News in brief
Patients promised speedier access to GPs as long waits named and shamed: Patients will be promised speedier access to GPs with family doctors named and shamed for long waiting times, under new NHS plans, reported The Telegraph. The new targets come alongside a major overhaul of emergency care, with promises to increase the proportion of 111 calls assessed by medics, amid concern that too many decisions are being made by ill-trained handlers. The plans come as official figures show record waits in A&E departments, and warnings that the number of patients stuck on trolleys is “going through the roof”. Head of the NHS, Simon Stevens, has ordered hospitals to empty up to 3,000 beds as soon as possible, in order to relieve pressure on services. It is part of sweeping changes in the way care is provided, in a bid to reduce the number of people turning to hospitals, by improving access to family doctors. Health officials have brought forward a manifesto pledge, which promised all patients 8am to 8pm access to GPs, seven days a week, by 2020. The target for longer hours on weekdays has now been shifted forward, to March 2019. Stevens said that every GP practice will be ordered to publish waiting times, in order to drive improvements, and allow patients to choose surgeries with better access.
Full £800m NHS ‘priorities’ fund to offset trust deficits: About £800m of funding that was intended for mental health, community and primary care will instead be used to ensure the Department of Health achieves financial balance this year, it has been confirmed, reported the Health Service Journal (HSJ, subscription required). NHS England said the “full amount” of the contingency fund held back from clinical commissioning groups (CCGs) in 2016-17 will be used to offset financial deficits among NHS trusts. The deficits are largely in the acute hospital sector. Paul Baumann, chief financial officer at NHS England, wrote to CCGs, saying: “The aggregate effect of this will be to increase the surplus across the whole of the commissioning sector by around £800m, which will help to offset the provider deficit position and help to secure a balanced position for the NHS overall.” Every CCG had 1% of their allocation held back at the start of the year, with any release of this funding requiring Treasury approval. Last summer, NHS England chief executive Simon Stevens said this money was stripped out of budgets that “would have been available from CCGs for mental health services, community health services, primary care and other things”. The provider sector was set a target of ending the year with a £250m deficit, which would have enabled most of the contingency fund to be spent on the other priorities. However, this target was widely deemed unachievable and the latest official forecast for the sector is a £873m deficit. It has been predicted for several months that the contingency fund would be needed in full to offset the provider position. The NHS provider and commissioning sectors account for the bulk of the Department of Health’s budget, which breached its spending limit in 2015-16.
Integrated ‘streaming’ service to be introduced in all hospitals by Christmas: NHS England has set a goal for all hospitals with an A&E department in England to have a “comprehensive front door streaming” service in place by next Christmas, reported National Health Executive. The streaming service aims to make care more efficient and take pressure away from emergency departments by having a primary healthcare professional “stream” patients coming through hospital doors, who can then refer them to primary healthcare or an emergency department. The scheme is already successfully in place in Luton and Dunstable hospital, which is one of the best-performing emergency departments in the country, as well as a handful of other hospitals – and it is hoped that the idea could drive efficiencies in the whole of the NHS. Around 50 to 100 hospitals will require remedial work or extra bed capacity to be able to put the service in place across all 44 of England’s sustainability and transformation plan footprints. The news was announced by NHS England CEO Simon Stevens at a Public Accounts Committee hearing about GPs, during which he said: “We are setting a requirement that all hospitals have GP streaming in place by this coming Christmas. Our assessment of the incremental capital required to do that is consistent with the funding we got from the chancellor [at the Spring Budget]. Obviously, without glossing over it, this is only a part of the solution. There are a set of other things that need to change as well, and possibly the most important will be using the extra social care support to ensure that frail older people are able to leave hospital.”
Virgin Care sues NHS after losing Surrey child services deal: Virgin Care, part of Sir Richard Branson’s business empire, is suing the NHS after the healthcare group lost out on a contract to provide children’s services in Surrey, reported the Financial Times (subscription required). The three-year, £82m deal covering health visitors, school nurses and speech and occupational therapy for children was awarded to a consortium formed by in-house NHS providers and a social enterprise. Virgin Care, which had a previous contract in Surrey that ends on 31st March, said it was “concerned that there may have been serious flaws in the procurement process”. “Never before have we been so concerned with the whole process that we have needed to make a challenge of this nature,” it said. The company filed proceedings against NHS England, Surrey county council and the county’s six clinical commissioning groups (CCGs) including the Guildford & Waverley CCG in the High Court at the end of last year. Guildford & Waverley CCG, representing all eight commissioning organisations, denied there was any wrongdoing in the process. “Despite the commissioning organisations’ confidence in the process and despite us sharing information to assure Virgin Care Services regarding the procurement process, Virgin Care Services issued court proceedings,” a spokesperson said.
CNO urges nurses to ‘lead service changes’, despite ‘relentless’ pressures: The chief nursing officer (CNO) for England has urged nurses to get involved more in redesigning local and regional services, while recognising that pressure on staff at the frontline has been “relentless”, reported the Nursing Times (subscription required). Jane Cummings noted that concerns had been raised in some parts of the country about a lack of engagement from nurses in the 44 sustainability and transformation plans (STPs) that are being developed. Speaking ahead of her annual summit with leaders from the profession, she said there was a need for nurses from both commissioning bodies and provider organisations to be involved in the plans. It was particularly important for nurses to be “actively engaged” in the workforce side of STPs, she suggested, following revelations that some of the draft plans involved staffing cuts. Professor Cummings said: “There’s been quite a lot of concern raised in certain places around nursing – or nurses – not being as engaged in STPs as they might want, or as others might want them to be.” She said she thought such concerns were “not unreasonable”, though she added that levels of nurse engagement with STPs had “been very varied across the country”. “I do generally think there’s not, perhaps, been as much as we would have expected or wanted.” In response to such concerns, the CNO said the summit would include several presentations that were designed to encourage the profession to become more engaged with the STP process. “We’ve got a session on the realities and opportunities for collaboration within STPs,” she said, adding: “We’ve got a couple of nurses who are really talking about what they have done, how they have done it and what are the opportunities.”
GM devo deal a halfway house to aligning health and social care: Establishing clear lines of accountability to deliver health and social care integration is going to be one of the major challenges facing the sector going forward, the chair of the Communities and Local Government (CLG) Committee has told Public Sector Executive – adding that Greater Manchester (GM) devolution is a “halfway house towards it, but still leaves some of the questions unanswered”. Following last week’s Spring Budget, where the chancellor announced an extra £2bn for social care and promised a green paper, Clive Betts, MP said: “Obviously, we are pleased that the chancellor has recognised that the problems of social care need more money, but are disappointed that he hadn’t gone as far as the committee asked. To pluck another £1bn over two years and say that is enough misses the point.” Discussing the GM health devo model, he said: “Pooling budgets is sometimes called joint commissioning, and there are different ways of doing it. The one difficulty with all these things is that they tend to work until they go wrong, and then everybody blames everyone else. You really have to have clear lines of accountability, but currently health and social care have very different accountability systems. Social care is accountable to, ultimately, elected councillors on the local authority. Health is accountable to the secretary of state. These are very different systems, and that is going to be a challenge for the future. No one has given us evidence that it could all be funded by the public sector. How you put that together, recognising the significant changes about localisation of business rates, which are coming as well, are issues we need to reflect on.”
GP practices could merge into 1,500 ‘super hubs’ under NHS reforms: Thousands of GP practices across England could be closed as general practice provision shifts into 1,500 super hubs delivering care for populations of around 40,000 patients, a health minister has suggested, reported GPOnline. Around 7,500 GP practices across England currently care for average populations of around 7,000 patients, but the switch to larger units could come through a gradual migration in coming years, health minister David Mowat told MPs this week. Comments from the minister came in a House of Commons debate on soaring indemnity costs for GPs, in which Mowat pledged that financial support to protect the profession from the impact of higher fees would extend beyond the current £60m package agreed for 2016-17 and 2017-18. General practice could move over time to a system where there are just 1,500 large ‘super practices’ providing care at scale, Mowat told MPs. Government plans to see more super practices – or hubs that bring multiple existing practices together – emerge across the country could see the number of practices overall reduced to just a fifth of the current number, according to the health minister.
Back-office efficiencies could save over £400m a year, claims NHSI: Improving the efficiency of NHS corporate services could save the health service over £400m in the next three years if all trusts performed as well as the average, NHS Improvement (NHSI) has claimed, reported the National Health Executive. By looking into corporate support activities, which are responsible for services like finance, information management and technology (IM&T), and legal and HR within the NHS, the organisation was able to see that crucial savings could be delivered if these services were run more smoothly. For instance, the regulator’s report found that despite the average costs for a payslip across the NHS being reported as £4.28, over 25% of trusts were actually paying over £5 each, whilst other outliers were forking out over £10 per payslip. If all trusts could hit the average target for back-office funding, NHSI estimates that around £422m per year could be saved for the NHS, which is currently scrambling to find extra cash in as many areas as possible. The disparity between the most and least efficiently run corporate services across the NHS was also marked, as NHSI announced that the top 10% most efficient trusts spend as little as £2.80 on corporate services per £100 of funding for patient care, whilst the 10% least efficient trusts were spending just under three times that amount, an average of £7.50 per £100 of patient care funds. NHSI’s report, which analysed data from 230 trusts, also highlighted the need for hospitals to work more collaboratively in providing corporate services as larger organisations were found to be more efficient than smaller ones, saying that it was willing to help trusts to collaborate with their neighbours to boost efficiencies in these services.
Public health hardest hit by NHS cuts, despite going ‘under the radar’: Public health and community services have been hit the hardest by the slowdown in NHS funding since 2010-11, an influential think tank has found as part of a major investigation. In its report, The King’s Fund revealed that contrary to popular opinion, acute and specialist services in the NHS have so far been relatively protected from funding cuts, and financial pressures have had “a much greater impact on some other services”, reported Public Sector Executive. “Factors that can combine to make some services particularly vulnerable include: a lack of data to monitor performance; block contract arrangements that have not adjusted to rising demand; services commissioned from the public health budget that has been cut in a way that NHS budgets have not; cuts having long-term implications that will not show up in outcome data for several years; and groups most affected by service changes not having a strong political voice,” the report explained. “With acute services such as hip replacement and neonatal care relatively protected so far, while some community-based and public health services like genito-urinary medicine and district nursing have been cut, the NHS appears to be moving further away from its goal of strengthening community-based services and focusing on prevention, rather than making progress towards it,” added The King’s Fund. Ruth Robertson, a fellow in health policy at the think tank and the report’s lead author, argued that the findings prove longer waiting times for hospital treatments and restrictions to operations are “just one small part of the picture”.
NHS to introduce £20m cap on new drugs: A new £20m-a-year cap on the cost of new drugs will be introduced in the NHS in England in an attempt to save money, health chiefs have announced, reported the BBC. The new measure could lead to delays of up to three years before new drugs are made available to give NHS bosses the chance to try to renegotiate the price with drug firms. The plan, to be introduced next month, was agreed by the National Institute for Health and Care Excellence (NICE) amid mounting pressure on NHS funds. NICE chief executive, Sir Andrew Dillon, said the move was needed given the “significant financial challenge facing the NHS”. Patient groups and the drug industry have already objected to the plan. Currently, drugs that are assessed as being cost-effective by NICE are automatically recommend for use in the NHS. Once that happens, the health service has 90 days to start offering the drugs. But crucially that process just assesses the cost versus benefit of the drug on the basis of the impact to an individual. It does not take into account how many people may take the drug and therefore the total cost to the NHS. The move comes as the drugs bill is on the rise. Last year £16.8bn was spent on drugs by the NHS, up from £13bn in 2011. There is concern a breakthrough in fields such as dementia could end up costing the NHS billions of pounds. Last year NHS bosses capped the number of patients that could be given a new drug for hepatitis C, to keep the annual cost at £200m. The new arrangements will be applied only to new drugs.
DeepMind’s first deal with the NHS has been torn apart in a new academic study: A data-sharing deal between Google DeepMind and the Royal Free London NHS Foundation Trust was riddled with “inexcusable” mistakes, according to an academic paper, reported The Business Insider UK. The “Google DeepMind and healthcare in an age of algorithms” paper – co-authored by Cambridge University’s Julia Powles and The Economist’s Hal Hodson – questions why DeepMind was given permission to process millions of NHS patient records so easily and without patient approval. “There remain many ongoing issues and it was important to document how the deal was set up, how it played out in public, and to try to caution against another deal from happening in this way in the future,” Powles told Business Insider in Berlin the day before the paper was published. DeepMind and Royal Free say that the study “completely misrepresents the reality of how the NHS uses technology to process data” and that it contains “significant mistakes”.” Powles and Hodson said the accusations of misrepresentation and factual inaccuracy were unsubstantiated, and invited the parties to respond on the record in an open forum. DeepMind has tried to defend the deal by saying that it’s providing something known in the healthcare industry as “direct care,” which assumes that an identifiable individual has given implied consent for their information to be shared for uses that involve the prevention, investigation, or treatment of illness. The initial deal is currently being investigated by the Information Commissioner’s Office, which is yet to publish any of its findings publicly. The National Data Guardian is also looking into the partnership.
Leeds Care Record adds community, mental health and adult social care: Leeds Care Record now has five major care settings viewing and contributing information across the region. Mental health, adult social care and community have joined hospitals and GPs since January in both seeing a view only summary and contributing their data, reported DigitalHealth.net. All 106 GP practices are now signed up in Leeds to the shared care record, which is powered and processed through the Leeds Teaching Hospitals NHS Trust’s in-house PPM+ system. Alastair Cartwright, director of informatics for three clinical commissioning groups in Leeds, said “while it’s certainly not everything” in what the record shows, it is “a limited but useful set of data”. For instance, if it was a hospital or social care worker the GP information that could be seen would include a list of current problems, medications, allergies and tests requested. He said that since it began in 2015 the record has saved time amounting to more than £1m a year. Doncaster is also to deploy a shared care record this summer, reported DigitalHealth.net. It will deploy an integrated digital care record, initially drawing on patient data from community, acute, mental health, and social care systems to create a “complete health record for patients on demand”. Initially this will be specifically aimed at supporting a new pathway developed for reducing falls. The benefits of a shared record would be tested for this specific group of patients for between 12 and 16 months, and potentially expanded if the benefits justify further funding.
Barts Health partners with Cera to prevent bed blocking: The largest trust in the country has partnered with a carer on demand service to get patients back home quicker, reported DigitalHealth.net. Barts Health NHS Trust has joined up with UK based company, Cera, to provide carers for elderly patients in their own homes. The start-up’s key selling point is that, within the M25, a carer can be provided within an hour. Ben Maruthappu, co-founder and president of Cera, told DigitalHealth.net that the company was working with Barts to “try and support and accelerate discharge from hospitals in a high quality, safe but also quick manner” and stop “bed blocking” in the NHS. “Because we can provide a carer to your door or to your hospital bed in less than 24 hours, we think we’re in an unique position where we can deliver very high quality service but also much more quickly than other providers.” Patients would not pay for Cera’s services, which usually cost £16 per hour. A spokesperson for Barts Health said in a statement that the trust is “working with a number of registered organisations, including Cera, to make sure patients get vital support in their own homes. This includes physiotherapy, nursing or domestic support to help people recover after a stay in hospital”. This month, Cera has also paired up with taxi company, Uber, to provide lifts for its clients using hundreds of specially trained drivers.
University College London Hospitals seals Epic deal: University College London Hospitals NHS Foundation Trust (UCLH) has approved a deal with US electronic patient record supplier Epic and plans to deploy the new system in 2019, reported DigitalHealth.net. The contract is part of a massive digital investment planned at the trust that also includes a new technology partnership with Atos and a contract with TeleTracking Technologies to provide new patient flow software. While the total investment in this “transformation programme” has not been disclosed, the tender for the Atos contract alone said it was worth between £150m and £400m. The full business case for Epic was approved by the trust’s board this month, but will still require sign-off by NHS England and NHS Improvement. In a statement, the trust described it as the “final major piece of UCLH’s digital strategy”. The transformation will be led by new chief executive Marcel Levi, said: “Our clinicians, nurses and other health care professionals will have access to all relevant patient information in one place. We can make significant further improvements in patient safety. We’ll be able to collaborate with other healthcare partners, such as GPs, more easily.” As well as being a single integrated clinical record for the trust, Epic will communicate with other patient systems, in particularly with partners across the North Central London sustainability and transformation plan footprint, he said.
Opinions
Technology could redefine the doctor-patient relationship
Artificial intelligence (AI) is already making inroads into the NHS and could have profound effects on the medical workforce, writes Richard Vize, public policy expert, in The Guardian.
“At last month’s DigitalHealth.London summit, Ali Parsa, founder of digital healthcare company Babylon, argued that mobile technology coupled with AI makes universal access a realistic goal, while replacing doctors with intelligent systems will slash costs,” he says.
“‘There is no solution which can fundamentally cut the costs of healthcare as long as we are reliant on humans,’ Parsa said.
“So [one] impact of artificial intelligence could be not merely augmenting the pool of medical talent but beginning to replace it.
Vize continues: “Big claims are being made for the clinical power of AI. [However] with the NHS still struggling to introduce electronic patient records, the idea of plugging the UK healthcare system into an all-knowing digital brain any time soon is fantasy.
“While there is no doubt that AI will enable faster and more accurate diagnoses, a more realistic prospect than replacing doctors is to redefine their role. That will be to put machine-generated information into the context of the unique life and needs of the individual patient, which cannot yet be reduced to an algorithm.
“It will be those who can harness AI to their own medical knowledge and their human skills of context and empathy who will be the leaders of their profession.”
Vital statistics? Big Pharma undervaluing commercial data, expert
Data is a core competence for Big Pharma that should not be outsourced, according to Stewart Adkins, director of management consultancy firm Pharmaforensic Limited, in In-PharmaTechnologist.com.
“The pharma industry is failing to realise the competitive advantage of commercial product data due to its reliance on third-parties.
“If you don’t have a good understanding of statistics, how are you in a good position to judge whether what is being offered to you actually meets the standards that you need to meet. I’m sad to say that in the vast majority of cases the pharmaceutical industry does not understand within the commercial area the statistics with which they are being sold.
“What you end up with is a constructed reality according to someone else, and then you’re judging and deciding what to do with your business based upon a report someone else is giving you on your own data. The basis of competitive advantage is compromised because you’ve handed it to someone else.
“The premise of data is – or should be – a core competence of the pharmaceutical industry within the commercial arena. It’s important, key, and significant competitive advantage which you do not want to give away.
“Microsoft’s Excel is totally unsuitable for professional statistical work. Pharma data is very rich, very complex and it does not conform to the rules that allow you to use Excel.”
The impact of NHS financial pressures – a mixed picture
Recent figures reveal a provider deficit of nearly £900m for the first three quarters of 2016-17 – a clear sign that NHS organisations are struggling in the face of constrained budgets and growing demand. At the same time, key performance data shows that hospital performance, in some areas, is slipping, writes Lillie Wenzel, policy fellow at The King’s Fund, commenting on the latest think tank’s “Understanding NHS financial pressures” report.
“As NHS organisations seek to manage current pressures, the number of media stories suggesting that tight health budgets are having a negative impact on patient care is increasing. But is this the whole picture? For the NHS, the relationship between financial performance and quality of care is complex. Indeed, a recent Public Accounts Committee report recommended that the Department of Health and NHS England undertake work to better understand the association between the two. We know that the actions NHS organisations take when they are under financial pressure can affect patient care in a number of ways. We also know that patient care is affected by many factors besides funding, and that both national data and public attention tend to focus on care delivered within hospitals.
“Looking across the four service areas we identified some common themes; for example, we found evidence that pressures are having a significant impact on staff, with many health care professionals working more intensely and for longer hours in order to protect patient care. This is particularly worrying given the well-established link between staff experience and patient experience. We also found that although organisations are working hard to maintain services and improve productivity in response to financial pressures, these pressures can also act as a significant barrier to innovation when either the funding, staff or skills necessary for change aren’t there.”
Highland Marketing Blog
The role of media and marketing in spreading innovation in the NHS
Adoption and diffusion of healthcare technology faces many barriers, including the challenge of bringing buyers and innovators together. Raising awareness through more active media engagement can help address this challenge, writes Rebecca Mellor.
