Healthcare Roundup – 17th February 2017

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News in brief

House of Lords calls for better funding of long-term care: The government must offer the public an incentive to save for potential long-term care costs before the financial services industry is able to respond to growing demand for new savings products, members of the House of Lords have said. Lord Warner, who sits on the Lords’ Select Committee examining the sustainability of the NHS, said the public health system was “near collapse” and an element of compulsion might be needed to ensure long-term care was properly funded, reported The Financial Times (subscription required). Without a sustainable revenue stream, which compulsion to save would provide, Lord Warner said the financial services industry would not step in to fill the savings gap with innovative new products. Germany introduced a mandatory insurance system for long-term care in 1995 to cover people who are unable to live independently for longer than six months. Japan has a similar social insurance system. Lord Warner said both models offered examples for the UK. More than a decade ago, the public was able to buy what were called pre-funded long-term care plans – “just in case” products sold by the insurance industry – but these did not catch on. The Department of Health said it had committed almost £900m of additional funding for adult social care over the next two years and allocated an additional £10bn per year by 2020-21 for the NHS to fund its own plan to build a “more responsive, modern health system”. A cap on care costs, as recommended by the Dilnot Commission into the funding of care and support in 2011, is due to be introduced in April 2020.

NHS overspending approaches £1bn: Hospitals are on course to overspend by almost twice as much as hoped, raising fears that patient care will suffer in the desperate search for savings, reported The Times (subscription required). Regulators have admitted that the goal of limiting overspends for hospitals, ambulances and mental health trusts to £580m will be missed, with cost control measures failing to work as hoped. Analysis of forecasts from all but five of the 237 NHS trusts in England by the Health Service Journal suggested that the overspend will be £970m by the end of next month. Jim Mackey, the NHS Improvement chief executive, said: “We’ll not hit £580m and I think it’s about containing this to as manageable a number as we can.” The regulator has insisted that hospitals must try even harder to find efficiencies rather than cutting staff or services. Mackey cited payments to locums of up to £4,000 a day as the kind of waste that must be eliminated, telling The Times that hospitals must stop “throwing money” at temporary staff. Analysts said that part of the reason for a higher overspend was because bosses were trying not to slash services.

NHS needs £9.5bn upfront to secure its future, says BMA: Modernising and securing the future of the health service in England would cost at least £9.5bn in upfront spending, money that the NHS does not have, the British Medical Association (BMA) has said. Health managers in 44 areas have been charged with creating sustainability and transformation plans (STPs) to help the NHS repair its crumbling finances and meet clinical and organisation challenges, reported The Guardian. However, such an overhaul would need significant capital investment, according to the BMA. The doctors’ union sent freedom of information requests to all the areas asking for their estimates to implement the STPs and 37 replied, with the figures quoted in responses totalling £9.53bn. Dr Mark Porter, the BMA’s chief, said: “These figures are especially concerning given that everyone can see a huge crisis unfolding within our NHS, with record numbers of trusts and GP practices raising the alarm to say they already can’t cope. The NHS is at breaking point and the STP process could have offered a chance to deal with some of the problems that the NHS is facing, like unnecessary competition, expensive fragmentation and buildings and equipment often unfit for purpose. But there is clearly nowhere near the funding required to carry out these plans.”

‘Alarming’ rise in level of unmet care and support needs: The level of unmet need for social care is rising at an ‘alarming’ rate, campaigners have warned. An analysis by Age UK found 1.2 million over 65s have some level of unmet basic care needs including washing and dressing – an 18% increase on the previous year, reported Community Care. The charity estimated 291,400 of this group would meet the Care Act eligibility criteria, on the grounds they struggle with three or more daily living tasks, but a quarter currently receive no help at all. Social services directors said the “extremely worrying” findings reflected the “chronic underfunding” of services in recent years. The government said it had given councils powers to raise “extra money” for social care and was committed to finding a sustainable long-term solution for the sector. Ministers used the autumn statement to hand councils extra flexibility in their use of the social care precept, on top of existing funding for social care provided through the Better Care Fund. However, at the time experts warned the funding was “a fraction” of what was needed. Age UK’s analysis found services required at least an extra £4.8bn a year on current funding levels and called on the government to provide “emergency” funding in the Spring budget.

Bed blocking rate in Scottish hospitals drops 11%: The number of patients kept in hospital after being told they were clinically well enough to leave is falling, new data has shown. A census carried out in hospitals in December found 1,333 people were affected, down from 1,509 the previous month, a fall of 11%, reported The Scotsman. The most common length of delay was between three days and two weeks, while 23 people had been waiting for a year or more. The problem of bed-blocking happens when patients are clinically ready to leave hospital but are waiting for the necessary care and accommodation arrangements to be put in place. A total of 45,067 days were taken up by bed-blocking in December, the figures from ISD Scotland show. This is down from 45,639 in November – a 1% drop. In the December survey, most people affected (69%) were aged 75 and over. The majority of delays were due to health and social care reasons, such as waiting for care home places or for social care support. Confirmation of the fall has been welcomed by ministers.

NHS cuts could be linked to thousands of excess deaths, say researchers: Cuts to health and social care could be linked to tens of thousands of “excess deaths”, a new research paper suggests, reported iNews. In 2015 there was an “unprecedented” rise in mortality in England and Wales and a possible explanation behind the spike could be the “relentless cuts” to health and social care budgets, according to two articles published in the Journal of the Royal Society of Medicine. Researchers from the London School of Hygiene and Tropical Medicine, University of Oxford and Blackburn with Darwen Borough Council said without “urgent intervention” the increases in mortality could continue. They said that 2015 saw the greatest rise in mortality for almost 50 years in England and Wales – with a particularly large spike seen in January. “Since the 2010 election, the impact of cuts resulting from the imposition of austerity on the NHS has been profound,” they wrote. “Expenditure has failed to keep pace with demand, and the situation has been exacerbated by dramatic reductions in the welfare budget of £16.7bn and further reductions in social care spending.”

STPs right way forward but not in current form, warns Reform: Sustainability and transformation plans (STPs) have been knocked back once again as a report released by the think-tank Reform reported that they cannot work in their current form, citing that they “have neither the support nor the executive power that they need to reshape health and social care in England”. The areas where Reform deemed STPs to be failing were in engaging with local authorities, who were currently not being treated as equal partners due to their much smaller budgets, meaning that they could not properly address problems in social care, reported National Health Executive. Engagement with NHS staff was also an area for improvement, as the report cited that in a survey last Autumn by the BMA of 615 GPs and consultants in London, 59% of them had not even heard of STP plans that were planned to be published at the end of the year. Reform also pointed to the failure of STPs to provide sufficient provision for mental healthcare. The review did, however, agree that though STPs are the right way forward, they required heavy reform in order to achieve their aim of contributing to the NHS’s savings target of £22bn. Researcher at Reform, Kate Laycock, said: “STPs are trying to integrate health and social care so the systems are much more streamlined and easy to navigate – this is the right thing to be doing. But having spoken to people we discovered that STPs weren’t going to deliver on this and that’s why we’ve written the paper.”

NHS a bigger concern for the public than Brexit, poll finds: The NHS is now seen as a bigger concern for the public than Brexit, according to a new poll. Almost half (49%) of Britons consider the state of the health service one of the biggest issues facing Britain, the Ipsos MORI/Economist Issues Index found – compared to 41% over our EU issues, reported iNews. Just under one in three (31%) believe immigration is a major challenge. The survey, of more than 900 people between 13th and 26th January, reveals concern over the NHS has risen nine percentage points since December and is now at the highest level recorded since April 2003. Women and the elderly are particularly concerned, with 53% and 55% respectively citing the health service as one of the biggest challenges today. Brexit leads when the public are asked to name the single biggest issue facing Britain. On this measure, 27% of the public cite Brexit, and 17% say the NHS/hospitals. Chris Ham, chief executive of The King’s Fund, said: “These results show the public are increasingly concerned about the pressures facing the NHS and should be a wake up call for ministers. The government needs to be honest about what the health service can deliver with its budget. If it wants to maintain current standards, it will need to look again at NHS funding in future financial statements. In particular, the pressures will peak in 2018-19 and 2019-20, when there is almost no planned growth in real-terms NHS funding.”

Imperial receives £7m government funding boost to drive patient safety: The Department of Health announced that the Imperial Patient Safety Translational Research Centre (PSTRC), coordinated by Imperial College Healthcare NHS Trust, will receive a total of £7.3m to support its research into improving healthcare delivery, reported Imperial College London. The Imperial PSTRC works to improve patient safety and the quality of healthcare services in the NHS and internationally by bringing together researchers and clinicians with relevant expertise. The latest cash injection from the government-backed National Institute for Health Research will provide a total of £17m over five years from August this year to institutions and NHS partnerships in England to turn basic research into advances relevant to patient safety. With the new funding, Imperial PSTRC will look to build upon its existing reputation as a leading centre for developing advances in healthcare delivery by funding London-based clinicians and academics to conduct translational research. Commenting on the latest funding award for the centre, Dr Tracey Batten, chief executive of Imperial College Healthcare NHS Trust, said: “We are delighted that our partnership with Imperial College London has been designated as the Patient Safety and Translational Research Centre. It highlights the many innovations that the partnership is leading on to improve patient safety within Imperial College NHS Trust, the NHS as a whole and beyond.”

Government drops target for ‘paperless NHS’ by 2018: Health secretary Jeremy Hunt has quietly ditched his flagship pledge to create a ‘paperless NHS’ by 2018 – blaming “weak hospital IT systems”, reported UKAuthority. He told the House of Lords select committee on the Long Term Sustainability of the NHS that he has been advised the target, set in 2013, is not achievable. “I perhaps rather bravely said I wanted the NHS to be paperless by 2018 in my first few months as health secretary, and I am quite relieved that most people seem to have forgotten that I made that promise,” Hunt said. “I think we are making good progress. There is definitely lots to do. We are weak at the moment on hospital IT systems. Professor Bob Wachter of the University of California, San Francisco, came over and looked at the state of hospital IT systems, and has given us some very good advice. He does not think 2018 will be possible.” Hunt told the committee the aim is now to “get our hospitals to world class levels over the course of the next five years”. He added: “We have some reasonable (hospital) IT systems in this country but, according to Professor Wachter, we do not have any that are world class anywhere.” He said there is “a long way to go when it comes to hospital IT systems”.

The NHS’s top trust chief executives in 2017: Three significant trends emerge from this year’s Health Service Journal’s (subscription required) ranking of the NHS’s top 50 chief executives: how the top leaders are increasingly running more than one organisation; how influential Care Quality Commission (CQC) ratings have become; and how women may soon come to dominate the top ranks of the provider sector. HSJ’s annual analysis of the NHS’s top trust chief executives was judged by some of the service’s leading figures, including CQC chief inspector of hospitals Sir Mike Richards, NHS England medical director Sir Bruce Keogh and NHS Improvement director of nursing Ruth May. The chief executives were judged on three main criteria: the performance of their trust; their contribution to the wider health economy or the NHS; and their personal example. The top 50 is split into two; the top 15, which are ranked, and the remaining 35. The full list can be viewed here.

23 trusts chosen for new Carter review: More than 20 trusts have been chosen to be part of a new NHS efficiency review led by Lord Carter. The Labour peer and a team from NHS Improvement (NHSI) will look into organisational productivity and performance at mental health and community service organisations. In a letter seen by Health Service Journal (subscription required), NHSI said the review will follow a similar structure and methodology to Lord Carter’s previous investigation into acute hospital productivity, published last year. The letter was written by NHSI director of sector development Luke Edwards, and was sent to all mental health and community trust chief executives and chairs last week. It revealed the 23 mental health and community service providers that will begin six months of detailed engagement in the first phase of the review with Lord Carter and a team from NHSI’s operational productivity directorate. Some of these trusts include: Derbyshire Community Health Services Foundation Trust, East London Foundation Trust and Hertfordshire Community Trust. Edwards wrote that Lord Carter will oversee the new review in his role as a non-executive director of NHS Improvement. He added: “As you may be aware, as Lord Carter was compiling and finalising his report into operational productivity and performance in NHS acute hospitals, he was contacted by many community and mental health trusts who expressed their willingness to be involved in a similar detailed approach. I am pleased to say that we have now commenced the review into community and mental health trusts, building on the approach of the original report.”

NHS England plans to issue new guidance for IT suppliers: In collaboration with clinical commissioning groups (CCGs), NHS England plans to issue new guidance around IT requirements for Integrated Personal Commissioning (IPC) and Personal Health Budgets (PHBs) to ‘support’ the development of personalised care across the health and care system, reported HealthIT Central. “The requirements are intended to be used by IT suppliers in order to develop appropriate solutions that take into account the needs of all service users, including those with PHBs and people in IPC cohorts, and support the delivery of the intended benefits from more personalised approaches to care,” a new document released by NHS England stated. IPC is said to be playing a ‘central’ role when it comes to the expansion of PHBs, focusing on supporting this new model of care: “A system designed around people’s needs should support genuine choice and control, reduce complexity and encourage take-up,” NHS England added, while emphasising that this is not a new ‘purchasing framework’. Along with core requirements, IT suppliers are asked to focus on identification, planning, management, monitoring, marketplace and community, although the document revealed these solutions will not represent a ‘magic bullet’ to the personalisation of care. IT suppliers are expected to reply by the 7th April as NHS England said it plans to take an iterative approach to draw official guidelines and encourage innovation.

NHS plan to access users’ web browsing history to provide ‘personalised’ health advice: NHS Digital is planning to implement a new patient information website,, that would require the technology to be able to examine users’ web browsing history in order to provide what it claims will be more personalised health advice, reported Computing. The idea was revealed at an event in which NHS Digital’s digital transformation director, Beverley Bryant, disclosed some of the organisation’s plans for its portal project. “If we can use location, time and cookies and history to provide content to people then it’s likely to be more relevant to visitors, and they are likely to come back for more information,” said Bryant. According to the website, which reported on the event, she suggested that “users that went a step further to register, would have access to a personal health record. This would allow them to perform transactions, such as booking appointments and repeat prescriptions, access medical records and upload their own app and wearable generated data”. Bryant said that people would have to opt-in, and willingly provide their personal information, location and browser history, though.

Great Ormond Street picks Epic in potential £50m deal: Great Ormond Street Hospital for Children NHS Foundation Trust has selected Epic as its preferred electronic patient record (EPR) supplier. In a statement provided to, the London specialist children’s hospital confirmed it had selected the US company to support its “clinical transformation programme and digital strategy”. Great Ormond is the fourth UK trust to select Epic, one of biggest EPR suppliers in the US. Only one UK trust, Cambridge University Hospitals NHS Foundation Trust, has deployed the system to date. Along with Epic, the trust also announced it had selected Aridhia Informatics to deploy a new “research and innovation platform”. Aridhia is a Scotland-based company that has worked with NHS Greater Glasgow and Clyde to analyse brain injury data. The total value of the deal was not disclosed. However, reported in February last year that the original tender covering both systems was valued at between £46m to £50m over 20 years. The trust plans to deploy the innovation platform later this year and the Epic EPR in 2019. Both systems will be cloud-based. Shankar Sridharan, chief clinical information officer at the trust, said the switch to Epic would change the ways clinicians worked. “The implementation of a paediatric hospital EPR system at GOSH will change the way we work as clinicians, helping us to deliver holistic care for our complex patients and facilitate communication with families,” he said.

System C and Graphnet deepen partnership with Microsoft: UK clinical software suppliers System C and Graphnet have announced they will integrate next generation technologies from Microsoft, reported The two companies are working with Microsoft on cloud-based solutions that will use machine learning to transforming patient engagement, clinical communications and enable new models of care. System C and Graphnet already use Microsoft technologies, including Microsoft HealthVault, and Microsoft Azure, including Azure machine learning. The next generation products will be deployed at System C clients including University Hospitals Bristol NHS Foundation Trust, a global digital exemplar, and will be promoted throughout the NHS. Steve Gray, director of IM&T at Bristol said: “It is very helpful for us to have our major software suppliers working together in this way. Microsoft products are standard across the NHS and this tight integration will allow us to properly leverage the rich functionality available in both product sets.” Dr Ian Denley, joint chief executive of System C, said: “Next generation healthcare IT is about agile clinician-friendly and patient-facing systems operating across care communities, and the integration of healthcare applications with modern communication tools.”

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The NHS needs a rethink. Its priorities no longer make sense
Early intervention on mental health and proper social care are vital if the health service is to stop merely lurching from one crisis to the next, writes Deborah Orr, one of Britain’s leading social and political commentators, in The Guardian.

She says:Media reports are becoming more urgent. There are the numbers, a flurry of them in the last 24 hours alone: 19 hospitals facing closure; 24 accident and emergency units earmarked for downgrading or closure; 150 hospitals failing to meet planned targets for daytime nursing levels; the NHS needing £9.5bn to secure its future.

“There’s so much bickering and arguing, about funding, about efficiency, about money, about targets, that there simply never seems to be the time or the inclination to do anything more than cobble together emergency treatment for the NHS itself. As soon as that seems to have temporarily averted the crisis, other discussions, perhaps more crucial to the long-term health of the service, rumble on, their own urgency deemed comparatively exaggerated.

“The NHS needs a rethink. When it was originally conceived, the idea was that it would make us more healthy. Instead, it just helps us to survive death to live longer, always in need of healthcare support. Above all, mental healthcare – and at an early stage – needs to become a priority, not an afterthought, so that people can liberate themselves from the psychological anguish that causes them to lose touch with the needs of their bodies.

England’s NHS is at crisis point – Scotland should be aiming higher than that
The special place that the NHS occupies in people’s hearts and the sheer scale of it compared to other parts of Scotland’s public sector mean that it is never out of the public eye, writes Dr Peter Bennie, chair of BMA Scotland, in

He writes: “The public rightly have high expectations for what our health service should deliver and as a result, every indication that the NHS in Scotland is in difficulty quickly makes people sit up and take notice.

“Numerous reports in recent months have set out in detail the increasing scale of the challenges facing Scotland’s NHS and the amount of the work that still needs to be done to meet them.

“Nobody doubts that currently Scotland’s NHS is in relatively better shape than south of the border. But the question we need to ask ourselves is whether all we are looking for is really a health service that is a bit better than England’s. Our ambitions for healthcare in Scotland should be far greater than that. Patients in Scotland want a world class health service that is properly equipped to meet their needs, not one that merely remains a bit better than other parts of the UK as they reach crisis point.

“Greater numbers of patients needing care means we need more health professionals than ever before to cope with demand. So while the Scottish Government is happy to boast of record numbers of NHS staff, the more telling and more concerning figure is the ongoing number of vacancies in the health service. Every vacant post for a doctor, nurse or other professional means we have fewer staff than the NHS needs.”

Read all about it: media coverage of NHS rationing
Media stories on NHS ‘rationing’ are on the rise, writes Anna Charles, policy researcher at The King’s Fund.

Writing in a blog for the think tank’s website, she says that headlines hinting that NHS spending has reverted to the 1950s, or that hip operations are being banned for those who can sleep, were just a tiny sample of the stories appearing in newspapers during the winter.

“The health service is a source of public interest and media scrutiny regardless of the economic and political context, but the spotlight has intensified over recent weeks as pressures have deepened,” she says. “As part of the work for our forthcoming report on NHS financial pressures, we examined how the media have reported on NHS pressures in recent years by looking at coverage of the controversial and sometimes highly emotive term ‘rationing’.

“We undertook a retrospective search for articles mentioning the term rationing in relation to the NHS in eight media sources (BBC News, Daily Mail, The Guardian, The Metro, The Mirror, The Sun, The Times and The Telegraph) between January 2011 and December 2016.

“NHS rationing was reported regularly throughout the five-year period, but increased markedly towards the end. A total of 86 stories in 2011 grew to 144 in 2015 and 225 in 2016. There was also a shift in the nature of reporting: in the latter half of 2016, we started to see increasingly hard-hitting stories about rationing due to the severe financial difficulties facing the NHS, with warnings that it is ‘in meltdown’ and ‘on the brink of collapse’.”

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