Guest interview
Richard Corbridge is on a mission to engage thousands of clinicians to use technology for better patient care. Ireland’s CIO at the Health Service Executive tells Highland Marketing that, whilst genomics and robotics are moving ahead with excitement, the country is also working hard to get the basics done.
News in brief
Brexit ‘will make NHS staff shortages worse’: The vote to leave the EU risks making staffing shortages in the NHS worse, health leaders have warned, reported the BBC. The NHS Confederation said doctors and nurses from Europe may be put off accepting jobs after the referendum. If that happened, the NHS could face some major problems, it said. The organisation, which represents health managers, said there were currently 130,000 EU health and care workers in the UK, including 10% of doctors and 5% of nurses. Elisabetta Zanon, the director of the NHS Confederation’s European office, said: “There is a real risk the uncertainty and the falling value of the pound will make people think again. If that happens, we could see shortages in some key areas get worse.” To counter the problems, the NHS Confederation has even launched a Twitter campaign called #LoveOurEUStaff. Speaking at a conference in London, the former health secretary and Tory peer Lord Lansley agreed there were many areas of concern. “The EU may not tell us how to manage our NHS, but it impacts in many ways,” he said. “If we don’t have enough people coming from the EU, our care sector cannot deliver,” he added. Jeremy Hunt, England’s health secretary, has tried to reassure EU health workers. He said: “you do a brilliant job for your patients, you are a crucial part of our NHS and as a country we value you.”
Diane Abbott appointed shadow health secretary: Hackney MP Diane Abbott has been appointed shadow health secretary after Heidi Alexander quit her post amid the political fallout from the EU referendum vote, reported Pulse. Ms Abbott, the MP for Hackney North and Stoke Newington and a long-time ally of Labour Party leader Jeremy Corbyn, has been a shadow junior health minister, and served as shadow international development secretary. Posting a picture of her resignation letter on Twitter, Ms Alexander said: “It is with a heavy heart that I have this morning resigned from the Shadow Cabinet.” In the letter to Mr Corbyn, she expressed that she believes the Labour Party needs new leadership. She said: “As much as I respect you as a man of principle, I do not believe you have the capacity to shape the answers our country is demanding and I believe that if we are to form the next government, a change of leadership is essential.” Mr Corbyn now faces a vote of no confidence of Labour MPs but has said he will not give up his post. He said in a statement that he “regretted” there had been resignations from his shadow cabinet but that he would not “betray the trust of” the “hundreds of thousands of Labour Party members and supporters” who voted him on last year “with an overwhelming mandate for a different kind of politics”.
STPs offer ‘a new vision’ of integrated care, says Dorrell: Sustainability and transformation plans (STPs) should be used to deliver “a new vision” of integrated public services, with full local authority involvement, the chair of the NHS Confederation has said, reported National Health Executive. Stephen Dorrell is the independent chair of the Birmingham and Solihull STP board, which is one of just three in the country to have a leader from local government instead of the NHS (Mark Rogers, the chief executive of Birmingham City Council). Speaking at the Health+Care Conference, he said that having a local authority lead in an STP “reduces the risk of the STP simply talking to itself. If the programme is to work, it seems to me it’s essential – it’s not an add on, it’s something which needs to be top and centre – that the STP process is about embedding the national health service in a broader range of public services.” Dorrell said Birmingham and Solihull’s work showed that STPs are “an extraordinary opportunity to create a new civic agenda” and cited Sir Howard Bernstein’s leadership of Greater Manchester Combined Authority, which recently became the first in the country to gain control of health services, as a model. “If Howard was here,” Dorrell said, “he would say, as he always does, this is not about changing public services, this is about creating a sustainable community and engaging all of public services around the subject of a population and a place.” He said that this should cover areas including employment, education and housing as well as health and care, and that existing silos should be encouraged to work together.
NHS funding must rise in autumn budget despite Brexit impact, warns Lansley: The government must substantially increase NHS funding in budget plans to be set out this autumn, despite Brexit undermining the economy and the fact that the £350m windfall its backers promised was “never remotely correct”, former health secretary Lord Lansley has said, reported GPOnline. Conservative peer Lord Lansley, architect of the controversial Health and Social Care Act implemented under the coalition government in 2012, told the Health+Care conference in London that he had not expected the NHS to feature in the EU referendum debate. As health secretary, he said “Europe didn’t tell me what to do”. But he added that, after the NHS featured heavily in the campaign, “there may be those quite understandably in the NHS who are expectantly waiting for £350m a week to turn up.” But referring to the £350m pledge, he said: “Frankly, it was never remotely correct.” Lord Lansley told the audience that the case for an increase in NHS funding in the autumn statement was now “inescapable”. The government would have to find new investment in the health service despite the likely negative impact of Brexit on the economy, he added.
Nearly one in four deaths ‘avoidable’: Almost a quarter of all deaths in England and Wales are potentially avoidable, 2014 figures released by the Office for National Statistics (ONS) have suggested, reported the BBC. The report revealed that out of some 116,000 avoidable deaths in total, more than a third were caused by tumours. And levels of avoidable deaths were significantly higher in Wales than in England. In England, the North East had the worst rates. Department of Health officials said they are investing to tackle the issue. The review looked at deaths that could have been prevented through good quality, timely healthcare or healthier lifestyle choices and public health interventions. It suggested that in 2014 there were 108,491 potentially avoidable deaths in England and 7,428 in Wales – 23% of all deaths that occurred that year. Commenting on the figures, Dr Anne Campbell of the ONS said: “People who die prematurely from avoidable causes lose an average of 23 potential years of life. For children and young people, this figure rises to 72 years.” Meanwhile, England’s Department of Health said: “We want to cut all avoidable deaths to help people live better and for longer. That’s why we’re investing up to £300m a year by 2020 to improve earlier cancer diagnosis, and an additional £150m for a dementia research institute to help fulfil our goal to find a cure.” A Welsh government spokesperson said: “Every avoidable death is a tragedy, and we are working hard with NHS Wales to reduce avoidable mortality rates.”
CCGs ‘spending £1,500 a year per patient’ on personal health budget administration: Commissioners are spending as much as £1,500 every year with third party organisations for administrating a single patient’s personal health budget, reported Pulse. The head of commissioning at NHS Shared Business Services told delegates at the Health+Care conference in London that the organisation has heard of brokers charging these fees, which only includes administrative support. Benjamin Damazer said that the high costs involved mean that using a third party is hard to justify, even though many patients may not be able to manage a budget for themselves. CCGs are currently under huge pressure to ramp up the number of patients adopting personal health budgets, as part of NHS England’s “personalisation agenda”. NHS England wants CCGs to give patients direct payments so they can spend the budget as they choose, but many CCGs are using third party organisations to administer the budget on their behalf. Mr Damazer said that CCGs are finding brokers “an expensive option”. He added: “We are aware of one broker that charges the CCG £1,500 per patient per year to act as the broker and intermediary and, for that, the patient doesn’t get support beyond the admin. Whether it comes off the patient’s budget or not, it’s still the CCG and the taxpayer they are charging. So it is a difficult model to justify financially.”
West of England begins pilot to help people with diabetes: A suite of mobile technologies is to be rolled out to 12,000 people with diabetes in the West of England later this year, as part of a two-year trial to help patients manage their condition more effectively, reported DigitalHealth.net. The trial, the Diabetes Digital Coach Test Bed, is a collaboration between 12 partners, led by the West of England Academic Health Science Network (AHSN). The project will provide people with both type 1 and type 2 diabetes with wearable technologies and smartphone apps, and will include elements of monitoring and coaching. Diabetes Digital Coach is one of seven test beds announced by NHS England in January. The test beds bring together health organisations, technology companies, universities and charities to investigate whether particular technologies, used in combination, can both reduce the pressure on NHS services and improve the quality of patients’ lives. Diabetes Digital Coach is one of two test beds funded by the IoTUK, a three-year government programme designed to increase adoption of the Internet of Things technologies. “A lot of the costs related to diabetes are around the different complications that typically come in after the 10-year stage,” said Liz Dymond, deputy director of enterprise at the West of England AHSN. “The project is about keeping people fitter for longer so they can carry out their life in the way they want to.” She hopes that the model, if successful, “could be applied to people with other long-term conditions like cardiovascular disease or chronic obstructive pulmonary disease”. Some of the participants will be recruited through health practitioners, but there are also plans to approach the public directly.
Digital early warning scores bring NHS closer to interoperability: A national focus on reducing avoidable patient harm in NHS hospitals is to benefit from a new collaboration between two vital signs monitoring and technology specialists, reported Digital Health Age. Welch Allyn, a medical diagnostic device company, and Patientrack, a UK-based specialist software firm, have developed compatibility between the Welch Allyn Connex Spot Monitor (CSM) and Patientrack’s software. Early warning score (EWS) systems, which rely on the accuracy of recorded data and the speed with which problems are flagged up and addressed, are widely used in UK hospitals to enable early intervention for patients showing signs of deterioration. Data collected through the Welch Allyn Connex Spot Monitor, including major vital signs (blood pressure, temperature, pulse and oxygen saturation), will now be instantly sent to the Patientrack software, which will interpret the information and calculate patients’ EWS automatically. Patientrack then detects patients at risk of deterioration and can be programmed to alert clinicians until action is taken and the situation resolved. The seamless communication between the Welch Allyn CSM and Patientrack software is a further step towards the interoperability required within the NHS. Suppliers are increasingly being challenged to demonstrate a willingness to work together and achieve greater connectivity. Alton Shader, president of Welch Allyn, said: “This exciting project with Patientrack has huge potential, and is an excellent example of what can be achieved when two companies dedicated to enhancing patient outcomes pool their technological know-how.” Donald Kennedy, managing director at Patientrack, added: “Providing timely, accurate data and putting valuable technology into the hands of clinicians is vital. Collaborating with Welch Allyn will help us do this even more effectively, as we work with hospitals across the country to help them deliver safer, more affordable care.”
Department of Health shake-up revealed: The Department of Health (DH) has reorganised its directorate structure, Health Service Journal (subscription required) has learned. It will no longer have separate directorates for digital, technology, local government and social care. Instead they will form a single new community care directorate. The new setup, which is now in effect, will see four new directorates under permanent secretary Chris Wormald. Will Cavendish, former director general responsible for technology, has moved permanently to the Cabinet Office, with his responsibilities moving to the new community care directorate. This will be led by former chief operating officer Tamara Finkelstein, who will also oversee social care. Jon Rouse, former director general of social care and local government, will stay on at the DH to oversee changes before taking on his new role as chief officer of the Greater Manchester Health and Social Care Partnership. Felicity Harvey, director general for public health, will be retiring from the DH and a new role of director general for global and public health has yet to be appointed. The changes are part of the department’s cost cutting drive aimed at reducing running costs by 30% by 2020 and losing up to 700 posts.
Nearly half of NHS CIOs concerned about paperless 2020 target: A large number of healthcare chief information officers (CIOs) are unsure they will be able to meet the target of being paperless at the point of care by 2020, reported Computer Weekly. A survey by iGov, on behalf of Opentext, found 46% of NHS CIOs are concerned they won’t be able to meet the target set out by NHS England. Originally, health secretary Jeremy Hunt had set a target for the NHS to be paperless by 2018, but this was later revised in NHS England’s Personalised Health and Care framework, published in November 2014. NHS England has promised £1.8bn in funding for going paperless, split between £900m in capital investment, available to frontline NHS services, with £400m in revenue funding to support the running costs of the investment. The funds are likely to come through another technology fund, based on local sustainability and transformation plans, which health and care organisations were told must be submitted by the end of June 2016. Commenting on the survey, vice-president of sales UK at OpenText Mark Bridger said it’s not too late for organisations to start implementing digital strategies. “My advice would be to think about how your organisation is going to manage all this new data created in a digital healthcare system beyond 2020,” he said.
Cancelled operations at their highest since January 2015: More urgent NHS operations were cancelled last month than at any time since January 2015, the latest NHS statistics have shown, reported National Health Executive. There were 378 cancelled urgent operations in May 2016, the highest rate since a spike in December 2014, when 408 operations were cancelled, and January 2015, when 396 were cancelled. The figures represent a growth from 358 cancelled operations in April 2016 and 300 in May 2015. The figures also show a rise in critical care bed occupancy. In May 2016, adult bed occupancy was at 83.6%, compared to 80.2% the previous month and 82.5% at the same time last year. Similarly, paediatric bed occupancy was at 80.8%, an increase from 79.3% in April 2016 and 74.1% in May 2015, and neo-natal occupancy was at 75.4%, compared to 71.6% in April 2016 and 72.3% in May 2015. Last month’s overall performance figures for the NHS also showed that delayed transfers are at their highest since records began.
Whitehall ‘wellbeing’ department should join up health and social care provision: Greater collaboration and integration between government departments and the NHS is needed to improve health and social care delivery across the UK, according to a “high-level” review, reported Public Finance. The strategic review was led by a panel comprising former local government secretary Hazel Blears, former chair of the Mental Health Act Commission Lord Patel and mental health practitioner and researcher Dr Jonathan Bashford. It focuses on “breaking down” inter-departmental boundaries, optimising physical health estates, and assesses the impact of increased devolution to local authorities. The review, entitled Breaking Barriers: Building a Sustainable Future for Health and Social Care, recommends the creation of a new Department for Communities and Wellbeing to manage an integrated health and social care budget. This would enable Cabinet-level collaboration through the use of “shared funding arrangements as part of a common pooled resource for health and social care”. Blears said: “Now is the right time for a new approach and a model of change that will put those who use services at the centre and build a sustainable future for health and social care.”
NHS providers on course for £500m deficit, says Mackey: NHS providers are on course to finish 2016-17 £500m in the red, despite national rules requiring the sector to eliminate its deficit this year, Jim Mackey has revealed, reported Health Service Journal (subscription required). The chief executive of NHS Improvement said the plans represented a “big movement” in the financial position, given that the sector finished last year with an underlying deficit of around £3bn and had access to a £1.8bn fund to cut deficits this year. However, he added that “we can’t stop there” and said NHS Improvement would be speaking to the sector in coming weeks about ideas to further improve its finances. These include the radical consolidation of provider trusts’ back-office services, to create “proper shared services” across large patches. Planning rules issued to the NHS in the wake of last November’s government spending review said the provider sector would “in aggregate, be required to return to financial balance” in 2016-17. However, the agreement of contracts and of trusts’ “control total” financial targets has proven intensely difficult, with the latter process dragging on for many months past its February deadline. Mr Mackey revealed there were still around 20 organisations that had not yet signed up to control totals, down from around 100 in mid-May.
eRedbook linked up to screening data: Parents in London are being invited to register to use the eRedbook personal child health record, reported DigitalHealth.net. In an update on its website, Sitekit, the Scottish company that developed the digital alternative to the familiar ‘Redbook’, said Central London Community Healthcare has become the first in the capital to invite parents to register. Parents in Barnet, Hammersmith and Fulham, Kensington and Chelsea, and Westminster who want to use the record have to record some key details on the site, sign up for a Microsoft HealthVault account, and then confirm their details with a health visitor to gain access. Sitekit is working with five London trusts to field-test eRedbook, which records immunisations, tests, and key developmental milestones. Kenny Gibson, NHS England’s head of early years, immunisation and military health, said that the first step would be a technical step to make sure the eRedbook worked with all its child health information systems.
Supplier chosen for Carter efficiency league table: A supplier has been chosen to provide the league table ranking NHS trusts on their efficiency, reported Health Service Journal (subscription required). AdviseInc, a supplier of spend analysis software, will provide the purchasing price index, which was a key recommendation of Lord Carter’s review on improving NHS efficiency. According to the Carter report, the index will involve “a basket of around 100 products, so that trusts are able to compare their performance with their peers on price and volume”. The index will develop with more “products added and reported on a monthly basis”, with three sub-categories focused on “common goods, clinical consumables and high cost medical devices”. The report recommended that NHS Improvement should use the league table to “hold trusts to account” on efficiency. It added: “In the medium term (one to two years) we would like this to develop into a national analytics and reporting system so that trusts have full visibility of what they buy, how much they buy and what they pay, and how this compares with their peers.”
Carter Review responsibility transfers to new NHS Improvement directorate: Jeremy Marlow, who currently has responsibility for the Carter Review at the Department of Health, will be joining NHS Improvement on secondment to lead a new directorate, reported National Health Executive. Marlow will become executive director of operational productivity, heading a team made up of both government and NHS Improvement staff, as responsibility for implementing the review transfers to NHS Improvement. The Carter Review, published earlier this year, suggested the NHS could save up to £5bn a year by 2019-20 through efficiency measures. Following the publication of Lord Carter’s report, national healthcare bodies underlined the scale of NHS challenges ahead as many claimed his recommendations are just the tip of the iceberg of overall necessary savings. “I’m very pleased and excited to be given this opportunity at NHS Improvement to lead the implementation of Lord Carter’s review in to NHS operational productivity and performance,” said Marlow. “Despite the fact the efficiencies and productivity improvements required are some of the biggest the NHS has ever delivered, I’m determined that they will also lead to better clinical outcomes and patient experience. From what I have seen working with healthcare professionals over the past year, I am also confident that the dedication and commitment exists within the service to achieve it.”
Wrightington, Wigan and Leigh go-live with Sunrise: Wrightington, Wigan and Leigh NHS Foundation Trust has gone live with Allscripts Sunrise electronic patient record, deploying it across five sites, reported DigitalHealth.net. The new EPR went live at the North West trust on Tuesday morning, with a spokeswoman saying at 4pm that it was “going well”. Sunrise is now deployed at Royal Albert Infirmary in Wigan itself, Leigh Infirmary, Wrightington Hospital, which provide more specialist services, particularly for elderly patients, the Thomas Linacre Centre, which handles outpatients, and the Wigan Eye Unit. Further trusts in the area may opt for the same technology, as part of a ‘hospital chain’ being developed across Greater Manchester. The new system includes a patient record, ordering and testing and e-prescribing and replaces a hodge podge of legacy systems. Sunrise went live in parts in the A&E department at 8am on Tuesday morning, by which time all elective patients had been migrated to the new system. In a statement on Tuesday morning, chief executive Andrew Foster said the system would “slowly trickle down to the rest of the hospital”, with outpatients expected to be migrated within the next few weeks. Foster said the project had been “massive”, with 18 months of preparation, testing and training involving 300 staff.
New delay for NHS 24 computer system roll out: A crisis-hit computer project for the NHS 24 telephone helpline will not be fully rolled out across Scotland until the end of next year – four years later than originally planned, reported the BBC. The call handling and IT system is more than £40m over budget and was initially due to be ready for October 2013. An earlier attempt to introduce the system had to be abandoned. The programme will now be phased in for some services from this summer with a national roll-out by the end of 2017. Earlier this year, the planned June launch was pushed back to the “summer of 2016” after an issue that caused computer screens to appear blank. It followed an earlier incident in which the system crashed and staff had to resort to pen and paper to deal with patient calls. The new technology is meant to make NHS 24 more efficient but is expected to cost £117m, more than 50% higher than the original estimate. Health secretary Shona Robison said: “While any delays to implementation are disappointing, patient safety must always come first. This is why NHS 24 has taken the decision to phase the roll-out of its Future Programme. This decision follows a comprehensive review of the new system which concluded that a phased roll-out later this summer, working towards full implementation across all health boards by the end of 2017, would be both safe for patients and deliverable by the organisation.”
Health and social care start-up? Exhibit at EHI Live for free: As a key partner of EHI Live this year, techUK is offering start-ups free exhibition space at one of the largest health and social care conferences in the UK. The conference is in Birmingham on the 1st and 2nd of November. The start-ups chosen for the free stand space will each have a half day to show their product, speak to attendees and exhibit alongside techUK. Start-ups that are keen to join the organisation in Birmingham in November, should submit a short paragraph (max. 175 words) to healthcare@techuk.org explaining their products and services, and why they would like to exhibit at EHI Live. Details of when the company was founded and total number of staff are also needed. The deadline for all expressions of interest is Friday 8th July.
Opinion
Referendum decision is a bitter pill for the NHS and social care
The vote to leave the EU is likely to inflict significant damage on the health service, says Richard Vize in The Guardian.
“In the next few months, the biggest threat to the NHS comes from a recession-driven round of additional spending cuts hitting non-ringfenced budgets such as social care. It would be political suicide for a government led by a pro-Brexit prime minister to cut NHS spending itself, since more funding for the NHS was at the centre of the Vote Leave campaign. That exploitation of the health service gives NHS England chief executive Simon Stevens a little leverage with the government – but not much.
“If more money was put into the system, it is far from clear how the service would respond. While the NHS knows it is crucial to maintain momentum in the drive for new models of care, would any easing of the financial position in the next two or three years accelerate change, or slow it down?
“Ministers might no longer have the stomach for the harder edge of NHS reform. With the government doomed to fight on many fronts as it works through the implications of Brexit, from reassuring business and the millions who want to stay in the EU to trying to meet the near-impossible demands of the more hardline Brexiters, it is difficult to see it having the will or bandwidth to push through the most controversial NHS service reconfigurations.
“In the longer term, issues such as the working time directive may well become important for the NHS, but at this distance it is impossible to say whether workers’ rights currently enshrined in EU law will simply be dumped, or reinterpreted, in domestic legislation.
“EU investment in UK medical research will be lost and further damage may well be inflicted by lower economic growth. The eventual deal on access to the single market will have huge implications for UK pharmaceutical companies and many more besides.”
The UK voted to leave the EU: what now for the NHS?
Elisabetta Zanon, head of the NHS European Office, considers what lies ahead for the NHS now the UK’s future lies outside the EU.
Writing in a blog on the NHS Confederation website, Zanon says: “The most critical factor will be whether the UK will remain, or not, in the EU’s internal market. The example of Norway provides some useful insight.
“Through their membership of the European Economic Area, Norway has the same access to the EU internal market as the EU member states, but equally has to comply with the full range of EU policy and regulations which govern the EU market and has to contribute to the EU budget.
“If the UK were to follow this model, in the long run, not much would change from an NHS perspective in terms of the application of EU policy and rules, ability to recruit EU staff, access to EU research funds and involvement in EU collaborative initiatives.
“It is, however, important to stress that negotiations on a new agreement could last several years, and during this time, uncertainty will reign, with the economy expected to seesaw.
“It should also be noted that we will no longer have a seat in the European Council nor have Members of the European Parliament, so the UK’s ability to influence EU policy will be very severely jeopardised.
“If, on the other hand, the UK were to leave the EU internal market, changes would be significantly greater and uncertainty much bigger from both an economic and regulatory perspective.”
Dealing with NHS financial pressures – what do the public think
Ruth Robertson, fellow in policy at The King’s Fund, discusses how commissioners and providers are faced with increasingly tough choices about how to prioritise their spending with the growing financial pressures in the NHS.
Writing in a blog on the think tank’s website, she says: “Our work on the impact of financial pressures in the NHS maps out six ways in which health systems can restrict access to care when budgets are not large enough to cover patient demand.
“How do the public think the NHS should approach these difficult decisions? To find out, my colleague John Appleby and I have looked at data from NatCen’s British Social Attitudes survey – an annual survey which asks randomly selected members of the public for their opinions on a wide range of issues including the NHS.
“The good news is that just 23% of the respondents were dissatisfied with the NHS in 2015 – a comparatively low figure. However the less-than-positive finding is that beneath this low level of dissatisfaction, public views on NHS funding point to an increasing sense of crisis. Almost everyone (93%) agrees that the NHS is facing a funding problem and one in three think that the funding problem is “severe”. But when we asked people what should be done about this, opinions were more fragmented. To raise more money for the NHS, over 40% of people support increasing taxes, 15% support introducing charges for each visit to the GP and A&E department, and a similar proportion support charging for non-medical services in the NHS such as food and laundry.
“When survey participants were presented with four strategies the NHS could use to stay within its budget, almost half of respondents said the NHS should not provide treatments that are poor value for money; one in five supported restricting access to non-emergency treatment; and one in ten supported raising the threshold for treatment so that people have to be sicker to receive care.
“This shows that the majority of the public would address budget pressures by implementing some restrictions on access to care. The difficulty for clinical commissioning groups, NHS providers and individual managers and clinicians is to work out which services potential restrictions should be applied to and for whom. Keeping the public on board as they make these tough decisions will be a key challenge for NHS organisations over the next year.
