News in brief
£1bn investment in children’s mental health care announced in 2015 Budget: Chancellor George Osborne failed to mention the NHS in his 2015 Budget speech on Wednesday, but the government later announced funding to improve children’s mental health and health data schemes, reported GPOnline. The money will help provide 110,000 more children gain rapid access to mental health treatments in what Nick Clegg said would bring about “a seismic shift to revolutionise children’s mental healthcare”. “There would be an outcry if a child with diabetes was left to cope without support or treatment. But that’s exactly what’s been happening with young people’s mental health services,” he said. “By introducing access and waiting time standards and committing to talking therapies for children in every region, we are helping to build a fairer society where young people can get the right treatment and support they deserve to live a better life.” A further £20m has been set aside as part of the Budget to fund four health and social care information projects.
Mental health trust funding ‘down 8%’ from 2010 despite coalition’s drive for parity of esteem: Funding for NHS trusts to provide mental health services has fallen by more than 8% in real terms over the course of this parliament, according to research by Community Care and BBC News. Figures obtained from 43 of England’s 56 NHS mental health trusts through Freedom of Information requests, an analysis of financial reports and other research, show that total funding for the trusts’ mental health services dropped in cash terms from £6.7bn in 2010-11 to an expected £6.6bn in 2014-15. The figures amount to a real terms reduction of 8.25%, or almost £600m, once inflation has been accounted for. At the same time referrals to community mental health teams, the services designed to stop people’s mental health deteriorating to crisis point, have risen by nearly 20%. The funding pressures have left some community services handling caseloads double the recommended levels and several are falling short of Department of Health staffing guidelines. Official figures show the pressure on inpatient services has also risen. Mental Health Act detentions to hospitals hit a record high last year while bed availability dropped to its lowest level in four years of data collection. One mental health chief executive called the situation “a car crash”.
Stevens, Rice hail IT focus in 5YFV: The “inexorable rise” of IT and data in UK healthcare must be accompanied by increased digital literacy and improved incentives for care providers to be a success, key NHS England figures say. Speaking at an NHS England event on widening digital participation, NHS England chief executive Simon Stevens said that digital participation from citizens is “central to the redesign of care” across the NHS. Stevens told the audience that digital inclusion must be considered within the context of the broader organisational changes outlined in NHS England’s Five Year Forward View plan, reported eHealth Insider. Stevens said the document’s push towards greater integration between care settings must be guided by a focus on care coordinated around individuals and underpinned by the “information revolution”. However, Stevens said the NHS must do more to meet the needs of the 6.4 million people who are not online, but are likely to have a greater need for health services.
Care for the elderly receives £200m boost: A fund worth £200m to improve the care of Scotland’s growing elderly population has been promised by the Scottish government, reported the Herald Scotland. Shona Robison, Scottish health secretary, announced the extra money promising it would deliver a “landmark change” to the way people are looked after. The cash will be ploughed into the new health and social care partnerships, which are bringing together NHS and council care services. By merging health and social services the Scottish government is hoping to improve the way people are looked after in the community, helping them to avoid hospital admissions and to get home again smoothly if they are admitted. Robison said: “The integration of health and social care services is one of the most ambitious programmes of work this government has undertaken, and one which we believe will deliver sustainable health and social care services for the future that are centred around the needs of patients.”
New ‘Connected Health Cities’ initiative launched to improve health, social care in the English regions: Four new health and social care information projects, aimed at tackling major health challenges by catalysing ‘big picture’ data through the collective expertise of the region’s universities, teaching hospitals and local authorities, have been launched by the Chancellor of the Exchequer, reported News Medical. The £20m ‘Connected Health Cities’ initiative will see the establishment of a world-leading partnership using large-scale data to drive public sector reform in health and social care across a 15-million strong population in the North of England, reported News Medical. The programme is the first investment of the government’s ‘Health North’ programme to unlock healthcare innovations in the English regions with the greatest health challenges. It will harness the world expertise of the region’s universities, teaching hospitals and Academic Health Science Networks to transform healthcare by assembling data, experts and technology in secure data facilities to generate new information that shapes health and social services to deliver better outcomes for patients and communities. This data-intensive information will be fed back to NHS practitioners, service managers, commissioners, public health professionals, local authority planners, researchers and policy makers to identify variations in patient and population needs.
NHS deficit could hit £2.5bn this year, warns top health chief: The NHS could slip £2.5bn into the red later this year and its financial position could spiral “out of control”, with many hospitals and vast chunks of the service running out of money, one of its most senior figures has warned. The deficit, by far the largest in NHS history, will pose a serious problem for the next government, said Chris Hopson, chief executive of NHS Providers. Ministers will have to rescue the NHS with an unprecedented bailout or risk damaging the quality of care because hospitals start slashing staff numbers to balance their books, Hopson added. An unprecedented financial squeeze meant that hospitals are already at the point where quality of care is at risk, reported the Guardian. He told an audience of NHS decision-makers at the King’s Fund thinktank that the collective £1bn deficit expected in the NHS in England by the end of the financial year is likely to at least double in the 2015-16 financial year starting on 1 April. He said “there’s a real danger that the strategic deterioration [in NHS finances] could speed up and get out of control.”
West London CCGs work on data sharing: An alliance of West London clinical commissioning groups (CCGs) is developing a memorandum of understanding to improve data sharing between the area’s GP practices, reported eHealth Insider (EHI). The group has held its first governance meeting to discuss its plans, which have been praised by national data guardian Dame Fiona Caldicott and the Independent Information Governance Oversight Panel. Laurie Slater, Hammersmith and Fulham CCG’s information governance lead, told EHI that GP practices in his area had “converged” on a single system – TPP’s SystmOne – with a view to learning how to better share data in the community. Slater said the Central London, West London, Hammersmith and Fulham, Hounslow and Ealing CCGs then formed a collaborative group. “There are a couple of million patients looked after using the same software system for GPs, and that lends itself to interoperability work at the GP level.” The collaboration’s focus is on allowing entire patient records to be shared electronically between GPs, such as between a federation of GP practices or for out-of-hours and emergency care.
Osborne confirms NHS funding increase but no extra cash for social care: Chancellor of the exchequer George Osborne this week confirmed that the government will increase NHS funding in real-terms for 2015-16, reported Health Investor. Announcing the budget Osborne only commented on NHS funding, though, in response to criticism from Labour leader Ed Miliband that not mentioning the NHS was a “glaring omission”. Miliband said that it was extraordinary there had been “no mention” of NHS funding. He asked: “Where was that discussion of the NHS and investment in public services?” Critics have also questioned why there is no mention of extra money for social care in Osborne’s budget either. Nuffield Trust senior fellow in health policy, Ruth Thorlby, said that the budget did not “give patients and NHS staff any certainty about wider funding plans up to 2020”. This was despite NHS England’s Five Year Forward View stipulating that this is the timescale that the NHS would have to find savings. She added: “Meanwhile, the chancellor’s wider plans for public service cuts mean no immediate prospect of the bleak funding outlook for social care being reversed either.”
NHS trust put into special measures: England’s biggest NHS hospital trust, Barts Health NHS Trust, has been put into special measures after a damning report by the health service regulator, reported BBC News. The Care Quality Commission (CCQ) found a culture of bullying and low morale among staff at Whipps Cross Hospital, part of Barts Health NHS Trust, which runs six hospitals across east London. And it raised issues in patient safety. The trust said it was committed to ensuring the safety and welfare of “every one of its patients”. But the chief inspector of hospitals, Prof Sir Mike Richards, said the trust must “get a grip on what is happening”. The CQC report on Whipps Cross University Hospital in Leytonstone raised a number of serious concerns including insufficient staffing levels to provide safe care, high use of agency staff and low staff morale, a persisting culture of bullying and harassment, bed occupancy that is too high and a failure to meet national waiting time targets.
Key Labour NHS pledge impossible to deliver, says influential thinktank: One of Labour’s key NHS election pledges, designed to protect services from being privatised, has been rejected as impossible to deliver by The King’s Fund, reported The Guardian. The influential health thinktank has warned that it would be extremely unlikely that a Labour government could implement Andy Burnham’s promise to exempt the NHS from EU procurement and competition rules. The shadow health secretary committed Labour to “claiming a full exemption for the NHS from EU procurement and competition law” when he launched the party’s 10-year plan for the NHS in January. He has pledged to repeal the unpopular Health and Social Care Act and reverse the creeping privatisation of services that has occurred under the coalition. But in a briefing paper the thinktank concludes that: “An incoming government could not, in our view, secure formal exemptions for the NHS from EU procurement or competition rules.” Its intervention led Jeremy Hunt, the health secretary, to claim that Burnham’s pledge was part of Labour’s alleged plan to “weaponise” the NHS as an issue before 7 May.
Welsh ambulance crews take digi pens: The Welsh Ambulance Service Trust has agreed a deal with Anoto for 1,700 digital pens to be given to its ambulance crews across Wales, reported eHealth Insider. Service for the pens will be provided by Vodafone UK. The total contract is worth £850,000 and will last for an initial run of three years. By using the digital pens, ambulance crews in Wales will be able to complete a handwritten patient clinical record as per usual. Rather than duplicating a copy of the form to be transferred to the trust’s clinical audit department for scanning and verification, the paramedic’s notes will be stored directly on the pen. This encrypted data can then be transferred instantly to the audit department once a pen is docked at a hospital or the ambulance station.
£1m IT project to predict clinical outcomes for diabetes patients: Camden Clinical Commissioning Group (CCG) has won funding for a £1m project that will use statistical data to predict outcomes for patients with diabetes, reported Health Service Journal (subscription required). The UK’s innovation agency Innovate UK awarded the funding as part of a £6m pot for collaborative research projects that develop new ideas in the digital health sector. The CCG will work with Speechly Bircham LLP and Surrey University on the project, which will link health and non-health data to predict clinical outcomes. Camden CCG accountable officer David Cryer said: “The insights will enable clinicians to understand whether their preventative measures or interventions are likely to be effective, ineffective, wasteful or even harmful.”
Kelsey pushes for free NHS wi-fi: The NHS should install free wireless internet across its entire estate to act “as an instrument of social transformation”, NHS England’s Tim Kelsey has said. Speaking to delegates at an NHS England event, on widening digital participation, Kelsey – the organisation’s director for patients and information – excited Twitter users by calling for the introduction of free wi-fi across NHS England’s GP practices, hospitals and other care settings, reported eHealth Insider. However, Kelsey later emphasised that this was not an official policy announcement, but instead his personal view on the need to roll out free wi-fi access more widely. “What I’m saying is in my view, and something I hope we will all be lobbying the next administration over, is that the NHS has a very important role to play in thinking about how it can use its physical estate better to support people who want to get involved digitally but are currently unable to afford broadband or don’t have access to the internet. There is an opportunity, I think, for a catalytic moment.”
One Health Alliance recruits technology suppliers to engage NHS: Technology companies across the UK are being given an opportunity for direct dialogue with senior NHS leaders through a series of open discussions being held by the One Health Alliance (OHA). The alliance, a collective of health and care technology suppliers from across the country, is now expanding its membership base, which provides solutions that match the breadth of pressing technology needs facing the NHS and other care organisations. The OHA is inviting companies ranging from small to medium sized enterprises (SMEs) through to multinational technology vendors to register their interest to become new members, which will enable them to have open discussions with those at the helm of NHS policy and delivery. Members attend small and intimate meetings four times each year, where they are joined by guest speakers including senior NHS England figures, chief clinical information officers, chief nurses and other key influencers from across the health and care setting. Companies wishing to join the One Health Alliance should contact Mark Venables directly for an informal discussion at markv@highland-marketing.com or on +44 (0)1877 339922.
Opinion:
The chief medical information officer of Elsevier Jonathan Teich examines why the next stage of the US’ meaningful use programme is hitting the buffers, and what needs to come next.
“The US ‘meaningful use’ programme set out with an ambitious but sensible goal; to use electronic patient record technology to improve quality and safety and so deliver better care.
Three years on, the programme has transformed EPR adoption. But US thinking has moved on. Meaningful use is no longer flavour of the month; programmes such as ‘accountable care organisations’ are higher profile. Some are saying that the US is in the post-meaningful use era.
“With financial benefits front-loaded, a straightforward path to implementation, and recognition that EPRs were indeed useful to have, many people felt the reward for achieving stage one was worth the effort.
“Some feel the next stage is too complex; others do not think it has gone far enough. Some providers and vendors are pushing back on the timeframes needed to meet stage two criteria, and the amount of reporting required. Original intentions have also changed. Deadlines have been delayed. Care benefits from other aspects such as advancing clinical decision support have been put back to later stages.
“Quality metrics are essential. The NQF has established these for high impact conditions such as congestive heart failure, diabetes and depression. These measure how well care is being delivered, and EPRs can facilitate fulfilment of these metrics by helping to optimise awareness and clinical decision-making at the appropriate moments in the care process.
“The right type of data is also important. In the US, much of the data held is related to paid-for activity rather than care – a similar situation for some in the UK. However, there is a growing percentage of total reimbursement that is linked to performance on quality metrics, so things are moving in the right direction.”
Integrated care: the end of the hospital as we know it?
Chris Naylor, senior fellow on health policy at The King’s Fund examines the dominant and changing role of hospitals in the integrated care health system.
“It is certainly true that an over-reliance on hospital-based care, and the political reluctance to challenge this, has long been a barrier to necessary change in health systems across the world.
“However, while integrated care clearly means change for hospital-based professionals, it is not by definition opposed to the institutional interests of hospital providers. A growing number of acute trusts in England are actively engaging with integrated care, seeing this as not only compatible with their interests, but as an essential part of the on-going financial sustainability of the services they provide.
“While integrated care certainly does not spell the end for acute hospitals, and may not lead to much reduction in their size any time soon, it will entail significant changes in terms of care pathways, workforce arrangements and organisational models. Integrated care requires acute care professionals to be willing to rethink the way that they provide services, with more care being delivered beyond the hospital walls and an increased role in prevention and population health.
“Bringing about the new models of care that it describes will inevitably be a disruptive process in many parts of the country, including for hospital providers. What is important is that this process does not descend into territorial squabbles between ‘primary care-led’ and ‘hospital-led’ models of integration. Hospitals should be neither demonised nor dominant but will certainly need to be part of the discussion.”
Policy makers understand that health and social care needs to be integrated to address the needs of an aging population, and that new care organisations will need joined up IT and information. But do they understand how best to achieve that? Ewan Davis has his doubts; but suggests that the open approach taken in Moscow could be one way forward.
“There are two things it is certain that we need to do in order to address the challenges that an ageing population creates for health and care. The first is closer integration of health and care and to move care nearer to the patient. The second is to leverage digital technology to support this change, using both big data and small data to deliver more appropriate care more effectively.
“One approach that I think has great promise has been adopted by Moscow City Council. It is responsible for pretty much all of the health and social services for 11 million citizens; and its services have the kind of siloed legacy systems with which all too many of us will be familiar.
“It wanted to separate data from applications and store it in a vendor and technology neutral format, and chose OpenEHR to do this. OpenEHR is a virtual community working on interoperability and compatibility in e-health and, as its name suggests, its main focus is electronic patient records and systems.
“It works by publishing specifications for clinical models – or archetypes – that make use of standard health terminologies and open components. Moscow piloted its approach by using the Marand Think!EHR OpenEHR implementation and Integrating the Healthcare Enterprise XDS components for electronic document sharing from Forecare.
“No individual or organisation can offer informed and impartial advice and it’s only if we are all honest about our motivations and concerns and debate the options openly that we can make progress.”
Blog
As the NHS is often portrayed in a negative light, in this week’s blog Myriam McLoughlin asks if we really should be spreading positive PR about our healthcare service.
