News in brief
NHS should get £5bn “Brexit bonus” – Lansley: The NHS should get a “Brexit bonus” of £5bn a year, former Conservative health secretary Andrew Lansley has said, reported the BBC. In the run-up to June’s EU referendum, leave campaigners said the £350m a week the UK paid into the bloc’s budget would be spent on the NHS instead. The figure proved contentious during the campaign, with remain supporters arguing that figure did not take into account money the UK got back from the EU in grants, subsidies, and the British rebate. Lord Lansley said: “At the referendum, on one hand the public were told that staying in would mean a strong economy and more money for the NHS. On the other hand the public were told that leaving would mean redirecting the EU budget and more money for the NHS. So for political reasons, both campaigns told the public that whatever was going to happen in the future, there would be more money for the NHS. So the public have a right to expect it. They have a right to expect a Brexit bonus for the NHS.” He went on to say that the UK would not leave the EU before 2019 at the earliest, so the extra payments should be paid from then.
Government’s lack of clear plan for digital NHS poses risk to ‘credibility’: The King’s Fund has called on ministers and national NHS leaders to set out a “definitive plan” for going digital, with “credible timescales” and clarity around priorities, reported Computer Weekly. The recent report by the think tank warned that confusing messages around when and how the NHS is expected to go digital could pose a risk to achieving its goal. Funding continues to be another issue. In February 2016, health secretary Jeremy Hunt announced a £4.2bn investment in a “paperless NHS” over the next five years. However, the full breakdown of where the money is coming from and how it will be spent is still unclear. The King’s Fund said the proportion of the funding announced by Hunt that “constitutes ‘new money’ remains unclear, as do the criteria and route of access for local areas and expectations for what this funding will deliver”. The report said: “If the government is serious about achieving its vision, whether by 2020 or 2023, clarity is needed about the funding available to support this, as well as consideration of whether further funding will be required.” It also highlighted the importance of getting clinicians on board if the NHS is to succeed in its digital transformation.
Scottish health boards to receive £9m to help with winter workloads: NHS health boards in Scotland will receive £9m to help patients get the “best treatment” possible during winter, reported STV News. The fund is aimed at helping ease the increased workload often seen during winter months. The Scottish government hopes the funds can be used to free up hospital beds by ensuring patients are discharged as soon there are no clinical reasons for them staying. The first minister said: “A&E attendances last winter increased yet emergency departments consistently improved their performance. This is testament to the immensely hard work and dedication of our NHS staff and follows a three-year, £50m unscheduled care fund which supported boards to make changes.” The Scottish Conservative shadow health secretary, Donald Cameron, said: “Any additional cash for A&E is welcome, particularly at the most difficult time of year.”
Underfunded, under-doctored, and overstretched NHS threatening patient safety: The triple whammy of an underfunded, under-doctored, and overstretched NHS is threatening patient safety, concludes a report on the challenges facing the NHS, published by the Royal College of Physicians (RCP), reported OnMedica. The report, which has drawn on the experiences, views, and concerns of consultant and trainee doctors, painted a picture of an NHS struggling to cope, adding to the accumulating body of national evidence illustrating the gravity of the situation the health service faces. The NHS budget has not kept pace with rising demand for services, which increase by 4% every year. However, in real terms, NHS funding is set to increase by only 0.2% a year to 2020, while cuts to social care are piling the pressure on NHS services. With hospital deficits hitting £2.45bn, money to transform services risks being sucked into a financial black hole, said the report. It went on to say that patients and the public deserve to know the stark choice that has to be made: increase funding or cut care. But the college believes they deserve an NHS funded and staffed to meet their needs, now and in the future. National Health Executive reported that Dr Andrew Goddard, the RCP registrar, said: “It is clear to all of us working in the NHS that we are at a point of no-return and the NHS in its current form is unsustainable without a significant increase in funding. As doctors, we see the problems this creates on a daily basis, be it at the front door of the hospital, in A&E or in out-patients. Patients can see it too and realise that the NHS is no longer the envy of the world and isn’t fit for our changing world.”
Call for cross-party commission into NHS and social care ‘crisis’: Three MPs with strong links to health have urged the prime minister to establish a cross-party commission to “confront” what they describe as the “growing crisis” in the NHS and social care, reported the Nursing Times (subscription required). The call to Theresa May comes from two former government health ministers and a shadow health minister. Liberal Democrat North Norfolk MP Norman Lamb, who was a minister in the coalition government, has joined forces with Dr Dan Poulter, former minister and Conservative MP for Central Suffolk and North Ipswich, and Liz Kendall, Labour MP for Leicester West and a former shadow health minister. In a joint statement, the three senior health figures argued that health and care services in England faced a serious existential challenge, and that partisan politics had failed to come up with long-term solutions to ensure that services are properly funded and sustainable for the future. They called on the government to start a “national conversation with the public and healthcare staff” to tackle the crisis. Mr Lamb said: “In a country with the world’s sixth largest economy, it should be possible to have a world-class, publicly-funded NHS free at the point of use, and a care sector where nobody loses out because they can’t afford to pay crippling fees. Everyone who believes in the NHS and social care – irrespective of political colour – should work together to guarantee its future.”
600 GP practices at risk of closure, says RCGP: Around 600 practices are at risk of closure by 2020 due to problems recruiting GPs, the Royal College of General Practitioners (RCGP) has claimed, reported Pulse. These practices all have at least 75% of their GPs aged 55 and over, which will lead to a shortfall of almost 10,000 GPs across the UK within four years. The RCGP said that patient safety is at risk unless the recruitment issues are addressed. Partners at an 18,000-patient practice in Oxfordshire announced they were handing their contract back after failing to recruit enough GPs to remain open. The RCGP said that it is “launching a ground-breaking new video and guide” to foundation doctors, medical students and sixth-form students, to show that general practice is “exciting and challenging”. RCGP chair Dr Maureen Baker said: “It is imperative that we recruit huge numbers of medical students and foundation doctors into general practice in order to keep the NHS on its feet. If we fail, there will be too few GPs to go round, practices will close, and patient safety in general practice will clearly be at risk.”
Parity for mental health services “difficult to achieve” amid funding restrains, say MPs: Achieving ‘parity of esteem’ between mental and physical health will be very difficult to achieve due to pressures on the NHS budget, the Public Accounts Committee has said, reported Public Finance. The committee said the government had a “laudable ambition” to improve mental health services, but was sceptical about whether this was affordable or achievable without compromising other areas. One in four adults is diagnosed with a mental illness within their lifetime, but only around a quarter of those estimated to need mental health services have access to them. As outlined by the committee, the challenge is to build joined-up services within the health service and across other parts of government that provide access to the services that people need across the country. Success in achieving parity would also hinge on the health service having the right staff with the right skills in place – but “there is not yet a clear plan to develop the workforce needed”, according to the report. Committee chair Meg Hillier said: “The government has committed to making much-needed improvements to mental health services, but we are concerned it does not yet have sound foundations to build on. If these goals prove beyond the scope of the funds available, then it is vital a plan is put in place to make best use of the money available. It is the responsibility of government to ensure its departments work together more effectively to support people with mental health conditions and in doing so reduce pressure on the public purse elsewhere.”
Scotland’s social care services “unsustainable”: The current system of social care in Scotland is “unsustainable”, according to the Accounts Commission. The BBC reported that the financial watchdog said an additional £667m would be needed by 2020 to maintain current levels of service, and called for a “frank and wide-ranging” debate on the issue. It said an ageing population, budget cuts and legislative changes were putting pressure on the system. The commission also said the public and service users needed to be more involved in shaping future care. Councils plan to save £54m from their social work budgets over the next financial year, with most now only providing services for people aged over 65 assessed as being at “critical or substantial risk”. Accounts Commission chairman, Douglas Sinclair said: “The main message is that the current approaches are not sustainable. Why do we say that? It’s really largely about money, but not only about money. Each year, councils spend over £3bn on social work and we estimate that if you wanted to maintain services in the way they’re currently delivered, you’d need not far short of £700m by 2020.” The overall aim of the audit by the Accounts Commission was to examine how prepared social work departments were for future financial and demographic changes. Mr Sinclair said: “Councils have increased spending on social work. They’ve tried to protect it over that period of time, but there just isn’t enough money in the system. The other problem is that as the money flat-lines, demand is always increasing.”
CCGs given £6 per patient to fund extended GP access from 2019: Every clinical commissioning group (CCG) will be handed £6 per patient to extend GP access from 2019, NHS bosses have said, reported GPOnline. New recurrent funding will be rolled out to the whole of England as part of the implementation of the GP Forward View. From this year the funding will be handed to areas running GP Access Fund pilots and expanded to include additional areas in 2017/18, new planning guidance from NHS England and NHS Improvement confirmed. “The investment will be extended in 2018/19 to enable the whole country to start developing additional capacity, so that from April 2019 every CCG can expect a minimum additional £6 per head to improve access to general practice”, the bodies said in a statement. NHS England’s director of primary care Arvind Madan, said: “We know that general practice is under pressure and we are determined to maintain the momentum in turning things around, as started with the launch of the GP Forward View. This planning guidance, with detail on how investment will look in the coming years, demonstrates the steps we will be taking with CCGs to both stabilise and transform GP services in the years to come, for the benefit of staff and patients.” The guidance orders CCGs to draw up plans to implement local elements of the GP Forward View. Local commissioners have until 23 December 2016 to submit their plans.
Surrey NHS trust launches Internet of Things trial for improving dementia care: Surrey and Borders Partners NHS Trust has launched a £5m trial of Internet of Things (IoT) technologies to improve healthcare for people with dementia. The trial, which will involve 700 people with mild to moderate dementia and 700 carers, will allow clinicians to remotely monitor the health and wellbeing of people with dementia, reported Public Technology. The aim is to allow earlier intervention, reduce unnecessary hospital admissions, relieve pressure on carers, and allow people with dementia to remain in their own homes independently for longer. Half of the participants will be randomly selected to have their homes kitted out with sensors, trackers and apps that will connect to the IoT and collect information that will be collated and analysed. The other half is a control group, who will continue their care as usual. The trial will use objects like fridges, kettles and beds to detect and assess behaviour patterns, such as if someone might be at risk of dehydration or are unusually active at night. “The technology is designed to alert us to any changes in behaviour or any changes in wellbeing that could signal someone is becoming unwell or that they are in trouble,” said Ramin Nilforooshan, leading dementia specialist at the trust. He added: “We could detect the early signs or symptoms of those infections and successfully treat them at home.”
Thousands more NHS operations cancelled than figures show, report claims: Tens of thousands more operations were cancelled at the last minute in English hospitals than official figures suggest, an investigation has claimed. The Guardian reported that about half of English NHS trusts admitted in response to freedom of information requests that they had cancelled nearly 42,000 operations between one and three days before patients were admitted. It comes after official figures in May showed the number of hospital operations in England cancelled at the last minute because of a lack of staff or beds rose to 74,086, its highest in 15 years. However, that statistic only records cancellations on the day of admission. An NHS England spokesperson said: “The proportion of patients seeing their operations cancelled at the last minute remains under 1% in spite of record numbers of operations being scheduled. Our national data collection rightly requires trusts to focus on monitoring the number of last-minute cancellations, as this is where the most distress is caused for patients. Hospitals should continue to ensure that every effort is made to reschedule cancelled operations as soon as possible.”
NHS ‘to do’ list puts IT and funding focus on STPs: The NHS ‘must do’ list, published three months’ earlier than usual, indicates that there will be funding for local digital roadmaps over the next two years, reported DigitalHealth.net. The NHS Shared Planning Guidance has indicated that money will be allocated to sustainability and transformation plan (STP) areas. The move is in line with the general direction of travel in the guidance, which places a big emphasis on the STPs as the vehicle for delivering the Five Year Forward View plan to close a £30bn funding gap across the NHS by 2020-21. The guidance said each STP will be “a route map for how the local NHS and its partners make a reality of the Five Year Forward View, and the spending review envelope (the money allocated to the NHS by the Treasury). STPs are more than just plans. They represent a different way of working, with partnership behaviours becoming the new norm. That’s why, although STPs are relatively new, we see them as having a significant role in the NHS.” The guidance reiterated the main themes of the forward view, that the gap between funding and demand will only be closed by a new focus on prevention and on new models of working. It stressed that these new ways of working must be “collaborative” rather than adversarial. However, it said plans must take account of the financial ‘reset’ announced earlier this autumn, which imposed ‘control targets’ on many trusts, and put into special measures some organisations that had not signed up or were unlikely to meet them.
First ‘outstanding’ rating given to specialist hospital: A specialist hospital has received an outstanding rating from the Care Quality Commission (CQC) for the first time, reported the National Health Executive. The CQC awarded the rating to Liverpool Heart and Chest Hospital NHS Foundation Trust, which provides specialist hospital and community care in cardiothoracic surgery, cardiology, respiratory medicine, adult cystic fibrosis treatment, and diagnostic imaging. It was rated “outstanding” for being caring, responsive and well-led, and “good” for being safe and effective. Professor Sir Mike Richards, the chief inspector of hospitals, said: “We found the care at Liverpool Heart and Chest Hospital NHS Foundation Trust to be of exceptional quality. There was a very clear vision and strategy for delivering the highest standards of patient care with a strong focus on quality and a positive patient experience. There was effective team work across all staff groups and we saw positive examples of collaborative working with the board and senior management to improve patient care.” Neil Large and Jane Tomkinson, the chair and chief executive of the trust respectively, said: “The CQC inspection process is rigorous and rightly challenging, and this rating pays testament to the dedication and professionalism of the team.”
NHS offers appointments with a doctor via webcam rather than in person: The NHS is offering appointments with a doctor via computer webcam rather than in person to reduce the time patients must wait to see a GP, reported The Telegraph. Three practices in Essex and Greater Manchester reportedly already provide the online video consultations – carried out by private doctors but paid for by the NHS – and others are expected to do so in the future. To complete the appointment, patients have to download an app on their computer or smartphone before logging in at the time of their allocated slot. Richard Vautrey, of the British Medical Association’s GP committee, said: “The real solution to these workload pressures that result in schemes like this is for the government to urgently reverse a decade of underinvestment in general practice so that GP services can be properly funded to meet the growing health needs of their patients.” Mr Hunt said at a conference in Manchester: “We live in the age of the smartphone, and we want the NHS to reflect that. Our new plans will make it easier for patients to get medical support and information they need, and should encourage more of us to use the growing range of online NHS services available.”
Cyber-attacks against NHS to rise, experts warn: The threat of cyber-attacks against healthcare organisations is only going to grow in the near future, NHS experts have warned, reported ITProPortal. Cyber-security will be one of the highlights of the upcoming UK Health Show, scheduled to take place on September 28 in London’s Olympia. According to a recent survey, 98% of healthcare professionals fear cyber-attacks against the NHS, with 84% saying they expect an increase in such threats against their own organisations, as well. Almost three quarters (70%) of professionals due to attend the conference doubt the NHS can securely share confidential patient data on apps and mobiles. People are also sceptical about the NHS’ ability to digitally transform, and hit the 2020-paperless deadline. Alexander Rushton, UK Health Show event director, said: “Technology will play a big role in shaping the future of the NHS and the way patients access services. UK Health Show delegates responding to the surveys have shown overwhelming confidence in the transformational power of data and technology, but have also revealed areas requiring immediate attention for this to happen. Delegates will now gather next week to discuss these issues and learn and benefit from best practice case studies on how to prepare for cyber-attacks and more generally about how technology is being used to improve patient care and save money.”
Standard weight loss methods better than wearables – study: Fitness devices may not offer an advantage over traditional diet and exercise plans for losing weight, according to a long term study in the US by The University of Pittsburgh, reported DigitalHealth.net. The 417 trial participants were split into two groups, and the half with a fitness gadget lost an average 8lb (3.6kg), as opposed to the control group which lost 13lb (5.9 kg). “Devices that monitor and provide feedback on physical activity may not offer an advantage over standard behavioural weight loss approaches,” the paper concluded. All participants were placed on a low calorie diet, prescribed exercise and had group counselling sessions. The group with the wearable technology monitored their diet and physical activity through the device and online, and the other group self-monitored using a website. The device used was Fit Core, a product that is manufactured by Jawbone’s BodyMedia and is worn on the upper arm. Jeremy Hunt announced this month that a new NHS Library would be created for apps and wearables by March next year. This is not the first time the NHS has attempted to create a Health Apps Library. The pilot of a previous library, hosted on NHS Choices, was closed down in October 2015 after research showed some could leak health data to third parties. Earlier this year, a study found that “the majority of mobile health apps failed security tests and could easily be hacked”.
Opinion
‘An underfunded mental health strategy is no strategy at all’
If we are serious about addressing the growing mental health crisis, we need to provide adequate resources for an early intervention strategy, writes Diane Abbott in The Huffington Post.
Abbott, Labour’s shadow health secretary, argues that the current mental health strategy calls on the NHS to do more without the required finances.
She writes: “It should come as no surprise to ministers that demands from central government for NHS trusts in the most resource stressed parts of the country to fulfil new and ambitious mental health targets will fall on deaf ears.
“The £120m of additional funding for 2014 to 2016 has been used by the NHS to plug finding gaps that have appeared in other areas of acute care.
“As a recent freedom of information request recently revealed, a third of clinical commissioning groups could not identify how much money had been allocated to early intervention in psychosis, after the deadline had elapsed for full implementation of the plan.
“I believe mental health and physical health should have parity of esteem and our national neglect of the mental health of our citizens is nothing short of a national scandal and a prejudice at the heart of the NHS.”
Saving paper, saving money or transforming care?
Has the most important objective in the government’s digital agenda been lost in translation? asks Matthew Honeyman, researcher for policy at The King’s Fund.
The King’s Fund recently published a briefing on the digital agenda. Honeyman discusses recommendations from the Wachter report and gives his view on the NHS’ digital future.
“Much of the commentary on Wachter’s review has been focused on its messages about unrealistic timetables and insufficient funding. But it also calls for a re-launch of the government’s digital agenda with a new name by the end of this year. Could the ‘paperless’ branding finally end up in the bin?
“While this term has often been used to provide clarity around some of Jeremy Hunt’s desired outcomes, it gets in the way of articulating a more fundamental case for change. It begs the question ‘what for’? And that’s something we think continues to be a challenge for national NHS bodies.
“Wachter has proposed that a cadre of information-specialist clinicians trained at a new digital academy should drive the development and roll-out of technology in such a way that it fits better into clinicians’ ways of working. He’s probably right in that that this could help, but training takes time and such a proposal must be a viable career path for clinicians.
“The ambitions of the government’s digital agenda have always commendably gone beyond simply making the system paperless. While the timetables might be relaxed in line with Wachter’s advice, the goal is still an ambitious one – to create a digital ecosystem that will ultimately transform NHS services and the experience of patients.
“Whatever the new programme is called, it needs to have a strong focus on communicating the fundamental purpose of these efforts.”
A voice from Ireland – do eHealth agendas need politics?
Richard Corbridge, chief information officer of HSE Ireland, asks why health has to work to a political agenda.
In an article for the British Journal of Healthcare Computing, Corbridge, widely recognised as the face of health technology in Ireland, voices his frustrations.
He writes: “The delivery of health is driven by politics by necessity. No matter where in the world you are the delivery of health and wellbeing to a population is an election winning and losing manifesto.
“In Ireland we are deploying solutions that are over ten years old, we continue to deploy them because they have been backed politically but the digital landscape has moved on three generations since the inception of some of these solutions.
“Will any country ever be brave and allow a system to just do it. If clinicians and patients are engaged and want ‘IT’ then why not?
“The suggestion is definitely not to do this without governance or engagement but to take away the political might, to empower the system, which is far more intelligently capable in this arena than the political system after all, to make the difference happen in clinical and technology settings.
“I do need to bring this back to Ireland though. Ireland has an electronic health record (EHR) business case it now believes in. The health system itself has approved it as a business case, clinicians, patients and the leadership of the system has made it clear that the 10-year direction in this business case is the right way for Ireland. If Ireland can continue to deliver the digital fabric it is doing, with the simple support of an engaged minister’s office and political team then we truly could be the first country in the world to do this effectively in a timely fashion and with the patient at the centre.”
