News in brief
NHS pressure worsens as key targets missed: The NHS is missing many of its key targets with more patients getting stuck in hospital, latest figures show. Data from NHS England showed in September the health service missed its A&E target to see, treat or discharge patients within four hours, reported the BBC. Performance also fell short on access to cancer treatment, diagnostic tests and ambulance response times. To make matters worse, hospitals have been struggling to get patients out when they are ready to leave. A snapshot taken on the last Thursday of September showed more than 5,000 patients in England were occupying beds, even though they could have been discharged. This was the worst level since records began in 2010 – with the rise in delays over the past few months largely driven by problems accessing social care services, such as help in the home. On almost every measure, the NHS in England is in a worse position than this time last year.
22 point plan for NHS digital adoption: A high-level report on NHS IT by management consultants McKinsey makes 22 recommendations to drive the adoption of technology and achieve the anticipated productivity gains; many of which have already become policy, reported DigitalHealth.net. The report was commissioned by NHS England’s Patients and Information Directorate to inform strategy and underpins its bid to the Treasury’s spending review for up to £5.6bn national strategic investment in NHS IT. It contends that the funding gap of £30bn that is projected to open up in NHS finances by 2020-21 could be reduced by 30% with the technological interventions outlined; but that investment totalling £7.3bn to £8.2bn will be needed when training, adoption and running costs are taken into account. NHS England’s director of digital technology, Beverley Bryant, has said that any further technology funding will be linked to an organisation’s local digital road map and digital maturity, measured through a new “digital maturity index” and to unspecified “meaningful use” criteria. McKinsey says there should be a review of the standard acute contract to incorporate digital requirements, such as requiring all patient data to be linked to the NHS Number. Use of the NHS Number as a single patient identifier across health and social care became law last month, however it is not yet included in the standard acute contract; except in regard to discharge letters. The 22 recommendations also include the accelerated adoption of health apps and risk stratification of the population to target high-risk individuals and families.
NHS needs other sources of revenue to survive, says ex-regulator: The NHS cannot survive as a purely taxpayer-funded service and will have to look for other forms of revenue, such as co-payments and top-up insurance, if it is to meet future demand, one of its most influential figures has said. David Bennett, until just over a week ago head of Monitor, the hospitals regulator, said Britons were “close to the limit” of what they were prepared to pay in tax, reported the Financial Times (subscription required). His comments will raise the stakes before this month’s spending round, as Simon Stevens, chief executive of NHS England, and Jeremy Hunt, the health secretary, attempt to secure a substantial down payment on an extra £8bn-a-year promised to the NHS no later than 2020. Simon Stevens raised fears that the government’s forthcoming spending review may not deliver a “workable” funding settlement for the NHS, as he called for budgets for social care to be protected from cuts, reported The Telegraph. The government has promised to increase health service funding by £8bn a year by 2020. Stevens has previously called for “front-loading” of the money, with a greater share of extra funding being made available early, to manage current pressures while changing services to cope with resigning demand. The NHS has racked up a deficit of almost £1bn in the first three months of this financial year, the worst in a generation, and more than the £820m reached the previous year.
All 154 NHS acute trusts in England are now GS1 UK members: GS1 UK has announced that all 154 NHS acute trusts in England are now registered as GS1 UK members, as mandated by the Department of Health’s (DH) strategy, reported Building Better Healthcare. The use of GS1 standards enable the NHS to shift towards integrated, patient-centric care provision, resulting in improved patient outcomes, significant efficiencies, and reduced errors. GS1 UK is now working with the DH, NHS in England and industry to ensure GS1 standards are implemented. The use of GS1 standards in the NHS is reinforced by the recent interim Carter Review, which states that the introduction of GS1 standards will allow every NHS hospital in England to save an average of £3m each year, while improving patient care. Glen Hodgson, head of healthcare at GS1 UK, said: “We are delighted that every NHS acute trust in England is now registered as a GS1 UK member. By using unique identification standards everywhere along the patient pathway it is possible to increase efficiency and significantly improve the quality and safety of care. We are working closely with the Department of Health and trusts to ensure the adoption and implementation of GS1 standards is just as seamless.”
Looming care collapse will add £3bn to NHS costs – think tank: The NHS will have to cope with an extra £3bn pressure as struggling care homes face the prospect of losing up to 37,000 beds over the next five years, a think tank has said. The ResPublica Trust argued that an imminent care collapse would force the NHS to care for patients forcefully removed from residential providers. It compared the imminent crisis to the 2011 collapse of the massive care homes operator Southern Cross Healthcare, reported National Health Executive. The think tank’s director, Philip Blond, said: “When Southern Cross failed, the private sector stepped in and cared for those left homeless. Now, however, with the sector losing money for every funded resident, there is no provider of last resort. We fear the worst case scenario is the most likely, that these residents will flood our local general hospitals costing £3bn per year by 2020.” The 37,000 beds at risk in the sector would represent 28% of all available NHS beds, which are already suffering from shortages as it is. The organisation estimates that the residential care sector will need another £1.1bn by the end of this Parliament to meet soaring demand. One-third of this figure would be needed to cope with the rise in staff pay because of the government’s national living wage, set to come into effect from April 2016. Emily Crawford, author of the think tank’s report on the care home crisis, said: “The national living wage is a great step forward. It is estimated it could help more than six million low-paid workers. But for the care sector, which is heavily reliant on its labour force, it could be catastrophic.”
Existing NHS indicators deemed inadequate for vanguards: National leaders have judged many current datasets to be inadequate in their current form to judge the success of the new care model vanguard sites, reported Health Service Journal (subscription required). The new care models team have decided to develop a new set of centrally reportable performance metrics over the coming months. The team, through which central NHS bodies are supporting vanguards, has launched a “dashboard” of metrics to track the effect of new care models on performance and outcomes. It currently only contains two metrics, as many other nationally reported measures do not adequately measure the performance of integrated care systems. The first version of the dashboard was circulated to vanguards late last month, with data on emergency admissions and bed days for each site. For vanguards trialling enhanced health in care homes, the emergency metric will be non-elective admissions for people over 65. These will be added to over the coming months as additional metrics are developed. A full set of around 18 measures is planned to be in use by April. Eventually, the complete dashboard is expected to form the basis for a new payment system for integrated providers. Accountable care organisations responsible for a defined population could be given capitated budgets with incentives attached to performance against a set of outcomes, which these metrics could measure.
Seven health boards miss A&E targets: Accident and emergency departments in Scotland’s hospitals have missed a key waiting time target, with seven health boards falling short, reported The Scotsman. A total of 93.9% of all patients were seen and either admitted, transferred or discharged within four hours in the week ending November 1, below the Scottish government’s interim target of 95%. NHS Ayrshire and Arran had the poorest performance on 87.6%, while Borders, Fife, Forth Valley, Greater Glasgow and Clyde, Lanarkshire and Lothian health boards also missed the standard. The lowest ranked accident and emergency site was University Hospital Ayr (83.7%), with Glasgow’s Queen Elizabeth University Hospital also lagging on 86%. Performance at Scotland’s newest hospital has improved from a record low of 77% in October but has consistently fallen below the 95% target. Labour’s public services spokeswoman Jackie Baillie MSP said: “The problems at this £850m flagship hospital are now quite clear. It is seriously struggling to hit A&E targets in the autumn, which does not bode well for patient care in the winter. We are hearing stories of staff in tears and sick with stress. This is not what our NHS in 2015 should look like.”
Hospitals and agencies come together to make Greater Manchester international centre for dementia treatment: A revolutionary vision to make Greater Manchester the international centre for dementia treatment has been unveiled. Salford Royal hospital, the Alzheimers Society and the region’s devolved health and social care team are joining forces to make the disease a top priority. Dementia United aims to make Greater Manchester the ‘go-to’ place worldwide for the best in dementia care, reported the Manchester Evening News. Housing providers, blue-light services, mental health trusts, transport bodies and cultural organisations are coming together to transform the lives of those with the disease. Salford Royal chief executive Sir David Dalton, who will be leading the drive, said it was an “incredibly ambitious” project. “It will support people to live, full, active and meaningful lives,” he said. “To do this we believe that we will need to change everything, from the transport systems, emergency services, shops and workplaces, and health and social care.” Part of the project will concentrate on early diagnosis, as well as improving support after diagnosis – but also creating “dementia friendly” communities. Salford has long been considered a trailblazer for dementia care, partly driven by ex-Salford and Eccles MP Hazel Blears.
E-discharge: unmonitored target defended: The October target for all providers to send discharge letters electronically is not being monitored nationally, but has focused attention on the need to make the process paperless, supporters have argued. NHS England head of enterprise architecture, Inderjit Singh, told DigitalHealth.net in July that NHS providers must send discharge summaries to GPs electronically by October this year. The requirement is part of the NHS standard contract, but no figures are available on how many trusts are complying. The ultimate aim is for structured, coded discharge summaries, with agreed clinical headings, to be distributed electronically within two years. Singh said more recently: “The main point to keep in mind is the end goal of being able to share structured, coded discharge summaries, aligned with agreed clinical headings, which we know will lead to improved patient safety and experience. The initial focus on completing discharges electronically for acute or day care patients transferring from hospital to the care of their GP is the first step on this journey.” Questions about e-messaging are included in the new digital maturity assessment, sent by NHS England to all providers this month. Due to be published in March, the “digital maturity index” will give the first indication of whether the e-discharge target is being achieved.
NHS children monitored using McLaren Formula One technology: Children in an NHS hospital have become the first in the world to be monitored using the same technology developed by the McLaren Formula One team for its drivers, reported The Telegraph. The Real-Time Adaptive and Predictive Indicator of Deterioration project (Rapid) continuously records heart rate, breathing rate and oxygen levels, to provide early warning signs of the problems. It is being trialled at Birmingham Children’s Hospital and is the first of its kind in the world. Health experts said the new technology would transform healthcare, save lives and reduce time in hospital. Wireless sensors are attached to the chest and ankle to measure vital signs which are processed using McLaren’s own data analytics programme. Usually vital signs are monitored by nurses and recorded on paper charts every one to four hours, but the new technology could free up staff while alerting them immediately to changes in the body. Dr Heather Duncan, Birmingham Children’s Hospital intensive care consultant and Rapid study lead, said: “This technology is truly transformational. For the first time it allows us to analyse patients’ data in real-time in the same way that various other high-risk industries have done for years. The ability to track and identify deterioration towards a cardiac arrest will give doctors earlier warning signs and the chance to save lives. I genuinely believe this will change the way we care for patients in hospitals forever.”
NHS 24 completes operational system transition: The unscheduled care component of Scottish telehealth organisation NHS 24’s new operational system technology has now gone live after its launch was delayed last month due to unspecified technical difficulties, reported Government Computing. NHS 24 said the unscheduled care service dealt with over 10,000 calls over the weekend having been switched to the new technology platform earlier in the month as part of a rollout across Scotland. Initially planned to launch in 2013, the new technology platform that is designed to modernise the organisation’s core telephone and online technology had been delayed indefinitely, leading to heightened scrutiny of its implementation. By the end of October, the platform went live supporting a number of care functions, although the final addition of unscheduled care services was pushed back until November to address concerns about service stability at peak times. “The successful move for the unscheduled care service completes the transition for NHS 24 services with mental health support and health information advisors operating on the new platform,” said a statement from the organisation. “A technical issue prevented the out of hours service switching at the same time, but this has now been resolved and no further issues reported.” The organisation claimed that the system will serve as a platform that can allow for development of new health and care services for the NHS in Scotland, while ensuring staff are able to access relevant information on a patient.
Intermediate care services “must double” to meet demand ahead of winter crisis: Although essential to the successful development of new models of care, intermediate care services are deteriorating nationwide, with older people waiting up to 9 days to get some kind of help, reported National Health Executive. The National Audit of Intermediate Care (NAIC) has launched its fourth annual report, but its content shows the future is bleak. The auditor has highlighted increasingly limited capacity to deal with intermediate care in the NHS, meaning patients are waiting longer times than ever before. Waiting times now average three days for bed-based care, 6.3 days for home-based services and 8.7 days for reablement, which is vital to get people back on their feet after an injury or illness. John Young, NHS England’s national clinical director for integration and frail elderly, said: “Intermediate care services act as a critical sense check of whole system integrity and performance for ‘at risk’ older people. Yet they remain curiously invisible to commissioners, managers and the general population. The success, or otherwise, of the new models of care, and other current whole system initiatives, will depend upon capacity building in the intermediate tier. This year’s NAIC reveals why we need to bring these services out of the shadows: it’s imperative that decision-makers heed and respond to its findings.”
EMAS looks at NHS spine patient management integration benefits: Ambulance service expects introduction of new patient management system to its existing technology will help further curb unnecessary call out rates, reports Government Computing. East Midlands Ambulance Service (EMAS) said it expects to expand the number of calls it can deal with remotely by integrating a new patient management system called Adastra into its clinical support technology to streamline access to NHS Spine services. Designed by Advanced Health and Care, the management solution will integrate with the company’s Odyssey clinical support system – currently in use by EMAS – so clinicians responding to emergency calls can have automatic access to NHS Spine services like a Summary Care Record. EMAS has claimed that it has so far saved £40m from using the clinical support system to manage 999 calls, reducing the number of ‘unnecessary ambulance’ journeys by 116,000 annually as a result of implementing Odyssey ten years ago. According to the ambulance service, 16% of the estimated 2,000 daily emergency calls received are being responded to with telephone advice, amounting to a daily reduction of 320 ambulance journeys. EMAS service improvement manager Neil Spencer said: “Accessing all the Spine services individually can be time consuming and inefficient as it means logging in and out of each service’s website. With seamless access to those services clinicians will have all the information they need at their fingertips, allowing them to quickly complete a thorough, accurate assessment of the patient and provide a tailored response.”
Mental health cuts “put lives at risk”: Cuts to adult mental health services in England have started damaging the quality of care given to patients, a report suggests. The review by The King’s Fund think tank found there was now “widespread evidence of poor quality care”, reported the BBC. Researchers linked this to the use of unproven, cheaper services in a bid to balance the books. One mental health charity says “disappearing” services are putting lives at risk. However the government said the amount of money being made available for mental health had been increased overall. The review also pointed to growing evidence that there was inadequate support for those with severe problems. It said only 14% of patients had reported receiving appropriate care in a crisis, while hospital bed occupancy rates were routinely exceeding recommended levels – leading to patients being sent to units many miles away from their home. The think tank looked at official data and previous research as well as carrying out its own analysis to come to its conclusions. It warned that many of the changes now being made to help trusts cope with cuts to their budgets – four in 10 have seen their income drop in the past year – represented a “leap in the dark” because of a lack of evidence they would work.
New Zealand hospitals use electronic system from UK specialist healthcare system supplier: Canterbury and West Coast District Health Boards (DHBs) in New Zealand are set to implement a new digital patient observation and alert response system, aimed at helping clinicians identify deteriorating patients earlier. The Patientrack system will be introduced from November and is designed to make patient observations immediately visible to clinical teams anywhere through hospital information systems, reported eHealthNews.eu. Susan Wood, director of quality and patient safety, for Canterbury and West Coast DHBs, said Patientrack uses the patient’s vital signs to calculate the Early Warning Score (EWS) and automatically sends alerts to the appropriate clinicians. It will track more than a million patient observations, which are currently recorded on charts in 10 hospitals throughout Canterbury DHB and West Coast DHB every year. “Replacing paper-based EWS with a broader suite of automated assessment and communication tools will reduce error rates and improve work flows, allowing clinicians to dedicate more quality time with patients, and ultimately reduce the number of adverse events,” said Wood. “Electronic capture of patient data will give our teams improved visibility of EWS, enabling more timely review and follow up of patients.” Donald Kennedy, managing director at Patientrack, said: “Patientrack has a strong record in the UK in helping doctors and nurses to respond to patients quickly and appropriately when they need it most. It is really positive news that 10 hospitals in New Zealand will start using Patientrack in a matter of weeks. The fact that clinical staff who use Patientrack also share ideas and innovative ways of applying the technology through a dedicated user group, means that this is also a great opportunity for international collaboration in improving patient safety.
Vodafone app turns your smartphone into a powerful cancer research machine: Smartphones contain processing power that would only be found in the most expensive supercomputers a few decades ago. Combined, they can in theory create a network that can crunch huge amounts of data. That’s the theory behind a new Android app from Vodafone that says it wants to use a network of thousands of smartphones to help research cancer, reported The Telegraph. The mobile network company’s Australian unit has launched DreamLab, which it says will allow users to “donate” their smartphone’s processing power while their owners are sleeping. When a phone is plugged in and fully charged, it is sent a tiny genetic sequencing task by Australia’s Garvan Institute of Medical Research to solve. When it is completed, the data is sent back to the Garvan Institute, which can use it as part of their research. Users can select what project they want to contribute to, whether it is breast cancer, ovarian cancer, pancreatic cancer and prostate cancer. According to Vodafone, 1,000 smartphones using the app can speed up research by 30 times. While an Australian initiative, the app is available in the Google Play Store in the UK. “Medical research is the key to solving cancer, but one thing slowing progress is the limited access researchers have to supercomputers to crunch their complex data. That’s where DreamLab comes in,” the Garvan Institute said.
Virgin Care wins £64m community child health contract: Virgin Care has won a five-year, £64m contract to run community child health services in Wiltshire, reported Health Investor. They will be responsible for the provision of children’s specialist community nursing, health visiting and speech and language therapy. The services are currently being provided by five NHS providers. However, Wiltshire Clinical Commissioning Group, NHS England and Wiltshire Council believe that moving community service provision to one operator means patients will have “access to consistent and equitable levels of service and support regardless of where they live in the county”. The contract commences in April 2016. Jayne Carroll, regional director at Virgin Care, said: “Staff working in areas affected by the change to the community child health services provider will continue in their current role with the same employment terms and conditions, but will be employed by Virgin Care as of April 2016. The changes made will help children’s community health services in Wiltshire to continue to meet its statutory duties in relation to safeguarding and new responsibilities in relation to children and young people with a special educational need or disability.”
Opinion
Can the NHS bank on IT for productivity gains?
NHS England is bidding for billions of pounds in IT investment to improve NHS productivity. If it succeeds, a McKinsey presentation obtained by Digital Health News shows that it will be required to deliver on a scale never before achieved, writes editor Jon Hoeksma.
“Against the background of one of the toughest spending reviews ever, the Treasury is being asked to consider a multi-billion pound investment in NHS IT.
“A report from management consultancy McKinsey, obtained via the Freedom of Information Act by Spinwatch, argues that this would drive health service productivity.If agreed, it would certainly demonstrate a strategic commitment to NHS modernisation and sustainability. However, if the Treasury were to commit anything like the additional £3.3bn to £5.2bn, the NHS would be required to deliver.
“The report suggests this investment – which, with training, adoption and running costs could reach £7.2bn to £8.3bnover five years – should deliver efficiency savings of between £8.3 bnand £13.7bn. Or, to put it another way, as much as a third of the projected NHS funding gap of £30bn by 2020-21.
“In many ways it is a testament to the standing and influence of Kelsey and Bryant that a new national programme of investment is even a possibility, just five years after the national programme was declared over by the incoming coalition government.
“But if we are at the dawn of a new round of national investment in NHS IT we should not be surprised if it comes with conditions. And having to realise productivity savings through very significant investment in IT is a problem that the rest of the public sector would jump at.”
Capacity, culture and collaboration: a formula for delivering the NHS Five Year Forward View
Suspicion, poor relationships, unhelpful competition – there are many opinions on why the NHS Five Year Forward View is being held back. But there is a way forward, says Anne Crofts, a partner at DAC Beachcroft.
“Two-thirds of NHS leaders state that there is insufficient leadership capacity and a distinct lack of collaboration between organisations, preventing them from realising the vision of the NHS Five Year Forward View.
“According to DAC Beachcroft LLP’s ‘Understanding the Barriers to Innovation’ research, in order to create real change around new models of care, organisations currently lack the resource and inclination to work in partnership within the current system.
“Another constant theme throughout the survey is the simple lack of time and opportunity for leaders to think strategically, with one writing: “It feels as though change is constant and there is no time for review or reflection… It was widely reported that leaders do not have the ability required to make the necessary organisational changes, whether through insufficient capacity to do so, or lack of direction from above.
“Of equal importance were “short-term operational pressures” and a “lack of clear vision and mission”. Some cite the onerous task of balancing the attentions of government bodies and regulators as a major barrier, whilst others state a lack of guidance. In both cases, there is a distinct feeling of a lack of empowerment for leaders, with many short-term pressures, no clear deliverables from the centre and a disordered balancing of regulatory, operational and financial burdens. It is a hard task for the most resource-rich and supported leaders.
“Many organisations understand what needs to be done, but require the guidance, capacity and skills to get there. And although many leaders are rather unconcerned about the legal frameworks needed, so caught up are they with overcoming cultural barriers, these frameworks can act as a lever in overcoming them. They are a great way to get people talking, and to try out what is possible in a relatively benign environment.”
Older people need healthcare closer to home – not in hospitals
Overcrowding in hospitals is largely due to “gross shortfalls” in other forms of home based and residential care, writes Mark Newbold on the Guardian’s Healthcare Network, this week.
The former acute trust chief executive, turned chair of NHS Confederation’s commission on improving urgent care for older people, says this means patients are often either unnecessarily admitted to hospital or are subject to delays in leaving.
“This insufficient provision of support in community settings is not in the best interests of patients. Acute hospitals are set up to treat the acute phase of illness, and older people in particular are at risk of losing independence and suffering complications such as chest infections if they stay in hospital for longer than necessary.
“This service imbalance was a major challenge for me and it is why I took up my current role as chair of the NHS Confederation’s commission on improving urgent care for older people. This work is focused on finding practical solutions that are locally based and tailored to people’s needs. We will report early in 2016.
“The commission has been looking at innovative practice around the country. Excellent frontline clinical leadership is behind initiatives in hospitals such as Sheffield and the Royal Berks, while the Age UK Pathfinder Project is demonstrating the impact care co-ordinators can have in patient care and bringing services together. In the south-west, the role of the ambulance service has been broadened, to great effect, and Oxford Terrace and Rawling Road surgery in Gateshead have mobilised the local community to provide a range of options for people who are better served by support that isn’t necessarily medical.
“We have visited numerous local health systems and found common themes and opportunities emerging. There is evidence that nominating leadership roles within local clusters can drive innovation, compensating for the inertia of so many organisations trying to work together.”
Highland Marketing blog
In this week’s blog Chris Marsom says that the key to eHealth communication is to ‘keep it simple, stupid’.
