News in brief
NHS needs to “take a reality check” and limit what it funds, hospitals say: The NHS needs to take a “reality check” about what it can provide and take national decisions about which treatments and services should be rationed, the leader of England’s hospitals has said, reported The Telegraph. The call came as official data showed the health service is in the grip of the worst bed-blocking crisis on record, while waiting lists are the highest for almost a decade, with 3.7 million people awaiting treatment. Chris Hopson, head of NHS Providers, which represents hospitals, said politicians and health officials needed to face the fact the NHS could no longer meet all the demands on it. He said an “honest debate with the public” was needed about what the health service could pay for, as it grapples with the worst deficit in its history, in the face of growing demand. Mr Hopson said the NHS could not meet waiting targets, maintain quality, and balance its books, with the latest figures demonstrating that “something has to give”. Vicky McDermott, chairman of the Care and Support Alliance, which represents 80 charities for the elderly and disabled, said: “The Government cannot continue to ignore the crisis that means that patients are stuck in hospital, when they could be at home. The funding crisis in social care is heaping needless pressure onto the NHS.”
NHS crisis deepens as bed blocking costs £6bn: More than 6,000 elderly people are trapped needlessly in hospital beds each month as nursing homes, families and social services fail to provide adequate care, reported The Times. The health service is facing its worst bed-blocking crisis at a cost of nearly £6bn a year, official figures from NHS England showed. Days lost to bed-blocking have increased by 80% in five years. More than 71,500 patients faced unnecessary delays after treatment last year, resulting in the loss of two million hospital bed days. This compared with 62,900 patients in 2014. The Royal College of Emergency Medicine warned this week that the gap between supply and demand for emergency doctors was leading to a “real crisis”. A national shortage of emergency doctors also led the Grantham and District Hospital in the East Midlands to announce that it would temporarily close its doors at night. Ambulance response times failed to meet the required standard for the most serious calls in the nine trusts that provided data. Sixty nine per cent of calls for heart attacks or a patient’s inability to breathe received a response within eight minutes, missing the target of 75% for the 13th month in a row. Campaigners described the unprecedented levels of bed-blocking as a threat to patients’ recovery. “Policymakers must recognise that in an ageing society we have to increase the amount of funding for social care to support the rising numbers of older people who need this kind of help. If this doesn’t change soon then the pressures on the NHS will become even more intense at a time when our hospitals are already under a considerable amount of strain,” Caroline Abrahams, the charity director of Age UK, said.
Mental health target being ignored: Some mental health patients in England are being denied timely treatment promised by the government, figures have revealed, reported the BBC. The target, intensive treatment within two weeks, was introduced in April 2016 to give mental health the same referral priority as cancer. Freedom of information (FOI) figures have suggested a quarter of clinical commissioning groups (CCGs) are ignoring the target. The waiting-time target requires that any patient aged 14 to 65 experiencing their first episode of psychosis – a mental health problem that can involve delusions or hallucinations – receives treatment within two weeks of referral. But the FOI request, sent to the 209 CCGs in England by the Liberal Democrats, has shown that in some areas this is not happening. Of those that responded (170 out of the 209), 23% said they had applied the target to for 14 to 35 year olds only. The package of intensive treatment that should be provided, known as early intervention in psychosis (EIP) should match the “best practice” blueprint contained in guidelines laid down by clinical watchdog the National Institute for Health and Care Excellence (NICE). But documents suggested most mental health trusts in one part of England were unable to say whether their care package had been delivered in line with the NICE requirements. NHS England estimates EIP should cost the NHS £8,250 a year per patient. About 64% of the CCGs that responded to the FOI request did not or could not say what they were spending on EIP, and another 29% said they were spending below £8,250 per patient. Liberal Democrats health spokesman Norman Lamb said: “It shows that across the country people are not getting the evidence-based treatment set out in the programme. It’s like saying to a cancer patient, ‘you can have the chemotherapy, but you cannot have the radiotherapy’.”
Rising numbers could face ‘crippling pain’ as NHS rationing spreads: Increasing numbers of patients will be left to endure “crippling pain” as rationing spreads across the NHS, one of Britain’s most senior surgeons has warned, reported The Telegraph. Stephen Cannon, vice president of the Royal College of Surgeons, said bans on all but the most urgent treatment would become “commonplace” without major changes to the funding of the health service. The NHS is in the grip of the worst financial crisis in its history, with increasing restrictions on cataract surgery and lengthening waiting times for hip and knee operations in most areas. St Helens clinical commissioning group in Merseyside took the unprecedented step of making plans to suspend all non-urgent treatment for four months, in an attempt to tackle its overspend. Mr Cannon, an orthopaedic surgeon, said such bans would become widespread without a “realistic” increase in funding. He also called for changes in the way existing funds are spent, to divert more money away from bureaucracy towards front-line care. “This is not a one-off, this is a growing problem across the NHS. We are deeply concerned. It is bad enough having to put up with crippling arthritis as waiting times get longer, but these sorts of delays can mean the hip crumbling away so the patient can’t even take a step. It also means that when patients do have surgery, it is infinitely more complex,” the surgeon said. Mr Cannon called for extra funding for the NHS to cope with rising demand from an ageing population. But he also said too much money was being spent on bureaucracy – including on long wrangles over which patients would be funded.
Clinical leadership strengthened in urgent care and specialised services: NHS England has appointed the outgoing president of the Royal College of Emergency Medicine as clinical lead for its recently launched Accident & Emergency (A&E) Improvement Plan, as well as 40 of the nation’s leading doctors to drive reform of specialised services, reported National Health Executive. Dr Clifford Mann will work closely with NHS England’s national urgent and emergency care director, Pauline Philip, and director for acute care, Professor Keith Willett, on the joint NHS England and NHS Improvement programme to redesign urgent care services and improve A&E performance. Under recent proposals, NHS England and the regulator announced that it would replace national fines with trust-specific improvement incentives in order to allow A&E and elective services to recover from extensive performance problems. “This new opportunity to represent the collective views of frontline emergency medicine clinicians is both welcome and timely,” said Mann. “Current challenges require us to ensure our emergency care systems are sustainable as well as effective. The creation of this role recognises the importance of emergency medicine clinicians within the system and I am pleased to be their representative,” he added. The role of clinical lead – which is a three-year appointment – will include chairing the programme’s Clinical Reference Group (CRG) and supporting local clinical commissioning groups and trusts to implement changes to care pathways. The specialised services commissioned by NHS England are grouped into six national programmes of care, each of which is then supported by CRGs focusing on specific clinical specialties. Simon Stevens, CEO of NHS England, said: “The appointments are another concrete step towards NHS England’s commitment to harness the nation’s top clinical leadership as we get going on implementing the NHS Five Year Forward View in every part of the country.”
NHS deficit will eat into transformation fund – threatening new models of care: Annual 2% efficiencies by 2020-21 would not be enough to close the funding gap, meaning providers must find savings of 4% next year and 3% in 2018-19 – but because such sustained efficiencies have never been achieved, money will have to be taken from the sustainability and transformation fund (STF) to balance NHS deficits in the meantime. National Health Executive reported that the stark revelations come in a new Nuffield Trust report, “Feeling the crunch”, which said even higher efficiency savings of 4% for this financial year would still leave providers with an underlying deficit of £2.35bn. Reducing that deficit altogether would require further savings of 4% in 2017-18, followed by 3% efficiencies the year after – an unrealistic expectation considering sustained and recurrent efficiency savings have never been achieved to date, and one which would still require extra funds. Even if providers make cost savings of just 2% per year, the funding gap will still be around £6bn by the end of the decade. But because the STF can only be spent once, using some of its cash to plug the deficit will result in little money left for transformational change that the NHS requires to modernise and reshape its services for the future, the Nuffield Trust said. The catch-22 lies in the fact that the health system relies on service change and new models of care to curb this activity growth and treat patients more cheaply, but this will be “highly unlikely” without access to the STF. “As such, the two tasks of huge provider efficiencies and successful commissioner investment in reducing demand growth need to happen in a timely and coordinated fashion,” the report said.
Waiting list error could see thousands of patients assessed for clinical harm: A large teaching hospital may have to assess thousands of patients for clinical harm after an investigation found its data systems could not guarantee people had been treated, reported the Health Service Journal (subscription required). St George’s University Hospitals Foundation Trust in south west London said it was investigating and was assessing whether patients had come to harm as a result. A report sent to the trust’s July board meeting said: “The (trust was) assured there were no patient safety issues or risk to patients which had not already been identified.” The trust said it was taking “urgent action to stabilise the risk” and had suspended reporting to the national data collection. The report found cases of “planned patients that do not appear to be managed”; “patients excluded inappropriately across admitted and non-admitted pathways”; and a “significant number” of cases where it was not clear how long patients had waited. A trust spokesman said it was not sure how far back the problems went or how many patients would need to be assessed for harm. Chief operating officer Corinne Siddall said in the board report that 65 patients had required “in-depth review” and 63 had subsequently been treated.
NHS England ‘will not sign off local plans unless they support GPs’: NHS England will not be signing off on sustainability and transformation plans (STPs) unless they are supportive of GPs, reported Pulse. NHS England said that commissioners in each area were allowed to decide themselves how they would engage with the workforce in their area. However, it said it expects “robust engagement” from commissioners, including with frontline GPs, while emphasising that the plans will have to support general practice. It has been revealed that Local Medical Council (LMC) leaders were being “excluded” from consultations on the STP plans, which are in the process of being approved by NHS England. The lack of transparency comes despite the brief from NHS bosses setting out that these STPs have to detail plans for the “sustainability and quality” of general practice, including “workforce and workload issues”. Following this, an NHS England spokesperson said that commissioners had to be “explicit” about how GPs would be “supported”, and the plans from April’s General Practice Forward View put into action. The spokesperson said: “While each STP footprint has rightly determined its own locally appropriate approaches to governance and workforce engagement, the national bodies expect robust engagement with local people and organisations throughout the development of the plans, including with front line GPs.” NHS England also highlighted that it would be working with the Royal College of General Practitioners’ (RCGP) STP “ambassadors”, of which the college has appointed 29 across England. The spokesperson said: “We welcome the introduction of the RCGP’s regional ambassadors, who will undoubtedly play an important role in supporting local engagement.”
Industry calls for action on Scottish drive to digitally-integrated care: Industry experts have urged rapid action to make digital healthcare a reality in order to realise the benefits of safer, more-reliable services, reported Building Better Healthcare. Delegates at the Delivering Scotland’s Vision for Integrated Digital Care Conference examined the use of technology to support health and care provision. It comes as the Scottish government is investing £400m in broadband across the country by 2020, as well as providing £30m for ambitious technology-enabled care projects. Delegates heard how current care-at-home services often rely on the traditional phone line to connect them to a network of alarm receiving centres that enable the elderly and vulnerable to call for help when required. Such “analogue technology” is seen by many to be inefficient and does not realise the potential for truly person-centred, integrated care that digital technology can provide. “Technology allows us to speak to our doctor, share measurements such as blood pressure readings, and ask for help from social care providers when we would like,” said Tom Morton, chief executive of digital care platform provider and event host, Communicare247. “We can achieve technology-enabled independent living now that could create efficiencies and help provide better care. The Scottish government has been at the vanguard of showing how technology can help us address current issues such as caring for people remotely, such as the benefits that can be delivered from telecare alarms for example. But, with digital technology having the power to offer so much, the government, local authorities, integrated boards, suppliers and citizens need to come together to switch from analogue and turn this digital vision into a reality.”
Greater integration needed to ‘break cycle’ of poor NHS performance: The government must incentivise greater collaboration between the NHS and councils in order to “break the cycle” of dwindling provider performance, NHS Confederation has said as stark performance figures for June were released. National Health Executive reported that Stephen Dalton, the confederation’s interim chief executive, recognised that frontline staff are working “flat out and deserve recognition”, but said unless the same cycle is broken, “performance results will continue to follow this downward trend”. He added: “The recent and important relaxation of some targets, and of the penalties for missing them, will give many hospitals much-needed opportunity. We now need the government to incentivise greater coordination between local authorities and the NHS and to invest more in out-of-hospital health and care.” The figures, which Dalton said is further proof that the NHS is under strain to maintain timely access to high standards of care, showed just 90.5% of patients were admitted, transferred or discharged from A&E within the four-hour target, below the 95% standard – which hasn’t been met in years. Across delayed transfers of care, June’s figures hit the highest number since data was first collected in August 2010 – over 171,000 delayed days compared to less than 140,000 the same time last year. A Department of Health spokesman defended June’s performance. “The NHS had its busiest June ever, but hospitals are performing well with nine out of 10 people seen in A&E within four hours – almost 60,000 people per day seen within the standard,” he said.
NHS Digital to pilot EPS ‘Phase 4’ with 16 GP practices: The next phase of the roll-out of the Electronic Prescription Service (EPS) will be tested in a limited pilot of 16 GPs across England, reported DigitalHealth.net. NHS Digital (formerly the Health and Social Care Information Centre) confirmed that the GPs will test EPS paper tokens for about four months. The GPs have not yet been chosen, but a spokeswoman confirmed that they will be geographically spread across England. The tokens, which have a barcode on, will be given to patients who have not ‘nominated’ a pharmacy. The idea is that the tokens can be redeemed at any pharmacy in England, where pharmacists will scan the barcode to download a prescription. An NHS Digital spokesperson said that pharmacies near the pilot GP sites will be supported with “factsheets and animation videos to explain the process”. But, as any pharmacy can be chosen, “all pharmacy teams will need to be ready and know what to do”. The start date is currently unconfirmed. The EPS programme is one of the longest-running, national, healthcare digital programmes. NHS Digital said the next phase, EPS Phase 4, represents the point where electronic rather than paper prescriptions become the default. Alastair Buxton, pharmaceutical services negotiating committee director of NHS Services, said the pilot will “test the move to ‘full’ EPS”. “EPS and paper prescribing systems currently coexist and this drives complexity and costs for pharmacy teams; successful implementation of phase 4 will shift the balance to the majority of scripts being electronic, which in turn will remove the inefficiency of the current dual system,” he said.
OUHNFT undergoes significant data migration: Oxford University Hospitals NHS Foundation Trust (OUHNFT) has successfully undertaken one of the largest data migrations in the UK, following a move to a new digital imaging system, reported Health IT Central. The migration of historical data took just four months with an integrated Enterprise Imaging picture archiving and communication system (PACS). As part of the deployment, breast screening was merged into the main PACS, allowing the sites to be able to view symptomatic and screening imaging in the same application for the first time. Other departments are already planning to transfer their services into the Enterprise Imaging system. The next step for OUHNFT is to enable the sharing of the service between themselves and their neighbouring trusts using the Insignia Sharing Solution, which will enable them to immediately and automatically view the entire regional patient radiology image record. Shared services and cross-site home reporting will enable ground-breaking service transformation for the NHS throughout the region. Annie Pinfold, PACS radiology information system senior consultant at OUHNFT, said: “Insignia and trust staff worked alongside each other to quickly resolve any issues that arose. The onsite support during the go-live and in the weeks afterwards was plentiful and excellent. Some key groups of clinicians are already seeing benefits from quicker access to studies sent from other trusts.”
Wearable and app in trial to prevent diabetes: Wearables and a “motivational” mobile app will be piloted in London as a fix for the swelling health burden of Type 2 diabetes, reported DigitalHealth.net. King’s Health Partners and wearable technology company Buddi are collaborating in a randomised control trial, part-funded by Innovate UK, to improve outcomes for pre-diabetics. The trial will test how effective a Buddi wristband monitor is combined with a mobile app, designed with clinical input from King’s Health Partners, in promoting exercise and healthy eating. Dr David Hopkins, co-leader of the King’s Health Partners diabetes clinical academic group, said the wearable monitored your movement, like an off-the-shelf fitness device but far more accurately. This data was linked into the mobile app, which would send the motivational messages to encourage further movement if a user appeared not to be staying active. Hopkins said the messaging was based on motivational interviewing techniques, a counselling approach focused on unlocking a patient’s own motivation and creating practical plans to achieve goals. The users will also be able to register their meals on the app and when they have a craving the app will provide “motivation strategies” to avoid overeating. Roughly one of three British adults are estimated to have “prediabetes”, with abnormal blood sugars levels that puts them at risk of Type 2 diabetes. Sara Murray, chief executive and founder of Buddi, said the trial was about moving away from reactive treatment to prevention. As far as she was aware, this was the first time wearables had been trialled as an answer to Type 2 diabetes prevention in the NHS. The trial will run for a year, with a cohort of 200 patients drawn from the Lambeth and Southwark London boroughs.
Patientrack hospitals win awards worldwide for life-saving innovations: Hospitals across England, Scotland and New Zealand have been recognised for innovative work to save lives by judging panels across the world, after achieving a major impact on patient safety with Patientrack, reported eHealthNews.eu. NHS Fife, which has significantly cut cardiac arrests and dramatically transformed clinical practice within just six months of using Patientrack, won the digital health award from Holyrood’s 2016 Connect ICT awards in June. In the same month another Patientrack project won the inaugural New Zealand Health Information Technology (NZHIT) Award for work with Canterbury District Health Board and Waitemata District Health Boards. The Patientrack early warning system is used in hospitals to prevent avoidable harm and alert doctors and nurses to patients at risk of deterioration, so that they can intervene early. In practice nurses digitally record vital signs, before the system automatically escalates patients at risk and directly calls doctors to attend when early warning scores trigger. A project at Western Sussex Hospitals NHS Foundation Trust to predict and prevent acute kidney injury was a finalist in the 2016 Patient Safety Awards, with the project representing an important step to tackling a devastating condition linked with 100,000 deaths each year across England. Patientrack is also a double finalist in the prestigious EHI Awards. Donald Kennedy, managing director at Patientrack, said: “Patientrack is helping the NHS and others deliver better, safer care, with proven results in reducing mortality and faster clinical attendance for patients most in need.” It was the only UK company listed in the champions category finals of the 2016 EU eHealth Competition, a programme supported by the European Commission as a means to increase visibility of what it describes as “the best” of healthcare technologies from SMEs across the continent.
South East Coast Ambulance Service deploys EPR on iPads: South East Coast Ambulance Service NHS Foundation Trust has gone live with the Kainos Evolve electronic patient record (EPR) system, reported ComputerWeekly.com. The system runs on iPads and lets ambulance staff enter and look up patient information while at the scene of an emergency. By the time the patient arrives in hospital, clinicians there already have the information at hand. The trust hopes that having up-to-date information available instantly will improve efficiency and patient care. Steve Topley, clinical lead at the trust, said that an electronic record means there is “never any need to waste time trying to decipher cryptic handwriting. Providing a hospital with a seamless handover of accurate electronic incident notes makes it quicker and easier for them to provide rapid, focused care. It saves precious time and greatly improves outcomes for patients”. Having patient details available right away also means that the review and audit process will improve. Previously it took up to six weeks to scan, review and distribute information on paper. The EPR system works both online and offline, so clinicians can enter information anywhere. When the iPad is online, it automatically updates. Mark Chivers, the trust’s head of IT, said the iPad is also used for messaging and browsing the web. “Additionally, it allows the trust to benefit from the inherent security benefits of iOS, so data remains safe wherever our staff need to be,” he said.
Opinion
Could IoT sustain the NHS?
James Norman, public sector CIO at EMC, writes about how the Internet of Things (IoT) is set to revolutionise the healthcare industry.
“The Internet of Things (IoT) is slowly becoming the new telemedicine. Just a few months ago it was announced that the NHS introduced some new major trials to improve patient care. At the World Economic Forum, NHS England chief executive, Simon Stevens, announced the launch of the first wave of NHS Innovation ‘test beds.’ These are collaborative projects between the NHS and other service providers, to address some of the issues facing patients and the health service by harnessing technology – specifically IoT.
“According to a recent study by MarketResearch, IoT deployments in healthcare are set to reach £81.6bn by 2020. Wearable devices are able to collect and send patient data to doctors in real-time and sensors will be able to monitor things like whether a hospital bed is free or occupied to help improve hospital efficiencies. The device is simply a new way to capture real-time data in a convenient manner for the patient. What will make an impact is what then happens with the data captured.
“In light of recent technological developments, the NHS is trialling two IoT test beds which are part of IoTUK, an integrated £40m, three-year government programme that seeks to advance the UK’s global leadership in IoT. The two test beds include: Diabetes Digital Coach, Technology Integrated Health Management.
“Better use of data and content across different devices will drive a more integrated approach, with the aim to eventually help where possible to predict what intervention may be required. Whilst not all wearables are approved for medical use, they all have a part to play in driving the wellness model approach – one that requires a proactive, personalised mind-set, not a reactive “illness-driven” health industry. This can only be achieved through collaboration and sharing data effectively.
“It’s great to see that the Department of Health is putting the NHS at the forefront of innovation. This is certainly a step in the right direction and it will be great to see over the next few years how IoT has had an impact on healthcare – not only in cutting costs and improving processes and efficiencies, but also the end result on patient care. The impact from IoT could certainly help sustain the future of the UK’s universal healthcare system.”
Get rid of targets to help improve NHS Scotland
Theresa Fyffe, director of the Royal College of Nursing Scotland, writes about the benefits of rethinking NHS Scotland’s “targets culture”.
“NHS Scotland’s targets (or “Local Delivery Plan Standards” as they’re officially known) are set by the Scottish government and they’re intended to give assurances to politicians and the public on how our health services are performing. This is all well and good and we certainly never want to go back to the bad old days of waiting two years for a hip replacement or sitting in A&E for hours on end, waiting to be seen.
“Yet what the current targets measure is how long it takes our health services to deliver. But there’s nothing in the current range of targets which measures how successful treatment has been or if an individual’s health has improved as a result of the care they’ve received. So, current targets will tell us if someone got seen in A&E within four hours – but they won’t tell us if they saw the right clinician, got the tests they needed or were admitted to the right ward. Current targets encourage health boards to focus on, and often invest money in, those areas with a target, sometimes at the expense of those areas where there isn’t one. In other words, our current targets often measure the wrong things, skew clinical priorities and waste resources.
“Wouldn’t it be better if we measured how successful our health services are at improving health and wellbeing in Scotland and achieving positive outcomes for those who use them?
“That’s why, in June this year, having listened to a wide range of opinion and having researched what works and what doesn’t, the Royal College of Nursing Scotland published a new report setting out a number of principles for a new approach to measuring success across our health services.
“This new approach should focus on Scotland having a single set of health outcomes across all services. Marginal change round the edges will not be enough to create a more sustainable health service in Scotland, given the pressures faced. Changing the current targets culture will be challenging and it’s good to see that the cabinet secretary is listening and agreeing to a review. But whenever that review begins, it must take a fundamentally new approach and put all options on the table for consideration.”
Interoperability and the NHS: are they incompatible?
The health and care sector must act now on interoperability, if patients are to avoid bringing their mobile device to appointments, just to let their doctor borrow their integrated care record, writes David Maguire, economic and data analyst, at The King’s Fund.
Writing in a blog on the think tank’s website, he says Jeremy Hunt’s New Year’s resolution on patients’ access to their records was a “bold claim, given that some hospitals are still using fax machines”.
“While much of the general public embraces the advances in information technology from our app-filled smartphones to our fitness-monitoring wristwatches, the NHS trails behind – often frustratingly so. If we’re ready to access our care records whenever and wherever we are, is the NHS ready to do the same?
“The NHS has been wrestling with IT challenges for years; billions were largely wasted on the IT plans of the early 2000s, in 2012 the coalition government outlined plans for a new digital strategy, and then in 2014 the Department of Health put forward an updated digital plan designed to work alongside the NHS Five Year Forward View. One of its key topics is interoperability – the ability of the disparate and almost innumerable IT systems and software applications in use in health and care to communicate, exchange and interpret data, and otherwise work efficiently together. Many aspects feed into this, from standardised data entry to improving the way information moves across locations and computer programs. The NHS hopes to achieve full interoperability by 2020, but all medical records should be digitally accessible by medical professionals in acute settings by 2018.
“The entire health and care sector has the opportunity to implement some long-term, efficient changes that could shake up how care is delivered: improved interoperability would allow the integration of health and social care records, greater ease of use for clinicians and reduced admin.”
Highland Marketing news
For the third year running Highland Marketing is to sponsor the EHI Awards 2016
With integration high on the NHS agenda, this year Highland Marketing has chosen to sponsor the ‘Best use of IT to support integrated healthcare services’ category. The integrated healthcare category highlights the most outstanding informatics work which has been completed by a provider across both acute and primary care. All the category winners will be announced at a formal awards dinner on Thursday 29th September 2016 at the Lancaster Hotel, London.
