal, with some areas battling over which A&E to save. Dr Chris Moulton, vice president of the Royal College of Emergency Medicine, said the notion was “crazy” and ignored the mounting strain on Britain’s hospitals. “Hospitals are under massive pressure, it’s now horrendously common to have 12 hour trolley waits and in some cases 30 hour waits in A&E,” the senior emergency doctor said.

Hospital operation ‘long waiters’ rise by 163%: The number of people facing “long waits” for hospital treatment in England has more than doubled in the past four years, reported the BBC. Patients needing routine care such as knee and hip replacements are meant to be treated in 18 weeks under NHS rules. However, the numbers waiting longer than that now top 350,000 – a 163% rise since 2012. There are 3.7 million people in total on the waiting list. Royal College of Surgeons president Clare Marx said the picture was “very disappointing” as these operations and treatments could make a huge difference to people’s lives. The latest figures cover the month of November and mean the target for the NHS – that at least 92% of patients on waiting lists will not have been waiting over 18 weeks – has been missed since February last year. A Department of Health spokesman said the NHS was having to treat more patients – 5,000 extra a day compared with 2010 – so the levels of performance were actually a “tribute” to the work of NHS staff.

Q&A: Billing overseas NHS users: As of April, hospitals in England will be required to check whether patients from abroad are eligible for free treatment, reported the Financial Times (subscription required). The government has been trying for several years to increase the amount charged to “health tourists” by the NHS as it struggles with record deficits. With this latest move, the health department hopes to recover about £500m a year. “We have no problem with overseas visitors using our NHS – as long as they make a fair contribution, just as the British taxpayer does,” Jeremy Hunt, health secretary, said. However, in 2012-13 it recovered only about £73m in costs from foreign patients and the National Audit Office recently estimated that, if the rules remained the same, the amount applied would be £346m in 2017-18 – well short of the £500m target. Virtually no one who is already entitled to free healthcare will have to pay in future. Rather, the changes mainly affect the timing of when those who are liable for payment for non-emergency treatment will be charged. Currently all UK residents, regardless of nationality, and visitors from the European Economic Area (EEA) are entitled to free treatment both for emergency and elective procedures. Under the European Health Insurance Card scheme, the UK can recoup the costs of providing healthcare to visiting Europeans from other EU member states. People from countries outside the EEA who work or study in the UK will also be largely unaffected as their visas require payment of a health surcharge when applications are made, which provides access to free treatment. The health department is not commenting on how payment rules will be affected by Brexit, saying this depends on how politicians negotiate the rights of EU citizens in the exit deal.

NHS Health Check: Nine in 10 hospitals ‘overcrowded’ this winter: The number of patients on hospital wards in England has been at unsafe levels at nine out of 10 NHS trusts this winter, BBC analysis showed. To minimise the risk of infections and delays in getting treatment, hospitals are meant to have no more than 85% of beds occupied. But the analysis showed 137 out of 152 hospital trusts have been above that level since the start of December. NHS bosses said hospitals had major problems discharging frail patients. One experienced hospital boss described some of the weeks this winter as the “worst” he had seen in his career. Meanwhile, patients have been contacting the BBC to report the chaos they had experienced in overcrowded hospitals, including long waits for treatment and operations being cancelled at the last minute.

Mental health experts warn of unacceptable number of treatments far from home: The number of mental health patients who are being treated in facilities far away from their homes is unacceptably high, experts have warned. The comments from the Royal College of Psychiatrists came as new figures revealed that during December last year 250 English patients were forced to travel over 100km to receive treatment, reported Care Appointments. The data, released by NHS Digital, also shows that 23 patients in England were treated more than 300km away from home. The college said that such placements cause significant psychological damage to patients. Ministers have pledged to eliminate “inappropriate out-of-area placements” for mental health patients by 2020/21. Commenting on the figures, Professor Sir Simon Wessely, president of the Royal College of Psychiatrists, said: “Sadly, today’s figures show that too many people still have to travel long distances to access acute mental health services. It has been a year since the commission on acute Adult psychiatric care called for an end to the practice of sending people out of area for acute mental health inpatient care due to local bed pressures, and yet the latest figures show that out-of-area placement figures are unacceptably high. If the government is to meet its own target of ending out-of-area placements by 2020/21, it needs to ensure investment reaches front line mental health services and hold commissioners and providers to account for achieving this target.”

Public Health England works on digital platforms: Public Health England (PHE) is working on four digital platforms in an effort to integrate technology with new ways of working and develop a set of core products, reported UKAuthority. It has outlined the plan in a new strategy document that makes clear the technology will be at the centre of its efforts in promoting good public health. The four platforms include consolidating content from other organisations’ websites, notably those of the hundreds of bodies from which PHE was created. This will involve more than just moving over the legacy content to PHE’s pages on GOV.UK, and will require some work on user needs and the redesign of sites. Over half of legacy sites have now been moved, but many of those that have a lot of relevant data are still to be migrated. PHE’s intranet, described as “not fit for purpose” is also set for a redevelopment, with an emphasis on making it a collaboration hub. More collaboration tools will also be developed, including elements of a planned CRM system that will be used to create a single customer view. PHE aims to develop a new mobile platform to support a more consistent approach to app development. This will give it more scope for building apps in partnerships or adapting products that already exist. The document says the framework and plan will be the next steps in what it calls “the change journey”, and will take in its approach to decisions on the use of technology, data architecture, governance and partnerships. It also points towards the strategy being updated regularly as the work progresses.

Health and social care integration not delivering expected benefits: The National Audit Office (NAO) has warned that progress with integration of health and social care has, to date, been slower and less successful than envisaged and has not delivered all of the expected benefits for patients, the NHS or local authorities. As a result, the government’s plan for integrated health and social care services across England by 2020 is at significant risk. In the face of increased demand for care and constrained finances, while the Better Care Fund, the principal integration initiative, has improved joint working, it has not yet achieved its potential in terms of expected value for money, savings, outcomes for patients or reduced hospital activity. There is general agreement across the health and social care sectors that place-based planning is the right way to manage scarce resources at a system-wide level. However, local government was not involved in the design and development of the NHS-led sustainability and transformation planning programme. Amyas Morse, head of the NAO, said: “Integrating the health and social care sectors is a significant challenge. So far, benefits have fallen far short of plans, despite much effort. It will be important to learn from the over-optimism of such plans when implementing the much larger NHS sustainability and transformation plans. The Departments do not yet have the evidence to show that they can deliver their commitment to integrated services by 2020, at the same time as meeting existing pressures on the health and social care systems.”

Jeremy Hunt to consider merging health regulation bodies: Ministers are considering a controversial shake-up of health regulation that could see nine bodies merged into one new super-watchdog covering around a million health professionals, reported The Guardian. Health secretary, Jeremy Hunt is preparing to publish a consultation paper that could lead to the medical and nursing professions no longer having their own dedicated disciplinary bodies. Ministers are determined to reform what they see as the unwieldy and confusing set-up under which different types of health staff each have their own regulator. For example, the General Medical Council regulates Britain’s 281,000 doctors and the Nursing and Midwifery Council performs the same role for about 600,000 nurses and midwives. Hunt believes an overhaul would improve patient safety and also make health regulation more efficient by streamlining how complaints from patients are investigated. Aides pointed out that Robert Francis’s 2013 report into the Mid Staffordshire hospital care scandal highlighted public uncertainty over which health regulatory body did what and the need for them to work more closely together. However, opposition to the plans is already building, with critics questioning the value and timing of any reorganisation that follows the consultation. “Is this the right time to be planning a major overhaul of professional regulation, given the myriad problems facing health and social care?” said Donna Kinnair, director of nursing at the Royal College of Nursing.

National Data Guardian to review health data sharing on illegal immigrants: The National Data Guardian will scrutinise the controversial data sharing agreement between the Home Office and Department of Health (DH) to identify illegal immigrants, reported Speaking at a Westminster Health Forum event in London, Martin Severs, who sits on Caldicott’s advisory panel, said Dame Fiona Caldicott would review the deal to determine whether the right “checks and balances” were in place. Following the publication of NHS Digital review of the data sharing agreement, she would meet with the DH, NHS Digital and Home Office officials to raise any outstanding questions, he said. A spokeswoman for the National Data Guardian’s office confirmed Dame Fiona would be “discussing” the agreement. “The National Data Guardian is clear that all uses of patient information should be transparent, legal and proportionate. Given the importance of this matter, Dame Fiona will be discussing this with the relevant organisations to seek assurance that the appropriate checks and balances are in place.” Critics of the deal say it will discourage some of the most vulnerable people in the UK from seeking medical treatment. This disclosure includes NHS number, name, date of birth, nationality and last known address. The arrangement came into effect on 1 January, 2017, although NHS Digital has already been sharing data with the Home Office. NHS Digital figures showed last year more than 8000 such disclosures were made, resulting in more than 5000 people being traced by immigration enforcement. In that time, less than 200 request were declined or rejected by NHS Digital.

Number of patients stuck in hospital ‘far higher than NHS data shows’: The Nuffield Trust has suggested that the official counting system is not detecting many ‘delayed transfers of care’ cases, reported The Guardian. The number of patients trapped in hospital despite being fit to leave is three times higher than official data shows, according to a study. NHS bosses said the findings bore out their own experience and the official figures hugely underestimated how many people had to stay in hospital because of problems elsewhere. Nigel Edwards, the Nuffield Trust’s chief executive, who undertook the research, said: “Our audits show that up to two-thirds of the patients stuck unnecessarily in hospital beds aren’t actually being counted in the official figures. That means that a typical 650-bed hospital may actually have only around 250 beds available for all its emergency patients, once you’ve taken out all the people who could go home if they had more support, and discounted maternity, paediatric and cancer beds.” Delayed transfers – which some call bed-blocking – are running at their highest ever level, with 193,680 bed days lost because of it in November, according to the most recent official NHS figures.

NHS crisis: Public back tax rises to boost healthcare – poll: More than two-thirds of the public would back an increase in income tax if the money was dedicated to the NHS, according to a poll for Sky News. The survey by Sky Data showed 68% would support a 1% rise in income tax if the government guaranteed to spend it on healthcare. The results also revealed that 64% of people believe the service provided by the NHS is getting worse – and 57% expect it to deteriorate further in future. The NHS is currently under unprecedented pressure. Hospitals have not met their A&E targets for several months because they have been overwhelmed by patients. Sky News spent a day in Milton Keynes University Hospital to see how the pressure is affecting care. The staff are doing their utmost to ensure patients get safe care. However, they conceded that it is still not to the standard they would like. Mandy Knight, head of nursing in the A&E unit, said: “We all came in to nursing to look after patients and do the best we can for them. But when you are in a full emergency department you can’t always do that – because you’re busy.” Hospitals across the country have seen demand for care soar in recent weeks. Since Christmas, dozens of hospitals have declared “black alerts” – signalling the extraordinary pressure they are under.

Three new digital health systems piloted across NHS trusts: Three new digital health systems developed by Oxford University Hospitals (OUH) NHS Foundation Trust in partnership with Oxford University will be trialled across four other NHS trusts this year, reported HealthITCentral. The technologies, developed through artificial intelligence software, offer clinicians the ability to manage ‘vital-sign observations’ for patients in hospitals (SEND), diabetes in pregnant women (GDm-health) and chronic obstructive pulmonary disease (EDGE-COPD). “SEND, GDm-health and EDGE-COPD, demonstrate the benefits of the multi-disciplinary collaboration we have developed over the past decade in Oxford,” said Professor Lionel Tarassenko, head of engineering science, Oxford University. The projects were funded through the NIHR Oxford Biomedical Research Centre as initial trials showed they reduced the number of both hospital appointments and admissions, cutting down costs for the healthcare system. OUH and Oxford University have partnered with Drayson Technologies to support wider testing of these systems across the NHS, including deployment and commercialisation. The company is expected to create an ‘internet of things digital health team’ at Oxford Science Park, a centre for science and technology managed by the university’s Magdalen College.

Twenty NHS digital fast follower trusts to get £5m each: NHS England plans to spend £100m on 20 “fast followers” to unleash a second wave of digitally advanced NHS organisations, reported Speaking at a Westminster Health Forum event in London, NHS England chief information officer Will Smart said 20 health organisations would be selected in the next few months. Each would receive up to £5m in central funding over three years to become digitally advanced organisations. To achieve this the trusts would partner with one of the 16 global digital exemplars, the first wave of trusts funded to become a digital health “Ivy League”. “We need to take the secret sauce from how the GDE [exemplars] digitalisation is working and transfer that to other organisations, to the fast followers. This would create a pool of ‘blueprints’ for the third wave of trusts to follow,” he said. “Our absolute imperative for this is that we end up with blueprints or maps that, as we move out of this phase, if you are Coventry and you need to replace your EPR [electronic patient record] you can look around and say which trust do we want to operate like?” Trusts too often started from scratch when deploying clinical IT but a blueprint could make this process much faster, he said. As opposed to what sometimes feels like every time you implement a new EPR you start a new journey… hospitals are different but there are not as different as we are currently treating them.” The fast followers is further sign that NHS England will fully adopt Robert Wachter’s digital transformation plan.The 14 acute exemplars that have been named use EPRs from eight suppliers. These include System C, CSC, IMS MAXIMS, Cerner, Epic, Meditech, Allscripts and Emis.

Sales acceleration


Why the NHS must act now against cyber criminals
Healthcare organisations must fully protect not only their own establishments, but also their patients from cyber-attacks, writes Redcentric’s Mark Hall on Computer Business Review.

Hall, Redcentric’s public sector director, says: “The NHS is currently facing the second highest number of cyber security related incidents on record. As patient data is becoming increasingly valuable and the role of IT seen as ever more crucial in healthcare, trusts are now a prime target for criminals.

“Only last month, the largest NHS hospital trust became infected by a suspected ransomware virus, resulting in parts of its IT systems being taken offline as a precaution. It is still unknown what caused the attack but it is thought that thousands of sensitive patient files were affected.

“This incident came just months after another large scale attack on Lincolnshire and Goole NHS Foundation Trust, which saw the cancelation of thousands of operations over four days. It was confirmed that a ransomware attack caused the temporary downtime and cancelation of 2,800 appointments. After carrying out a rigorous recovery strategy, systems were up and running just 48 hours after raising the alarm.

“Attacks of this size can have detrimental consequences for a hospital and its patients. For those living far away with scheduled operations or diagnoses and relying on organised transport, it can not only create inconvenience but could also impact health.”

Taking the lead on data security
NHS Digital’s head of security Dan Taylor asks what organisations are doing to be prepared for cyber attacks in an article published in National Health Executive.

He notes: “Cyber-attacks have and will affect patient care. It is no longer just about our email or our IT but the digital transformation, which means delivery of care is underpinned by working software. That said, the benefits of digital information lead to huge patient benefits and drive much-needed efficiencies. We shouldn’t be fearful of cyber-attack, but be prepared, forward-thinking and, most of all, be leaders.”

He says that ransomware is the number one area for enquiries at NHS Digital, which runs the CareCERT data security service for the NHS.

“In the UK, health has never paid a ransom; instead organisations have restored systems from back-ups after clearing the infection, but as we have seen recently this can still lead to days of cancellations to patient facing services.” 

“Data security (I do generally dislike the term cyber) needs to be on the leadership agenda. Maintaining public trust in the use of patient data is key to realising the benefits digital transformation can bring.

“Invest not only in technology but people too – invest in their development. However, my absolute piece of advice is don’t panic!”

“Leading on data security doesn’t mean you have to be able to set your firewall permissions or run a training session for 50 staff. It means taking responsibility, understanding the threat is real, having the right plan and taking trusted advice. If we can get more people in the NHS to do this we will become best of class. The more we share and learn, the stronger the whole sector becomes.”

The NHS and its crisis: Myths and realities
There are no simple solutions, no simple explanations, and ignoring the complexity of the problem undermines its severity, writes Ed Conway, economics editor, in Sky News.
Conway provides insights on different aspects of NHS spending:
In some senses the NHS is very well-funded in comparison to other countries. To understand why, consider the following statistics: in the three years to 2015, the average amount spent on health across the world’s 23 leading developed economies, from Australia to the US, was 9.9% of gross domestic product. How much did the UK spend in that period? 9.9% – so bang on the average.

“However, there are a few important provisos: first, this is the exception rather than the rule. For most of history, UK spending on health has been around one percentage point below the average. In other words, the UK’s hospitals are still facing a funding overhang from many lean years.

For instance, France has typically spent around one percentage point of GDP more on health each year for more than a decade and is widely regarded as having better outcomes than the UK – for instance the number of cancer deaths per 100,000 people is 198 there, compared with 222 in the UK.

“It’s certainly the case that the population is ageing – and indeed growing. And this does play a small part in the increase in NHS costs in recent years.

“But a variety of studies of the causes of higher health costs have found that demographics are actually less responsible for rising costs than “income effects” (the propensity of health spending to rise in line with GDP) and, even more importantly, other costs, including more expensive drugs, more prevalent new treatments and technological advances.

“Now, on the one hand, judged by the number of care home beds available to those over the age of 65, Britain’s rate is higher than in the US or Japan. The big problem is, as with NHS spending, this number is falling – as is the amount of investment going into the long term care industry. Indeed, spending has been falling at a real terms rate of about 1% a year for some time, equating to an 11% fall per head in the past five years.

“But the real problem when it comes to social care and health is not simply one of money – it is that there are too few effective administrative links between the two systems.”

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