News in brief
Trusts’ deficit forecast more than £250m worse than feared: NHS provider trusts have forecast a deficit in the region of £850m, for 2016-17, compared to a planned £580m, Health Service Journal (HSJ – subscription required) reported. HSJ research into trusts’ mid-year financial reports has suggested the sector will fall well short of the £250m deficit targeted by national NHS leaders. In recent weeks, NHS regulators have stressed the importance of giving “confidence” to the Treasury that the provider sector finances are on track against plans. Leaders at NHS Improvement said the mid-year performance figures will be a “very important milestone for us all”. Experts have warned that performance could deteriorate further over the second half of the year due to various accounting incentives and “back-loaded” savings plans. HSJ understood they are concerned that a major divergence such as that suggested by the latest projections will weaken confidence in the NHS’ financial discipline and could lead to greater intervention from the Treasury. There are also concerns at the Department of Health, which may again face a struggle to balance its budget this year.
Think tanks issue major funding warning for NHS and councils ahead of Autumn Statement: Three major health think tanks have issued an urgent warning ahead of the Autumn Statement that it will be difficult to achieve NHS sustainability and transformation in light of current financial pressures, reported the National Health Executive. In a joint briefing, the Nuffield Trust, The King’s Fund and The Health Foundation said that total health spending in England will rise by £4.2bn from 2015-16 to 2020-21, not the £10bn promised by the government. The actual increase will be 0% in 2018-19 and 0.3% in 2019-20, which the briefing said would not be enough to maintain current standards of care and meet rising demand, let alone transform services and implement seven-day care. John Appleby, director of research and chief economist at the Nuffield Trust, said: “After years of austerity, by the middle of this parliament we will start to see the amount of NHS money per person actually fall in real terms. In this context, providing high-quality healthcare that meets the needs of a growing and ageing population will put the NHS under enormous pressure.” The think tanks also said that council cuts were so deep, the sector may no longer be meeting their duties to the elderly and disabled and there is a real risk that families may take legal action, reported the BBC. Councils have complained they have not been given enough cash to meet their statutory duties under the Care Act. The government said it is investing in the care system, with £5bn set aside for the NHS to work with the care system. Last month, the regulator, the Care Quality Commission, said council care cuts were one of the major factors behind the growing demands on A&E units, reported the Guardian.
Delay transfers at record high as NHS braces for tough winter: Delayed transfers of care in the NHS were at a record high in September this year, renewing fears about its ability to cope this winter. The increase in delayed transfers has been attributed to the crisis in social care provision, which makes it harder to ensure follow-up care for elderly and vulnerable patients, leaving them occupying hospital beds, reported National Health Executive. NHS England’s monthly performance figures for September 2016, published this week, have shown that there were 196,246 delayed days in the month, compared to 147,738 last year. This is the highest number since records began in August 2010. At the snapshot time of midnight on the last Thursday of the month, there were 6,777 delayed patients, again the highest since records began. Stephen Dalton, chief executive of the NHS Confederation, said: “As we enter an unpredictable winter, these stats are extremely worrying and the worst we’ve seen since records began in 2010. They reflect the enormous strain the NHS and the wider health and care system is under. With less than two weeks to go until the Autumn Statement, the government has an opportunity on the 23rd November to help relieve some of the pressure, by dealing with the current social care funding crisis. It is only by protecting social care that we can truly protect the NHS.” In its recent report into winter pressures, the Health Select Committee warned that NHS trusts are anticipating a “substantially more difficult” winter this year and called for additional social care funding to cope with the pressures.
Social workers face arduous data entry and difficulties sharing information, says NHS Digital: A lack of interoperability between social care organisations’ IT systems and burdensome data entry processes are holding back technology adoption by social workers, a study has found, reported PublicTechnology.net. According to the first phase of a research project commissioned by NHS Digital, there needs to be better guidance for social workers on the use of IT systems and data protection rules. The study is now entering its second phase, with the report due in spring 2017. NHS Digital said that the first phase of the work had identified a number of “concerns and challenges”. The study also found that there was a need for more timely access to information across the board, and that there was an “absolute requirement” that technology was used as an enabler and not a replacement for face-to-face engagement.
GP practices serving more than 5 million patients could close in the next year: More than 5 million patients in England could be forced to look for a new GP over the next year, a new poll has suggested. According to GPOnline, one in 10 GPs said their practice was now at risk of closure in the next 12 months because of underfunding, workload or recruitment problems. The publication’s opinion poll of 298 GPs found that a further 41% of respondents knew of a neighbouring practice that was at risk of closure in the next year. General Practitioners Committee deputy chairman Dr Richard Vautrey said: “These findings echo those of those of the BMA, which suggest that more and more practices are set to close and more and more patients are set to lose their local GP service. Commitments by NHS England of funding to bail out hospital trusts, or to provide appointments at weekends, or invest millions of pounds for IT developments, demonstrates that resources are available, but they are not yet being spent where it they are most needed – core general practice.”
NHS Scotland chief apologies to patients over failings: The head of the Scottish NHS has apologised to patients who suffered a delay in their treatment, reported STV News. Paul Gray was responding to an Audit Scotland report which found health boards have failed to meet seven out of eight key targets. The NHS Scotland chief executive made the apology during an appearance before Holyrood’s health committee. He told MSPs health boards should continue to make efficiency savings despite an increase in budgets. Convener Neil Findlay said almost every witness that has appeared before the committee had raised concerns about cuts to services. Findlay asked: “What comment do you have to those patients who have been waiting longer for treatment than they should because seven out of those eight targets have been missed?” He told the committee: “I apologise to patients who wait longer than they should, I have done so in the past. I regard it as appropriate and proper that I should do so.” Health secretary Shona Robison said progress against the targets should be viewed in the context of increasing funding but also rising demand. She said: “If you look at outpatient demands, for example, increasing over the years, despite those huge increases in demands… most people are still being treated within the 12 weeks’ target for a first outpatient consultation. Also, in terms of inpatient waits, 91.2% of inpatients were treated within the 12-week treatment time guarantee for quarter two of this year. That isn’t good enough, we want everybody to be treated quickly, but I think it’s important to make the point that the vast majority of patients are still treated quickly within the NHS. What we need to do is to make sure through our transformation programme we improve that performance in a sustainable way.” The latest figures published show that NHS Scotland missed its targets regarding A&E waiting times and delayed discharges.
Welsh care info system builds momentum: The country’s push to integrate health and social care onto one IT platform is making progress, reported UKAuthority. A programme to integrate health and social care at national level across the whole of Wales is now on course to include all the relevant organisations – but only by not waiting until all stakeholders were ready. The news was shared with delegates at last week’s EHI Live NHS IT conference by Andrew Griffiths, director of NHS Wales Informatics Service, talking of the Welsh Community Care Information System (WWCIS). “We were able to get health and social care bodies to sign up quickly, but for a long time local government held back,” said Griffiths. He said the vision of bringing the two systems closer together begun to become achievable after a decision to only see services through the user’s point of view, not those of the many component organisations. The idea seems to have worked: as it stands, WWCIS now has some significant users – two authorities and a Welsh NHS organisation with another, Powys, set to go live this month – and 12 more confirmed contracts in place. Griffiths and his team expect the majority of participants to be live by the end of 2018-19. “Of the 29 possible participant organisations across health and social care, 28 have now said yes to coming on board,” he pointed out. “As a result, the next two years will see every relevant stakeholder using the same system, with one single record and one single database for the population as a whole.”
One in six A&E admissions ‘may not have been necessary’: Sixteen per cent of emergency hospital admissions in Northern Ireland may not have been necessary last year, the Audit Office has said, reported the Belfast Newsletter. Too many patients also faced delayed discharges because community care packages were not available, the review found. Financial pressures, shortages of staff, an ageing population and an “unsustainable” configuration of hospital services have made improvement difficult, comptroller and auditor general Kieran Donnelly said. He added: “My report shows that emergency hospital admissions are costly and frequently avoidable. To compound matters, once admitted, many patients can remain in a hospital bed longer than is necessary. With hospitals struggling to cope with increasing levels of demand for emergency care, particularly among older and chronically ill patients, ensuring that patients are treated in the most appropriate setting is crucial if the resources available for emergency care are to be used to best effect.” Despite the challenges, the report acknowledged earnest efforts being made to improve emergency care across the entire health and social care sector – including GPs, the social services and acute hospitals, it pointed out that there was still room for improvement. Too many patients admitted as emergencies still faced unnecessary delays in their discharge from hospital due to problems in securing appropriate care packages in their homes or the community. The department’s target in 2015-16 was that no patient with complex needs should remain in hospital for more than seven days after clinicians and other health professionals had deemed the patient ready for discharge. However, in that year over 1,700 such patients continued to occupy a hospital bed.
Missing GP records in Essex, Norfolk and Suffolk ‘total 9,000’: More than 9,000 patients’ records in Norfolk, Suffolk and Essex have gone missing since private firm Capita took on a national contract for transferring files from one GP to another, a BBC survey has revealed. The survey of 78 GP practices has shown that 9,009 records have been missing for more than two months. Capita reportedly said it did not “recognise these claims”. “[However] we know there have been serious issues with services delivered by Capita which have had an unacceptable impact on practices,” a spokesman for NHS England said. In a statement, Capita said it had taken on the “challenging initiative” to streamline GP support services and there had been “teething problems”. “[But] medical records are now being delivered securely up to three times faster than under the previous system,” it said. According to GPOnline, health minister Nicola Blackwood told MPs that Capita had been “inadequately prepared” to take over the primary care support services contract earlier this year and that the government was working with NHS England and Capita to resolve ongoing problems. The minister said: “I have made it clear to Capita that I expect it to consider compensation as an option.”
Liverpool telehealth project ‘adding 50 patients per week’: The LiveWell programme has reduced emergency admissions of its participants by 10% according to the clinical lead, reported UKAuthority. One of Europe’s biggest telehealth schemes is being scaled up by Liverpool NHS organisations with a careful, ongoing analysis of who are likely to be the most consistent, long term users of the technology. Maurice Smith, a GP and clinical lead for the LiveWell programme, told last week’s EHI Live NHS IT conference that this is encouraging the city’s ambitions to be ranked as one of the top ten most advanced tech-enabled health and social care local economies in Europe by 2020. “We want to be proactive and make the best use of digital technology we can,” he said. “That’s because we see technology as being key to shifting healthcare out of hospitals and A&E to lower cost care settings as much as possible.” Telehealth is a key part of the programme being delivered by the city’s main clinical commissioning group (CCG), Liverpool CCG, which delivers healthcare to just under half a million residents with an £860m budget. “We have a target of getting the patients who will most benefit onto telehealth,” Smith said, and that is being gradually met by intensive work with local surgeries to identify the best candidates for the support option. After three years of early work, 3,200 patients are now on board, with about 50 more being recruited per week. “What we’ve found is that it’s not the technology of telehealth that’s the issue, but the human factor,” he said.
Smartphone app launched to improve NHS patient care: A new mobile app has been launched to help NHS patients monitor their long-term health conditions, reported the British Journal of Healthcare Computing. The app allows users to send health information to clinicians and receive in return dosage instructions, as services include tracking of the international normalised ratio (INR) and blood glucose levels, heart rate, blood pressure, in addition to oxygen levels and weight. Patients can also use the app’s calendar to set out reminders for taking medication and keep a diary for medical appointments, addressing the issue of self-management when it comes to the use of digital platforms. The healthcare platform is available to NHS patients in Berkshire, Durham, Lancashire, Norfolk, Yorkshire and the Isle of Wight and is meant to provide savings for the NHS in the long run by reducing the number of outpatient appointments at hospitals across the country. The data is connected to patient record systems, therefore allowing clinicians that have been authorised to access their patients’ files. Health secretary Jeremy Hunt announced earlier this year that data from health apps that have received approval will feed directly into personal health records, according to the BBC. “By March next year NHS England are going to publish a library of approved apps in areas like mental health and chronic conditions like diabetes. These will link into people’s medical records,” said Hunt. The app can currently be found on Google Play and starting from next month Inhealthcare representatives revealed it will also be available on the App Store and in order to connect to patient records users need a registration code provided by their GP.
Second set of GP practices to receive technology funding announced: NHS England chief executive Simon Stevens has revealed the full list of the nearly 300 GP practices set to be supported by the Estates and Technology Transformation Fund, reported the British Journal of Healthcare Computing. “Today marks the next instalment of our practical action to strengthen GP services, in this case by providing modern buildings in which a wider range of local care can be offered to patients across England,” said Stevens at the annual conference of NHS Clinical Commissioners. Earlier in the year NHS England revealed that 560 schemes have already been already completed, while a further 316 are still at a construction stage. The Estates and Technology Transformation Fund was launched by NHS England to improve the technology and premises of GP practices across England as the overall investment has been estimated to add up to nearly £900m by 2020-2021. “We meant it when we said GP services are the bedrock of the NHS, and we’re backing that commitment with concrete action to deliver the General Practice Forward View,” added Stevens.
Information Governance network launched: NHS England has set up a new information governance network in a further sign that big changes are coming for the Information Governance (IG) Toolkit, reported DigitalHealth.net. In a recent blog, NHS England chief data officer Geraint Lewis said “there is a widespread view that [information governance] in England has become too Byzantine in its complexity and that, in practice, it is too risk averse and too inflexible to meet the modern needs of patients and clinicians”. Lewis said overcoming these barriers was particularly important as the NHS moved to models of care that required greater sharing of patient information to work effectively. The network would aim to simplify IG, “challenge the myths” and hold national bodies to account when their IG requirements were “outdated and unwieldy”, he said. Much of its work would involve improving guidance and sharing best practice. The IG Toolkit is essentially an online tool that allows health and social care organisation to assess themselves against government standards. Lewis said the IG network would be backed by the Information Governance Alliance, and would have an initial focus on assisting vanguards and integrated care pioneers, with representatives from each of these on the network. It will be hosted on the FutureNHS Collaborations platform that will include forums, webinars and other resources on information governance. Lewis’ comments come after NHS Digital chief operating officer Rob Shaw told an audience at EHI Live 2016 last week, that the organisation was trying to “scrap” the IG Toolkit in its current form.
NHS England launches innovation competition for general practice: GP practices can apply for up to £100,000 for an innovative idea to cope with rising demand, reported Pulse. The Small Business Research Initiative (SBRI), together with NHS England and the Academic Health Science Networks (AHSNs), have launched a competition which aims to find innovative technology that will help general practice. Single organisations, companies or charities can apply by 24th November with their idea, which will be fully funded up to £100,000 for six months’ maximum. Within the competition’s theme of ‘general practice of the future’, there are three categories: workload and demand management, diagnostics and earlier triage, and self-care. Questions applicants may address with their technology include: “What if diagnostic technology was designed for use in primary care?” The projects will be selected primarily on their potential value to the health service and on the improved outcomes delivered for patients, the invitation said.
London North West Healthcare NHS Trust to get to grips with patient flow: Computer Weekly has revealed plans to roll out a patient flow management system across London North West Healthcare NHS Trust from supplier Intouch with Health. The trust hopes a new system will improve patient experience and increase efficiency, especially in outpatient clinics. The roll-out will include the installation of check-in kiosks in outpatient wards and automated calling screens in waiting rooms. It will also enable staff to monitor patients’ journeys through the hospital using the system’s patient flow manager, giving them a real-time view of where patients are. This will reduce bottlenecks, enabling clinics to run more efficiently. Don West, project lead for the deployment, said the trust had been heavily focused on improving patient experience. “Enabling patients to quickly check in for appointments using kiosks will reduce queues at the front desk,” he said. “It will also allow reception staff to focus on ensuring patient details are correctly recorded, booking follow-up clinics and making sure the outcome of the attendance is correctly recorded to ensure the hospital is funded correctly.”
Opinions
How apps can help patients take care of themselves
Digital technology that allows patients to manage long-term health conditions is saving the NHS cash and transforming lives, writes Rachel Pugh in the Guardian.
She describes how former soldier Paul Quinn plugs into state-of-the-art technology, costing only £20 and operated through his iPad, to manage his chronic, life-threatening respiratory disease.
“Since the 64-year-old started using the chronic obstructive pulmonary disease (COPD) management app he has lost weight, his depression has lifted, he sees his GP once a year (compared with twice-monthly visits previously) and he has not needed hospital treatment for 18 months. Quinn says he has his life back,” she says.
“Chronic disease dominates the expenditure of the cash-strapped NHS. COPD is one of a number of chronic conditions including diabetes, arthritis and heart disease which, according to NHS England figures, affect 15.4 million people and absorb 70% of the budget. Heavy investment is being channelled into all areas of technology by NHS England but its greatest hopes for IT are in tackling chronic disease.”
Listening to the chorus of concern around social care
The government must either increase funding for social care or be open with the public on access to services, writes Richard Humphries, assistant director for policy at The King’s Fund.
Following a joint assessment by the think tank, the Health Foundation and the Nuffield Trust, released ahead of the Autumn Statement, Humphries writes in a blog:
“The existential crisis facing social care is not just about money. But as one experienced director of social services commented, ‘the number of people who need help with getting out of bed, getting dressed, going to the toilet and eating is growing. You can’t manage demand for those things’.
“The gravity of the situation is reinforced by our latest independent assessment, with the Health Foundation and the Nuffield Trust, of the funding position for the NHS and social care ahead of the government’s Autumn Statement on 23 November. We estimate that social care faces the prospect of a funding gap of £1.9bn next year, rising to £2.3bn by the end of the parliament – based on the government’s very optimistic assumption that every council will levy a full 2% precept on council tax every year for the next four years – an unlikely prospect. Even under this best-case scenario, social care spending will rise by just 1.2% per year in real terms over the lifetime of this parliament, falling well short of the 4% annual increase needed just to stand still.
“Beyond the Autumn Statement, the NHS and social care together will need increased funding as the secretary of state for health has himself recognised. If the government is not prepared to address these longer-term funding challenges, then it will need to be open with the public about the consequences for access to services and quality of care.”
How will the NHS cope this winter?
The headlines may be dominated by Washington politics and the Brexit debate, says BBC health editor Hugh Pym, but NHS managers are focusing on one issue above others – the winter and what it will mean for already stretched services.
“Temperatures have dropped this week, and the Met Office has warned of an increased risk of cold snaps between now and Christmas. That has certainly been concentrating minds in the upper reaches of the NHS. There is nothing new about planning for winter in the health service. Ministers and NHS leaders are always apprehensive at this time of year.
“Mild winters in recent years have helped the system muddle through, although there were intense strains in late 2014 and early 2015. But, as is well known, it only takes a stretch of cold weather and a prolonged bout of flu for hospitals to struggle.
“The latest NHS England figures showed attendances at accident and emergency units and emergency admissions up nearly 4% over 12 months.
“Hospitals will be encouraged to plan leave allocations to ensure enough doctors are available for non-urgent care. Social care managers will be expected to keep as many services open as possible, including home visits.
“Contingency plans are being made, but in Whitehall they can only sit, wait and hope.”
