News in brief
NHS faces tight financial position at year end: The Department of Health’s (DH) overall financial position appears to be tighter in 2013-14 than it has been for a number of years reports Health Service Journal (subscription required). In recent years the DH has recorded significant surpluses, including an underspend of £2.2bn in 2012-13. However, the significant overspending by providers this year is believed to be putting significant pressure on the overall NHS and DH financial position. Non-specialist acute trusts and foundation trusts in England are forecasting a total net end of year deficit of £373m. NHS England predicted in its board papers this month that, while it will overspend against its own direct commissioning budget by £36m, NHS England and clinical commissioning groups (CCGs) will record a £702m underspend overall. The overall NHS and DH position will also depend on the DH’s own spending and that of other arm’s length bodies, such as Health Education England. King’s Fund chief economist John Appleby said it was likely providers’ deficits would be “balanced out” by CCG underspends. However, he said it was possible that nationally NHS finances were becoming tighter earlier than had been expected. Professor Appleby said: “I’m guessing that up at the national level the DH don’t have an awful lot of extra cash just lying around. A lot of those things will have gone. We’re entering the fifth year of essentially no real extra money for the NHS.”
EHI Intelligence forecasts IT growth: NHS spending on IT will increase over the next five years in response to pressures on the health service, according to eHealth Insider. This year’s market sizing, forecast and trends report, which looks at IT spend across the UK, says trusts in England will need to invest in software as the National Programme for IT comes to an end, and they look to improve efficiency and quality in response to financial and regulatory challenges. This will lead to increased spending on infrastructure, hardware and staff and – eventually – cloud services and outsourcing. EHI Intelligence collected actual and predicted spending figures from the majority of NHS trusts in England, and found they spent a total of £1.3 billion on NHS IT last year and plan to spend £1.4 billion in 2013-2014. EHI Intelligence forecasts that this will rise to £1.5 billion next year and £1.6 billion by 2016-2017, the final financial year covered by the report. SA Mathieson, senior analyst for EHI Intelligence, said he expects significant growth in spending on patient administration systems and the key departmental and clinical functionality that goes with them to create an electronic patient record. However, he noted that the legacy of the national programme means suppliers face a “complicated picture” in the different local service provider regions. EHI Intelligence also identified health secretary Jeremy Hunt’s ‘paperless’ agenda, the ‘Safer Hospitals, Safer Wards: Technology Fund’ and the Nursing Technology Fund as key drivers in energising the IT market in England. It notes that the situation is different in Scotland, Ireland and Wales, where more spending is determined nationally, and health boards often work from single framework contracts. The Market Forecast report details the split and identifies key elements of national spending in the devolved administrations for the first time.
Fresh squeeze on NHS pay sparks union strike warning: NHS staff have been told they will get a below-inflation 1% pay rise next year – but not if they are due to get an annual “progression pay” increase according to the BBC. About 400 top NHS managers will not get either a progression pay rise or 1%. Minister Danny Alexander said pay restraint was helping the public finances. But the Unite and GMB unions said they would consult members on taking industrial action. Unison’s Christina McAnea said it was a “disgrace that 70% of nurses and midwives will not even get a pay rise this year”. She also accused the government of conflating annual pay rises with the progression pay increments. “Increments are designed to reflect the growing skills and experience of nurses and other healthcare workers and are closely linked to competency,” she said. “They are not a substitute for the annual pay rise that is needed to meet the increasing cost of living.” However, in an interview with the BBC, health secretary Jeremy Hunt defended his move saying he would like to be more generous, but he was trying to avoid laying off staff.
Martin Severs appointed to HSCIC role: The Health and Social Care Information Centre (HSCIC) has appointed Professor Martin Severs as its Caldicott Guardian and lead clinician writes eHealth Insider. The move comes a month after the HSCIC was criticised for not having a clinician on its board, following the departure of Dr Mark Davies, its director of clinical and public assurance, who leaves at the end of the month. Professor Severs is a practicing consultant geriatrician and Professor of healthcare for older people at the University of Portsmouth. He is also a well-known health informatics expert, both in the UK and internationally. Professor Severs leads on health information for the Royal College of Physicians and chairs the information advisory structure of the Academy of Royal Medical Colleges. He led the Information Standards Board for Health and Care in England for more than a decade, until its roles were divided up among some of the new, national bodies being created for NHS IT. Professor Severs also designed, set up and chaired the International Health Terminology Standards Development Organisation until 2012. He was also the clinical lead on Dame Fiona Caldicott’s second review of information governance, which reported last year. In a statement, Professor Severs said: “I am delighted to take up what will be a challenging role, but one that offers the opportunity to ensure best practice and foster public trust. It is important that clinical experience and expertise plays a key part within the leadership and development of the HSCIC as it continues to evolve and support the health and social care system.”
More than a third of hospitals set to end year in the red: More than a third of hospital trusts are predicting deficits at the end of this financial year, according to Health Service Journal (subscription required). Data collected from trusts shows 54 of the 141 non-specialist hospital trusts in England are expecting to end 2013-2014 in the red. Hospitals appear to be in a significantly worse position than they were last year. At the end of 2012-2013, 22 trusts reported deficits with Monitor or the Department of Health. The net total forecast deficit of the 141 hospital trusts for this year is £373 with hospital bosses and finance experts saying the difference was due to increased spending on staff in the wake of the Francis inquiry, financial penalties on trusts and the end of “transitional support” funding from strategic health authorities. Eleven trusts predicting deficits of £20m, with another 43 trusts forecasting smaller shortfalls. Monitor and NHS England also said “as a priority [they were] gathering and analysing further evidence to underpin reform of the funding for urgent and emergency care generally”. A Trust Development Authority spokesman said plans were in place to turn around trusts predicting a deficit but “in some instances [this] will only be achieved in the medium term”. He said proposals would be developed in trusts’ five-year plans, due to be submitted in the summer.
NHS England releases budgeting tool: Commissioners 2012/13 programme budgeting data has been released by NHS England as an interactive tool reports The Commissioning Review. NHS England hopes that the information will allow NHS organisation to compare their spending on different services and settings with other commissioners with the data could be used to make “evidence based investment and prioritisation decisions”. NHS England has suggested that clinical commissioning groups and commissioning support units could include the information into their strategic planning work. An NHS England statement reads: “NHS England is committed to giving commissioners practical support in gathering data, evidence and tools to help them transform the way care is delivered for their patients and populations. The principles of programme budgeting directly support this commitment, promoting clinically led commissioning and patient involvement by providing financial information across disease areas, also known as ‘programme categories’. The programme budgeting collection provides a framework for estimating NHS expenditure across these programmes categories covering the whole care pathway.”
Trusts need two years’ extra XP support: eHealth Insider reports that trusts will need an extension of Windows XP support for up to two years in order to migrate safely on to a newer operating system, NHS IT experts have said. Microsoft is due to end support for XP on 8th April 2014, leaving system users open to cyber-attacks as there will be no more security patches, software updates or bug fixes for the software. But experienced NHS users say that rushing through an upgrade project would do more damage than the risk posed by hackers. Head of IM&T at University Hospitals Bristol NHS Foundation Trust, Andrew Hooper, said news of a national extension for the NHS came as a surprise. The trust will have largely completed its migration off XP on to Windows 7 by the time support runs out in April after starting the migration three to four years ago. Hooper said: “The way we did it was the best and easiest way because if you have 5,000 PCs and you migrate them all to Windows 7, you are talking about a massive amount of work and the pain and agony that would go with having to do it quickly.” The trust’s support services manager, Simon Jones, said the trust started the process by replacing old machines with new PCs running on Windows 7. Both agreed that larger trusts that have not begun migrating would need up to two years of extra support. Jones Said: “I would like to say a year, but for those trusts larger than ours you would need support for one to two years. You need to do it in a very controlled fashion, you need some sort of plan of what to tackle and when and even then it’s a constant battle.”
King’s Fund: Ageing society demands a ‘fundamental shift’ in healthcare delivery: A fundamental shift is urgently needed in the delivery of health and care to meet the challenges of a rapidly ageing society, says a new report from The King’s Fund. The report, ‘Making our health and care systems fit for an ageing population’, argues that health and care services have failed to keep up with dramatic demographic changes, which will see one in five people in England over the age of 65 by 2030. According to Integrated Care Today, the report finds that transforming services for older people will require a fundamental shift towards care co-ordinated around individual needs rather than single diseases, and that prioritises prevention and support for maintaining independence. The report also offers practical advice, evidence and guidance for service leaders to provide high-quality care in each area. David Oliver, Visiting Fellow at The King’s Fund, said: “The health and care systems have a long way to go to adapt to the twin challenges of an ageing population and tighter funding. Many local service leaders are transforming services for older people, but we urgently need to see their experiences spread more widely. But marginal change will not be enough; transformation is needed at scale and at pace.”
NAO raises social care alarm: The National Audit Office (NOA) has raised questions about whether the government’s drive to integrate health and social care will save money and improve services reports eHealth Insider. In a report on ‘Adult Social Care in England’ the NAO says pressures on the care system are severe and increasing. Councils are spending less on social care just as demand is rising, particularly among the growing proportion of over-85 year olds in the population. This is leading councils to restrict what help is available to those with ‘severe’ and ‘critical’ needs, and putting what the NAO warns “may be unsustainable pressure” on carers and acute health services; where they can show up as A&E attendances and delayed discharges. The watchdog, which reports to the Commons’ public accounts committee, says “national and local government do not know whether the care and health systems can continue to absorb these cumulative pressures, and how long they can carry on doing so.” It also warns that the mantra of integrated care, which is being supported by a £3.8 billion Better Care Fund, is unproven and may increase pressures in the short term, because £2 billion of this money has been taken from acute budgets.
Four South trusts tender for ePMA: Four southern acute trusts have tendered for an electronic prescribing and medicines administration system worth £5m-£7m, backed by central funding reports eHealth Insider. The seven-year contract will see one ePMA system delivered to Salisbury, Poole Hospital and Royal Bournemouth and Christchurch Hospitals NHS foundation trusts, and Portsmouth Hospitals NHS Trust. The ePMA group is the fifth to go to tender from a total of six acute collaborations formed as part of the Southern Local Clinical Systems Programme, which was set up to support trusts that received nothing from the National Programme for IT. Each of the four trusts in the collaborative will enter into separate contracts, with a total estimated value range of £5m-£7m, including support and maintenance. Peter Gill, director of informatics at Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, which is leading the tender process, said all four trusts had a similar vision of using ePMA to improve quality and safety. Gill said: “The intention is that there will be a closed loop, from the idea of prescribing occurring to a doctor to a drug entering somebody’s body, with all the information between these two points captured and auditable.” The government has approved more than £80m of central funding for the six acute groups in the Southern programme, which predates the Safer Hospitals, Safer Wards approach and technology funding, which have put a significant emphasis on e-prescribing.
Events
UK Trade & Investment and NHS England work in partnership to organise a UK SME delegation to Health Datapalooza: Health Datapalooza is a US national conference focused on liberating health data and bringing together companies, start-ups, academics, government agencies and innovators to discuss the latest and most effective uses of health data to improve patient outcomes. The event, which takes place in Washington, D.C. on 1-3 June 2014, is expected to attract over 2,000 attendees and provides the perfect opportunity to network with key Health IT industry leaders from both the U.S. and abroad. To register your interest please complete the application form before 5pm on 20th March 2014.
HC2014, 19-20 March, Manchester Central: Visit Highland Marketing on stand P4 to see how we can help you keep your marketing healthy! You can catch up on all the action from the event on our livestream.
Opinion
A bland euphemism which hides a dangerous lack of planning
In Health Service Journal this week (subscription required), Andy Cowper, discusses Clause 119 which shows recognition that a system without planning faces a whole new range of problems that may waste public money without improving patient care.
“One of the finest euphemisms in management speak is “right-sizing”. It’s as bland a euphemism for sacking people and shutting things as you could hope to find. There are several problems with right-sizing healthcare provision in the way that the new failure clauses being debated in [Wednesday’s] Care Bill reading would permit if they pass.
“While there is clear evidence of quality improvements with certain volumes of clinical procedures – a fine summary of which was given at the Nuffield Trust’s Health Policy Summit last week by Dr Barbro Friden, chief executive of Sahlgrenska University Hospital in Sweden – we lack convincing evidence of the secretary of state’s or the Department of Health’s capacity and capability to know what the right size for a provider is.
“This year the problems and financial climate are quite different. And where a health economy has what some see as an oversupply of troubled providers, then the logic of the act – which also brought in a clear failure regime – tells us that the market should decide.
“There are reasoned arguments that provider diversity and competition at the margins for elective care have useful roles to play in providing some challenge to major incumbents. Yet we see in the desire for clause 119 that even those like the secretary of state – who voted for the act – have since recognised that a system without planning faces a whole new range of problems that may waste public money without improving the quality of patient care.”
Safer wards and safer hospitals through harnessing technology
In her latest blog, Beverley Bryant, director of strategic systems and technology, NHS England, discusses creating safer wards and safer hospitals through harnessing technology.
“We have a strong track record in developing and using new medical technologies to revolutionise the way we care for and treat patients – the thermometer, diagnostic ultrasound, the MRI scan, the ophthalmoscope used to examine our eyes – to name but a few. All developed or invented by British innovators and used across the world to deliver healthcare to millions of people every day.
“The NHS is good at harnessing new medical technologies and techniques but this is only half the story.
“Technology is not just about treatment techniques or procedures. Technology is also crucial to safer, better care.
“Technology helps protect patients by making sure details of their care are available to doctors and nurses at the click of a button. And it makes a patient’s journey through different parts of the NHS much safer, because their records can follow them electronically wherever they go, with doctors and nurses able to see up to date information about patients, their medications and their history at the point of care.
“With NHS England’s aspiration for all patient records to be available by 2015, the most important things is the systems adopted must enable secure sharing of data and comply with requirements for modern, safe standards of record-keeping.”
How can the NHS tackle its innovation deficit?
In this week’s Guardian, Michael Macdonnell, head of strategy at NHS England, reflects on a study by Nesta focusing on the diffusion of specific innovations between GP practices.
Macdonnell identifies three insights from the report which significantly impact health policy. The first is that there is an innovation deficit in the NHS, secondly adoption of innovation is a social process, and thirdly, scale matters.
On these insights, Macdonnell said: “Nesta’s work shows that informal networks may have a more powerful effect than Nice recommendations. Indeed, a number of practices were prescribing the innovative drugs before Nice formally recommended them. This suggests we should invest in networks and learn how to accelerate their metabolism.
“This approach is akin to what’s called a “platform strategy” in other industries. A well-known example is Apple’s App Store, which provides others with the environment to build products and services, and to co-create value. In a similar fashion, national bodies like NHS England should focus on creating the environment, infrastructure and incentives to enable providers and patients to co-create better ways of delivering care.
“Nesta’s work also has potential implications for the shape of healthcare providers. If innovation requires a minimum infrastructure, then this is still more evidence that healthcare – primary care in particular – should no longer revel in being “the world’s largest cottage industry”, to quote incoming NHS England chief executive Simon Stevens.”
A&E performance: a winter’s tale
This week The King’s Fund director of policy, Richard Murray, discusses how A&Es performed over the winter and what, if anything it tells us about the state of the NHS and its prospects.
“First, and critically, despite the many harbingers of doom, winter 2013-14 has been remarkably short on ‘A&E in crisis’ headlines, at least at a national level (not forgetting that local variation means there are still hospitals operating consistently below the target). With due credit to the hard work of NHS staff and the hours spent on planning, A&E performance this winter is better than it was last year, and unless the weather takes a turn for the worse, March and April are likely to continue this turnaround.
“So was the relative success of this winter due to new schemes helping people to manage their care better at home without a hospital admission? Or indeed, once admitted, to be sent home without delay once they are ready? Well, the answer seems to be no to both on the evidence available so far.
“The planning guidance issued by NHS England and its national partners noted that in 2015/16 the NHS will need to reduce emergency activity by 15 per cent as a consequence of supporting social care and its integration with health through the Better Care Fund. With that in mind, coming through winter 2013-14 with growth rates in emergency admissions of +4 per cent just underlines how much still needs to be done to reduce emergency admissions and to get patients discharged quickly once they have been admitted. Our own work on this has shown the potential for reductions in admissions, but this is no easy ask. So while congratulations are in order for making the ‘old model’ work rather better than it has done recently, this still leaves next winter looking as hard as ever and the (never great) odds on delivering fundamental change by the following year ever slimmer.”
Highland Marketing blog
In this week’s blog, Matthew D’Arcy explains why the health service needs to become less complicated.
