News in brief
TechUK launches five year strategy: Improving technological innovation within the NHS is crucial if it is to reach the “holy grail” of reducing healthcare costs and increasing productivity, according to a TechUK manifesto. The suppliers body’s manifesto for 2015 to 2020, ‘Securing our Digital Future’, is aimed at encouraging politicians to recognise the “critical significance of the global digital revolution” and makes a number of recommendations to improve digital innovation and increase growth, reported eHealth Insider. The manifesto says increasing productivity in the delivery of healthcare should be considered “the holy grail of public policy”, given the financial impact of an aging population and the associated long-term chronic conditions. It says there is “enormous” potential to improve health outcomes and reduce costs using technology, such as by improving data flows to speed up diagnoses, enable earlier interventions and make more efficient use of resources. “However, the ability of the health and social care system to understand, adopt and absorb the benefits of new technologies is often hampered by organisational structures, budgets and processes that are not designed to encourage innovative new ways of doing things.” The manifesto describes the government’s goal to make the NHS paperless by 2018 as “an important attempt to change [the] status quo”, but says more must be done to ensure it is a success while also encouraging more “bold challenges” in future.
Scottish independence: NHS in Scotland ‘faces £400m funding gap’: Confidential papers passed to the BBC suggest a radical cost-saving plan will be implemented in the Scottish NHS after the referendum. The papers were presented to a meeting of health board chief executives and civil servants last month. They suggest the NHS is facing a £400m funding gap, and sweeping changes will be needed for boards to break even. The Scottish Government said it was committed to “protecting and increasing the NHS budget”. The documents state: “The status quo and preservation of existing models of care are no longer an option given the pressing challenges we face.” The whistleblower has alleged that pressures on the NHS come from Scottish Government policies. As part of an initiative to transform care by 2020, legislation has been passed by the Scottish government to encourage more community care. However, the papers say this has been undermined by “continued commitments” which are “directly in conflict” with the 2020 vision and increase the cost of expensive hospital care. The documents say new obligations are “not fully funded”. The documents conclude that the “status quo in terms of service and workforce planning is not an option”. The papers outline a funding gap of £400-£450m in the next two financial years, 2015-17, which is described as “a level significantly in excess of that previously required”. The Scottish Government said the paper was “part of the regular discussions among NHS leaders to plan for NHS Scotland’s future”. Health secretary Alex Neil said: “Despite Scotland’s budget being slashed by 7.2% by George Osborne between 2010/11 and 2015/16, our increases in health spending means that the NHS is receiving record high funding, with a budget increase of over £1bn between 2010/11 and 2015/16.”
Stop reorganising the NHS and invest more, says Royal College of Physicians: The Royal College of Physicians (RCP) has called on the political parties to stop reorganising the NHS, to increase funding and to commit to a health service free at the point of delivery. The manifesto, published ahead of the party conferences, warns of an “impending financial crisis” unless action is taken, according to The Telegraph. The Coalition carried out the biggest reorganisation of the NHS in its history shortly after coming to power, scrapping primary care trusts and middle management layers and replacing them with clinical commissioning groups run by frontline staff. At the same time the service was having to make unprecedented savings in the face of flat budget growth and increasing demand. The overall NHS budget is around £110bn and has had to make £20bn savings over the last four years. However experts believe there could be a £30bn funding gap by 2021 if budgets remain frozen and demand continues to increase. RCP president Professor Jane Dacre, who will be attending party conferences with other senior RCP representatives, said: “The NHS has suffered badly from the instability caused by constant reorganisation, and funding policies that have made it harder for hospitals, GPs and community services to work together to improve patient care. The next government must commit to a long term vision that brings joined-up care to patients wherever they are.”
Digital monitoring key to health future: Personal digital health technologies could replace the traditional healthcare systems in the way that electricity made candles obsolete, health entrepreneur Ali Parsa has claimed. Speaking at the King’s Fund International Digital Health and Care Congress in London last week, Parsa, founder of Circle Health, and now chief executive of the soon to be launched mobile health service start-up Babylon, said a rapid and continuing decrease in the cost of diagnostic testing is making it easier for wearable health devices and other monitoring technology to be more widely used. Babylon aims to offer real-time video consultations, diagnostics, monitoring, prescription ordering and appointment booking, as well as cloud-based access to patient records in a smartphone app, with users paying by subscription or on a consultation basis, reported eHealth Insider. Comparing healthcare to automobiles, Parsa said that cars used to break down all the time, but the proliferation of sensors and monitoring technology means that the hard shoulder of motorways is now largely obsolete. He suggested current healthcare models may soon be made similarly archaic: “We will soon have the same capabilities to know about our bodies what we can know about our cars. Thomas Edison said that he would make electricity so cheap that only the rich could afford candles. I and other entrepreneurs are going to make healthcare so cheap that only the rich can afford the existing, inaccessible healthcare system.” Parsa said the growing capability of smartphones has provided an “ideal platform” for the distribution of health apps and software, while information freely available on the Internet has made it easy to develop sophisticated symptom checkers and other useful algorithms. “We’ll soon be able to intervene with diseases in a way we never have before.” He said applications such as the Babylon service will be particularly valuable to the 70% of the world’s population who have “no meaningful access” to healthcare.
NHS hospital comparison website launched: A new website to enable patients and staff to compare hospitals across a broad range of metrics from accident and emergency waiting times to the quality of meals has been launched. The Department of Health said the new MyNHS website would “highlight the best performing areas and improve standards through competition and transparency”. The site includes data on patient safety, efficiency, quality, public health, social care commissioning and hospital food standards, reports Health Service Journal (subscription required). All the metrics included are already published but they are often hard to access or find, or presented in a format which is not user friendly. Hospital metrics used on the site, which will be hosted on the NHS Choices website, will include mortality ratios; infection and cleanliness ratings; agency staff spending; and whether or not fresh fruit is available. Measures related to public health will include excess weight in adults, smoking prevalence, breastfeeding prevalence at 6-8 weeks, and take up of NHS health checks. Data on clinical commissioning groups, mental health services, GP practices and clinicians will be added at a later date. National director for patients and information at NHS England, Tim Kelsey, said the site represented “a big step forward towards our transparency vision, bringing together data from across the health and care system for the first time and presenting it in accessible, understandable and meaningful way”.
NHS England to publish telehealth toolkit: NHS England’s Technology Enabled Care Services (TECS) programme will publish a telehealth toolkit for commissioners later this autumn, according to eHealth Insider (EHI). Speaking at the King’s Fund’s International Digital Health and Care Conference in London last week, Cathy Hassell, programme head for the TECS programme, said it had consulted with stakeholders and commissioners. And during the process, it became clear that “people wanted support” on how to use telehealth and telecare. “[Commissioners] wanted a ‘how-to-guide’ that is written for commissioners and by commissioners,” she said. “We are developing a central repository of evidence that can be accessed by health and social care professionals and commissioners. We are also working in collaboration with the Royal College of General Practitioners to develop an online learning module for primary care commissioners. Commissioners don’t have time to go out and research everything on every single topic so we need to do that for them. What we are doing now is developing a commissioning resource and toolkit which we expect to launch this autumn.” She added that the toolkit is being developed by the NHS Commissioning Assembly and will not be an NHS England product. As part of the shake-up of the NHS in April 2013, NHS England took over responsibility for the programme, formerly known as 3millionlives, which initially aimed to have 3m people using telehealth or care by 2017. A new strategy on the programme was due out in May this year, but EHI understands that the decision was made not to publish. Instead, a letter outlining the programme’s plans will be sent out to stakeholders and interested parties in the coming weeks.
NHS faces mounting financial crisis as deficit heads towards £1bn: The NHS is facing a mounting financial crisis with more than half of all hospitals now in deficit and the service likely to end the year almost £1bn in the red, reported The Guardian. Two sets of official figures covering the NHS’s performance in April, May and June confirmed a sudden, sharp and dramatic deterioration in its financial health between the first three months of 2014 and that quarter. The pressure on services is so great and money so tight that, for the first time, a majority of hospitals ended that period in the red and accumulated a collective deficit approaching £500m. NHS officials familiar with the situation say the speed with which financial troubles have deepened, and sheer number of NHS hospital trusts now affected, is causing unease at the Department of Health. Insiders say that figures are far worse than expected and likely to make “grim reading” for health secretary Jeremy Hunt. Hunt has already given hospitals more than £1bn of extra funding over the last year to help them cope with winter pressures and tackle a mounting backlog of operations, which recently reached a six-year high. NHS leaders say privately that without an urgent bailout from the government, hospitals’ overall deficit is likely to have increased further, and be approaching £1bn; by the time the NHS’s financial year ends in March. And as many as three-quarters of all England’s hospitals could be in the red by then, they believe. Hospital chief executives say the need to hire extra staff to maintain care standards in the wake of the Mid Staffs scandal, demand for A&E care, cuts in the fees they receive for treating patients and the NHS’s £20bn savings drive has left them increasingly unable to balance their books.
Harrogate trust leaps ahead in patient safety with tech fund money: Faster clinical intervention for deteriorating patients at Harrogate hospital is to improve safety with the go-live of the Patientrack early warning system reports the Harrogate Informer. A new digital approach to capturing vital signs and recording critical bedside observations will allow hospital staff to respond much more quickly to patients who need urgent attention, following the introduction of Patientrack at Harrogate and District NHS Foundation Trust. The real-time patient vital signs, early warning and alerting system has now gone live and aims to have a significant positive impact on patient safety, hopefully reducing mortality and allowing healthcare professionals to avoid a wide range of risks and adverse events for patients in their care. Patientrack will automatically identify and escalate patients who may be deteriorating, before sending alerts directly to those clinicians who need to take action. Paper based observation processes will now be completely removed. Patientrack will instead allow nurses to capture observations in real-time at the patient bedside on handheld tablet devices, with clinicians also able to access that information from anywhere in the hospital. Robin Pitts, paediatric advanced nurse practitioner at the trust, said: “When a nurse has a deteriorating patient they need a response as quickly as possible. With Patientrack, nurses will no longer need to leave a deteriorating patient to go and identify the right doctor to bleep. The nurse will know that the bleep has already been sent, as the system has calculated the NEWS score for them and automatically alerted the doctor. They know that doctor will respond.” The system is being implemented in a £1.2m clinically led project made possible with money from the government’s Safer Hospitals, Safer Wards Technology Fund. Donald Kennedy, managing director at Patientrack adds: “This is a compelling example of the NHS taking the initiative with innovative technology to make important advances in patient safety, whilst at the same time embracing the help that UK SMEs can offer.”
Hospitals face legal requirement to display CQC ‘scores on doors’: Hospitals, care homes and GP surgeries could be legally required to ‘prominently’ display their Care Quality Commission (CQC) service ratings from April 2015, according to National Health Executive. Under new proposals from the Department of Health (DH), it has been suggested that the CQC rating must be clearly visible, such as in waiting rooms or entrances, and must be published on the provider’s website with a link to the inspection report. Failure to comply could result in a £500 fine for the provider, with the CQC also able to issue a £100 penalty notice in lieu of prosecution. The proposals form part of the DH’s consultation ‘Placing a legal requirement on registered providers to display the rating published by the CQC’, which care minister Norman Lamb believes will significantly help boost transparency in the health sector. He said: “I am sure that providers who are awarded a ‘good’ or ‘outstanding’ rating by CQC, will want to highlight their achievement. Providers who receive a ‘requires improvement’ or ‘inadequate’ rating are less likely to wish to publicise this fact. David Behan, CQC chief executive, said: “People who use health and care services want to know that they are safe and of high quality. When we rate services, we think it is important that the public know what our judgement is.”
CGI seeks to expand patient records partnership with NHS trusts: Twenty NHS trusts are currently in discussion with CGI over the possibility of adopting its e-CareLogic integrated records system into their operations as part of a collaboration agreement with the University College London Hospital (UCLH). Government Computing, reports that under the agreement signed with CGI, UCLH will assist in offering the technology to other healthcare trusts after working together to develop the management system, which is designed to provide secure access to patient information for clinicians, GPs and other health stakeholders. UCLH clinicians have worked directly with the company to drive innovation that can better meet the needs of patients and staff, notably with the development of a mobile application called ‘Find my Patient’, according to CGI. The app, used to locate specific patients within a ward, is currently in the process of further development to expand treatment information and other data available to clinicians working across the trust. “Traditionally, the main challenge for NHS trusts in implementing systems is to get the full benefits from what it is capable of delivering. Large scale systems are significantly challenging to bring into any trust, distracting from day to day patient care and consuming significant resources,” said UCLH ICT director James Thomas.
EHI Awards 2014: Highland Marketing will be sponsoring the ‘Best use of social media to deliver a healthcare campaign’ category of this year’s EHI Awards. Media such as Twitter and Facebook are useful tools to seek out hard-to-reach groups and deliver information to support health campaigns. This category will identify the smartest operators and most successful campaigns. Finalists include – The King’s Fund digital advent calendar – using Vine to spread important health messages – The King’s Fund; Feel well, choose well – NHS Arden Commissioning Support; Facetime for ITU – The Walton Centre NHS Foundation Trust; and MyHealth – Patient.co.uk. The awards take place on Thursday 9th October at the Roundhouse, London.
Opinion
Adrian Byrne, director of IM&T at University Hospital Southampton NHS Foundation Trust, considers the pros and cons of the ‘paperless’ agenda and what implications this transition holds.
“At a recent Health CIO Network event, I was asked to chair a discussion on ‘Paperless by 2018’. […] One observation was that paperless is “a vision not a target”. That kind of works for me, in the same way that the suggestion that an electronic patient record is not a system, but a strategy, works for me.
“Clearly, even if we can remove all the paper from our operations, we cannot do it in one go. We will continue to receive paper from some sources, and we will need ways of ingesting that and putting it into a seamless workflow. We will also need to produce hard copy for those not prepared to go electronic; and there may be quite a long tail on this when we consider the needs of patients.
“It’s easy to get excited about the idea of paperless, which may be why it is catching on. However, one thing we know about paper is that it has been around for a long time and has a great user interface. It tends to be quite fault tolerant; even if the back-up options are generally poor and tend not to be implemented. The current system is not perfect, but it’s a good idea to bear its good and bad points in mind when thinking about a major change. In particular, it is worth asking whether we should doggedly pursue the extinction of paper when it may be fit for purpose when it is just in transient use. Even so, the benefits of paperless systems are generally fairly obvious.
“There’s no doubt that well implemented software systems can reduce certain harms and deliver a better result overall. However, as with any system in clinical practice, we shouldn’t overlook the possibility of new risk; even if this can be difficult to fathom against existing risk.
“Whether we regard ‘Paperless by 2018’ as a target or not, we should regard it as an aspiration. Every organisation should set a sensible definition of what it means for them; and use it for leverage whenever possible. We should use the paperless idea to intelligently do the right things. That, after all, should always be our aim.”
What is stopping a digital revolution in health and social care?
In her latest opinion Gill Hitchcock discusses the views of the attendees to the Guardian Healthcare Professionals Network seminar regarding the barriers to digitising services and possible solutions.
“The health and care system is heading for a crisis, unless it changes the way it works. Shrinking budgets and increasing demand on services make this no baseless warning from Norman Lamb, the care services minister. But while digitisation has revolutionised many transactions for British citizens, making services more accessible and efficient, it can seem as if digital transformation has passed health and social care by.
“Chairing the event, the commentator and journalist Richard Vize said our health and care system is advanced at collecting and publishing data, but “only at the foothills of exploiting its full potential”.
“Vize regretted that much of the reporting and discussion around data was focused on the more difficult areas: whether it’s the NHS National Programme for IT, the misreported whole system demonstrator for telehealth, or the continuing debate around the care.data programme.
“Panellists spoke of the barriers to achieving this vision. Orlando Agrippa, a deputy chief information officer in the NHS, said he had worked in 14 hospitals and none of the executive teams put data “in the really important camp”. Key to this, in Agrippa’s view, is that these teams had not seen big examples of how digitisation could transform healthcare.
“At one of the roundtable discussions, on integrated care, participants were keen to highlight success stories. Among these were the 40% reduction in complex amputations for diabetes patients in Scotland over four years, as a result of data sharing and an integrated care model. Also, integrated health and social care services in Airedale and Salford and Torbay.
“We are really rubbish at promoting successes,” said Millen. “We have got to get better and smarter at that, and networks are one way that we can do it.”
The deafening silence on the funding of health and care must be challenged
The referendum on Scottish independence is a timely reminder that politics is about argument, debate and disagreement says Chris Ham, The King’s Fund chief executive.
“The passion generated in the run-up to the referendum stands in stark contrast to the quiescence among the main political parties in the UK on the future of health and social care ahead of next May’s general election.
“Nowhere is this more apparent than on the question of how care will be funded in future. An unprecedented squeeze has left the NHS on the brink of a financial crisis, while cuts in local government budgets mean that 25% fewer people have access to publicly funded social care than at the time of the last election. On current plans the outlook for both is even worse. Politicians need to be honest with the public about the scale of these challenges and how they propose to tackle them in future.
“Our advocacy of reform from within the NHS is founded on a belief that transforming care depends less on bold strokes and big gestures by politicians and more on engaging the 1.4 million staff employed in the NHS in England in a long march of improvement. The role of politicians should be strategic – determining levels of funding, setting priorities and accounting to parliament for performance – allowing leaders at the local level space to innovate and improve. Devolution to these leaders linked to transparent reporting of information on performance holds out the best hope for making the sustainable and fundamental changes on which the future of the NHS depends.
“Throughout this process our aim is to speak truth to power and to keep alive discussion of issues that are of huge importance to the kind of society in which we live and the support we are able to provide to our most vulnerable citizens. In so doing we shall be challenging politicians to make clear their intentions in order to stimulate the debate that is desperately needed. The deafening silence on future funding amounts to a failure of the political process at a time when the NHS is heading rapidly towards a deep and damaging crisis.”
A year of putting patients first and laying foundations for the future
Sir Malcolm Grant, chairman of NHS England, looks back over 2013-14.
“This past year NHS England has clearly demonstrated its full commitment to putting patients at the very heart of everything we do. We have promoted transparency and accountability for our work and our services, and ensured we have spent finite taxpayer resources in the most efficient, fair and inclusive way, and to the benefit of everyone we serve.
“I have been deeply impressed by the refreshing energy, enthusiasm and expertise of the local clinical leaders I have met and their determination – and that of all the NHS staff, from porters, to nurses, doctors and carers – to bring about long overdue improvement to the quality of services we provide across the country. We have tackled head-on inefficiency and outmoded working practices, all in the interests of ensuring patients get the highest quality care.
“Without doubt, the NHS is facing one of the most challenging times in its history. We are treating more patients in our hospitals than ever before – with 1.5 million people being referred to treatment every month and, since 2010, our hospitals are now performing 2,000 more operations a day. GPs are under increasing pressure – with one million people seeing their GP every working day. And there has been a big increase in A&E attendances – with the number of attendances having risen by two million over the last ten years to around 16 million a year.
“But these are the broad brushstrokes and it would be remiss of me not to recap some of the other hugely successful achievements and major advances we have made over the last year. These include: The Urgent and Emergency Care Review, NHS 111, Friends and Family Test (FFT), 7-Day Services.
“So, not only have we enjoyed a tough but hugely successful and rewarding year, under the toughest of financial constraints, but we are also looking to the future that will see a more flexible NHS adapting to the needs of a growing and ageing population.”
Highland Marketing blog
In this week’s blog, Gregor MacKenzie shares his outlook on stress management.
