News in brief
Health Foundation analysis predicts £65bn NHS funding gap: The NHS will end up with a £65bn hole in its finances by 2030 unless ministers plug the gap or allow the quality or availability of care to slip, say health economists. The Guardian reported that the Health Foundation analysis identifies the sum as the extra amount of Treasury funding the NHS will need by then because it is unlikely to meet unrealistically optimistic productivity targets. It says the NHS will need its budget to rise by 2.9% a year above inflation each year between 2015-16 and 2030-31 if it is to maintain the standard of services and avoid having to ration access to treatment. This is higher than the expected annual increase in gross domestic product of 2.3%, and indicates that an additional £65bn is needed by 2030/31, chief economist Anita Charlesworth told Public Finance. She added: “We are calling for the next government to establish a public and political consensus on the longer-term funding levels necessary for the NHS. The next government needs to act immediately in order to secure the future of the health service in years to come.” The £65bn will also be needed because the health service is likely to make only 1.5% annual gains in productivity and not the 2% and 3% envisaged in the Five Year Forward View, NHS England’s recent blueprint for securing the service’s uncertain future.
£240m technology fund raided to prop up A&E, sources say: The government has raided a £240m NHS technology fund to bolster financial support for hospitals struggling with accident and emergency demand this winter, senior sources have told Health Service Journal (HSJ, subscription required). Senior health service figures said a large amount of the money originally earmarked to help pay for projects such as digital patient records had now been diverted into the £700m winter pressures fund. One senior NHS IT director told HSJ: “We are being told that at least half of the money is going to be cut and that there is probably going to be nothing by way of an announcement until after the election about which trusts have been successful.” Another well placed figure in NHS IT said: “It is the uncertainty as much as the cut which is causing the problem. If we knew we were not going to get any money we could make plans, but the uncertainty is really damaging.” NHS England, which is responsible for allocating the integrated digital care technology fund, had been expected to announce successful bidders in autumn 2014, but no announcement has yet been made.
Care.data in “last chance saloon”: NHS England has been warned its controversial care.data programme is at its “last chance saloon”, as it pushes ahead with the trial phase of the project. At a parliamentary health committee hearing this week on the pathfinder phase, MPs were told that a number of questions about the project remain unanswered, with regulations outlining restrictions on access to the data still to be released. eHealth Insider reported, that NHS England was forced to “pause” the programme in February last year after medical and privacy groups objected to a public leaflet campaign that failed to include a clear account of the programme, who would receive the data, or an opt-out form for patients. Last October, clinical commissioning groups in Leeds, Blackburn, Somerset and West Hampshire were selected as care.data ‘pathfinders’ as part of a revised roll-out plan. However, a December report by the Independent Information Governance Oversight Panel, chaired by national data guardian Dame Fiona Caldicott, said there were a wide range of unresolved questions that must be answered before the pathfinders can proceed.
CQC rejects accusations of Hinchingbrooke bias: The leaders of the Care Quality Commission (CQC) team that rated Hinchingbrooke Health Care Trust ‘inadequate’ issued a strong rejection of claims that their inspection was biased, reported Health Service Journal (HSJ, subscription required). The inspector who led the team told the CQC’s public board meeting that Hinchingbrooke was “one of the worst” providers she had inspected, while the inspection chair, who has been accused of a public sector bias, denied that he was “anti-private practice”. The trust is currently run by private provider Circle. However, the regulator said at its board meeting that it will be revising its policy for declaring potential conflicts of interest in light of the fallout from the inspection. Earlier this month the CQC issued a highly critical report on Hinchingbrooke, which is the only privately operated trust in the country, resulting in it being put in special measures. The Daily Mail, which had previously written a number of positive stories about Hinchingbrooke, claimed the trust might have been the victim of a “stitch up” because one member of the inspection team had warned against NHS privatisation and another is alleged to have belonged to a group campaigning on the issue.
HSCIC ‘chipping away’ at NME exit plans: Progress is being made in managing the transition away from local service provider (LSP) contracts in the North, Midlands and East of England, the Health and Social Care Information Centre (HSCIC) has said. Mary Barber, the CSC LSP programme director at the HSCIC, told eHealth Insider (EHI) the organisation has been “chipping away” at the issue since her presentation at EHI Live 2014. Barber told the show in November that the end of the LSP contracts – placed by the National Programme for IT in the NHS a decade ago – would unleash huge a demand for systems that suppliers might struggle to meet. In an update for EHI, Barber said the number of organisations that have still to draw up a transition plan has decreased from 82 out of 266 to 60. Those organisations are responsible for 150 of the 700 systems covered by the LSP contract, which expires on 7 July 2016. Barber said: “I’m comfortable that we’re chipping away and reducing the challenge, so we’re getting to the point where organisations know what they’re doing, or they have a direction of travel. The HSCIC has been working with NHS Shared Business Services, which is putting together a procurement framework to support the change that is due to launch soon.”
Trusts challenge NHS England decision to award contract to private firm: A number of NHS trusts has launched a formal challenge against an NHS England decision to award a 10-year, £80m contract for PET CT scanning to a private company, reported National Health Executive. The contract, which covers about five million patients, was awarded to Alliance Medical in December, beating a bid from a consortium of the University Hospitals of North Midlands Trust, Wirral-based Clatterbridge Cancer Centre Foundation Trust and the Royal Liverpool and Broadgreen University Hospitals Trust. The consortium confirmed it has lodged a formal challenge to the procurement decision. University Hospitals of North Midlands Trust chair John MacDonald said: “We have now launched a formal challenge and are currently waiting for those discussions to be completed.” Details have not been released but the challenge is believed to focus on the bid process followed by NHS England. The existing contract for imaging services is due to end in April when the new contract with Alliance Medical is scheduled to begin. This may be delayed by the trusts’ challenge, but patients will still be seen and treated under the terms of the current contract.
Patients miss out on bowel cancer screening after opting out of care.data: At least 100 patients who opted out of the record sharing before care.data was delayed in February last year may have been missing out on invitations for cancer screenings and other programmes, reported Pulse. Speaking at a health committee meeting, the newly appointed national data guardian, Dame Fiona Caldicott, said that some patients had said they did not want the NHS information centre sharing data with other parties, but this meant they were not being called in for certain services. At the same meeting, the senior responsible owner for care.data, NHS England’s Tim Kelsey, said that 80 practices, in three CCG areas, have so far signed up for the pilot scheme, and one area was yet to start. He also said that pilot practices will be paid for the costs of the letters they send out to patients, but not for the work they are doing to send out the letters.
Ramsay partners with IMS MAXIMS for next decade: Ramsay Health Care UK, one of the leading providers of independent hospital services in England, has signed a 10-year contract with IMS MAXIMS to provide an open source electronic patient record (EPR) system and clinical modules to improve patient satisfaction and outcomes, reported Integrated Care Today. The agreement aims to help the independent healthcare sector provider achieve its commitment to continuous service improvement. “It’s about putting the patient at the heart of everything we do,” said Andrew Till, corporate service director at Ramsay Health Care UK. “We are always striving to provide a safe, high quality seamless service and IT is a cornerstone to achieving this mission.” The contract will see the implementation of the full openMAXIMS product suite released to healthcare providers last summer. The suite includes a patient administration system, and solutions for order communications and results, eDischarge, integrated care pathways, theatre scheduling, bed management and clinical noting. The openMAXIMS technology will be deployed across all 32 Ramsay Health Care UK sites, with an average of 1,500 active concurrent users of the system at any one time.
NHS to bring two IT systems in-house away from BT: Two NHS IT systems will be moved from BT to be managed in-house by the Health and Social Care Information Centre (HSCIC) from February 2015, reported Computer Weekly. The transition is part of a plan to move major NHS IT projects in-house to the HSCIC so they can be managed in a more flexible and responsive way. The two IT systems to move away from BT will be the Secondary Uses Service (SUS) and the Care Identity Service (CIS). SUS – the single, comprehensive repository for healthcare data in England – and CIS, which is the smartcard system used to identify users on the NHS Spine platform, will move over to the HSCIC during specific time slots. The CIS transition will take place from Thursday 19 February to Tuesday 24 February 2015, while the SUS transition will run from Friday 20 February to Tuesday 3 March 2015. Both timeframes have been chosen with minimal user disruption in mind. It follows the transition of the infrastructure behind the critical NHS Spine platform, which was replaced by HSCIC in August 2014.
Birmingham reboots central care record: A “proof of concept” trial for a Birmingham central care record is underway, following an overhaul of the troubled project. eHealth Insider revealed last October that plans for the record to share patient information across health and social care had been cut back after GP leaders raised concerns. The aim of the original project, which was being run by NHS Central Midlands Commissioning Support Unit on behalf of local clinical commissioning groups, NHS trusts and local councils, was for information to be recorded once and shared between provider systems via a central data warehouse. Leadership of the project was transferred from the CSU to the Birmingham CrossCity Clinical Commissioning Group as part of the revamp, while a number of changes were also made to the scope of the record. Approximately 120,000 patients from eight GP practices are now taking part in a pilot of the revised project, which began this week. University Hospitals Birmingham NHS Foundation Trust, Sandwell and West Birmingham Hospitals NHS Trust, Heart of England NHS Foundation Trust, and Birmingham and Solihull Mental Health NHS Foundation Trust are also participating in the pilot.
Prof Bruce Keogh: wearable technology plays a crucial part in NHS future: Devices worn on the wrist like the ones that record your heart rate, calorie intake or distance run have a vital part to play in securing the NHS’s future, the service’s medical director told The Guardian. Prof Sir Bruce Keogh believes that gadgets similar to fitness trackers, which are growing in popularity, and others resembling games consoles will revolutionise the monitoring of patients’ health, especially those with a serious condition. “Fitness trackers are becoming increasingly sophisticated. But there are devices coming along which not only measure how much exercise you do but can also measure your heart rate, your respiratory rate, and whether or not you’ve got excess fluid in your body – quite complex changes in your physiology. Technology is emerging which enables those to be brought together and transmitted through mobile phones or other methods where health professionals can analyse them and act upon any warning signs,” Keogh said. Wearable technology could easily prove useful for people with heart failure – one of the most common causes of admission to hospital – and thus relieve the strain on overcrowded hospitals.
Integrated care reduces admissions: An integrated care programme (ICP) is helping to reduce long-term hospital admissions in Norfolk, reported The Commissioning Review. Launched in 2010, the programme was developed by NHS North Norfolk Clinical Commissioning Group (NNCCG) in partnership with regional GP practices and local social services. During this period the number of people admitted into the region’s hospitals with long-term and preventable illness has decreased. This in turn alleviates pressure on the urgent care system. The programme also covers many of the requirements of the national Better Care Fund, which seeks to drive forward the integration between health and social care – and meets the challenge issued by NHS chief executive Simon Stevens in his Five Year Forward View for new patient-centred models of care to be developed that meet the needs of an ageing population. NNCCG’s chairman, Dr Anoop Dhesi said: “The importance of integrating health and social care has long been a priority for the NHS but with hospitals across the UK facing unprecedented demand, the need for a system that allows people to receive care in their homes and communities has never been greater.”
Another Welsh board rolls out free wi-fi: Hywel Dda University Health Board is rolling out free wi-fi to patients, staff and visitors, with plans to provide tablets to chemotherapy and dialysis patients during their treatment, reported eHealth Insider. Anthony Tracey, the board’s interim assistant director of informatics, said it wanted to provide patients and visitors with “the best access and experience when visiting our hospitals”, while also improving staff operations. Tracey said the board is initially focussing on rolling out wi-fi at nine key locations, including five hospitals. It will roll out access at other sites over the next 12 months. Patients in the board’s chemotherapy day units and renal units will also be given tablets to use while receiving their treatment, Tracey added. The provision of effective wi-fi networks has become a topic of debate in the NHS, with both staff and patient groups lobbying for better access.
Opinion:
Urgent care: we need a shared sense of scale
A lack of data is contributing to a poor understanding of ‘scale’ in urgent care, says Rob Webster, chief executive of the NHS Confederation.
Webster cites some large statistics including that 22 million attendances go through A&E or equivalents in England. He points out that “very small changes in one sector could engulf another, or lots of very small, positive steps in one sector could mean a big step in the system overall.
“Unfortunately, our understanding is hampered as we don’t know whether general practice is generating any pressure at all or sucking up even more itself. The data does not exist in real time and consistent community services data is even more elusive. Social care data – so important to flow – is patchy.
“Overall, while there has been significant public debate, and some suggested theories regarding the causes of pressures on urgent and emergency care, there is widespread acknowledgment of the lack of clear, detailed information on whole system demand and a consequent lack of robust alignment between any proposed system responses.”
Webster identifies pharmacists, but also physiotherapists and occupational therapists to help “pick up the burden” on A&E: “The scale of their impact could be huge; one in three over 65s will fall, and there are 3 million falls a year, of which up to 25% sustain a serious injury. Plus, falls are significant drivers of premature mortality.”
Power to the people on: Charlie Hebdo and the NHS
Paul Hodgkin, founder and chair of Patient Opinion, wonders what the recent massacre of French cartoonists has to say to the NHS, and argues that it will need to be vigilant against new demands for its data.
“The NHS is the polar opposite of terrorism. Its values of solidarity are specifically designed to enable us to face pathology together, regardless of religion, class and creed. The NHS is the glue that holds significant parts of the British society together and is part of how we know we are British. But precisely because the NHS is indeed the closest thing to a national religion that we have, that makes it a target of immense symbolic significance. Time perhaps to prepare for the unthinkable.
“In the wake of Charlie Hebdo, David Cameron has proposed making digital surveillance even tighter. As Cory Doctorow has pointed out in a devastating critique, these plans are simply technically impossible. Meanwhile, thanks to Edward Snowden’s revelations, Google and Facebook seem to be moving towards encrypting everything.
“If so, the security services will be left between a rock and a hard place and it is possible they may come to rely more heavily on the state’s own databases to detect terror attacks. The pressure to allow them access to selected parts of the data held by the NHS Information Centre may well become intense.
“Staff will have wondered whether and how they might express solidarity with those from communities that feel threatened. Or how to assert their own integrity when faced with racist comments.
“Such deviations from clinical neutrality are never easy. But they are still worthwhile because this is how we come to know what sort of professional this new low-friction, always on, fully connected world demands us to be.”
Starting with hospital reform will make things worse
Ben Gowland, the CEO of NHS Nene clinical commission group, says, that efforts to transform the NHS will fail if we heed the Dalton Review and put all our effort into changing hospitals, instead of focussing on the needs of the whole system.
“The main problem with the report is that it is only talking about the future of hospitals. The majority of options are only really open to hospitals. Even the description of an Integrated Care Organisation as a potential model places hospitals firmly at the centre. Meanwhile the startling omission from the document is that it does not even mention general practice.
“The starting point for this review should have been how we transform the system, in the way outlined in the Five Year Forward View. But instead it is premised on making existing hospital providers sustainable. Provider reform should not be an end in itself, but rather an enabler for system reform. The token references to the Five Year Forward View in this report are lost in the recommendations for immediate action and milestones and trajectories, that all look like a mini-industry waiting to happen.
“There is no doubt that hospitals need to change. But the priority for the NHS must be to change the way our systems operate that will enable us to build care around the needs of patients, rather than around the organisations within it. This report unfortunately misses this point, and sadly as a result is likely to focus efforts in a way that will hinder rather than help the delivery of real improvement in the NHS.”
Blog
In this week’s blog Myriam McLoughlin argues that it’s time for IT suppliers to rethink their marketing strategy and consider targeting patients direct as healthcare technology evolves into a B2C industry.
