News in brief
NHS suffers worst month in six years despite mild winter: The National Health Service recorded its worst monthly performance for six years in February, despite a mild winter and the absence of a flu epidemic. Experts seized on the figures as the latest evidence that years of straitened funding — for social care, as well as health — are taking an increasing toll on the NHS, reported The Financial Times. NHS England data for February showed that only 87.8% of patients were seen within four hours of arriving at an accident and emergency department, against a target of 95%. This is the worst performance since the current measure was introduced in 2010. There were more than 157,000 such “delayed days” in February 2016, an increase from more than 134,000 a year earlier. About one in three of these delays was due to the absence of suitable social care, compared with one in four a year ago, the data showed. Richard Barker, interim national director of commissioning operations and information, acknowledged that, in A&E, “we really are now seeing the effects of the delayed flu spike which peaked in February and March this year compared with pre-Christmas last winter”. Jennifer Dixon, chief executive of the Health Foundation think-tank, said that in the past three months delays in social care provision “were the fastest growing cause of people not being able to leave hospital”. This had contributed to a backlog of patients in A&E and longer waits for non-emergency care as beds were filled with patients with delayed discharges.
NHS England clarifies tech funding position: Around £500m of the £1.8bn of funding earmarked for making the NHS paperless by 2020 will be spent on contracts set up under the National Programme for IT, NHS England’s director of digital technology Beverley Bryant has told Health Service Journal (HSJ subscription required). A story on HSJ’s website reported comments from Bryant who said £500m had been “secured for the Southern Local Clinical Systems Programme, and for the residual work going on with the [local service provider contracts].” She told HSJ: “There is still money going [into some health economies] to allow them to continue with their implementation of CSC Lorenzo and Cerner. We could have said: ‘we’re cutting it off, that’s the past, it’s over’. But we are staying true to those organisations that have taken that path.” Bryant confirmed the total amount of unallocated new funding for the paperless programme was £1.3bn, and that guidance on how this money would be allocated would be published “soon”. Bryant also revealed that £119m of capital funding would be made available to trusts in 2016-17, adding that from 2017-18 the rest of the £1.3bn would be allocated on the basis of local areas’ sustainability and transformation plans.
BMA demands urgent £2.5bn investment to end GP crisis: GP leaders have called for an additional £2.5bn funding for general practice as an urgent measure to help relieve pressure on the service, reported GPonline. The BMA’s ‘urgent prescription’ to turn around the crisis facing general practice was published as NHS England and the Department of Health prepare to announce their GP Roadmap policy package, expected within days. GPC chairman Dr Chaand Nagpaul said GPs were calling for “both urgent and sustained action to resolve the current crisis”. NHS England chief executive Simon Stevens has said the delayed GP Roadmap policy package would be ‘far wider’ than the annual contract changes to help practices with workload, workforce and care redesign. Dr Nagpaul said: “GPs across the country are calling for both urgent and sustained action to resolve the current crisis facing general practice and ensure that practices can deliver high-quality and safe patient care, both today and in the future. This important document brings together practical and deliverable ideas from GPs and sets out a comprehensive, positive and practical approach which, if adopted, would make a significant difference to both practices and patients.”
Hospital trust A&E department downgraded: A hospital’s accident and emergency department is to close temporarily as it cannot “recruit enough staff to provide a safe service”, reported the BBC. Chorley Hospital in Lancashire will be downgraded to an urgent care service, a move that will “put lives at risk”, the area’s MP has claimed. Lancashire Teaching Hospitals NHS Trust said there were “no other safe options” due to a shortage of doctors. Chorley Hospital has eight of the 14 doctors it needs and can therefore only staff less than half the hours required. Consultants have been working extra shifts to cover the staff rota, but “this is not sustainable and this approach is beginning to affect our ability to cover the consultant rota”, the trust said. Jessica Knight, who was in hospital for five to six months after she was stabbed, said: “The A&E at Chorley was a major point of my recovery. One of my wounds was in the neck and I might have had a heart attack. The A&E was critical to my survival. If that was to happen now I wouldn’t be alive because I might have been taken to a hospital further away.” Professor Mark Pugh, consultant anaesthetist and medical director of the trust, said: “Changing the current service provided at Chorley is a direct response to the immediate and significant staffing problem. We simply cannot staff the rotas, and it is an unacceptable risk to patient safety to attempt to provide an emergency department service with no doctors available to see people.”
CQC to carry out inspections of how trusts learn from deaths: The Care Quality Commission (CQC) will implement recommendations following the scandal at Southern Health by investigating how all acute, community and mental health trusts learn from the deaths of patients, reported National Health Executive. The CQC announced it would write to all the trusts asking how many patients in contact with their services have died, how they decide which of these should be investigated and how they carry out the investigations. The regulator will also seek to find out how trusts involve families and how they learn from the results, with a particular focus on the deaths of patients with learning disabilities and mental health problems. They will then conduct phone interviews with 30 trusts and visit 12. Professor Sir Mike Richards, CQC’s chief inspector of hospitals, said: “Every year thousands of people under the care of NHS trusts die prematurely because their treatment or care has not been as good as it could have been. Healthcare workers might have failed to identify an illness that could have been treated, not provided the advice that might have prevented an illness developing, not made a life-saving intervention with a person who is critically ill or made some other error that contributed to a premature death. It is essential that, when this happens, NHS services identify and investigate the circumstances of these deaths so that staff can learn from them and reduce the likelihood of a similar event happening in the future. It is also essential, that NHS providers are open and honest with the families and carers of people who die whilst under their care.”
Next junior doctors’ strike will put patients at greater risk – GMC chair: The planned junior doctors’ strikes at the end of this month, in which doctors will stage an unprecedented withdrawal of all care including in emergency medicine, cannot be done without putting patients at risk of harm, the chair of the General Medical Council (GMC) has said, reported National Health Executive. Professor Terence Stephenson said that he sympathised with the “deep-seated concerns” of junior doctors, who are striking over the imposition of an unpopular contract which includes a reduction of the times available for anti-social hours pay. However, he urged doctors to consider the impact of the strike, warning it will become harder to justify as each subsequent strike has a greater impact on patients – for example, problems for patients in chronic pain will increase each time an elective operation is cancelled. The most recent two-day strike, on Wednesday and Thursday last week, led to 5,165 operations being cancelled. Professor Stephenson said that the GMC are preparing new guidance for doctors contemplating strike action, based on “the fundamental principle that the first concern of every doctor must be the welfare of their patients”.
NHS care.data records still being shared with third parties due to Department of Health delays: The Department of Health (DH) has still not signed off a system that would finally opt out NHS patients from having their data shared with third parties, reported Computerworld UK. Several years ago, the Health and Social Care Information Centre (HSCIC) took on the task of designing a system to recognise and opt out the one million people who objected to the NHS care.data record-sharing programme. HSCIC now knows exactly who has opted out. And it has a working system that can action those opt-outs – but the Department of Health has delayed in signing this off. As a result, one million people are still having their data shared to third parties, even though the technical means to stop this has existed since January this year. Data has been released to companies including American healthcare provider IMS Health and HR software company Northgate Information Solutions, as well as universities like Leeds and Imperial College London. A spokesperson for the DH, however, said that patients who have made a “‘Type 2’ objection” – requesting their data not be passed on – have “never had their data sold”. HSCIC has “developed a system to implement ‘Type 2’ patient objections, and is finalising the process to put this in place,” the spokesperson added. But minutes from a 27 January HSCIC board meeting showed that not only is the implementation yet to take place, but it was the secretary of state for the DH – Jeremy Hunt – who had delayed it.
NHS England publishes ‘mixed’ picture of digital maturity: NHS England has published data on a series of self-reported digital maturity measures for 239 NHS trusts, reported DigitalHealth.net. Paul Rice, head of technology strategy at NHS England, said: “The data published is self-assessment from 239 NHS trusts on their judgement of their readiness to exploit digital technologies. It details their view of whether they have the capability to exploit and highlights how far [they] have got.” He described the overall picture on NHS ‘digital maturity’ nationally as “mixed”. “The high level summary on digital maturity is good, but with opportunities to improve.” Nationally, “the picture is quite good on access to care records, but the picture is less good on access to e-prescribing”, added Rice. NHS England is at pains to stress that the new Digital Maturity Index is not a league table. The data is said to describe the current digital maturity of all NHS providers and will, together with Local Digital Roadmaps and Sustainability and Transformation Plans due to be submitted to NHS England in June, help determine how future investments in digital technology are made.
London surgery broadcast via virtual reality tech: An operation performed at a London hospital on a patient with colon cancer is the first in the world to be broadcast live through virtual reality technology, reported DigitalHealth.net. Thousands of medical students will watch the surgery, performed at Barts Health NHS Trust by leading cancer surgeon Dr Shafi Ahmed, remotely through VR headsets and using their smartphones. Barts Health is working with Medical Realities, a healthcare company set up by Ahmed to transform medical training through VR and augmented reality, as well as live streaming and VR specialists Mativision. The operation was filmed on two 360° cameras with multiple lenses and was live streamed to enable viewers to move around the theatre and zoom in and out of any aspect of the operation. A number of medical students from Barts Health have been provided with VR headsets and will be participating in the operation from nearby seminar rooms in the hospital and at Queen Mary University of London. Ahmed described the surgery as an, “unparalleled learning opportunity. As a champion of new technology in medicine, I believe that virtual and augmented reality can revolutionise surgical education and training, particularly for developing countries that don’t have the resources and facilities of NHS hospitals.”
GP roadmap may herald move to ‘self-assessment’: GPs could face fewer inspections in future under a proposal being considered for the sector’s support package to be launched next week, reported Health Service Journal (subscription required). Several sources with knowledge of the discussions for the GP “roadmap” between NHS England, the Department of Health and other relevant bodies have said the possibility of “self-assessment” is being seriously considered as part of the long promised support package. Under the changes, after all GP practices have been inspected once by the Care Quality Commission they could then self-assess on a number of performance measures. The roadmap, which will be announced by NHS England, has been described by its chief executive Simon Stevens as “substantial and wide ranging”. The package is expected to include funding and other support for GPs and primary care, with changes being finalised on workforce, workload and service redesign issues. Practices rated “good” or “outstanding” based on their first CQC inspection could be freed from the need for further inspection as long as quality monitoring information does not give regulators cause for concern. One source knowledgeable of the changes being discussed said: “I have heard the term ‘self-assessment’ coming in [alongside] this ‘light touch’ idea,” in reference to the proposed changes to CQC inspection.”
MidiPi open source telehealth kit piloted in NHS: An open source telehealth kit built using a Raspberry Pi will be piloted with heart patients at a southern NHS trust this financial year, reported Digitalhealth.net. Richard Robinson, a technical integration specialist at the Health & Social Care Information Centre (HSCIC), developed the telehealth prototype called MediPi to prove that “telehealth is affordable at scale”. Robinson presented his idea to colleagues and bosses who all felt it was worth pursuing so he “knocked together a demonstrator with some devices” at the EHI Live Connectathon last year. There he spoke to clinicians who were very encouraging and met with one from a southern trust, which cannot yet be named, who wanted to try the technology out with heart failure patients. Robinson then developed MediPi. The hardware, which includes a blood pressure cuff, a finger oximeter and some diagnostic scales, comes in at £250 along with the Raspberry Pi and screen. The devices were bought off-the-shelf and are connected via USB. The software is open source, programmed in Java and JavaFX and therefore platform agnostic. Damian Murphy, technical integration manager at HSCIC, said the information centre is not going to start manufacturing the kit, but wants to encourage the development of a community of people interested in MediPi and that could include commercial companies. The HSCIC is also talking to universities about potentially producing some of the hardware at lower cost.
Manchester vanguards will not access national fund: The new care model vanguards being developed in Greater Manchester will need to be funded from the region’s already allocated transformation fund, not the national pot, reported Health Service Journal (subscription required). As previously reported, Greater Manchester has been given a £450m transformation fund with £60m available in 2016-17. This was a key part of the region’s devolution deal. Acute providers will still be able to access national “sustainability” funding to cover their deficits this year, but there was some doubt whether the vanguard projects in the region would be able to access national funds. There are four vanguard projects involving organisations in Greater Manchester, including a “provider chain” across the acute trusts in Salford and Wigan, and potentially Bolton. An integrated care organisation is also being created in Salford, along with a multispecialty community provider in Stockport. There had been uncertainty whether the vanguards would need to be funded through the Greater Manchester fund, but Salford Clinical Commissioning Group, which is involved in establishing the integrated care organisation, reported in its latest board papers: “NHS England and the Greater Manchester devolution team have confirmed that, with the exception of the cancer vanguard, all Greater Manchester vanguards form part of the Greater Manchester devolution settlement.”
Scotland links Orion clinical portals: West of Scotland’s health boards plan to share information by connecting their Orion clinical portals, creating a regional view of patient records, reported DigitalHealth.net. Phase one is about to go-live and will connect NHS Greater Glasgow and Clyde’s portal with NHS Lanarkshire’s. Others are expected to follow on, ultimately bringing them together into a single, regional platform. The implementation of portals formed a key plank of the Scottish eHealth Programme that was drawn up almost a decade ago, and has since been revised at least twice. Glasgow’s director of health information and technology Robin Wright estimated around half of the population of Scotland is covered by an Orion portal, with the product in use at seven health boards. The linked portals will initially provide a read-only view of patient information, with role-based access and each board deciding what information to make available. Wright explained: “We realised we had got to a stage with all our systems where we needed to move away from transactional stuff towards a more coherent clinical workflow.” Ensuring alerts and allergies information is up-to-date is a constant struggle and having a trail showing who has entered what information when will improve this.
Mental health deaths under-reported: A charity for bereaved families is demanding the government investigates the way deaths of young people in mental health units are recorded, reported the BBC. Research by Inquest suggested that at least nine young people have died in England as in-patients since 2010. Health minister Alistair Burt told BBC Panorama he didn’t know the figure and is calling for further research. The Department of Health has now accepted there have been at least four deaths. Since the interview with Panorama Mr Burt has issued a statement saying: “Panorama’s investigation has unearthed questions about record-keeping and I’m seeking assurances from NHS England that they have the right processes in place for recording any such death and that lessons are learned.” Calling for statutory notification and an independent investigation when a child dies in a mental health unit, Deborah Coles, inquest director said: “How on earth can we learn if we don’t know the true picture and circumstances? What’s been really shocking is how difficult it is to find the true picture of the number of children dying in psychiatric care.”
National supply chain for med devices to save NHS millions: NHS England has unveiled a new nationwide system for purchasing expensive medical devices which, it claims, could save the NHS over £60m in its first two years, partly through reducing variation in cost, reported PharmaTimes. NHS England spends around £500m a year reimbursing specialist units for devices, such as implantable cardioverter defibrillators (ICDs) and bespoke prosthetics, but there can be significant differences in the prices trusts pay for the same products, as well as in the rate of adoption of devices across the UK. A single national approach for purchasing and supplying such devices has now been agreed with the NHS Business Services Authority, which will be run by NHS Supply Chain. According to NHS England, by taking a more rigorous commercial approach, the advantage of economies of scale and reducing price variations, “it is estimated that tens of millions of pounds can be saved from the annual cost of devices currently being purchased – savings which will be reinvested into other specialist services and treatments”.
Opinion
Can we make the hospital a safer place at night?
It has been 10 years since the introduction of Hospital at Night. Caroline Chapman, nurse consultant for Hospital at Night, Portsmouth Hospitals NHS Trust, argues “it is time to modernise” and explains how this can improve safety.
“Hospital at Night started in 2005 to address the shortened working week for junior doctors with the European Working Time Directive. Many trusts adopted the system, which involved moving away from every ward for itself to a pooled on call team to be used across the hospital. At Portsmouth Hospitals NHS Trust we ran ours in a conventional way, relying on highly experienced, senior nurses to run a co-ordination centre. Ward nurses telephoned the co-ordinator who would triage the call and bleep the most relevant person.
It worked well but Chapman says there was room to improve the coordination of care and reduce potential for harm: “Implementing our new system involved significant change to our processes, but even so we found staff adapted quickly and easily. Our new Nervecentre Hospital at Night system is very pro-nursing. Our co-ordinators, who are very senior and experienced staff, are no longer tied to a desk answering the phone and chasing bleeps. They are now able to oversee the system while working on the wards. In the first year we halved the number of red and amber incidents, in which patients were put at severe or moderate risk of harm, and we haven’t had a single adverse death at night.
“With a proper audit trail, we now know what our on call clinicians are doing at night, and we can review incidents in much more detail. We now know, for example, that technicians and not our on call doctors are inserting cannulas and taking bloods. We have demonstrated to the trust the level of support required to operate more safely at night and have since employed an additional technician as a result.”
Conference event sponsorship – a plea for diversity
Event organisers must make it feasible for smaller organisations to take part, not just big sponsors, writes Jos Creese in a blog this week.
Creese, the former chairman of SOCITM and former president of the BCS, argues that events are relying more on sponsorship, due to tight margins and time pressures from potential delegates.
“Sponsorship helps to keep delegate rates low and, if there is enough corporate sponsorship, an event can be quite lavish, without appearing on a delegate’s business expenses.
“But there is a downside to this: that only the wealthiest sponsors can afford to take part if sponsorship packages are set too high. And naturally sponsors expect their return on their investment, after all, there is no such thing as a free lunch. But more importantly, the value which small and medium sized businesses and specialist groups can bring is at risk of being priced out.
“Most conference delegates attend events for the value that they get from a diversity of case studies and opinions, not to just to hear the views of the biggest companies. If they don’t get this there is a risk that delegate numbers dwindle (however lavish the event), and then the sponsors won’t want to be involved either.
“So, a plea for event and conference organisers: please don’t be over-reliant on big sponsorship packages, attractive though they may be. Value in conference attendance comes from diversity of opinion and case studies and there needs to be room for smaller organisations and specialist interest groups to take part too, without breaking the bank.”
The NHS’s fines and performance hokey cokey
Edward Cornick, policy officer for commercial and contracting at NHS Providers, asks if the NHS should prioritise getting its finances in order or hitting performance targets, in an article on Public Finance.
Cornick references the back-and-forth between NHS England and CCGs in their use of fines to incentivise providers to deliver targets, and removing fines to balance the books over the past year, concluding: “All this shows NHS system leaders are still wrestling with the fundamental question of what matters more: a sector in balance or a sector hitting targets? It is apparent they have not come to a clear position. The result has been a lack of coherent narrative given to providers, who just want to know what the system will be prioritising, while they struggle with balancing the quality finance equation.
“The way forward is for the system leaders to recognise that financial balance vs hitting targets is the wrong starting premise. This means breaking the view that withholding funds and improving performance are inextricably linked. They aren’t.
“Providers are already heavily scrutinised on performance through the national regulators and standards are actively managed by boards – introducing financial penalties into that mix is counter productive. If a trust has to pay a fine (or is denied the extra funding it needs), it can’t spend that money on extra staff and better patient care. It also clearly impacts their ability to return to financial balance. NHS system leaders therefore should re-examine the use of withholding funds to see if that is really achieving what it is designed to do, let the regulators focus on performance, allow boards to exercise full accountability and give providers the support they need to return to balance by the end of 2016/17.”
Highland Marketing Easter competition winner
The lucky winner of the Highland Marketing Easter competition hamper was Susan Weston, assistant director – provider procurement, NHS Shared Business Services.
Many congratulations Susan from the Highland Marketing team.
