News in brief
Hospital ‘long-waiters’ show sharp rise: Hospitals waiting times in England have deteriorated markedly in the past five years, an analysis has shown. The Health Foundation review of official NHS data between 2011-12 and 2016-17 found longer waits for cancer, A&E and routine operations, reported the BBC. Last year the NHS missed all three targets for the first time in its history – and researchers warned it could get worse before it improves. However, the Conservatives said investment was being made to improve services. “Under Theresa May’s leadership, the NHS has more doctors, more nurses and record funding,” a spokesman added. The Health Foundation chose the last five years because 2012 is when the most recent target – the 18-week wait for routine operations – came into force. Researcher Tim Gardner said: “Maintaining, let alone improving, the quality of care provided is going to be very difficult in the current financial climate. Funding for the NHS in England will need to increase if these hard won gains to the quality of patient care are to be upheld and built upon in the future. Waiting time targets for A&E, cancer and consultant-led treatment are a useful barometer of pressure on the NHS.”
Health Foundation wants increased NHS Funding:the next two years, in what will be the toughest decade of funding growth in NHS history, reported The Clinical Services Journal. In its new briefing, the independent charity also outlined how the new government urgently needs to bridge an alarming funding gap in social care, which has resulted in at least 400,000 fewer people in England receiving care. In the first of three briefings ahead of the 2017 general election, the Health Foundation’s paper provides a comprehensive analysis of the state of NHS and social care finances in England. It outlines three unavoidable financial challenges that need to be tackled by the next government if it is to maintain healthcare and social care services. The briefing also called for an independent financial body for the NHS to be established, similar to the Office of Budget Responsibility, to lay out the long-term financial outlook for health and social care, as recommended by the House of Lords’ committee on sustainability. Anita Charlesworth, director of research and economics at the Health Foundation, said: “Years of austerity have left the NHS and social care sector in an increasingly perilous financial state. Government funding plans are not keeping pace with demand and cost, and as a result, these vital services are showing increasing signs of serious strain. Health and social care are vital public services that all of us rely on in times of need. We’ve seen years of funding volatility, going from feast to famine and back again, which is damaging for the long-term planning of services.”
General election 2017: NHS pay cap ‘must be lifted’: The pay cap on NHS staff must be lifted because it puts patient safety at risk, NHS bosses said. NHS Providers said the cap, which limits pay rises to 1% a year to 2019, was causing severe recruitment and retention problems in England, reported the BBC. The body, which represents NHS trusts in England, said the next government must look at the issue immediately. Labour said it would look to increase pay, however the Tories and Lib Dems have not yet set out any pay plans. Labour wants to increase pay so it better reflects the cost of living, but has not said by how much. The Lib Dems have announced they would increase income tax by a penny-in-the-pound to boost investment in the NHS. Last year the Public Accounts Committee warned that the NHS in England was 50,000 people short of the frontline staff it needed – about 6% of the workforce. NHS Providers chief executive Chris Hopson said his members were now worried the situation was so bad that services were at risk. “Growing problems of recruitment and retention are making it harder for trusts to ensure patient safety,” he said. “Unsustainable staffing gaps are quickly opening up.” He said the seven years of pay restraint, combined with stressful working conditions, had taken a toll on the workforce.
Glasgow’s super-hospital records worst ever A&E waiting times: A quarter of patients had to wait more than four hours to be seen in the A&E department at Scotland’s flagship hospital, reported The Herald. NHS figures showed that over the last week in April, the Queen Elizabeth University Hospital in Glasgow only managed to deal with 75% of A&E patients within the four-hour target waiting time. Liberal Democrats said that was the worst performance since the £842m facility opened in 2015. The statistics showed that in the week ending April 30, 91.3% of A&E patients across Scotland were seen and either admitted, transferred or discharged within four hours – below the Scottish government’s interim target of 95%. There were 223 patients who spent more than eight hours in an emergency department, with 45 waiting more than 12 hours. Across the NHS Forth Valley area, more than a fifth of A&E patients waited more than four hours, with 78.4% of cases dealt with in within the target time. Liberal Democrat health spokesman Alex Cole-Hamilton said: “It is clear from these new statistics that emergency departments across Scotland are really struggling to meet demand. At the Queen Elizabeth University Hospital alone almost 500 patients waited longer than four hours to be dealt with. It has struggled to meet this target from day one and staff and patients will be frustrated that there is little sign of this changing.”
Simon Stevens: NHS will ‘roll up sleeves’ on service reform after election: Simon Stevens has said “there is no version of reality” in which the priorities of the Five Year Forward View delivery plan will not be needed, regardless of who wins the general election, reported the Health Service Journal (subscription required). The NHS England chief executive reasserted his commitment to the Next Steps plan despite an election being unexpectedly called within a month of its publication, at a King’s Fund conference this week. Stevens said: “Without prejudging the outcome [of the election] – we will obviously be guided by the new government – it is pretty clear that the core operational priorities that the NHS set out in the Next Steps document are the right things for us to be working on over the year ahead. There is no version of reality where we don’t need stronger primary care; no version of reality where we don’t need more expansive and resilient mental health services; no version of reality where we don’t need better health and social care integration – to name just three.” Stevens said that 2017-18 “will be a sleeves rolled up year with a lot of change across the country”. He also added that NHS England will continue to invest in general practice, reported Pulse.
One in six GP practices carry out ’email consultations’ with patients, poll suggests: A GPOnline poll of 265 GP practices has revealed that almost all practices offer telephone consultations (96%), although less than 2% of 265 GP partners responding to the poll said their practice offered video or group consultations. NHS England’s 10 high impact actions – proposals meant to release time in general practice – include a call for practices to “introduce new communication methods for some consultations, such as phone and email, improving continuity and convenience for the patient, and reducing clinical contact time”. The survey findings showed that significant numbers of practices were offering consultations options beyond face-to-face visits. More than a quarter of GPs said more than one in five contacts with patients at their practice were carried out via telephone consultations. Among the 17% of respondents who said their practice offered email consultations, the vast majority said email accounted for less than 5% of contact with patients. But GPs warned that alternative consultation techniques were not suitable in many cases and that technology was holding back wider adoption of some methods. Wessex LMCs chief executive Dr Nigel Watson said that practices “do far more by phone than we used to”. He said video consultations were largely not being implemented because practices were not set up to use it easily. “As a business we have looked at video consultations and the broadband speed is just not adequate in many places. So that’s not widespread,” he said.
GPs held back by lack of patient confidence in technology: Despite the fact that almost two-thirds of the British public want to take greater control of their own health, less than half have taken any action to do so in the last year – and almost a quarter are not confident that they can help prevent or reduce health-associated problems, reported National Health Executive. The stark findings, revealed in a report by Nesta, underlined a significant missed opportunity to take charge of healthcare as the country moves towards community-based population health. For example, just a quarter of the surveyed members of the public said they currently use technology such as health apps, fitness trackers and other wearables to manage their own health. In contrast, a whopping 64% of GPs surveyed said that this data provides useful insights for their own consultations. On the other hand, out of the 1,009 GPs surveyed, Nesta also detected a higher trend of social prescribing, where patients are linked with sources of support in the community such as health coaching, group activities or peer support. Group activities and self-management education in particular topped the list, but doctors nevertheless cited issues with patient confidence or willingness amongst the chief reasons preventing them from recommending these alternatives more frequently. Other reasons as to why GPs do not recommend certain social prescribing routes to their patients – especially when it comes to peer support and health coaching (61%) – include a lack of familiarity with what is available in their local area.
Bauer’s personal NHS experiences drive digital action: Speaking at the recent e-Health Week event, NHS England’s director of digital experience said her first-hand brushes with the NHS during her difficult second pregnancy are fuelling her desire to change the service for patients including the role of technology, reported Government Computing. Bauer, who leads all patient facing digital technology projects for NHS England, including the transformation of the NHS Choices website said: “We all know that the service is under real pressure. To continue to provide great care, we have to make our service as efficient as possible. I hope we all agree that efficiency is not going to be an optional extra in the provision of great care. Improving the delivery of care is imperative if we’re going to create the financially sustainable systems that we need. I passionately believe that people deserve the wonderful and transformative benefits offered by technology. And that’s why I’m here. That’s why I joined.” Bauer continued: “Seeing healthcare from my hospital bed convinced me that we have unnecessary delays, unnecessary burdens, pressure on clinicians that just doesn’t need to be there and also that if we don’t give them the right technology, or give them technology that doesn’t work, or don’t give them technology at all, then it’s just not going to work.” She said it was her job in the NHS to drive the implementation of new technology and help people manage their health and well-being.
TPP and Emis Health share data across SystmOne and Emis Web: Emis Health and TPP have launched a London-based pilot, which will connect The Orchard Practice’s Emis Web system with Hillingdon Diabetes Service based on TPP SystmOne, reported DigitalHealth.net. The data exchanged is initially limited, with GPs at the practice now being able to view community nursing data from the diabetes service. Clinical staff at Hillingdon Diabetes Service can now view patients’ GP records. Dr Mohamed Adem, senior lead GP at Orchard, told DigitalHealth.net that, with patients’ consent, their medical summary, problems, medication and allergies are now being shared. He said: “With the pressures facing NHS and budget constraints, we also feel that sharing information will reduce medicine waste during medication treatment regimes after diagnosis.” Other benefits for Dr Adem included: making informative, accurate and timely decisions; effective communication with colleagues; and an ability to view problems relating to medication and regime change. Veronica Green, diabetes team leader at Hillingdon Diabetes Service, said that the pilot “will greatly improve communication between the patients’ GPs and us which will improve care, save time and reduce the potential for errors”.
NHS taps artificial intelligence to crack cancer detection: The NHS and Intel are working together to make cancer detection more efficient through artificial intelligence, reported ZDNet.com. The University of Warwick, University Hospitals Coventry & Warwickshire NHS Trust (UHCW) alongside Intel said a new collaboration between the groups will push forward the classification of cancer cells “more efficiently and accurately through ground-breaking artificial intelligence”. A team of scientists, hosted by the University of Warwick’s Tissue Image Analytics (TIA) laboratory and led by Professor Nasir Rajpoot are currently creating a digital repository of known tumour and immune cells based on thousands of human tissue cells. This database of cancer information will then be used by algorithms to recognize these cells automatically. While some types of cancer are more aggressive than others, time is almost always an issue. The quicker this disease, in whatever form, can be diagnosed accurately, the sooner treatment can begin. In turn, this may also improve survival rates. Professor David Snead, clinical lead for cellular pathology and director of the UHCW Centre of Excellence, said that researchers and medical professionals “have long known” that computers can analyse cells far quicker than humans, and by bringing this science into practice, this will result in better patient care in the future. Launched in collaboration with the Alan Turing Institute, the initial research into how data analytics and how artificial intelligence can be used to create a model for cellular distinctions will primarily focus on lung cancer.
UKCloud launches dedicated health division: Fast-growing cloud services specialist UKCloud has launched a new dedicated healthcare division UKCloud Health, reported DigitalHealth.net. The company said the new dedicated health business will provide an open, collaborative and UK sovereign public cloud platform specifically for the healthcare industry, supporting health and care providers, research and life sciences and pharmaceuticals. The new business launched this week with a community of 29 partners and 30 customers, including Genomics England and the Devon Partnership NHS Trust. “To date, we’ve focused on developing a unique cloud platform exclusively to meet the needs of the UK public sector,” said Simon Hansford, CEO of UKCloud. The company hosts over 200 public sector clients and projects. He added: “We’re now looking to replicate our business model with a new division exclusively focused on the healthcare sector, where cloud adoption rates are typically impeded by a host of different challenges.” Speaking at the launch at the Royal Society of Medicine in London, Hansford said that UKCloud Health would provide the level of customisation and responsiveness that big American cloud vendors “either can’t or aren’t interested in providing”. Hansford said that the openness and interoperability of UKCloud’s Health platform, and focus on health and life sciences, were key differentiators.
Hyland acquires Lexmark’s EDM business, Perceptive Software: US firm Hyland is to acquire an enterprise content management business currently owned by printer maker Lexmark, reported DigitalHealth.net. Lexmark’s software unit – which includes Kofax and ReadSoft as well as Perceptive Software – has been sold to Thoma Bravo, a leading US private equity firm which already owns Hyland. The deal is due to complete in the third quarter of this year. Kofax and ReadSoft will unite to create a single, independent company under the Kofax brand. The Perceptive Software business will become part of Hyland. Citing sources familiar with the sale, Reuters estimated its total value at $1.5bn. In an open letter to existing and prospective customers, the president and chief executive of Hyland suggested the firm was “incredibly well positioned to continue to do the important work of digitally transforming businesses across the globe”. Bill Priemer continued: “When I think about the opportunities to extend our current solutions, I’m particularly enthusiastic about the possibilities in clinical healthcare and higher education.” More than 1,800 healthcare providers use Hyland’s OnBase for electronic document management. In the NHS, it has notably been used by Barts Health NHS Trust, Liverpool Heart and Chest Hospital NHS Foundation Trust and University Hospital Southampton NHS Foundation Trust. Industry commentators have suggested Hyland’s acquisition of Perceptive will serve to create the market’s single largest enterprise content management business.
Healthcare will become ‘increasingly dependent on data,’ says industry leader: Jeroen Tas, chief innovation & strategy officer for Philips, explained healthcare will become ”increasingly dependent on data, information and intelligence” over the coming years at the Artificial Intelligence (AI) Summit, reported the British Journal of Healthcare Computing. He noted that this is the main driver behind building a “data infrastructure”, adding that the advancement of technology is offering the potential to gain “deeper, denser, more longitudinal insights than ever before” in healthcare. Predictive analytics, he said, could “help enable preventative health management” of the population; his presentation revealed non-intrusive tech that would augment the need of people is required, with some of the main challenges around AI including “appropriate patient privacy protection, curated, clean databases” or trust and transparency, amongst many others. However, if done correctly, he stated this could make healthcare more precise, more predictive and more accessible to citizens, requiring careful co-operation. During the techUK workshop at the AI Summit, Lydia Drumright, clinical informatics lecturer at Cambridge University’s department of medicine, suggested the UK has a long way to go from implementing AI in day-to-day healthcare provision, saying there is a pressing need for “fully integrated health records and social records” to be developed. She explained this could empower clinicians and allow them to share information and use it for research purposes that would in turn improve the health of the population.
Opinions
End of life care planning: why it should be everyone’s concern
To mark Dying Matters Awareness Week, Michelle Brown of the University of Derby’s College of Health and Social Care, explains in National Health Executive why everyone should make sure they know what end of life care planning involves.
“Starting any discussion surrounding end of life care can induce anxiety among health and social care professionals but also generate anxiety in those close to the person who is reaching the end of their life and to the individual facing that prognosis.
“Without those discussions however, there is a definite risk that the individual’s wishes may not be determined or, worse still, professionals and loved ones run out of time before they can put plans into place.
“Everyone has a right to the highest quality care no matter what diagnosis, geographical area, age, socioeconomic status and, in addition, marginalised groups should have equal access e.g. travellers, prison population. Having those key, important discussions in a timely manner is vital in being able to determine a person’s wishes regarding the end of life.”
She argues that there are numerous barriers to achieving high-quality end of life care and points to communication as being an important consideration.
“Discussing end of life care requires constant reiteration; checking and information provision as people can change their mind particularly when they are faced with new fears, concerns and/or symptoms on a daily basis.
“To ensure there is a mutual understanding and awareness regarding the current issues in the patient’s journey, the plan of care, any new symptoms or concerns that may present, and regular discussion utilising a holistic approach, is vital in ensuring a responsive approach to their care needs. Communication in palliative care sets the tone for all the care which may be required because without effective communication, patients and relatives may be left feeling isolated, unaware of the current situation presented and begin to lack trust in those providing care.”
Automating healthcare: Balancing efficiency and ethics
Along with predicting epidemics, diagnosing disease, and counselling patients, Artificial Intelligence (AI) is finally proving its worth in healthcare delivery to enable a better patient experience. Michael Breggar, managing partner at Infosys Consulting, asks what this means ethically.
Breggar explains, “as machine intelligence continues its inexorable march, the ethics of allowing machines into decision making is never far behind. Nowhere is this truer than in healthcare as the industry learns to face tricky dilemmas in adopting AI in medical diagnosis.
“As long as algorithms are used to make recommendations based on input symptoms and histories to the medical practitioner, we are on firm ground.
“But, if actual, non-curated medical advice is given by the machine, we are moving into potentially-shaky territory. Also, what happens if the algorithm makes a mistake, such as seeing a false pattern where none exists, or acquiring a bias because its input data is skewed or incomplete?
“Finally, where does one draw the line? For instance, just because we now have a machine that can predict with 80% accuracy when a person with a defective heart will succumb to it, should we pass on that information?
Breggar goes on to say that, “while AI and machine learning relies on millions of analyses of data alone for diagnosis, a healthcare practitioner, in addition to data, also uses intuition and experience in making a medical decision. Going forward are we willing to let go of the value that offers? These are tough questions that we must eventually work our way through.
Breggar believes that many ethical issues can be confronted by setting the boundaries for what AI can and cannot do.
He states, “the key principle is to leverage the full power of AI in clinical settings to assist, enable and co-work with human professionals, who continue to remain in charge of big decisions, such as diagnosis and treatment. The industry also needs to establish ethical standards and obligations for the organisation, as well as metrics to assess the performance of AI systems.”
Three unavoidable challenges ahead for the NHS and social care
Any incoming government must address this trio of fundamental issues if health and social care are to be sustained, writes Anita Charlesworth, director of research and economics at the Health Foundation, in the Health Service Journal (subscription required).
“Social care needs immediate attention from an incoming government. It is severely under-funded and unaffordable for people on low incomes who are ineligible for free care. The government is increasing spending on social care over the next three years, but that’s after a seven-year period that saw an 8 per cent funding cut. The trouble is that pressures on the system are increasing at twice the rate of funding growth.
“Funding for the NHS in England needs to increase in the next two years. Spending on healthcare per person in England is planned to fall in real terms by 0.2 per cent in 2018-19 and by a further 0.2 per cent in 2019-20. The pressures on the healthcare system, combined with a struggling social care sector, mean it is difficult to see how the NHS can sustain quality and access to care for patients with this planned decrease in spending.
“Beyond 2020, the pace of funding growth for the NHS and social care system will need to accelerate, taking a greater share of GDP. This will be necessary to keep pace with the increasing and ageing population, rising chronic disease levels, to meet public expectations for healthcare and to fund new technologies and medical advances. The most authoritative estimates of the spending pressures facing the NHS and care system in the long term come from the Office of Budget Responsibility (OBR), stating that funding pressures will rise by over 4 per cent a year in real terms in the next decade.”
