Guest blog
Future proofing our nation’s health requires ‘black box thinking’
Jeremy Hunt’s legacy needs to be future proofing the health of the nation by ensuring failure becomes an opportunity to learn and improve, argues Michael Thick, chief medical officer and chief clinical information officer of IMS MAXIMS.
News in brief
NHS struggling to plug a £22bn funding ‘black hole’, says report: The NHS in England lacks a convincing plan to plug a £22bn “black hole” in funding within five years, according to parliament’s spending watchdog. A significant number of acute hospital trusts are in “serious and persistent financial distress”, there is a “spiralling” trend of increased deficits and the current payment system is “not fit for purpose”, the Public Accounts Committee said. A report published this week found that reliance on agency staff, sometimes at “rip off” costs, had contributed to the dire situation and NHS trusts were also trying to meet unrealistic savings targets, reported The Guardian. The conclusions followed a further examination of a National Audit Office inquiry into NHS finances, which was published in December. Meg Hillier, the chair of the committee, said the government had done little to support trusts facing financial problems. “Without urgent action to put struggling trusts on a firmer financial footing there is further serious risk to services and the public purse,” she said. “In particular, it is unacceptable for senior government officials simply to point to excessive agency costs as a source of trusts’ difficulties.” The NHS is expected to find £22bn in efficiency savings by 2020-21, but MPs on the committee remain unconvinced that such savings are possible. “There is not yet a convincing plan for closing the £22bn efficiency gap and avoiding a “black hole” in NHS finances,” the report concluded. The Financial Times (subscription required) has also reported on the findings of the Public Accounts Committee and that worse lies ahead. Three out of four health service hospitals were already in deficit half way through the financial year and their predicted total overspend for 2015-16 is now about £2.5bn.
EHR to cost almost €1 billion to roll out: The Health Service Executive (HSE) electronic health record (EHR) system will cost an estimated €875m to implement over the next ten years, reported The Medical Independent. Projected capital costs for an EHR for public health services in Ireland, spread over the period 2016 to 2022, amount to €467m, while the revenue costs over a longer period, up to 2026, are estimated at €408m. The costs are contained in the HSE’s business case for the EHR, which is due to be published on the eHealth Ireland website. Commenting on the costs, Richard Corbridge, HSE chief information officer, said: “When we consider though the recent launch of an EHR for just one large hospital in the NHS has a cost set at around £60m then we can start to see the value to taking a countrywide approach.” Corbridge pointed out that the EHR business case has been created in such a way as to provide commercial protection to the healthcare system, so the HSE will only pay for systems once implemented and they will only be implemented when the health system is ready to do so. He said this approach is “a huge lesson learnt” from a number of other countries that have tried to roll out EHR systems. The EHR is currently being piloted through three different HSE Lighthouse’ projects, in both the hospital and community setting. An EHR for all women and babies in maternity services in Ireland (the Maternal and Newborn Clinical Management System) is being rolled out on a phased basis this year.
Budget failure to invest in NHS ‘a disgrace’, says BMA as Osborne unveils sugar tax: BMA leaders have hit out at chancellor George Osborne after the 2016 budget failed to boost NHS investment, but backed plans for a sugar levy on soft drinks to tackle rising obesity, reported GPOnline. Unveiling the 2016 budget in parliament, Osborne said five-year-old children were “consuming their bodyweight in sugar each year”. Citing warnings that “within a generation over half of all boys, and 70% of girls could be overweight or obese”, he pointed to sugary drinks as “one of the biggest contributors to childhood obesity” and set out plans for a sugar levy to take effect two years from now. The chancellor also set out changes to public sector pensions that look set to increase employer contributions. Reacting to the budget, BMA chairman Dr Mark Porter hit out at the failure to announce new funding for an NHS facing a growing financial crisis. He said: ‘It is disgraceful given the crisis facing the NHS that there was no promise of extra funding for a health service that is buckling under pressure from rising patient demand, falling resources and staff shortages. Hospitals and GP practices around the country are at breaking point and need urgent, extra investment to maintain even basic care to their patients. The political rhetoric does not match the reality on the ground of an NHS in crisis. The government’s funding promises have simply not materialised.”
BMA calls crisis conference to prevent health service “collapse”: The British Medical Association (BMA) will hold a special representative meeting to discuss the deepening crisis facing the NHS. Members of the BMA Council called for the “extraordinary” conference, which will take place on 3 May in London. BMA council member and Lancashire GP Dr David Wrigley tweeted from a meeting on 16th March, saying that UK doctors saw the NHS “collapsing”. Dr Wrigley told Pulse: “The BMA council discussed the parlous state of the NHS due to the year-on-year funding cuts, something which is a political choice made by this government. This extraordinary meeting will discuss the crisis in the NHS and attempt to come up with solutions, challenging our politicians to step in and rescue the NHS from collapse.” BMA council member Dr Allyson Pollock, a medical academic, said in a tweet that the meeting would “highlight [the] NHS crisis in England and implications for UK public and patient[s]”. A BMA spokesperson said: “I can confirm that a special representative meeting will be taking place and we will confirm further details in due course.”
NHS England names council chiefs among health transformation leaders: Details of the 44 areas that will develop of sustainability and transformation plans (STP) for the health service have been revealed by NHS England, with two council chief executives among those named to lead the initiative. These areas will bring together health and care leaders, organisations and communities to develop local blueprints for improved health, care and finances in regional areas known as footprints. It takes forward part of the NHS’ Five Year Forward View, reported Public Finance. Eight leaders of the areas have been named, including two local authority chiefs – Manchester City Council’s Sir Howard Bernstein will lead the Greater Manchester footprint, while Birmingham City Council chief Mark Rogers will lead the Birmingham and Solihull footprint. Each area will now work on local plans to bring together local health and care leaders, organisations and to develop new models of care. The NHS called for the formation of the STP areas last December to ensure that health and care services were planned in local areas over a period of five years, rather than annually. Each area also needs to set out how it will meet the ‘triple aim’ in the Five Year Forward View of improved health and wellbeing, transformed quality of care delivery, and sustainable finances.
MPs criticise ‘lack of progress’ on NHS self-care rollout: A report by the all-party parliamentary group (APPG) on primary care warned of a lack of progress on promoting self-care, and on making sure the prevention and wellbeing aims of the Five Year Forward View are met within the five-year period it envisaged, reported GPOnline. The APPG report called on the Department of Health and NHS England to develop a national strategy for self-care, and for the appointment of a minister and a national lead to drive its implementation. Public health funding handed to local authorities should be ring-fenced to stop it being diverted elsewhere, the report warned. It also highlighted problems with ‘inconsistent information on where to seek medical help’, which drives patients to GP practices and A&E unnecessarily. The APPG highlighted NHS England chief executive Simon Stevens’ pledge that the health service would move on from being a “care and repair” service to focus more on prevention and wellbeing. “We are gravely concerned about the lack of progress towards these goals since the [Five-Year Forward View] was published in 2014,’ the report warned.”
Nearly 350 incidents of lost or breached medical records at trusts in four years: Since 2012, nearly 350 incidents of records being lost or patient confidentiality being breached by health trusts have been reported to the Department of Health. The figures, which emerged in an answer to an Assembly question to the health minister, have led to calls for action to be taken to protect confidentiality, reported The Belfast Telegraph. There were 346 incidents in total, the highest in 2014 when the number of cases rose to 108, dropping 12 months later to 69. The minister’s response did not reveal any detail of the type of losses in each trust area. Ulster Unionist Party health spokeswoman Jo-Anne Dobson, who asked the question, said that any loss was a serious matter. It has previously been revealed that in 2012 a client’s referral details appeared on Facebook after a staff member dialled the wrong number and left a message on a machine. Dobson said the latest figures were concerning and that she was “deeply disturbed” by the volume of incidents. “The problem has deteriorated significantly over recent years so it is essential that Simon Hamilton gets to grips with an issue which he was very vocal about himself as a backbench Member of the Legislative Assembly in 2008 – a time when the number of reports going missing was comparatively lower compared to two or three times that now,” she added.
E-discharge: standard clinical headings required by December: All NHS providers must send digital discharge summaries to GPs using standard clinical headings by December this year, the new draft NHS standard contract says. The contract, which is out for consultation, also encourages providers to adopt structured messaging for discharge summaries, but this will not become a formal requirement until next year’s contract, NHS England head of enterprise architecture Inderjit Singh told DigitalHealth.net. The new General Medical Services contract will also make it a requirement for GPs to be able to receive discharges electronically from next month. All four principal GP system suppliers now have the functionality to be able to receive structured documents directly, as specified under the latest GP Systems of Choice contract. “The key message to the service is we are asking to move to clinically consistent headings, but also structured documents and that functionality is in place with all GP system providers,” said Singh. The requirement to send electronic discharge summaries was included in last year’s NHS standard contract and was mandatory from last October. According to the first round of results from NHS England’s new Digital Maturity Index, around two thirds of trusts are now sending the majority of their discharge letters to GPs electronically. Singh said NHS England’s strategy has been to align contractual levers with professional buy-in and supplier readiness to ensure uptake is high.
Leeds trust and GS1 launch new partnership in demonstrator site programme: The GS1 demonstrator programme has launched with a partnership between GS1 UK and Leeds Teaching Hospitals NHS Foundation Trust, reported National Health Executive. GS1 will open an on-site project office to help with the delivery of full GS1 implementation against defined timelines. Leeds is one of six NHS acute trusts receiving £12m funding to demonstrate significant efficiencies and cost savings, reduced errors and better patient outcomes by adopting GS1 electronic barcoding standards in procurement. Tony Whitfield, director of finance at the trust, said: “We are delighted to be working on this exciting project. It will mean that every location, medicine and medical device will be identified using a unique barcode which is also associated with a particular patient, providing additional monitoring for safety purposes. It will make it easier to track individual patient journeys through our hospitals and ensure we only order the stock we need at the time we need it, delivering significant cost savings.” Whitfield and Chris Slater, the head of supplies and procurement at the trust, will showcase ‘the Leeds way’ of implementing GS1 standards at the annual GS1 UK Healthcare Conference on 12-13 April.
Not enough doctors for 7-day NHS, says Royal College head: There are not enough doctors to run a seven-day NHS in England, according to a leading doctor. Royal College of Physicians president Prof Jane Dacre warned ministers the issue must be addressed if their policy is to work, reported the BBC. She highlighted research that shows vacant posts are not being filled and gaps in rotas are being seen. It comes as ministers are locked in a dispute with junior doctors over their plans for improving weekend care. Last week thousands of medics went on strike over the government’s decision to impose a new contract on them, designed to make it cheaper to rota on staff at weekends. Prof Dacre raised her own concerns at the RCP’s annual conference in Harrogate, saying NHS trusts are struggling to find enough staff to cope with existing demands. Prof Dacre told delegates: “I feel sorry for NHS trusts, I really do. Across the country, they have created a raft of new posts to meet the rising demands for patient care, only to find that there is no-one to fill them. If we have neither enough trainees nor consultants to run the service now, how are we going to implement a safe seven-day service?” A Department of Health spokeswoman pointed out extra money was being invested during this Parliament – £8bn more by 2020. She said this would help “make sure the right staff and support is available to create a safe NHS seven days a week”.
Surrey and Sussex trust to use PKB with 3,200 IBD patients: Surrey and Sussex Healthcare NHS Trust is to offer patient-controlled electronic records to more than 3,200 people with inflammatory bowel disease (IBD), reported DigitalHealth.net. A pilot study funded by pharmaceutical company Janssen has already seen more than 400 patients with IBD use the Patients Know Best system. The solution is integrated with the hospital’s Cerner Millennium electronic patient record, allowing the patient record to augment the hospital record. Dr Azhar Ansari, project lead and consultant gastroenterologist at Surrey and Sussex Healthcare said: “By using Patients Know Best, the patient can self-manage their condition far more effectively and warn us before problems occur. In many cases we can avoid A&E visits and that’s good news for the patient – and for our hospital.” He called the use of electronic, patient-held records “our Gutenberg moment in healthcare” and said: “We cannot have a long enough interview to discuss the social movement that is happening with unrestricted patient access to secondary care and shared data.” Dr Ansari said the technology, in combination with investment in specialist nurses by NHS East Surrey Clinical Commissioning Group, is helping to transform the way he cares for 3,200 patients with IBD.
Crediting nurses who admit mistakes could improve safety: Nurses and midwives who admit to their mistakes could receive less severe sanctions when their case is reviewed by a Nursing and Midwifery Council panel (NMC), the health secretary has suggested. As part of a series of new measures announced this week to improve safety and learning from mistakes in the NHS, Jeremy Hunt said nurses should now receive “credit” from the NMC for being honest about errors during tribunals. Speaking at the inaugural Global Patient Safety Summit in London, he said that under changes to NMC guidance, when NHS staff admit mistakes and apologise, “a professional tribunal will give them credit for that, just as failing to do so is likely to incur a serious sanction”. Nurses and other health professionals need to know that they will get credit for being open and honest, and the government is committed to legal reform that would allow professional regulators more flexibility to resolve cases without stressful tribunals, where professionals have admitted their mistake,” he told delegates. The health secretary told Nursing Times (subscription required) the NHS needed to “move away from the idea that there are going to be automatic professional consequences” if people admit to a “human mistake”.
Vanguard trust gets £23m Department of Health loan: A South West trust which is a prominent vanguard site has received a £23m loan from the Department of Health (DH), Health Service Journal (subscription required) has learned. Yeovil District Hospital Foundation Trust received the loan for 2015-16, but will require further financial support in 2016-17. The money will cover the trust’s deficit, which is forecast to be £18.4m for 2015-16, plus some additional capital expenditure. Yeovil was one of NHS England’s initial 29 vanguard sites chosen to implement new care models in line with the Five Year Forward View. It is developing a primary and acute care system – a hospital led care model involving vertical integration to create a single organisation delivering acute and primary care services. A trust spokesman said: “Our forecast financial position for the end of 2015-16 is in line with our plan submitted to Monitor, and reflects a challenging year in which activity has significantly increased. This has driven additional operational costs, including those for agency medical and nursing staffing, which is being addressed through a comprehensive recruitment strategy in both the UK and overseas. We have secured loans from the DH to enable required investments into the fabric of our hospital, to secure our cash position and to enable delivery of operational improvements, such as the development and implementation of our electronic health record.”
Half of health boards miss A&E waiting time targets: Eight out of 14 health boards have failed to meet a waiting time target for accident and emergency (A&E) treatment, reported The Scotsman. The Scottish Government wants to see at least 95% of A&E patients seen, admitted and transferred or discharged within four hours. Data for the week ending March 6 shows the target was met in 91.3% of cases across Scotland – down from 92.9% the previous week. Health boards covering the Borders, Dumfries and Galloway, Fife, Forth Valley, Greater Glasgow and Clyde, Highland, Lanarkshire and the Lothians region failed to meet the target – with NHS Greater Glasgow and Clyde dealing with 86% of cases within four hours. Sixteen of the 30 hospitals where performance is monitored did not achieve 95% with lowest rate recorded at Glasgow’s new Queen Elizabeth University Hospital (QEUH), where 77.4% of A&E patients were seen within the target time. Health Secretary Shona Robison said: “The improved performance this winter is testament to the dedication of staff working right across the NHS and social care. But, as we have seen throughout the winter period, A&E performance will fluctuate from week to week and also from hospital to hospital. Peaks in demand are still affecting performance in some places, particularly over the course of a single week. That is why we are clear that there is still much more to be done to retain and build on improved performance and cut waiting times even further.”
Opinion
The digital age can take the doctor-patient dynamic into a new era
Giving patients online access to their GP record helps redefine the relationship in unexpected new ways, says Dr Jagdeesh Singh Dhaliwal
“The familiar rhyme and rhythm of the GP consultation takes place around 900,000 times each day in surgeries up and down the UK. As general practitioners we must establish and maintain rapport with our patient; take a history; conduct a physical examination; order tests if required; offer and discuss options and agree on a plan, all within an allocated appointment time of 10 to 15 minutes.
“The digital age has transformed the way in which we engage with banks, shops, takeaways and just about every other service industry. Surely there must be novel ways of reimagining the doctor-patient relationship in general practice? It was this thought that led our suburban GP practice team to embrace digital communication technologies back in 2014.
“We now encourage patients to conduct ‘safe’ searches online for symptoms and conditions through our practice portal where they can access targeted self-help information and advice from a wide range of health professionals who might be able to help. We support our patients to consider using health apps and – crucially – to obtain online access to their full medical records.
“Older patients with multiple illnesses have glowed with enthusiasm about how much more empowered they feel through really ‘knowing what’s going on’. Several have described how they have asked their ‘wired’ teenage grandchildren to help them to gain online access, opening up new conversation and even some fresh ‘respect’ for grandparents gaining new IT skills.
“Today’s digital technologies open up the possibility of helping patients and their doctors to re-energise their therapeutic relationship of trust: “Here’s the data which we’ve previously both read. What sense do we jointly make of this? How do we together now find the best way forward for you?” This is the essence of what I always hoped being a GP would be about.”
The King’s Fund responds to the 2016 Budget
Lost revenues from business rates must not result in additional public health budget cuts, The King’s Fund warns in reaction to the Chancellor’s budget announcement.
David Buck, senior fellow at The King’s Fund, says: “The Chancellor announced the abolition of business rates for small businesses, which could result in a £7bn loss in revenues, a third of business rate revenues. Public health spending is going to fall by at least £600m in real terms by 2020/21, on top of £200, cuts this year, so it is essential that this does not result in further cuts to public health budgets in future.”
He also comments on the new sugar levy for soft drinks: “Childhood obesity is one of the most significant public health challenges facing the UK – so the Chancellor’s surprise tax on sugary drinks will provide welcome revenue for funding schools sports and other activities. The levy could be a helpful addition to the UK’s approach to addressing obesity, but details need to be ironed out. To have most impact, it will need to be at a sufficient level to change behaviour, be well designed and targeted, and be part of a broader strategy on obesity.”
What next for digital health in the UK?
Eren Ozagir, CEO and founder of PushDoctor.co.uk, looks at the opportunity still abound across the UK’s digital health landscape.
“The UK’s care ecosystem is undergoing a metamorphosis as digital technology and the infrastructure necessary to support it reach a convergence point; which in turn means an inflexion has begun. While the potential benefits offered by each have been the subject of much discussion for years, it’s only now that the capabilities and positive differences that a technology-enabled care world can create have been realised.
“High-speed internet has reached around 90% of the UK, and nearly everyone is holding a mobile device as powerful as a desktop computer in their hands, making connecting into networks simple and easy to do.
“The UK government’s Office for Life Sciences has identified mHealth as the fastest growing segment in digital health – forecasting a 35% CAGR (compound annual growth rate) between 2014-18 in the UK and 49% globally.
“In general, the majority of healthcare relies on self-care and there’s innumerable opportunities for mHealth and connected technologies to proactively assist people in this regard – helping them to tackle nascent issues, preventing them from evolving into full-blown problems and thereby reducing strain on the overall system. We hear it all the time – ‘prevention is the key’ – but with digital health, we are building and providing the tools that enable the patient to truly live up to their important role in the preventative process.
“In response to the demands of connected consumers, we’ve begun to see a digital primary healthcare system emerge in the UK. Powered by connected technologies and answering the need for more timely care that works around the individual patient – maintaining high-quality care, but also solving the challenge of immediacy of delivery. This enables patients to get a consultation in minutes, but more importantly, delivers on that promise.
“The coming years look bright for digital healthcare, both for private companies like us and the NHS, whose ambitious plans set out in the Five Year Forward View will see it harness new and existing technologies to tackle the problems of a growing and increasingly-aged population.”
