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Guest interview – GP CCIO Masood Nazir – at the frontline of digital health
GPs have been at the forefront of digital health for some time, and have much to show the rest of the NHS how it can embrace technology as part of care. EHI Award winner Dr Masood Nazir outlines some of the lessons that primary care can share with the rest of the NHS, as well as giving his views on the new breed of digital disruptors shaking up the primary care market.
News in brief
NHS hospitals facing toughest winter yet, say health experts: Record numbers of patients are leaving accident and emergency (A&E) units without being treated, new figures reveal, sparking fears that the NHS is on the brink of a winter crisis and cannot cope with soaring demand. The figures for September show 53,000 people left an emergency department in England before receiving treatment, up 24% compared with September 2015, reported The Guardian. The data released by NHS Digital does not include patients’ reasons for leaving, but many are likely to have done so because they felt they had waited too long to be seen. “Our NHS is facing a massive crisis and most politicians seem happy to look the other way,” said Tim Farron, the Liberal Democrat leader. “The strain of overcrowded A&E units and a creaking social care system means the government are failing millions of sick and vulnerable people.” Questions are also being asked about the quality of care that A&Es provide because the number of patients who have to come back for further treatment within a week of their first visit is increasing quickly. Experts say the trend may indicate A&E staff are struggling to provide the highest standard of care because they are now too busy too much of the time.
Scotland publishes blueprint for future of NHS and social care: The Scottish government has published its blueprint for the future of the NHS, with a focus on treating people closer to home rather than in hospital, reported the BBC. The government’s health and social services delivery plan pledges to free up hospital beds by cutting the number of patients staying longer than they need, marking a “fundamental move” away from a “fix and treat” approach. The focus will be on preventing people becoming ill in the first place, and then intervening as quickly as possible to prevent their conditions becoming more serious. The plan also aims to reduce unscheduled bed-days in hospital care by up to 10% by 2018, through reducing delayed discharges, avoidable admissions and inappropriately long stays in hospitals. Additional commitments include recruiting more GPs and nurses, wider access to palliative care, and regionalising some hospital services. The Scotsman reported that it is understood the plan will be supported by £128m of funding in 2017-18. Health Secretary Shona Robison said: “The plan I am setting out puts actions and timescales to an already established direction of travel which we know has the broad support of healthcare professionals, charities and patient groups. It recognises that we must up the pace of change if we’re to deliver modern, sustainable health services and that local health boards and integration partnerships have an important role to play in taking this forward over the next year and beyond.” The Scottish Government said the blueprint would fulfil its commitment to provide a delivery plan following publication of an Audit Scotland report about the NHS in October, which said the NHS had met only one of its eight waiting time targets.
Hospitals ordered to divert patients from overstretched A&Es: Hospitals have been ordered to divert thousands of patients from accident and emergency (A&E) units in an unprecedented step to help stave off a winter crisis, reported The Telegraph. GPs and nurses will be sent to the front doors of casualty units to turn away less serious cases, in a bid to tackle record demand and overcrowding as Christmas approaches. At least 14 hospitals have already set up such schemes, which are supposed to ensure that the sickest patients get priority treatment, in the face of mounting strain. NHS England has now ordered dozens more struggling hospitals to set up such services in a matter of days. Hospitals have already been ordered to stop carrying out the majority of operations for at least a month, in a bid to reduce dangerously high levels of bed occupancy. They were given a deadline of Monday December 19 to reduce occupancy from 95% to a recommended safe limit of 85%. The new measure, revealed in papers to the board of NHS England, is an attempt to reduce numbers coming through the front door of A&E, amid warnings of “unprecedented demand” for services. The paper warns that health officials have found “significant gaps” in health service plans for winter.
Rise in hospital activity outstripping NHS funding: Demand for hospital services has continued to rise sharply every year, outstripping increases in the NHS budget, found new analysis published by The King’s Fund. The analysis shows that admissions to hospital have risen by 3.6% every year since 2003-4, reported OnMedica. But real-terms increases in NHS funding have shrunk to an average of just 1.2% a year since 2010-11. This compares with average increases of 4.8% a year between 2003-4 and 2010-11. Detailed analysis of hospital activity data over the past 13 years shows that emergency admissions from major accident and emergency (A&E) departments have increased by an average of 4.3% a year since 2003-4. Attendances at outpatient clinics have also risen by an average of 3.8% a year since 2007-8, and admissions for planned treatment have increased by an average of 4.3% a year since 2003-4. Rising hospital admissions could jeopardise the plans set out in the NHS five year forward view, because this assumed that growth in hospital activity would be reduced to 1.3% a year, says the analysis. Yet, in the first half of 2016-17 alone, admissions to hospital increased by 3% compared with the same period last year. The analysis highlights several reasons behind the increase in demand for hospital services including population growth, the rising number of older people, and an increase in the number of people living with one or more long-term conditions. With NHS budgets set to tighten further over the next three years, the figures suggest that the financial and operational pressures facing the NHS will intensify further. Chris Ham, chief executive of The King’s Fund, said: “The NHS is treating more patients than ever before, which is a tribute to the hard work and commitment of its staff. However, our analysis provides more evidence that the health system is buckling under the strain of trying to meet rising demand and maintain standards of care within constrained resources.”
Hospitals to be rated on new A&E ‘scorecard’: Hospitals will be rated against a new accident and emergency (A&E) standard from 2017, which will combine the existing waiting time target with clinical standards and data on staff and patient experience, reported Health Service Journal (subscription required). The four hour target will remain the “headline indicator” but the new metric “will give a clearer picture of the health of our A&E departments”, NHS Improvement has told trusts. A letter sent to trusts outlined plans for the new “scorecard”, as well as fresh drives for a “greater focus on the sickest patients” and “better ways of managing flow” for patients who could be treated away from A&E. The letter, from NHS Improvement chief executive Jim Mackey, said: “We want to increase the focus on patient safety and experience and believe that there is merit in broadening our oversight approach, beyond a single metric and towards a new, combined, metric that aggregates waiting times, clinical standards, staff and patient experience. We will look to build this metric into our oversight framework to inform and drive our improvement and support offer, and will develop an approach to peer review and collaborative support with the royal colleges.” Regarding the “greater focus on our sickest patients”, the letter said: “We expect to focus on ‘time to see a relevant clinician’ for key pathways (eg: stroke PCI), or time to start a bundle (such as sepsis six). We also believe that this will lead to better care for these patients, shorten waiting times, or guarantee that treatment commences within a timeframe that is shorter than four hours.”
HSE may pay for GP IT upgrades: The Health Service Executive Ireland (HSE) is considering paying for IT upgrades in general practice in order to facilitate the introduction of individual health identifiers for patients, and intends to consult GPs and their service providers on the appropriate funding involved, reported the Irish Medical Times. HSE chief information officer and CEO of eHealth Ireland Richard Corbridge said: “In 2017, the HSE intends to work with GPs and their IT system service providers to understand what level of financial investment is required for us to put money into that space as well. Such an investment would allow GPs to make changes to their systems, which while they may not necessarily be the priority for each GP, would be for the good of the wider healthcare system. If you think about it, it’s often the HSE that wants to have the identifiers inside the GP IT system, for example. It being in the GP system then benefits the wider health system rather than the GP. So it makes sense for the HSE to pay for that rather than the GPs.” The HSE would respect the partnership, built over several years, between GPs and their system providers and seek to collaborate with all the parties for the benefit of the health service, Corbridge committed.
Government rejects key public health recommendations: Warnings that further public health cuts would be a false economy have been rejected by the Department of Health (DH) in its response to a Health Select Committee report, reported National Health Executive. The ‘public health post–2013’ report warned that public health services since 2012 have suffered from ongoing spending cuts and a failure to embed public health across national policy. In its response, the DH insisted it “fully appreciated the importance of protecting and improving public health”. However, it refused to rule out further cuts, which are due to reduce the public health budget from £3.47bn to under £3bn by 2021. It argued that by “taking action to reduce the deficit”, it was protecting “the long-term health” of the economy and public services. Instead of agreeing to protect public health budgets, the DH responded: “The duty on local authorities to improve the public’s health involves more than delivering a set of narrowly-defined services from a ring-fenced grant.” Harnessing policy across the whole of the public sector for “the good of the public’s health” could deliver better outcomes without extra costs, it said. The DH also rejected the committee’s suggestion of establishing a cabinet office minister with specific responsibility for embedding public health in national policy. It argued that the remit of the Parliamentary Under Secretary of State for Public Health and Innovation included encouraging public health in all areas of policy, and creating a second minister would generate unnecessary confusion. The Academy of Medical Sciences has also called for more to be done to embed public health in all areas of policy. Responding to the Health Select Committee’s argument that the department needed to set clear milestones for what it expected public health spending to achieve, the DH said it already had, pointing to its heavily-criticised childhood obesity strategy.
Six NHS mental health exemplars to get £5m each: NHS England is freeing up more money for a second wave of digital exemplars focused on mental health. DigitalHealth.net understand that NHS England has invited eleven mental health, community and combined trusts to apply to become digital exemplars. Of those, it is expected six will eventually be selected and receive £5m each in central funding to help improve their digital maturity. It is understood that the following trusts have been invited to apply: Mersey Care NHS Foundation Trust; Northumberland, Tyne and Wear NHS Foundation Trust; Cheshire and Wirral Partnership NHS Foundation Trust; Berkshire Healthcare NHS Foundation Trust; 2gether NHS Foundation Trust; South London and Maudsley NHS Foundation Trust; Tees, Esk and Wear Valley NHS Trust; South Staffordshire and Shropshire Healthcare NHS Foundation Trust; Oxford Health NHS Foundation Trust; South Essex Partnership University NHS Foundation Trust and Birmingham and Solihull Mental Health NHS Foundation Trust. The £5m indicated per exemplar is half of the £10m available to 12 acute or ‘global’ digital exemplars revealed in September. NHS England allocated £100m to the first round of exemplars and additional funding will be likely needed, probably from the Paperless 2020 fund, for the second round. A NHS digital leader told DigitalHealth.net that less money was available for mental health partly because most trusts in this sector were already digitalised. Applications for the mental health exemplars must be submitted by 19th January, 2017.
New minister joins Department of Health: A former Downing Street aide and policy director to David Cameron has been appointed as a minister at the Department of Health (DH), reported Health Service Journal (subscription required). Number 10 said that Lord O’Shaughnessy had been made parliamentary undersecretary of state to the DH as well as a government whip. He is a former Downing Street aide, and was director of policy for Cameron from May 2010 to October 2011. He will replace Lord Prior, who has overseen drugs spending, life sciences, NHS commercial issues, and blood and transplant since July after Theresa May reappointed Jeremy Hunt as health secretary. Lord Prior was originally made a parliamentary undersecretary of state in 2015 after the general election. Lord Prior, who is a former chair of the Care Quality Commission and Norfolk and Norwich University Hospitals Foundation Trust, has become parliamentary undersecretary of state at the Department for Business, Energy and Industrial Strategy.
New joint data chief at CQC and NHS Improvement: A new role has been created to ensure data consistency across the Care Quality Commission (CQC) and NHS Improvement, reported DigitalHealth.net. Peter Sinden will be starting the job of chief digital officer for both organisations in January, moving from his previous role as chief information officer at Monitor, part of NHS Improvement. Sinden said in the past the two bodies collected information independently, analysed it slightly differently and presented it back to the sector in “slightly confused ways”. “What we do want to do is make sure the data comes in the right format, is manipulated in consistent ways, presented back to trusts in the same timelines,” Sinden said. The role will be split evenly in terms of time with each organisation. The CQC is the independent regulator of health and adult social care in England, and NHS Improvement is responsible for holding providers to account. One of the key things Sinden wanted to achieve by the end of 2017 was reducing the data burden on trusts, but “exactly how far we get along those journeys with all providers, is yet to be seen”.
SBRI Healthcare announces £4.3m funding for health tech firms: The Small Business Research Initiative for Healthcare (SBRI) has announced £4.3m in funding for technology firms to improve health outcomes for NHS patients, reported HealthITCentral. Innovations that could relieve pressure from accident and emergency (A&E) departments have been selected to take part in the scheme, including wireless monitoring, self-management apps, point of care diagnostic testing and an urgent care flow and discharge system. “As demands and pressure on the urgent and emergency care system increase, we need to find new ways to bring high value innovation into the NHS. The announcement today will bring new and creative solutions into this space that will improve care for patients and efficiency for the NHS,” said Richard Phillips, chair of the SBRI board and director of the Association of British Healthcare Industries. The companies (Healthera, Microbiosensor, Biovici, 365Response and snap40) will all receive up to £1m in funding to further develop their technologies, after being selected from a shortlist of companies that had previously received ‘feasibility funding’ for six months in March this year. SBRI Healthcare was initiated by NHS England and is being led by the 15 Academic Health Science Networks across the country, currently supporting innovators that tackle known NHS challenges through the use of technology.
Countess of Chester to track staff and patients with sensors: A northern trust is deploying 4,000 infrared sensors to track the location of patients, staff, beds and valuable equipment throughout its hospitals, reported DigitalHealth.net. The Countess of Chester Hospital NHS Foundation Trust will install the TeleTracking Technologies sensors in January next year. The static sensors placed throughout the hospital will use infrared to register the movement of readable tags. The trust’s wifi network will send these reading to a “centralised care co-ordination centre”, where the data will be collated, displayed and relayed to relevant teams. Rob Howorth, deputy director of health informatics at the trust, said the new tech would give the trust a “global view of the hospital”, tracking the patient’s journey from “front door to back door”. The sensors would manage bed occupancy and staff flows by creating a “virtual wall around the particular bed or location”. With staff and patients wearing readable tags, the sensors could then register who enters and leaves those spaces, he said. Valuable assets such as bladder scanners and infusion devices will also be tagged and tracked using the technology. Howorth said there was an “aggressive” deployment plan with the first module of the overall system to go live in mid to late February, and the rest throughout the year until October to November. The benefits included using data to improve patient flow and intelligently allocating devices to wards, he said.
HIMSS CEO plans to step down in 2017: Steve Lieber, president and chief executive of HIMSS since 2000 has announced his plan to retire, reported Healthcare IT News. Lieber broke the news to the HIMSS staff in a conference call, saying that he expected to stay through to the end of 2017. During Lieber’s tenure, HIMSS has grown steadily with more than 65,000 professionals now enrolled as members of the association. The organisation has also grown in influence, affecting policy in healthcare and information technology, and helping to shape services available to improve care delivery. Lieber, 63, assumed his position in April 2000 as president and chief executive officer of HIMSS. Among his many memorable appearances at HIMSS have been on-stage interviews with former Presidents Bill Clinton and George W. Bush as part of the annual conference keynote sessions. Under Lieber’s leadership, HIMSS has become a global operation with educational events taking place around the world including Turkey, Spain, Singapore and Sydney. Lieber also led the acquisition of MedTech Media, publisher of Healthcare IT News, which now operates as the HIMSS Media business unit within HIMSS. HIMSS has started a search for his successor. The process is scheduled for completion by the summer. Lieber told the HIMSS staff that he expects to serve alongside the new president and CEO to ensure a smooth transition.
DigitalHealth.London Accelerator: 12 key moments of 2016: DigitalHealth.London Accelerator was launched this year alongside its first Accelerator programme, to speed up the adoption of digital health solutions and innovations in the heart of London. Its mission is to select 30 of London’s best digital health SMEs each year, over the next three years, and help them connect with clinicians and the right decision makers in the NHS, so that a greater number of patients can benefit from ground-breaking technology more rapidly and at scale. The first cohort of companies were announced in September. Listed here are the 12 key highlights from 2016.
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From all the team at Highland Marketing, we would like to wish all of our Healthcare Roundup readers a very happy Christmas with all best wishes for 2017.