Healthcare Roundup – 18th November, 2011

Payment by Results to be abandoned
NHS leaders expect the 2012-13 operating framework to endorse ‘bundled’ and block payments in a bid to control costs. HSJ claims that the document, due out this month, will allow trusts to abandon Payment by Results.

Some PCTs and acute trusts have already moved away from the Payment by Results tariff for some services. A formal endorsement by the DH would be a response to growing concerns that, under the current system, increasing numbers of commissioners could run out of money as demand and activity continue to grow.

It is argued that the change would also encourage providers to increase productivity rather than trying to put the brakes on demand.

1.2 million hospital follow-ups axed
GPs faced a huge extra burden of work as hospitals cut back the number of follow-up appointments they carried out by 1.2 million last financial year. An investigation in Pulse reveals the ratio of follow-up appointments to surgical procedures fell by 4.3% in the last year, and 5.9% over the last two years, as managers impose efficiencies.

The overall drop included steep falls at Pennine Acute Hospitals NHS Trust, where the ratio fell from 2.87 in 2008/9 to 1.78 in 2010/11, and at Ealing Hospital NHS Trust it fell from 2.51 to 1.84. In a separate development Pulse claims that GPs in the north east fear being ‘overwhelmed’ by extra work after North Tees and Hartlepool NHS Trust announced a £40 million cost cutting drive to stay financially viable.

Stem cell research for repairing hearts
Stem cells from patients’ own hearts have, for the first time, been used to repair damaged heart tissue. More clinical trials, starting in 2012, will further-investigate the potential of the technique. A study in the Lancet reported that small-scale trials had been encouraging, improving the ability of damaged hearts to pump blood.

The procedure, pioneered by the University of Louisville, involved taking stem cells from patients as they were being operated on. These were cultured for 100 days until there were around two million, then injected back into the patient.

The BBC reports that large-scale trials are underway in Britain using stem cells from bone marrow to repair hearts. Clinicians from Barts and the London School of Medicine and Dentistry are investigating the effect of giving patients stem cells from their own bone marrow within six hours of a heart attack.

Waiting list crackdown brings return to targets
Ministers are ordering a crackdown on ‘hidden’ waiting lists. They are demanding that NHS managers reduce the number of long waiters by about 50,000 by April. According to the BBC hospitals there are nearly 250,000 who have waited for longer than the current 18 week limit. More than 100,000 have waited for more than six months and 20,000 at least a year.

The waiting times initiative has raised eyebrows in the NHS as the government pledged to move away from Labour’s target-based approach, and announced that the 18-week limit was being relaxed. Health service insiders regard the new move as the reintroduction of targets but in a new guise.

Nine ways that IT transforms healthcare
When many people think of healthcare IT, what springs to mind is medical records. Healthcare IT News covers a US report by Booz Allen Hamilton which highlights nine far more diverse ways in which information technology is transforming care.

The report notes that IT has tremendous potential to make healthcare patient-centred. Among the nine areas of transformation listed are the reduction in medical errors and the increased speed of emergency care. The authors are especially impressed by the way mobile technology can provide clinicians with real-time patient information.

Health records made Simpl
England’s first integrated health and social care patient record system has been procured in a £3.8m deal between Torbay Care Trust and IT firm Simpl. HSJ says it will enable staff to access a single record for each patient receiving community health and social care services.

The record will also be accessible remotely via smartphones or tablet computers, allowing the trust’s staff to capture more information closer to patients at home, and giving greater access to information when they are out of the office.

News in Brief
Longer GP training: The NHS Future Forum wants GP training extended to ensure better care for older patients with complex needs. Dr Clare Gerada, chairman of the Royal College of GPs welcomed the proposal. GP magazine says the change will be recommended in a report to the DH on education and training in December.
Better diabetes care needed: The NHS has been criticised over its ‘reluctance’ to improve outcomes. The BMJ reports that Rowan Hillson, England’s national clinical director for diabetes, said that 10% of the population will have diabetes by 2020 but that current care is variable and inconsistent.
Games to cut violence: Free wi-fi in A&Es could cut attacks on staff. The Telegraph says the winners of a bid to redesign three A&Es believe access to online games and entertainment would keep potentially disruptive patients occupied. There are 36 assaults a day on general hospital staff, costing the NHS nearly £70 million.
Risk information will be made public: BMJ reports that health secretary Andrew Lansley has been ordered by the information commissioner to release a document outlining the risks that his controversial reforms could pose to the NHS.
CCG funding uses obsolete data: The Commons Public Accounts Committee says some of the data used to decide on funding for NHS commissioners is a decade old and has called for urgent action to bring it up to date.
NHS consultancy cut by £200m: DH figures show a 39% decrease in NHS spending on consultancy services from £503.2m in 2009-10 to £304.9m in 2010-11.

Better care through information
Effective integration: The King’s Fund is recommending that care providers adopt a case management approach to deliver good integrated care. Its report Case Management: What it is and how it can best be implemented examines how the strategy can benefit those with long-term conditions. A key finding is that information must be available for all care team members, across organisational boundaries.

The fund says case management is a well-established way of integrating services around the complex needs of people with long-term conditions. It is a targeted, community-based and pro-active approach that identifies those at high risk of hospital admission, produces a personal care plan, and ensures co-ordination of care.

Carers on the web: The internet must be developed as a tool for helping carers, according to two leading charities. The Princess Royal Trust for Carers and Crossroads Care looked at how carers use the internet and the barriers that limit them. They call on health and social care providers to become more web-friendly.

The charities’ report, How Can the Web Support Carers, explores the advantages of online carer support, as well as the pros and cons of current web services. Its contents may be of value to companies involved in telehealth and other innovations in home-based care. Among the findings are that 14% of net-using carers have online networks of support. Some 30% have taken part in elearning.

Online resource promotes remote care: The Health Foundation has launched an online self-management resource centre with information and practical tools that can be adapted locally to enable services, and health professionals, to develop their own patient support programmes. It builds on the foundation’s Co-creating Health programme and a wide range of national and international evidence.

Highland Marketing blog
Maps, apps and mortality rates Matthew Shelley wonders whether we will ever be well-enough organised to exploit the full benefits of mobile technology in healthcare.

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