Guest blog
The NHS needs to support frontline staff and work with suppliers in financially challenging times, if it is to spread innovation at scale, writes EMC’s public sector CIO and Highland Marketing industry advisor James Norman.
News in brief
The NHS debate continues on the EU Referendum: As the debate continues this week, around the EU referendum the NHS took centre stage again. Dr Sarah Wollaston, Commons Health Select Committee chairwoman and a Conservative MP has defected from the Vote Leave campaign in favour of Remain in protest over claims made about the NHS. She said the pro-Brexit claim that withdrawal from the EU would hand the NHS an extra £350m a week was “untrue”, reported the Independent. With this defection of Dr Sarah Wollaston, the rival campaigns’ claims about the NHS have come back into the spotlight. In a TV EU referendum debate, Nicola Sturgeon, on Vote Remain, and Boris Johnson, on Leave, clashed on the topic of the NHS, reported the Evening Times. Sturgeon said that the NHS benefited from immigration and blamed the Conservative government for the NHS problems. Mr Johnson said the cash Britain spends on EU membership, which he claimed amounted to £10bn a year could be spent on the NHS. Academics at Imperial College London have published a report, called A briefing for the National Health Service on the European Referendum, that finds that withdrawal from the EU is likely to reduce NHS funding, lead to staffing shortages, and hamper Britain’s world-leading health research sector. The BBC reported that leave campaigners have said the Welsh NHS would need an extra £246m a year by 2030 to cope with EU migration if the UK stays in the union.
Patients not interested in Sunday GP appointments, say vanguards: The prime minister’s plans for seven day GP services have been publicly questioned by two vanguard leaders, who said patients have not been enthusiastic about Sunday appointments, reported Health Service Journal (subscription required). The remarks were made at a conference hosted by The King’s Fund on new models of care in London this week. GP John Ribchester of Whitstable Medical Practice said: “We found that patients had an appetite for Saturday mornings, but the rate dropped off at about 3pm Saturday and didn’t recover until Monday. [It went down to] a rate of about zero to one patients per hour. I have to challenge the [prime minister] on his assertion that people want a GP appointment all hours of the weekend – they don’t.” Dr Naresh Rati of Modality, the influential extended GP practice which is establishing an MCP in Sandwell and West Birmingham, also said at the same event that patients were not making use of the service on Sundays. Modality has been trialling weekend services for two years. At the beginning of October 2015, David Cameron said “millions of patients” would benefit from seven day GP care by 2020. Less than a month later, an NHS England evaluation of the first wave of the prime minister’s £50m GP access fund found that while additional hours on weekdays and Saturday mornings were very well received, “patient demand for routine appointments on Sundays has been very low”.
Bed-blocking delays may continue ‘up to five years’: Delays in releasing elderly patients from hospital could continue for up to five years, NHS England boss Simon Stevens has warned, reported the BBC. So-called bed-blocking is estimated to cost the service about £820m a year. A recent report by the National Audit Office said delays in discharging patients from hospitals in England had risen by nearly a third over two years. Mr Stevens told MPs the number of blocked beds may not reach zero soon because of social care pressures. Bed-blocking occurs when a patient is deemed medically well enough to be released from hospital, but something else delays their discharge. More than a million days of bed occupancy were lost to other patients last year. The main reasons were delays in getting a home care package or nursing home placement. A senior Department of Health official, John Rouse, also told the Public Accounts Committee there was an unacceptable variation in performance, but that more than 40% of local authorities providing social care had reduced delays. Across England, the audit office found that for every 100 beds, three days of use were taken by patients who no longer needed to be in hospital between March 2015 and February 2016. It represented a rise of almost one third on the same period two years earlier.
GPs to review 260,000 patients as full scale of CV risk calculator error revealed: As many as 260,000 patients may have received inaccurate cardiovascular disease scores and will need to be actively reviewed by GPs through scheduling appointments, blood tests and reviewing records, NHS England has told Pulse. NHS England said that up to 100 patients will need to be reviewed in an average practice using the SystmOne IT system – of which there are approximately 2,600 in the UK – to see whether they should be put on or taken off statins. It has told practices in a letter that they should prioritise patients who should be on statins but who have missed out because of the bug. NHS England, which has been coordinating the response from the organisations involved, said that they will audit the workload implications for practices. A letter to practices has said that “for some patients, practices will wish to call patients in for reassessment”. But GP leaders warned that the workload implications may be bigger than this as GPs will need to consult with the majority of patients face to face or on the phone, and the GPC is demanding compensation for practices. The bug is in the process of being corrected, and practices using SystmOne will be able to access the QRISK2 tool this week, NHS England has said. Dr Grant Ingrams, deputy chair of the GPC IT subcommittee, said that, while re-running QRISK2 should be a quick task, the number of patients GPs will need to consult could be quite high, “and that’s going to take a lot more time”.
GPs embracing phone but not Skype consultations: GPs remain resistant to politicians’ calls to adopt Skype consulting, with many citing poor technology and a lack of patient demand, reported DigitalHealth.net. A recent survey – published in the British Journal of General Practice – showed just one of 391 practices that responded was using video appointments, and few were interested in adopting video consultations. Lead author and GP Professor Chris Salisbury, of University of Bristol, said that even the one Scottish practice that had adopted Skype barely used it. “They set up this specialised place for it and only use it once a month,” he said. “They view it as a waste of money.” While telephone appointments were increasingly prevalent, with six out ten GPs using them, email consultations were barely more popular than video, with only 6% using them to check-in on patients. Video consulting has repeatedly been touted by politicians as a part of a solution to growing burden placed on GPs, but progress has been faltering. Prime minister David Cameron said a patient should be able to “use Skype, FaceTime or email to get some advice without setting foot outside his front door”. However, an independent review of the first wave of pilots in October last year revealed mixed results. Video consultations had been “challenging to implement”, with barriers including poor broadband connections and lack of enthusiasm among patients. Rather than alleviating pressure, many GPs who responded to the survey felt video was just another cost, which provided no advantage over other ways of interacting with patients.
NHS staffing levels in Scotland hit record high: The latest statistics on the number of staff working in the health service showed that at the end of March, there were 161,656 people employed by the NHS in Scotland, with 99.6% of all care delivered by staff on NHS contracts, reported TheCourier.co.uk. Overall, since September 2006, the NHS Scotland workforce, excluding GPs and dentists, has increased by 9%, with almost 11,400 more whole-time equivalent staff. The use of agency nursing and midwifery staff increased substantially for the third consecutive year, providing cover equivalent to 276.7 whole-time equivalent staff in 2015/16, compared to 191 in 2014/15. This represents an increase of 44.9%, with costs rising at a similar rate from £16m to just under £23.5m. Health secretary Shona Robison said: “Under this government, NHS staff numbers have risen significantly, with more consultants, nurses and midwives and allied health professionals now delivering care for the people of Scotland. This demonstrates that, to give people the high quality healthcare they deserve, we are investing in and supporting a highly-skilled NHS Scotland workforce. In addition to having record staffing levels, Scotland is leading the UK in developing mandatory nursing and midwifery workload and workforce planning tools that help health boards to plan for the number of staff they require, ensuring the best possible care for patients. We know our NHS faces many pressures and is treating more patients, with more complex illnesses, than ever before. Despite these pressures, the fantastic staff working in the NHS continue to deliver high-quality care.
Personal social care budgets may be incompatible with cuts, PAC warns: Personal budgets for social care may result in worse outcomes for recipients as local authorities’ drive for savings is prioritised over good results for users, the Public Accounts Committee (PAC) has warned, reported Public Finance. In a report, the committee said it had not been assured that councils could fully personalise care while seeking to save money. Personal budgets are funds allocated by local authorities to individuals, who then use the money to meet their social care needs. The budget is either managed by the authority, a third party or is given as a direct payment to users themselves. The aim is to give service users more choice and control over the services they receive and to tailor their care to personal circumstances and desired outcomes. However, the PAC said it was concerned this was not happening and that local authorities do not provide the necessary support to help people get the most out of their budget. PAC chair Meg Hillier said: “The need for adult social care is increasing but in recent years the amount spent on such care by English local authorities has fallen in real terms. Against this backdrop there are clearly risks in pursuing new approaches to providing care. Personal budgets have great potential but the interests of users are paramount and must be protected. It is vital people receiving care do so through the form of personal budget that best suits their circumstances. They should also be supported to make best use of it.”
E-prescribing use remains extremely low in the NHS: Levels of electronic prescribing in NHS hospitals remain stubbornly low, with less than a fifth of hospitals making widespread use of inpatient e-prescribing. In addition, trusts that have had e-prescribing systems the longest are making the poorest use of them, reported DigitalHeath.net. The bleak picture emerged from NHS England’s Digital Maturity Index (DMI), which found that despite the focus on e-prescribing in successive IT strategies and two rounds of technology funding, only 19% of NHS hospitals use e-prescribing for 60% or more of inpatient prescribing. Ann Slee, NHS England’s e-prescribing advisor, said: “Trusts that have been using e-prescribing the longest have the poorest use. Those coming up from behind are starting to leapfrog those ahead.” More recently, the coalition government aimed to support e-prescribing through the technology funds that it set up to take forward the ‘Personalised Health and Care 2020’ framework. In a Digital Health News special report on e-prescribing, Professor Michael Thick, the chief medical officer of IMS MAXIMS, said: “The ambition is there; but not the means.” Suppliers interviewed for the special report said they remain optimistic that further funding will be found from the £4.2bn that health secretary Jeremy Hunt has said will be spent on healthcare IT this Parliament.
Mitigating effect of public health cuts may not ‘continue indefinitely’ – Stevens: Efforts to save money for the NHS by preventing health problems are likely to be hit by local government cuts, the chief executive of NHS England told MPs, reported National Health Executive. In a Health Select Committee hearing, Simon Stevens said he estimated that investment in public health would save between £0.5bn and £1bn in the next five years and more in the longer term. For example, he said measures to reduce consumption of salt had saved £1.5bn since 2001 and he expected similar results from measures to reduce sugar. However, he admitted that local authority cuts in areas such as smoking prevention and alcohol reduction were having “an impact on downstream demand”. He said that although local authorities were extracting value for money from reduced funding, he did not know “whether the squaring of the circle can continue indefinitely”. The Chartered Institute of Public Finance and Accountancy has predicted that the NHS deficit could be as high as £16bn by 2020 in a worst-case scenario. Stevens also appeared in a Public Accounts Committee where he admitted that he did not know when the problem of delayed transfers of care, linked to funding cuts in public health and social care, would be resolved.
Newcastle Hospitals NHS Trust rated ‘outstanding’: A North East hospital trust has been rated “outstanding” following an inspection by health watchdogs, reported the BBC. Services at Newcastle upon Tyne Hospitals NHS Foundation Trust were found to be of “exceptional quality” by the Care Quality Commission. It has become the fifth trust nationally out of 200 to be given the rating. The trust’s chief executive officer, Sir Leonard Fenwick, praised the organisation’s 14,000 members of staff for their hard work. He said: “The staff have been tremendous and done a great job. The initial response of the board was to grant them an additional day’s holiday.” Professor Sir Mike Richards, the chief inspector of hospitals, said: “There was a very clear vision and strategy for delivering the highest standards of patient care with quality and safety as a key focus.”
Babylon Health launches new AI triage tool: Babylon Health has said it has launched the first artificial intelligence (AI) capable of triaging patients; although the company acknowledged that it doesn’t always agree with clinicians, reported DigitalHealth.net. Babylon, founded by former Circle chief executive Ali Parsa, offers mobile-based health services that cover about 300,000 users. The biggest of these is a subscription-based remote GP consultation service, through which patients can arrange a quick phone or video appointment with an on-call GP over their mobile. The new “check” function is designed to triage patients automatically before they even talk to a GP. Algorithms draw on a customised clinical database to answer patients’ questions and advise them on what to do next. Parsa compared the function to NHS111, but claimed babylon’s algorithms were more likely to make the correct triage decision, and do so quicker and cheaper. Babylon is one of several health tech companies trying to disrupt health service largely from outside the NHS system by offering alternative models of care. It is also not the only company focused on clinical AI, with Your.MD working on launching its own AI health app later this year and other AIs, such as IBM’s Watson, partnering with NHS trusts.
Major NHS digital review delayed: HSJ (subscription required) has revealed that the review led by US “digital doctor” Professor Robert Wachter is now likely to be published in July or September. Professor Wachter, who was commissioned to carry out the review by health secretary Jeremy Hunt last year, will use a speech at the NHS Confederation annual conference next week to set out its main principles. The prominent academic and physician, currently interim chair of the department of medicine at the University of California, is likely to focus on the need to beef up the stature and professionalise the role of chief clinical information officers in NHS hospitals. HSJ understood Professor Wachter will argue that the role is underdeveloped in terms of the total number in post, the time allocated for their digital brief, and their authority and responsibility within organisations. He told HSJ in February CCIOs were the “connectors between clinicians and technology people [and were] essential” to successful technology deployments. Their US counterparts, chief medical information officers, were lauded as “rock stars”, he said, and the role in the UK should “grow and be certified, potentially, and be validated”. He also said changing the financial and regulatory incentives in the NHS to encourage digital adoption was one of the “fundamental challenges’ for his review. Mr Hunt said in October the review would “be as pivotal to the NHS as Don Berwick’s review on patient safety” and help the NHS become a leading digital health system.
Healthwatch England survey reveals patient sharing concerns: While most patients are happy to have their medical records used to support medical research, few are comfortable with how it is being handled, reported DigitalHealth.net. Research by the patient organisation, Healthwatch England, has found that nearly two thirds of people surveyed were happy to share their health data, providing it was anonymised. But in practice, the vast majority were concerned about how their health information was being used, and by whom. More than half of the respondents to a survey of 2,044 patients, carried out online by YouGov in February this year were worried that they would later regret providing their data to a third party. And just one in five felt properly informed about what was being done with their health records. Six in ten people also believed patients should be able to opt out of data-sharing programmes at any time. Jane Mordue, interim chair of Healthwatch England, said people understood that their health data could be used to save lives, much like “give blood or registering as an organ donor”. However, she argued that more needed to be done to inform the public about how this information was used if the NHS wanted to build and maintain trust in how that information was handled. “The NHS is still in the very early stages of realising the possibilities presented through mass data, but they need to build a strong foundation of trust with the public before any benefit can be truly realised,” she said.
New system for WWL trust to go live later this month: A new health information system (HIS) at Wrightington, Wigan and Leigh (WWL) NHS Foundation Trust will launch on 28 June across the trust’s five sites, Health IT Central has reported. WWL’s new system, #HISGoLive, will help to decrease the use of paper and ensure that patient notes are always accessible. The system will support doctors, nurses and clinicians in their care of patients and give them more time to spend with patients. WWL chief executive Andrew Foster explained: “The HIS project is one of the biggest initiatives the trust has undertaken in recent times and it will put WWL at the forefront of modern healthcare delivery. We chose to partner with Allscripts, which is a leading supplier of healthcare solutions and has been used by Salford Royal and Liverpool Heart and Chest Hospitals for a few years, and University Hospital of South Manchester will use it shortly after WWL.”
NHS memo details Google/DeepMind’s five year plan to bring AI to healthcare: More details have emerged about the sweeping scope of Google/DeepMind’s ambitions for pushing its algorithmic fingers deep into the healthcare sector — including wanting to apply machine learning processing to UK NHS data within five years, reported TechCrunch. New Scientist has obtained a Memorandum of Understanding (MoU) between DeepMind and the Royal Free NHS Trust in London, which describes what the pair envisage as a “broad ranging, mutually beneficial partnership, engaging in high levels of collaborative activity and maximising the potential to work on genuinely innovative and transformational projects”. Potential areas of future collaboration include developing hospital support systems such as bed and demand management software, financial control products and private messaging and task management for junior doctors. They also say they want to work together on real-time health prediction – which is where the pair’s first effort (an app called Streams) has focused – involving a range of healthcare data to try to identify the risk of patient deterioration, death and/or readmission. The pair have said their first co-designed app, Streams, is not utilising any artificial intelligence (AI). Nor indeed is it powered by algorithms created by DeepMind but instead the core software was written by the NHS. But the scope of the MoU makes it clear that applying machine learning to public healthcare data is exactly where the ambitions lie here.
Phone app that can detect heart attack a week out considered by NHS: A smartphone app that can tell if users are in danger of having a heart attack by the tone of their voice is being considered for use by the NHS, reported The Telegraph. Clinical trials of the software showed it accurately predicted admission to hospital for people with congestive cardiac failure one week before they were taken gravely ill. The app is one of a wealth of gadgets and systems under review by the health service with the aim of revolutionising personalised healthcare. Professor Tony Young, NHS England clinical director for innovation, told the Cheltenham Science Festival the voice-monitoring app, Cordio, was “one of the most brilliant things” he had seen. “It is an app that runs in the background on your mobile phone and while you are talking on it, it analyses changes in the tone of your voice,” he said. “You can ring your mum up and say ‘Mum, how are you?’ and she says ‘I’m fine’, but you look at your phone and the app says she needs to take another 20mg of heart medicine. It’s unbelievable,” he added. Professor Young, also a consultant neurologist at Southend Hospital, said systems that allowed individual patients and their families to monitor and treat conditions would be crucial to caring for an ageing population with more chronic diseases.
Opinion
Shane Tickell, CEO of IMS MAXIMS addresses the challenge of female representation in technology, advocating a different approach to dealing with gender inequality.
“The technology industry prides itself on addressing challenges head on, solving problems and enabling effective decisions. But one challenge we still face today is the lack of women employed in our industry.
“I was therefore disheartened, but not surprised when I read that, as a percentage, the number of women employed in the UK technology industry has declined over the past 10 years. Fewer than one-in-five of Britain’s 1.18m technology jobs is held by a woman and just one in ten IT Directors are female.
“We took the decision to embody the change we wanted to see in the business. By recruiting the best people, training them so they could work anywhere in the world, but supporting them so they never want to leave, we have succeeded at having equal representation between men and women on our board. In the nine years I have been involved in the business, the number of females has more than tripled, with plans for the board to mature and grow further.
“It’s not just at board-level. We know that at all levels within the company our staff benefit from different perspectives, opinions and approaches to challenges. And I’m proud of the fact that the representation of female employees across the company is 23% higher than the industry average.
“Everyone gets the support they need. Our annual appraisal process for example, is supported by individual coaching from several external sources, and we choose to use an online training service so that staff can pick and choose their training package and have access to the courses 24/7.
“Achieving equality in the boardroom and throughout our organisation is important, but it isn’t a numbers game. Equality is about investing in talent, in performance.”
Meeting cancer promises and more – a new model for NHS diagnostics?
A distant memory already, George Osborne’s November Spending Review made vital pledges for cancer survival and essential new NHS care models that cannot be forgotten, writes Jane Rendall, on OnMedica (subscription required).
Rendall, managing director at Sectra UK & Ireland, says: “Investing an extra £300m per year in cancer diagnostics was one positive outcome from the Autumn Statement. But push the headline figures aside, and there is another promise that could now make real the mission to save an additional 11,000 lives each year as a result of earlier cancer diagnoses.
“Right at the very end of the Department of Health’s Spending Review settlement, you find a pledge from the government to “encourage” long-term partnerships between the NHS and the private sector, especially where these partnerships support the upgrade of diagnostics capabilities and the development of new models of care.
“This policy has enormous potential for fully harnessing NHS diagnostics, and in shifting cancer diagnoses away from the all too late stages of the emergency floor, towards much earlier points in patient care – where clinicians can still make a difference.
“These partnerships could mean a huge advancement of England’s diagnostic capability. They require more than a ministerial nudge – they need fundamental commitment from across the NHS, industry, the private sector and research communities to succeed and allow the NHS to really maximise its diagnostic assets, people and skills.”
Richard Corbridge, HSE chief information officer, gives an update on the development of the electronic health record and other major HSE eHealth projects.
“It has been an exciting few weeks for eHealth Ireland and the concept of a digital fabric for the health system of Ireland. The electronic health record (EHR) business case has progressed well through the approval systems, the last hospitals have gone live with eReferral, making digital referral possible in every hospital in Ireland, and the team received a number of nominations and awards in the technology sector in Ireland and across the EU.
“The HSE created the eHealth Ireland Committee as a Committee of the Directorate in the spring of 2015. The group is an independent advisory group from across the EU that provides the Directorate (the most senior leadership of the HSE) with advice and guidance on technology in health. It has been suggested that this group could provide a review of the business case for government, ensuring that the information reviewed in the case is done by a cohort of eHealth experts and also ensuring that there can be some agility to the delivery of a final review and comments for the Department of Health and, indeed, government itself.
“Another positive for the EHR business case is the way in which it has been created as a modular solution to a system-wide problem. There are four key components that make up the business case and even in isolation, these components can be a foundation for the reform of the health system.
“The components are: The ability for a clinician and patient to have ‘single sign-on’ with the requisite legitimate relationship to information from disparate systems that make up the EHR. The ability to pass information through the system securely and in an integrated manner. The acute hospital EHR solution available on a framework for each hospital group to draw down when they have met the requisite readiness criteria. The Community Health Organisation (CHO) EHR available on a framework when each CHO can demonstrate appropriate readiness to implement and release benefits.
“The importance of these elements being available in isolation, as well as a solution set for health, has been described as fundamental to the success of the solution’s deployment. As eHealth Ireland has always made clear though, the EHR is one of a series of projects that will see a digital fabric for the health system being created.”
