News in brief
48-hour junior doctors’ strike called off: The 48-hour junior doctors’ strike due to start next Tuesday in England has been called off by the British Medical Association (BMA), reported the BBC. The decision comes as talks continued this week between the doctors’ union and the government about the disputed junior doctor contract in England. The BMA said the move did not mean a deal had been reached. A planned strike on Wednesday 10 February could still go ahead if the negotiations stall. That stoppage is considered to be potentially the most disruptive as it is a complete walk-out, whereas next week’s one will see junior doctors provide emergency cover. BMA junior doctor committee chair Dr Johann Malawana said: “The BMA’s aim has always been to deliver a safe, fair junior doctor contract through negotiated agreement. The BMA has today taken the decision to suspend the industrial action planned for 26 to 28 January, thereby giving trusts as much notice as possible so as to avoid disruption to patients.” A Department of Health spokesman said: “The strike that took place last week was unnecessary while talks are ongoing, so it’s extremely welcome news that the BMA has suspended next week’s action. In the end, the government and junior doctors want to do the same thing by improving patient care at weekends – and we look forward to further constructive discussions.”
NHS funding is falling behind European neighbours’ average, research finds: Britain’s spending on its health service is falling by international standards and, by 2020, will be £43bn less a year than the average spent by its European neighbours, according to research by The King’s Fund. The UK is devoting a diminishing proportion of GDP in health and is now a lowly 13th out of the original 15 EU members in terms of investment, an analysis for the Guardian by the think tank’s chief economist shows. Prof John Appleby also found that the government’s decision to increase the NHS’s budget by far less than the anticipated growth in GDP meant the service would miss out on what would have been an extra £16bn by 2020. Ministers highlight that they are giving the NHS in England an increasing share of overall government spending, ring-fencing its budget and handing it annual increases totalling £8.4bn in real terms by 2020-21, despite very tight public finances. However, The King’s Fund figures have cast doubt on ministers’ repeated claims that they are giving the NHS generous cash settlements. Critics argue that Britain is becoming “the sick person of Europe” in terms of health spending because the sector receives one of the lowest levels of investment compared with many European countries, such as France and Germany. Appleby warns that Britain’s status as an increasingly “low spender” might mean the NHS cannot deliver improvements in the quality of care and outcomes from treatment that patients want.
GPs under pressure as registered patients rise 1.1m in two years: The total number of patients registered with GP practices in England increased by 1,116,636 between January 2014 and January 2016, the analysis of data published by the Health and Social Care Information Centre (HSCIC) revealed. Practices in nearly one in 10 of England’s 209 clinical commissioning groups have seen patient numbers rise by an average of 4% or more over the past two years, GPonline has found. GP leaders warned that practice funding had failed to keep pace with the rise in patient numbers, and that rising pressure put the safety of patient care at risk. GPonline revealed last week that GP practices had maintained high levels of patient satisfaction despite rising pressure. GPC deputy chairman Dr Richard Vautrey said: “The rise in the number of people practices are having to cope with is not matched by an increase in investment to expand the number of GPs, nurses and other members of the practice team, nor sufficient support to expand practice premises. Patient care will suffer as a result unless NHS England urgently steps up funding. Many practices are now bursting at the seams and will increasingly struggle to be able to take on more patients even if they wanted to. The £1bn promised for premises must therefore be spent on premises development and not diverted to other politically motivated projects.”
NHS 24 admits ‘systematic failure’ of £117m IT project: NHS 24’s bosses have admitted the project to replace its IT system was dogged by an inadequate business case, bad project management and spiralling costs, which are likely to rise still further, reported ComputerWeekly. Ahead of giving evidence in the 20 January session of the Scottish Public Audit Committee, NHS 24 submitted a document on the project, in which the health board “apologises unreservedly for its failure” to deliver the programme. As part of its Future Programme, which aimed to improve patient service, supported by modernised phone and online technology, NHS 24 went live with a new IT system from Capgemini in early November last year, two years behind schedule. But after the system crashed on go-live and experiencing several performance issues, NHS 24 decided to shut it down after 10 days and revert to the old system “on the grounds of patient safety”. The implementation of the system had already been heavily criticised in an Audit Scotland report, published in October, which found that poor procurement management, lack of skills and “over-reliance on the supplier” had inflated project costs by 55%, and racked up a total bill of £117.4m. NHS 24 has now set a new go-live date of summer 2016, by which time the system will be three years behind schedule, so costs could increase even further. “Current planning assumptions are that costs could increase by as much as £7.6m. The main reason for the increase relates to additional double running costs and the costs associated with preparing for the relaunch in 2016,” the NHS 24 document said.
TechUK advises on info sharing: techUK has produced recommendations for safe and effective information sharing in health and social care, reported DigitalHealth.net. The industry body hopes its five guiding principles and 12 recommendations will inform Dame Fiona Caldicott’s review into data security standards and the wording of a new consent model for data sharing, due out later this month. In a new report, techUK points out that while the commercial companies it represents do not own or control patient data, they process the vast majority of it on behalf of public sector organisations and therefore have a pivotal role in addressing the challenge of sharing it appropriately. TechUK recommended national guidance on how and why someone’s data will be used for both direct and indirect care, as well as a national effort to inform patient about the benefits of data sharing. TechUK said there needs to be closer collaboration between the technology industry and government, recommending that arm’s length bodies such as NHS England, implement techUK’s Three Point Plan for better engagement, more consistent approaches to information sharing and a more favourable environment to use technology and data in innovative ways. Natalie Bateman, head of health and social care at techUK said: “Data sharing for primary and secondary use will enable providers to improve care outcomes within ever increasing pressures on already stretched resources. It’s vital we reach a consensus on what and how information is shared at every level, to achieve an optimal balance between personal privacy and security, and safe, cost effective, evidence-based health and care services.”
A&E performance dips as Scottish hospitals under pressure: Nearly 3,000 patients waited too long for treatment in A&E in a dramatic spike in waiting times as ministers admitted Scottish hospitals are facing “substantial increased pressure” during winter months, reported The Scotsman. Across Scotland, 88.3% of patients were seen within four hours and the numbers of patients waiting beyond four, eight and 12 hours were at their highest since the end of February 2015, according to official figures for the week to 10 January. Liberal Democrat health spokesman Jim Hume MSP said the health secretary should “pull her head out of the sand” over waiting times. He added: “Staff are working flat out but despite the total number of people attending emergency departments dropping during the first week in January, the number of people waiting over four hours doubled.” Dr Richard Simpson, Scottish Labour public services spokesman, said: “This is a time of substantial increased pressure on our NHS. We know from previous experience that these weeks are always the period when the performance of our A&E departments are affected most significantly. Our clear focus is now on supporting boards and hardworking staff to ease pressure across the system.”
‘No smartcard’ Spine apps on way: HSCIC: NHS staff will soon be able to get mobile access to the NHS Spine without the use of a smartcard, reported DigitalHealth.net. The Health and Social Care Information Centre (HSCIC) is developing a mobile access project called CIS Mobile that will enable applications to be developed against a security framework that meets the requirements of the Spine. Users of these applications will be able to access Spine data without a smartcard. The HSCIC has also piloted a specific mobile application, called Oxygen, for the Apple iPad, which makes the iPad a “proxy” for the smartcard. Users can then access some Spine services with two-factor authentication. Adam Lewis, head of product, identity services at the HSCIC, said the new technology will initially allow mobile Spine access on iOS devices within a hospital campus. He recognised that this still places constraints on users, but emphasised that this is the first step in a wider mobile strategy. The ability to work in an “offline mode” and developments for Android devices are also part of the strategy. The project is part of the HSCIC’s Care Identity Service programme. Rob Shaw, HSCIC chief operating officer, said when the CIS was insourced it provided an opportunity to make changes at “quite a good pace and in a way that’s affordable to the NHS”.
NHS patient survey finds sharp rise in backing for Sunday opening for GP surgeries: Record numbers of patients in England are waiting more than a week to see their GPs, prompting the proportion of those backing Sunday opening for doctors’ surgeries to top 40% for the first time. The NHS’s six-monthly patient survey shows that while the majority are satisfied with their GPs and their access to them, a growing minority report frustration in getting appointments, reported the Guardian. The survey of more than 800,000 patients found that 11% were unable to get an appointment at all, while a record 18.1% had to wait a week or more to see their doctor. It also found that more than a quarter (25.8%) found it difficult to get through to surgeries on the telephone, compared with 18.4% in June 2012. It found that 18.7% of patients said their GP surgery was not open at convenient times – an increase of three percentage points since June 2012. It also found more support for GP surgeries opening outside normal working hours, with 41.6% backing Sunday opening – a sharp increase since 2012, when the figure was 31.7%. The shadow health secretary, Heidi Alexander, said the survey suggested millions more patients were struggling to get appointments.
Wales adopts NHS Number: NHS Wales has adopted the NHS Number as the official patient identifier for all of its IT systems, reported DigitalHealth.net. A newly launched standard means that all national new and local NHS Wales patient-focused systems, and all systems that integrate with NHS Wales Informatics Service products, must allow the NHS Number to be built into their software development. NHS Wales said this will ensure information can be shared safely across systems and will increase patient safety, adding that the majority of systems are already using the “one number for one patient.” Introduced in 1996, every NHS patient in England and Wales has a unique ten-digit number, which permanently identifies them from birth. It was made mandatory for all NHS trusts in 2014, but its use as the primary patient identifier is varied across the healthcare system, making it harder to share patient information between care settings. NHS England has also committed to driving up usage of the NHS Number and its use as a single patient identifier across the health and social care system in England was enshrined in law last October. According to the Department of Health, there is a “legal requirement for health and adult social care organisations to share information with each other when they are working together to provide direct care and treatment to a patient.” To make sure this is happening, health professionals have to use a patient’s NHS Number as a single identifier to ensure the information they share is accurate and up-to-date.
A&E ‘on the edge and waits too long’, says leading doctor: Hospital emergency departments in Wales are “on the edge” with staff shortages and waiting times too long, a leading A&E doctor has warned. Dr Robin Roop, head of the Royal College of Emergency Medicine in Wales (RCEM), said some patients were waiting more than 24 hours in A&E. He warned no A&E department in Wales had enough consultants to meet minimum RCEM staffing levels, reported the BBC. The Welsh government said the pressures were not unique to Wales. He was speaking as the latest statistics showed around 81% of patients spent less than four hours in A&E – the same as last year. Although at Morriston Hospital in Swansea, 58.7% spent less than four hours in A&E in December 2015, compared to 69.3% in the same month in the 2014. Dr Roop said there was also a shortage of senior doctors and emergency unit nurses. The gaps, which he claims are “notoriously difficult to fill”, added to the pressures, mean frontline staff are “working excessively hard”, “morale is going down” and more people are quitting emergency medicine. “In Wales staff turnover in emergency medicine is getting worse. We have not been able to recruit new consultants at the same level here as in other countries,” he said. Dr Roop, who is a consultant in Wrexham, said A&E waits because wards were full were also a “continuous” problem, despite efforts by health boards to open additional hospital beds and postpone non-urgent surgery at times of high demand.
HSCIC report highlights inconsistencies in hospital dementia care: The Focus on Dementia report from the Health and Social Care Information Centre (HSCIC) has highlighted inconsistent hospital record-keeping for patients with dementia, reported the Alzheimer’s Society. The report shows that in at least 50% of cases, hospitals are not recording a patient’s diagnosis of dementia, despite having identified it on previous admissions. This follows the launch of Alzheimer’s Society’s Fix Dementia Care campaign, which found further shocking variation in hospital care for people with dementia. The investigation revealed that too many people with dementia are falling while in hospital, being discharged at night or being marooned in hospital despite their medical treatment having finished. Alzheimer’s Society is calling for greater transparency in the quality of hospital care for people with dementia, and all hospitals to publish an annual statement on dementia care. Other key findings from the HSCIC Focus on Dementia report include: a six-fold increase in prescriptions for dementia drugs over the past ten years and an increase in dementia diagnosis rates, from 643 per 100,000 to 755 per 100,000 between April 2014 and December 2015. George McNamara, Head of Policy at Alzheimer’s Society, said: “These new figures support Alzheimer’s Society’s new Fix Dementia Care campaign calling for greater transparency about dementia care in hospitals. For at least half of all hospital cases, a patient’s diagnosis of dementia is not being consistently recorded in subsequent admissions. This is a simple point that could so easily be addressed to ensure that people with dementia get the specialist care they desperately need.”
Healthcare model “hard to sustain” as financial pressures mount: Northern Ireland’s Public Accounts Committee has said it is hard to see how the local health and social care model can be sustained as financial savings start to dry up, reported the BBC. The committee has voiced serious concerns over the financial stability of the health trusts. The criticisms are made in its general report on the health sector. It also raised concern over breaches in hospital waiting time targets, especially for cancer patients. Some of the recommendations are targeted at helping the trusts break even. The report found that despite only the Western Trust failing to break even in 2014-15, with a deficit of £6.6m, this masks an underlying funding gap for trusts from that year. The funding gap is reckoned to be over £131m. This will be carried forward to 2015-16. The report makes now familiar criticisms associated with high levels of spending on locum doctors as well as what it described as the “mediocre” implementation of Transforming Your Care. The report suggests that Northern Ireland could follow Scotland’s lead and benefit from a three-year budget, instead of the constraints of an annual budget in which money cannot be carried over. The chairperson of the committee, Michaela Boyle, said the health and social care bodies are facing an unprecedented financial squeeze. “Putting the health and social care trusts on a sustainable footing is a major challenge, unless there is a significant change in funding or transformation of services,” she said.
Health boards get £2.5m to tackle hospital bed-blocking: Health boards have been handed £2.5m to tackle delays in people being discharged from hospital, reported the BBC. The problem – known as bed-blocking – happens when support is not available in the community for patients. The Welsh government money will support a “series of measures” to “free up hospital beds for people who need them”, health minister Mark Drakeford said. In December, 435 people experienced delays in being discharged. More than half of the delays occurred because community care assessments were not carried out quickly enough, older people were selecting a care home or patients were waiting for a care home places to become available. The investment is part of the Intermediate Care Fund which was set up to integrate health and social care, maintain people’s independence in their own homes and prevent unnecessary hospital admissions.
Bitcoin tech has role in NHS: Walport: The technology behind the Bitcoin currency has potential application in the NHS, where it could open up new ways to share records, the government’s chief scientific advisor has argued, according to DigitalHealth.net. In a report issued this week, Sir Mark Walport argued that the government should invest in research and pilot projects to determine how it might use the distributed ledger technology that is used by block chain, the innovation that underpins the peer-to-peer cash system. “In distributed ledger technology, we may be witnessing one of those potential explosions of creative potential that catalyse exceptional levels of innovation,” he argued. “The visibility in these technologies [could] reform our financial markets, supply chains, consumer and business-to-business services, and publicly held registers.” His report went on to explain how distributed ledgers work, and how they might be applied to specific government services. It argues that in the NHS, “the technology offers the potential to improve health care by improving and authenticating the delivery of services, and by sharing records securely according to exact rules.” IT systems have tended to take paper ledgers and make them electronic; relying on messaging to keep different databases up to date. Distributed ledgers are an innovation, because they share identical copies of the ledger across many sites. Every holder has an identical copy of the ledger, and any changes that are made are date-stamped and reflected in every copy. Sir Mark noted that the Bitcoin ledger is constructed so that “anyone can add a block of transactions if they can solve the cryptographic puzzle [required] to add to the block.”
Dementia test shows five-year risk just using medical records: NHS patients could be told their chance of developing dementia within five years based solely on information already in their medical records, reported the Telegraph. University College London (UCL) has come up with an algorithm which predicts the risk based on details already held by GPs, including age, postcode, health and education. It is the first test which does not need any extra information, such as blood samples, memory checks or DNA analysis. Instead it relies on pooling together known risk factors such as history of depression, stroke, alcohol intake, diabetes, irregular heart rate, weight loss, smoking, high blood pressure and social deprivation. The developers say the Dementia Risk Score could give peace of mind to patients who are concerned they may develop dementia, while also alerting people early enough to make lifestyle changes which could prevent the disease’s progress. Lead researcher Dr Kate Walters of the Centre for Ageing and Population Studies at UCL said: “Our algorithm can be added to clinical software systems and a practice could, for example, run this risk model on all eligible people and offer those at risk more detailed testing or specific preventive management.”
Scotland invests £54m into mental health services: First minister Nicola Sturgeon has pledged £54m over four year to improve access to talking therapies for both adults and children, reported Pulse. Around 10,000 additional patients in Scotland will benefit from these services in the first year – an increase of 25% on current numbers – and by 2019/20, an extra 20,000 patients will be seen annually, she added. Health boards will use the money to improve capacity to see more people more quickly, work with Healthcare Improvement Scotland to redesign local services to be more efficient and sustainable, and to improve workforce supply to deliver extra services for children. Sturgeon said: “We have been investing heavily for a number of years, but there is still work to be done, particularly as awareness of mental health issues increases and the stigma in seeking support is reduced.” Lee Knifton, head of the Mental Health Foundation, Scotland, backed the move. He said: “Children and young people face more challenges to their mental health than ever, and demand for services at all levels is high. The evidence is clear that early intervention enables young people to recover quickly, often preventing longer term engagement with services and reduced life chances. Improved access and workforce skills should ensure services are both available, and responsive to what young people want and need.”
Cancer patients join genome sequencing project: Cancer patients have joined those with rare diseases as part of the 100,000 Genomes Project, which aims to sequence 100,000 complete sets of DNA from 70,000 NHS patients. By recruiting cancer patients, scientists will be able to build more detailed understanding of how their DNA affects their susceptibility to disease and response to treatment, reported Gov.UK. As well as the potential to benefit patients in the UK, this could also help in the global fight against cancer. Life sciences minister George Freeman MP said: “The recruitment of cancer patients is a significant milestone in the revolutionary 100,000 Genomes Project. It will help to unlock our understanding of the causes of this devastating condition, make the UK a leader in genetic research, and provide better diagnosis and more targeted treatment for thousands of NHS patients across the UK. A test is performed on a cancer patient’s tumour, which is compared to healthy cells from a sample of blood and saliva. The testing happens alongside the normal care and involves a small sample of the tumour being analysed in much more detail by scientists. Health secretary, Jeremy Hunt said: “Genomics is the future of medicine and the sequencing of cancer DNA confirms why the UK is a global leader in this field. Over half a billion pounds has been invested in genomics to ensure that NHS patients continue to benefit from the prospect of better diagnosis and better treatments.”
Opinion
Online communities can help the NHS, so why does it ignore them?
People with conditions such as diabetes increasingly seek support on forums and social media, but the NHS overlooks them, writes Arjun Panesar on the Guardian’s healthcare network this week.
“Social media has changed most aspects of life – including how people gather information about their health,” writes the chief executive and co-founder of Diabetes.co.uk. “While online forums for those with particular conditions, such as diabetes, are rapidly growing in popularity, the NHS is continuing to ignore them, even though they have the potential to save large sums of money. It is a frustrating blind spot.
“My own experience of co-founding and running Diabetes.co.uk – the largest online community for people living with the condition – suggests these kind of forums have almost no contact with the NHS, despite our estimation that we could be saving it more than £7m a year by educating people about their condition and helping them manage it so they can avoid costly ambulance call-outs and hospital admissions.
“Diabetes now affects more than 4 million people in the UK, a 65% rise in the past decade. The condition is a major user of NHS resources, with treatment costs for type 2 now taking £10bn a year, nearly 10% of the total budget. Complications, including heart disease and amputations, are by far the most expensive part of treating the condition. Inpatient care of complications costs between £1,800 and £2,500 for each patient.
“If the health service made more use of self-supporting communities to educate people with diabetes, it would reduce the need for costly inpatient care.”
Can more be done with limited care homes data?
With around 300,000 people in England and Wales over the age of 65 resident in care homes, Chris Sherlaw-Johnson, senior research analyst at The Nuffield Trust, looks at ways data can be used to monitor the quality of care they provide.
“Some care home providers already collect data on their residents, and all have to report notifications of serious harm, abuse and deaths to the Care Quality Commission (CQC). There have been previous initiatives to collect comprehensive data at a local level, but these have not led to national data collections. Other useful measures can be derived from hospital data such as emergency admissions to hospital from individual care homes, particularly for conditions which may reflect poor or insufficient care in the home, such as dehydration or diabetes. Though it is not perfect as a measure, there may be some sense in identifying whether particular care homes are better at preventing the sort of crises in care that lead to emergency admissions. There is certainly evidence that social care does reduce hospital use.
“For individual care home residents, the chances of an adverse event occurring will depend on their underlying risk (for example, their degree of frailty or long-term illnesses). However, tools for using this information to predict risk are not widely available, so methods are likely to have to rely on counting crude numbers. It would be feasible for care homes to adapt approaches that are already being used by NHS hospitals. Outcomes could be compared against a peer group of similar homes caring for a similar mix of residents, or against a home’s own history.
“The methods for generating the control limits can be complex, but the formulae can be provided within a simple spreadsheet that could be available for individual homes or local authorities to use. These are not perfect methods for identifying good or poor quality care, but can provide information that acts as a starting point for a more in-depth investigation of the care they provide.
“It is perhaps better to have some guidance about potential quality issues rather than no guidance at all.”
NHS planning guidance: an opportunity for collaboration across places?
Hugh Alderwick, senior policy assistant to the CEO and integrated care programme manager at The King’s Fund, writes about the new NHS planning guidance that arrived just in time for Christmas.
“As well as asking NHS organisations to produce their own operational plans for the coming year, it also asks them to work together to make joint plans for their local health and care services – a ‘sustainability and transformation plan’. The focus for NHS policy-makers is shifting from organisations to places. But how will sustainability and transformation plans work in practice?
“More detail on the process has been promised later this month, but the initial guidance gives NHS leaders plenty to think about in the meantime. After agreeing the right geography for their plan – their ‘transformation footprint’ – health service leaders are asked to develop five-year plans covering all areas of NHS-commissioned care in their area (including by working closely with colleagues in local government).
“Taking a place-based approach to planning and delivering health and social care services is the right thing to do. This means organisations working together – in partnership with patients and the public – to govern the common resources available for improving the health of the population they serve.
“While the guidance focuses mainly on NHS services, developing a credible plan will require the NHS to work closely with social care, public health and other local government services, as well as third sector organisations and members of the local community. It’s odd that the meat of the guidance doesn’t focus on these aspects of integration in more detail.
“This is where the big problem lies – namely, that doing all of this properly within the timescales provided will be difficult even for those areas with a long history of working together. For others, simply developing the co-operative relationships needed between leaders more used to competing than collaborating will be a challenge in itself. Either way – and as the planning guidance itself hints – the right answer won’t be to outsource the problem to external consultants.”
