News in brief
G8 ‘will develop dementia cure or treatment by 2025’: Leading nations at the G8 Dementia Summit have committed to developing a cure or treatment for dementia by 2025, reported the BBC. Health ministers meeting in London said it was a “big ambition” and that they would significantly increase funding for research to meet that goal. The UK has already said it aims to double its annual research funding to £132m by 2025. The global number of dementia sufferers is expected to treble to 135m by 2050. The G8 said it would “develop a co-ordinated international research action plan” to target the gaps in research and ways to address them. It also called on the World Health Organization to identify dementia as “an increasing threat to global health” and to help countries adapt to the dementia timebomb. In a statement it said: “We recognise the need to strengthen efforts to stimulate and harness innovation and to catalyse investment at the global level.” dementia is incurable and ultimately leaves people needing full-time care as brain function wastes away. There is growing concern that some countries will simply not cope with the growing burden of dementia. David Cameron called on governments, industry and charities all to commit more funding. He said the G8 should make this the day “the global fight-back really started”. He said the UK government would boost annual research funding from £66m, the 2015 pledge, to £132m, which will be adjusted for inflation, by 2025. Cameron told the summit: “This disease steals lives, wrecks families and breaks hearts.”
£50m of tech fund rolled over: Around £50m of the ‘Safer Hospitals, Safer Wards: Technology Fund’ will be rolled over into ‘Tech Fund 2’ because projects could not meet deliverability targets, reported eHealth Insider (EHI). The initial £260m fund was approved by Treasury a week ago and trusts have since been informed if they were successful. NHS England director of strategic systems and technology Beverley Bryant, told EHI that the entire £90m that must be spent before April next year has been allocated. However, around £50m of the £170m that was earmarked for the next financial year has not been assigned because not enough projects passed the “deliverability test”. This left-over money will be rolled into ‘Tech Fund 2’, which was announced by health secretary Jeremy Hunt in September and worth £250m. Health Service Journal also reported that three plans to join up patient records across a number of health and social care organisations are among 135 projects to have secured a share of the fund. Bryant said successful trusts in the first round were either told that they have got the funding, or that they have passed the deliverability test, but need to improve their ‘value for money’ (VFM) case in order to be accepted by Treasury. Trusts that have resubmitted their VFM cases are hoping to hear back before Christmas, but may not know until January. For some that may be too late to spend the money by April, in which case it will be returned to the Treasury. Bryant also revealed to EHI that about £20m of the first fund remains earmarked for open source projects, but said these are still going through evaluation.
NHS trusts offered slice of £100m Nursing Technology Fund: NHS England has launched a £100 million fund for trusts to buy innovative mobile and digital technologies to support nurses, midwives and care staff to help improve patient care, ComputerWorld UK reports. The Nursing Technology Fund aims to help NHS staff work more flexibly and effectively by reducing the amount of paperwork they are required to carry out. NHS England said it is trying to create an “information revolution” within the National Health Service and an essential part of this is ensuring that staff have the right tools to do their job properly. “Nurses and midwives chose their profession because they wanted to spend time caring for patients, not filling out paperwork. New technology can make that happen. It’s better for patients too, who will get swifter information, safer care and more face-to-face time with NHS staff,” said health secretary Jeremy Hunt. The fund aims to mostly support projects that have a particular focus on mobile and digital technologies, which help improve communication and allow staff to do their jobs more easily. NHS trusts providing hospital, community, mental health and ambulance services can all apply for funding. Applicants must demonstrate that funding will be used to buy technology that nursing staff and midwives will see the practical benefit of using and ultimately that will benefit patient care. Some £30 million of the fund will be available for projects that can be delivered in 2013/14 and the remaining £70 million for projects delivered in 2014/15. The deadline for first round applications is 15 January 2014 and funding decisions will be announced in February.
Clash over allocation of £3.8bn integration fund: Department for Communities and Local Government officials are battling for a £3.8bn health and social care fund to be weighted more heavily towards deprived areas, in order to address criticisms that cuts have hit these places hardest, Health Service Journal (subscription required) reported. Officials at the department are said to be calling for the Better Care Fund, a pooled budget for clinical commissioning groups and councils to join up health and care services, previously known as the Integration Transformation Fund, to be shared using the formula used for local government grant allocations rather than one which has been used in the past for NHS funds. This is because the local government formula would place greater emphasis on deprivation, it is understood. It comes in the wake of a fierce debate about whether councils in deprived areas have been hit hardest by cuts. Last month the Audit Commission and the Joseph Rowntree Foundation (JRF) published separate reports claiming this had been the case. However, local government minister Brandon Lewis strongly denied these claims, saying the JRF report was “wrong” because “the independent House of Commons library has already shown that deprived areas continue to receive and spend far more funding per household than other parts of the country”. Mr Lewis also told the Commons’ local government committee this week that his department’s funding allocations were “fair to north and south, rural and urban” areas. He said he had seen no evidence of deprived areas being disproportionately hit.
NHS reform will speed up next year, consultants warn: Health consultancy firm KPMG, which has advised a quarter of England’s 211 clinical commissioning groups (CCGs), says that GP commissioning groups will play a ‘critical role in reshaping care’ and integrating services with social care next year, GP Online reports. NHS England is due to publish its long-anticipated vision for general practice in 2014. Early details of its plans for London suggest it will force practices to federate to expand services. CCGs could also be handed a greater role in commissioning primary care in partnership with area teams, NHS England revealed last week. KPMG head of UK healthcare Andrew Hine said: “It is widely accepted that left untouched, and despite its relatively favoured financial protection, the NHS will hit the financial buffers within two years. Yet, solving this problem isn’t just a question of rebalancing budgets. It’s about addressing long-standing and long-evaded questions of sub-scale, high-cost, low-quality services. Many of these services are much loved but they were fit for the twentieth, not twenty-first century and their weaknesses, although widely known, are rarely discussed.” Hine added: “Models of care will start to change dramatically as public, private and voluntary organisations combine forces to ensure patient needs come first and the shift of care from hospitals towards primary care and home will accelerate.”
NHS boards in Scotland miss waiting time target: Scottish health boards have missed a new government target for all outpatients to receive their first appointment within 12 weeks, reported the BBC. Audit Scotland also found two boards did not meet another target that 90% of patients should wait no longer than 18 weeks from referral to treatment. However the watchdog said improvements had been made to the ways waiting lists were managed and scrutinised. Scottish health secretary Alex Neil said waiting times were continuing to improve. The Scottish government said the 18-week target had been met at a national level. Audit Scotland checked progress on the management of waiting lists 10 months after the NHS in Scotland was warned that public trust was being put at risk. Problems emerged in 2011 when NHS Lothian was found to have manipulated data. Patients had been marked as unavailable for “social reasons” such as failing to get time off work or going on holiday. Some patients were deemed to fall into this category if they declined to travel to England for treatment at short notice. Audit Scotland found that the use of these codes indicating that patients were not available for treatment had reduced considerably. It also reported that better controls and audit trails were being put in place by Scotland’s 14 health boards.
NHS data ‘useful but hard to collect’: Clinicians think that two thirds of data collections in the NHS are useful and relevant to patient care, according to a report by the NHS Confederation. The ‘Challenging Bureaucracy’ report, which was commissioned by health secretary Jeremy Hunt earlier this year, found that clinicians spend between two and ten hours per week collecting data. However, administrative staff spend up to 20 hours on the same job, with much of their effort going on finding data for nationally-mandated returns and reports to regulatory bodies, reported eHealth Insider. The report states that front-line staff perceived that national bodies impose a small burden on them directly. However, the burden on managerial and administrative staff appeared to be substantial; on average they reported that the clinical staff we interviewed reported, on average, that 65% of the data they collect is useful and relevant to patient care; this breaks down to 69% for acute providers and 59% for mental health providers. The report adds that data collection costs each trust an average of £1.4 million a year, bringing the total yearly cost for the NHS to £300-500 million. In a foreword, Mike Farrar, former chief executive of the NHS Confederation, says the review discovered that the “burden of bureaucracy is much bigger than originally thought”. The review calls for data collections to be reviewed on a regular basis to judge their relevance, and asks for a core dataset to be developed, which can be used across the health service.
NHS England calls for pharmacists to play ‘stronger role’: Community pharmacy should play a larger role in out-of-hospital care, NHS England has proposed. Its new consultation calls for pharmacy professionals to consider how it can be used as a viable alternative to over-subscribed primary care services, National Health Executive reports. This includes how pharmacies can work with general practice to help deliver integrated out-of-hospital services and improve health outcomes, as well as the management of long-term conditions, supporting public health, and boosting efficiencies across the whole system. Clare Howard, deputy chief pharmaceutical officer for NHS England, said: “We want community pharmacy to play an even stronger role at the heart of more integrated services. We are now developing an even greater understanding of the challenges that face Primary Care and how we must work differently to achieve sustainable change and support better health outcomes for patients, to provide more personalised care and deliver an excellent patient experience; this has to go hand-in-hand with the most efficient possible use of NHS resources.” Mark Robinson, pharmacy, medicines and medicines optimisation advisor to the NHS Alliance said: “There are many excellent examples of innovative community pharmacy based services around the country – our issue is both integrating these more effectively within the total community based primary care service and spreading them across the country to provide a consistency that patients can recognise and rely on. Small improvements in the use of technology, accelerating the access to Summary Care Records, direct access to GP appointments and teleconsultation can make a significant difference.”
Lack of mobile technology hampering transition to ‘paperless NHS’: Computing has reported that, despite government plans to make a ‘paperless NHS’ by 2018, most medical staff still rely on handwritten notes and word of mouth communication in order to share information. According to data obtained in a Freedom of Information (FOI) request by wireless technology company Spectralink, less than five years until the deadline for creating a paperless NHS, nearly two-thirds of medical professionals still rely on old-style documents, and pen and paper. The FOI request revealed that 61% of nurses still use handwritten notes, charts or verbal communication to share patient details, medication notes and discharge instructions. Meanwhile, 34% use electronic records to capture some patient details, but they can’t be accessed on the ward floor due to the need to access them through a desktop terminal. The figures are based on responses from more than 100 NHS trusts and none had any sort of mechanisms in place to check how long doctors and nurses need to spend checking information and replying to messages on a daily basis. Previous research suggested that 45 minutes per day is wasted on these activities, time which could be used helping patients. A paperless NHS is intended to cut costs by allowing staff more time to aid patients and the ability to do so in a quicker and more efficient manner. Digital records are also designed to cut errors when important patient information is being shared. “Nurses and other healthcare professionals play a critical role in our everyday lives and should spend the bulk of their time focused on delivering exceptional patient care,” said Simon Watson, director at Spectralink, the organisation which made the FOI request.
Junior doctors need help to understand healthcare IT: Junior doctors want to learn more about IT and health informatics, but don’t know where to turn for help, Building Better Healthcare reports. Dr Wai Keong Wong, organiser of the 2013 Digital Doctor Conference, said: “The premise of the conference was to help clinicians understand that technological change starts with them if they want to be able to change and influence health IT in their hospitals or practices. It is vital that clinicians engage with this if we are truly going to have a fully digital healthcare ecosystem.” Speaking after the event, he added: “We found that personal productivity skills such as being able to master email, work collaboratively and use RSS feeds are very valuable for those delivering healthcare. In addition, we have learned from this year’s conference that there is a willingness by clinicians to engage with the development of clinical IT at their workplaces, but that they need more support and training to do so effectively.” Dr Ed Wallitt, another of the organisers, spoke about how to turn health improvement ideas into concrete mock-ups and specifications providing a common language that both clinicians and software professionals can understand and relate to. The conference featured a patient panel for the first time, which proved to be extremely effective and helped to demonstrate that patients and doctors in secondary care share many similar frustrations and want the same thing from technology in healthcare.
Barts clinicians view GP data in Cerner: Barts Health NHS Trust is using Cerner’s Health Information Exchange to view a summary of patients’ GP records, embedded within its Millennium electronic patient record system, reported eHealth Insider. Hospital clinicians can see GP data showing the patient’s problems, diagnoses, recent medications and recent diagnostic tests. Patients must give explicit consent for staff to view their ‘community record’, though there is an exception in emergency situations. Around 70% of GPs in Tower Hamlets have agreed to share their data and sign-ups are also going well in Newham. Their information is shared via Healthcare Gateway’s Medical Interoperability Gateway. Only GPs using Emis are currently connected to the record-sharing project, which also allows them to view hospital information from their system. A number of GPs in the area use TPP, which has signed a contract with the MIG, but the functionality is still in pilot phase. Barts’ chief information officer Luke Readman said GPs can only see attendance data, but will get access to future appointments in January. “Over the years, the pressure has always been for hospitals to provide GPs with information electronically. There are not many examples where it’s a two-way exchange of data, so this is a paradigm shift forward in what we are doing,” said Readman.
NHS England ‘shouldn’t beg for money’: NHS England should not “become an agency that begs for more money for business as usual”, Sir Malcolm Grant has said. Several commentators have suggested the NHS would soon need more funding to pay for increasing demand and the maintenance of care quality, while efforts continue to make services more efficient. Sir Malcolm acknowledged that “if there’s [economic] growth it would be realistic to assume some proportion could be assigned to healthcare”. He told Health Service Journal (subscription required): “I don’t think it’s appropriate to start talking about additional funding until we’re absolutely clear we’re best investing the funding we’ve got.” Sir Malcolm also said the independent NHS board should consider the risk of the “needs of our ageing population” being “disproportionately charged to a younger generation”. He said he was “rather taken with the proposition that each generation should pay for its own healthcare”. He also said: “We’re not best investing resources in the best interests of patients at the moment.” In the past the NHS had “tended to invest very heavily and rightly in new technology and pharmaceutical products and new hospital premises,” he said. “We will be wishing to see some rebalancing in coming years, in relation to public health and prevention.”
CGI signs £62m IT services deal with London NHS trust: Central & North West London NHS Foundation Trust has signed a £62 million deal with CGI (previously Logica) to provide IT infrastructure services for the next five years, reported ComputerWorld UK. The deal will see CGI introduce enhanced mobile working capabilities for the trust, as well as more innovative, digital technologies. A contract notice outlines that as part of the deal the trust will receive service desk services, service management, data networks, desktops, laptops, end user devices, fully integrated unified communications, infrastructure, videoconferencing, printing services, ICT training, as well as implementation services. It also states that CGI must be capable of increasing the service provision to additional users by a factor of up to three times over the life of the contract. The trust currently has 5,200 end users and 5,500 staff working across 150 sites. It is expected that CGI will have the new infrastructure and service provision in place by the end of May 2015. “This is an exciting time for the trust. The appointment of CGI is a critical milestone in delivering a major ICT Strategy which will fundamentally improve the IT and systems we use,” said Trevor Shipman, finance director at Central and North West London NHS Foundation Trust.
‘Maggot-infested’ GP surgeries exposed by inspectors: Following the first national inspection of more than 900 GP surgeries in England the BBC reports that one in three is failing to meet basic standards. The Care Quality Commission (CQC) unearthed failings in some practices, many of which had been selected after concerns. It said it had found examples of poor standards in the handling of medicines and cleanliness and in nine cases the failings were so serious that they could “potentially affect thousands of people.” In addition patient records in many organisations were not being handled appropriately, the CQC said. These practices have been ordered to improve, although in one case new GP management has been brought in. The checks were targeted mainly at those practices deemed to be high risk ahead of next year’s rollout of the first national GP inspection regime. The CQC said it had found examples of emergency drugs being out of date and vaccines not kept in properly regulated fridges – something which could damage the effectiveness of the jab and cause outbreaks of disease. The regulator said some practices were “visibly dirty”, and in one of the better-performing practices, Dale Surgery in Sneinton, Nottinghamshire, inspectors found maggots. The details of a second practice where maggots were found have not yet been released. Pulse has also reported that the CQC is considering ‘OFSTED-style letters’ to patients of practices where it has found unacceptable failings or inadequate care, as the chief inspector for primary care unveiled the findings from its first 1,000 inspections and his plans for the regime from April 2014.
NHS job cuts harming patient care and safety, say staff: The Independent has reported that cuts to NHS jobs has harmed hospital care and patient safety, according to more than half of UNISON union members working in the health service. A survey of nurses, midwives, paramedics, and social care staff carried out by the union, which represents nearly half a million health sector workers, found that nearly two thirds had experienced staffing cuts in their department in recent months. Fifty-five per cent said they believed cuts had “significantly impacted on patient care and safety”. The survey also found that two in five NHS workers represented by the union believe the health service is at risk of privatisation. NHS bodies have made redundancies totalling more than 10,000 in the past three years, and the Royal College of Nursing has reported that then health service is operating with 20,000 fewer nurses than required, because positions vacated by staff retiring or moving on are not being refilled.
Opinion
Power to the people
This week, Paul Hodgkin, the founder and chief executive of Patient Opinion, reflects on the government’s industrialised feedback frenzy – and whether it will deliver for patients in the social world of the twentieth century.
Hodgkin discusses the political and managerial drivers for collecting data for the Friends and Family Test (FFT) before pointing out that patient engagement is key to valuable feedback: “To understand feedback in the 21st century you have to move beyond the mechanistic ‘feedback’ embodied in the FFT and see the human reality that lies beyond each data point. When people are typing their stories into Patient Opinion they don’t want to be ‘feedback’ they want to be heard. By a human. Preferably one that works in the team that looked after them.
“Sharing their stories online is becoming a way of defining themselves, of understanding what has befallen them in relation to the disease, distress and death that form the core business of the NHS.
“We have always made sense of these fell events by telling and re-telling these stories. In the age of democratised voice, we now do that in ways that are public. And since a key audience in this sense-making process is the staff who created the care I experienced, I want them, above anyone else, to listen and to respond.”
Clause 118 could mean the end of independent GP commissioning
This week in Pulse Today (subscription required), Dr Brian Fisher, a semi-retired GP in New Cross south London, and patient and public involvement lead for the NHS Alliance, says the Trust Special Administrator should not have the power to close or privatise hospitals.
“The NHS in England is faced with the prospect of wholesale reorganisation from above with virtually no accountability to CCGs or local people. The Government have added Clause 118 to the Care Bill: this will give a Trust Special Administrator (TSA), called in for a failing Trust, new powers to reconfigure services across a whole health economy.
“It allows fast-track closures – or privatisations – to happen to any hospital, however high quality, popular and solvent, if it has a more struggling hospital nearby. The Bill is going through Parliament now and the amendments, including this clause will probably be voted on in January or February.
“CCG independence is threatened. With a wider geographic area potentially affected, there is a requirement for all affected CCGs to be consulted. However, even if they disagree (which is highly likely, as we found) NHS England will still be able to make an overruling decision. So this means that CCGs’ ability to have any real say in services for their patients virtually disappears. And even if the Bill goes through, it may not even be possible to implement the TSA’s recommendations.
“There is vanishingly little consultation with the public – 40 days, hardly time to fix meetings. Local people will be confused. It will be very difficult for Healthwatch across a number of boroughs and Trusts to coordinate to discuss proposals which will affect a large area in complex and often unpredictable ways. GPs up and down the country are likely to be dragged into arguments and frustrations as solutions are imposed.”
Where does Dementia policy go next?
In Health Service Journal (subscription required) this week, Ben Nunn asks why national progress is stalling and challenges remain to get Dementia front of people’s minds.
“Tony Blair explained his priorities in three words: education, education, education. I can do it in three letters: NHS,” David Cameron told his party conference in 2006. While we can debate whether the prime minister has lived up to this statement, there is little doubt the health issue he has become most associated with tackling is dementia (a personal commitment other areas of disease are envious of).
“One of three pillars of David Cameron’s “Dementia challenge” is to improve research into dementia. This is arguably a pillar in which he can demonstrate immediate success, through doubling the UK’s investment in research by 2015 and celebrating the G8 summit’s outputs. However, the ultimate goal − an effective treatment or cure − remains out of reach for now. This is where the hopes of many people affected by the disease lie.
“Two years ago, MHP Health’s work with the Alzheimer’s Society found that the government’s reforms of the NHS, while hugely controversial, provided a real opportunity to improve care for people with dementia and their families. Today, Dementia is a key priority in the NHS mandate and all three outcomes frameworks; providers are rewarded for improvements in care through the national commissioning for quality and innovation, the quality and outcomes framework and enhanced service agreement; and two quality standards for dementia have been published. But national ambition has stalled, with a focus on diagnosis and a lack of incentives to prioritise care and support.
“The final element of the prime minister’s dementia challenge is making people and communities more “Dementia friendly” − a concept borne out of the World Health Organization’s age friendly initiative and David Cameron’s own attachment to the “big society”. But the initiative doesn’t appear to have yet captured the public’s imagination and is still some way from becoming the kind of social movement comparable with, for instance, Movember.”
Concluding, Nunn says: “Coming into this [G8] summit, David Cameron has two audiences to communicate with: an international audience in need of a leader to fight a global epidemic and a national audience that is still trying to understand what his personal challenge means for them.”
The NHS needs to welcome complaints and staff who raise concerns
When warning signs are ignored, minor problems can turn into crises, says Richard Vize in this week’s Guardian Healthcare Network.
“Complaints and compliments should be key drivers of reform in any NHS organisation. Services constantly alert to the experiences and views of their patients and staff will spot problems early, respond quickly and effectively, and welcome rather than resent criticism.
“When warning signs are ignored or not pursued, small difficulties will develop into crises. In the review by NHS England medical director Sir Bruce Keogh of the care provided by 14 trusts with high mortality rates, being slow to learn lessons when things went wrong and failing to drive change through the system were among the faults he identified. When staff did raise concerns they often did not know if anyone had taken action, and in some cases they felt uncomfortable about approaching managers.
“In the wake of the Francis inquiry, there was a widespread realisation that many boards were obsessing about finance while relegating issues around the quality of care to the end of their meetings.
“Improving integration between services is an obvious example of where patient insights can drive change. If someone writes to tell you that their hospital care was seamlessly co-ordinated with social services support and a home visit from their GP, it might be as well to investigate how all that happened and make sure it happens again.
“NHS services which welcome complaints, discuss them with an open mind and embrace them as an opportunity to secure a better experience for patients are likely to be confident, trusting organisations that value their staff and patients. Ultimately it is about distributing power – enabling those who both give and receive care to make the system better.”
Highland Marketing blog
With the festive session upon us, Myriam McLoughlin looks at Christmas party etiquette in this week’s blog!
