Healthcare Roundup – 24th March 2017

Hospital hallway

News in brief

NHS services face ‘impossible’ budget crisis, health trusts warn: NHS Providers said operation waiting lists and delays at A&E departments will soar next year under predicted funding, reported The Guardian. Frontline NHS services face “mission impossible” in meeting next year’s targets, health trusts have said. Longer waiting lists for operations and delays at A&E departments in England loom under the present financial constraints, said NHS Providers, a trade association that represents acute, ambulance, community and mental health services. Chief executive Chris Hopson said the government needed to “sit up and listen”. “NHS trusts will strain every sinew to deliver the commitments made for the health service. But we now have a body of evidence showing that, with resources available, the NHS can no longer deliver what the NHS constitution requires of it. We fear that patient safety is increasingly at risk.” NHS Providers predicted its members would receive £89.1bn in funding in 2017-18, an annual rise of 2.6% but less than the 5.2% demand is expected to grow by. It warned the number of people waiting more than four hours in A&E would increase by 40% next year to 1.8 million, and the number waiting more than 18 weeks for routine operations would rise 150% to about 100,000. The NHS is already under strain in the wake of the Brexit vote. The number of EU nationals registering as nurses in England has dropped by 92% since the referendum in June, and a record number are quitting the NHS.

Lack of community care packages delays hospital releases: About 120 people every day in Northern Ireland are having to stay in hospital unnecessarily because there is not a suitable care package for them in the community, reported the BBC. Figures released by the Health and Social Care Board relate to those waiting 48 hours or more to get home, with the  average figure ranging from between 90 and 155. Despite being deemed well enough to go home, some patients are waiting more than a fortnight due to a lack of community care. The health service is losing at least £1.5m a month due to bed blocking, said the Independent Health and Care Providers (IHCP), which represent private, voluntary, charitable and church affiliated providers of health and social care. The group warned that unless health and social care (HSC) in Northern Ireland was reformed, the delays would continue to cost more than £50,000 per day. “Unless the necessary HSC reforms progress quickly, local quality of care will plummet and the system risks collapse,” said the IHCP in a statement. “Officials and clinicians are united behind plans for change, but recent years have seen other barriers such as political opposition at a local level.” The issue is being addressed by a number of independent providers across Northern Ireland.

NHS pledges to free up thousands of hospital beds by allowing home care: The Department of Health (DH) has pledged to free up hundreds of thousands of hospital beds which are currently taken up by bed-blockers by allowing more people to be treated in their own homes, reported The Telegraph. In the new NHS mandate for the coming year, the government promised to reduce bed-blocking to 3.5%, the equivalent of releasing more than 2,000 extra beds a day. Currently around 5% of the 137,000 hospital beds in the NHS are taken up by people who do not need to be there but have nowhere else to go because of a lack of social care. It means around 7,000 people are forced to wait in hospital when they should be at home or in care homes. Under plans set out in the mandate, the DH said the targets would be met by ‘piloting hospital services to people in their own homes’. A pilot being carried out in NHS South Worcestershire clinical commissioning group sends patients home as soon as they no longer need care by sending out nurses to help with changing dressings, managing medication, washing and eating. With growing pressure on health and care services it is more important than ever that people can leave hospital with the support they need to get well and stay well, preventing unnecessary readmission to hospital. Healthwatch chair Jane Mordue said: “If the new target makes this happen, it will help improve thousands of people’s experience of care and reduce the financial and human cost caused when discharge goes wrong.” The mandate also pledges to roll out evening and weekend GP services for 40% of the country by next year, and ensure that all over-75s are given a same-day appointment if they need one.

Minister outlines intention to scrap HSE as part of eight-point plan for health sector: The Irish health minister Simon Harris has said it is his intention to scrap the Health Service Executive (HSE) as part of a plan for the future of Ireland’s healthcare, reported Harris has been outlining an eight-point plan to an Oireachtas committee, which is largely based on the development of hospital and community health organisations. He said “big, transformational change” is needed to secure the future of good quality healthcare. Harris believes looking at the HSE’s future is a key part of that. He said: “Once statutory responsibilities and accountabilities are devolved from the centre to hospital and community organisations, dismantle the HSE and replace it with a much leaner national health agency. But in the interim, because we can’t wait for all this to happen, reform the existing legislation within which the HSE operates to improve its governance structure.” The IMPACT trade union said it supported the idea of a “significantly downsized” HSE. The group represents clerical, administration and managerial staff in the health service. A statement from the union agreed that a small number of regional health groups could better perform most of the HSE’s functions, while reporting directly to the Department of Health.

£2bn for social care to require hospital focus: Councils will be required to report to the government on a regular basis to show how the extra £2bn of social care funding announced in the budget has been spent, as ministers seek to ensure investment is focused on easing pressure on hospitals, reported Health Service Journal (subscription required). The guidelines, due to be published shortly, are set to require councils to treat the new money as a local government contribution to the Better Care Fund and spend on the integration of health and social care services. Government officials are understood to have received clarification that the Care Quality Commission (CQC) can assess council social care arrangements as part of an inspection of hospitals where delayed transfers remain high, without the need for new regulation. It is not yet known what criteria will be used to determine the threshold that would trigger a CQC inspection. It is believed a wider ranging accountability framework with even tighter restrictions on how the funding can be used is already under development and could be introduced as early as 2018-19. Ealing council chief executive Paul Nasjarek, who is spokesman on community wellbeing for the Society of Local Authority Chief Executives and Senior Managers, questioned how much impact the extra money will have if there are limited flexibilities over the funding, especially as he said new demand on social care in most parts of the country was being driven as much by younger people with disabilities as older people. He said: “If councils are restricted from dealing with the 75% of cases that come into the system directly from the community that will have a detrimental knock-on effect on hospitals. The risk is if there is a focus on pressure in hospitals that will restrict our ability to deal with community care packages and that will put further pressure on the health system.”

Integrated health and care portal targeted in Holyrood digital revamp: The Scottish government has committed itself to develop a national portal to access health and care services and records, electronic voting solutions, as well as a “Pay As You Go ePurse” for transport as part of its latest digital strategy, reported Government Computing. The document, entitled ‘Realising Scotland’s full potential in a digital world’, details broad ambitions for broadband access, cyber security efforts, strategies to support business growth and digital skills, and also sets out ambitions for public sector service delivery and data use. In line with similar UK government initiatives, interoperability and more integrated care, supported by a refreshed policy for sharing open and personal data to underpin services, were included among the key focuses of the strategy. Holyrood is committed to publishing a new Digital Health and Social Care Strategy in 2017, while also pledging to deliver the 2021 Census “predominantly online” and ensuring public trust in the process. The document also commits to engage with stakeholders, the public and campaign groups on implementing mechanisms for ID assurance, building on existing ‘myaccount’ solution work. Under the guise of making use of further devolved powers, the Scottish government said it hoped to redesign the process of applying for social security benefits.

Government demands ‘concrete progress’ on STPs: The government’s instructions to the NHS this year call for “concrete progress on local sustainability and transformation plans (STPs)” and say it must deliver “the productivity and efficiency gains necessary to maintain financial balance”, reported the Health Service Journal (subscription required). The Department of Health (DH) published its annual mandate to NHS England this week, more than three months later than usual. One of the reasons for its delay was the vexed debate between the government and NHS England over delivery and accountability, particularly on STPs, financial performance and emergency care. Parts of government have been disappointed that many STPs didn’t produce robust cost-saving actions in their first year. Many feel they didn’t make good progress. The document says in future “a number of metrics will be used to measure progress across STP footprints in delivering the Five Year Forward View, linking performance of the NHS at a local level more explicitly to national accountability”, though no further detail is given on these. In a foreword to the mandate, health secretary Jeremy Hunt said: “2017-18 should be the year in which we see concrete progress on local sustainability and transformation plans. As part of this effort, the government has already made £325m of capital funding available for the best STPs over the next three years.”

Also reporting on the mandate National Health Executive confirmed that the DH will continue it drive towards a seven-day NHS, as well as setting goals around emergency care, although the aim of treating 95% of patients within four hours remains a long-term target, the date that this is expected to be achieved has now been extended to 2020. While hitting the overall target is listed as a 2020 goal, NHS England set out, as a 2017-18 deliverable, the desire to “co-implement the agreed A&E recovery plan with NHS Improvement and deliver aggregate A&E performance in England above 90% in September 2017, with the majority of trusts meeting 95% in March 2018”.

Ministers insist GP Forward View ‘on track’ as MPs hit out over GP crisis: Plans to increase overall GP funding to more than £12bn by 2020-21 under the GP Forward View remain on track, health ministers have told MPs, reported GPOnline (subscription required). Health secretary Jeremy Hunt and health minister David Mowat faced a series of questions from MPs on the GP crisis, with MPs from across the UK highlighting problems with recruitment, practice closures and underfunding. Labour MP for Redcar, Anna Turley, tabled a question during health questions in the House of Commons asking what steps the government was taking to ensure the GP Forward View had the funding needed to achieve its goals. Hunt told MPs that during his time as health secretary “real-terms investment in general practice has gone up by £700m or 8%, and we are planning to increase it by 14% – £2.4bn – over this parliament”. He said: “A lot of extra money is going in, but I recognise that there are still a lot of pressures.” Hunt told the House of Commons that there was ‘no evidence’ of an increase in the number of doctors leaving the UK to work abroad, but highlighted his view that “there should be some commitment” for NHS-trained doctors to work in the UK health service for a minimum period of time. An ongoing government consultation proposes that doctors could face five years mandatory service. Ministers also said that there was evidence that golden hello payments to attract trainees to underdoctored areas were working, and cited improvements to the GP retainer scheme and plans to boost the GP workforce by 5,000 by 2020-21 among efforts to resolve the GP crisis.

Spending on management consultancy ‘gravy train’ costs STPs £18m: Spending on management consultants advising England’s 44 sustainability and transformation plans (STPs) has been described as “a gravy train” by Unite, following a revelation that health bosses spent just under £18m with various firms to formulate the plans. Unite’s harsh words came following an investigation by the Press Association which found that at least £17.6m so far had been spent on fees for advice from firms such as KPMG, McKinsey and PricewaterhouseCoopers. The union, which is the biggest in the country and has 100,000 members who work in the health service, has been vocal about doing what it describes as “exposing the agenda” behind STPs. But the Management Consultancies Association told National Health Executive that at a time of unprecedented change and challenge, “NHS spending on external consultants remains extremely low, but is delivering enormous benefits”. Unite’s national officer for health, Sarah Carpenter, said that the findings revealed a “management consultancy gravy train that is completely out of control”, at a time when frontline services, such as A&E departments, are being stretched to breaking point. She said: “Unite has been raising the alarm since last year that the highly secretive STPs in England are a trojan horse designed to push through an agenda of cuts and privatisation of NHS services.”

NHS Digital extends scheme to boost digital health skills: NHS Digital is to run 20 local projects funding to help people improve their digital health skills as part of its widening digital participation scheme, reported Public Technology. The scheme, which is being run in collaboration with the Good Things Foundation, is the second such programme the pair have worked on – the first running from 2013 to 2016. Helen Milner, chief executive of the Good Things Foundation, said that the group had been “itching to do more” in the field. The first phase had exceeded its targets, she said, training nearly 220,000 people to improve their digital health skills and reaching almost 390,000 with messages about digital health literacy. However, Milner said that the second phase would not be “more of the same” and that the team was now taking a different approach. “We’re still looking to help socially disadvantaged people to improve their digital health skills, but this time it will be more focussed – we’ll be recruiting 20 ‘pathfinder’ centres over three years,” she said.

Make ‘digital’ part of health service running costs, recommends HSE CIO: Health Service Executive (HSE) CIO Richard Corbridge expressed hopes this week that IT will become ‘part of delivering healthcare’ in the future in terms of running costs, adding that leadership in health technology is a ‘collective responsibility’, reported Health IT Central. “We need to make digital part of what it costs to run the health service,” Corbridge said at the Executive Leadership Summit. “We live in an environment where, let’s face it, change is always going to happen,” he went on to add, encouraging senior management teams present in the audience to acknowledge that change is driven by ‘inspiration’, which can combat ‘inertia’ and fatigue. He also revealed a key element in delivering IT strategies represents understanding the ‘user’s needs’ and taking feedback, giving as an example terminal five of Heathrow Airport, where there was an issue with overcrowding in male toilets because it was the only place where you could hear flight information. “It was a disaster and now it’s an amazing place,” he said.

UK data scientists, digital media company team up to develop AI chatbots to triage care for NHS: The University of Essex has a plan to save the NHS billions of pounds per year: outsource treatment of minor ailments to a fleet of automated, AI-powered general practitioners, available right on a smartphone, reported MobiHealthNews. Through a partnership with digital and social media company Orbital Media and Innovate UK, a group of developers, data scientists and research will collaborate for 30 months to develop photo realistic avatars that will function as primary physician chatbots. People can access the service to get interactive medical information on things like coughs, colds and flu, which fall into the category of self-treatable conditions that the NHS estimates account for nearly $2.5bn (£2bn) per year of wasted healthcare spending. It’s not quite telemedicine, or even a fully-versed virtual health assistant, but the developers call it a “visual, reliable and robust online health advice service, to meet the rapidly growing demand for online symptom searches”. Symptom-checking for rare conditions may not be in the cards with this initiative, but it could reduce demand on overworked primary care physicians in the UK. “GPs are currently under immense pressure, with significant amounts of money devoted to dealing with minor ailments,” Orbital Media CEO Peter Brady said in a statement. “This comes at a time when the NHS is required to find $27.4bn (£22bn) of efficiency savings by 2020. The potential for AI [artificial intelligence] technologies to help relieve pressure from the heavily burdened primary care system is significant.” Brady noted that even if costs on minor ailment treatment are reduced by 1%, the AI technology could still potentially save the NHS almost $25m (£20m) per year.

Thousands more NHS staff have their data compromised by Landauer hack: A major English teaching trust is the latest to fall victim to NHS staff radiation data breaches, as the US-based company behind the hack refuses to confirm the total number affected, reported Radiation monitoring company, Landauer, has stayed silent on how many people have been affected by the extensive cyber security incident that has affected health boards and trusts across the United Kingdom. Last week, University Hospital Southampton NHS Foundation Trust confirmed more than 2,000 current and former staff members’ data had been compromised. Personal information taken included name, date of birth and national insurance number. Responding to questions from, Landauer said its “security team worked to secure our UK system within 24 hours of any data being compromised and ensure that the data compromised was kept to a minimum”. “Following the incident, we engaged a leading global firm of forensic IT specialists to conduct a thorough investigation to identify the scope of data compromised. We are confident that we have identified all affected clients and have undertaken a program to notify them of the incident.” The data breach occurred in October last year. Trusts and health boards affected were not informed until January 2017. A spokeswoman for NHS Digital said the agency did not know how many trusts had been affected.

NHS working on data sharing framework following security concerns: The NHS is working on developing a strategic policy framework for data sharing, expecting all suppliers to ‘adhere’ when it will be finalised, following security fears raised by the use of TPP’s SystmOne, reported the Health IT Central. It has been revealed the Information Commissioner’s Office (ICO) was investigating the use of GP records from nearly 3,000 practices, focusing on the Enhanced Data Sharing Model (EDSM) function in SystmOne, which offers clinicians from different settings access to patient records. Keith McNeil, NHS chief clinical information officer, revealed the NHS is currently working with both TPP and GP representatives to ‘address concerns raised by ICO’, emphasising that access to information is ‘essential to good care’. “Doctors, nurses and other health care workers need to see a person’s medical history to be able to give them safe and effective treatment. Every health and care worker knows that medical information is sensitive, personal and should only be accessed when appropriate. Rules about appropriate use are written into individual contracts, and for clinicians it is also part of professional codes of practice,” McNeil added. The ICO has re-emphasised that it does not encourage users to ‘switch off data sharing’ at the moment, and they are working ‘closely’ with TPP, NHS Digital and NHS England to ensure that ‘further work’ is planned as their main concerns are focusing on ‘fair and lawful processing of patient data’ and ‘ensuring adequate security’. “Medical data should always be managed fairly and lawfully, with the highest levels of security and safety. Access to records in commonly used GP IT systems is audited and can always be traced back because users log in using unique identifiers and secure access methods,” McNeil highlighted.

NHS patients able to download GP records by September 2017: NHS patients will reportedly be able to download their GP records from the NHS.UK website by September of this year, according to David Corbett, programme head at NHS Digital, reported the Health IT Central. Speaking during the NHS Digital & techUK industry briefing webinar this week, Corbett revealed a number of initiatives which are expected to be delivered over the next two years, including the roll-out of NHS wifi to secondary care organisations starting from the summer of 2017. “The vision for PHRs (personal health records) is to provide citizen access to online health services so that they are able to access and contribute to their health information, and to interact and transact with those that care for them. Patients will be able to come to NHS.UK and navigate to local demonstrators of care specific enabled apps and local services that are available by September 2017,” Corbett added, saying the NHS will transform ‘the experience for patients’ by allowing them to download their GP records without leaving the NHS.UK website by September 2017.

NHS Digital Academy to train 300 CCIOs and CIOs: NHS England is hoping to train 300 NHS staff to become “digital leaders” by 2021 by running them through a 12-month training course, reported Acting on behalf of NHS England, Capita is looking for a partner to run the “NHS Digital Academy”. The contract will be worth about £6m over three years, according to an advertisement published by the company. The academy will train up to 300 chief information officers (CIO) and chief clinical information officers (CCIO) covering off, informatics, system design, leadership and management, clinical decision support, using data and IT implementation. The resulting qualification needed to ensure partipants were ready “to lead and set strategy for digital and ehealth innovation across the health system from large scale health IT systems… to personal health and wellness devices”. These leaders are also expected to develop a strong understanding of data and how it could be used to improve clinical decision making and care planning. Every six months another 50 potential digital leaders would begin a 12-month part-time course, with a cohort of 300 needed by end of 2020/21. That suggests that the academy will need to start training its intake in the latter half the 2017/18, with about £20,000 allocated per digital leader. The advertisement said these 300 professionals would help “drive health and care transformation enabled by technology and informatics including up-skilling of current CCIOs/CIOs”. Prospective bidders for the academy contract are holding their first “market engagement event” with NHS England. A formal request of proposals is expected to be published by the end of the month.



Backup and recovery in healthcare – what’s virtualization got to do with it?
For the enterprise, virtualization is not a new concept and when it comes to healthcare, virtualization is being fully embraced, writes Chris Welch, Product Manager – RAPid, BridgeHead Software in the Health Technology Newspaper.

“It’s hard to argue against the benefits of virtual machines – they cut maintenance and administration costs, they provide flexibility to meet the changing and growing demands of users, and allow an organisation to make the most of its hardware and reduce the potential for downtime and data loss,” he says.

“All of those enterprise benefits make sense for healthcare environments – especially given the ever-increasing need for efficiency, reliability, scalability and data governance, as well as the requirement for multi-user access, 24 hours a day, 7 days a week. Added to this, the availability of physical space is a big concern for hospitals – it is expensive and must therefore be utilised wisely.

“But, above all, hospitals are buying into the concept of virtualization because it promises to improve uptime, as well as supporting cloud adoption.

Welch continues: “If the worst happens and your hospital suffers any kind of data incident, then full and instant recovery is the best scenario you can hope for – ensuring minimal disruption to patient care. Think about the potential use of instant recovery clones within healthcare.

On cyber security Welch explains, “if, for example, there were a huge power outage] with a virtual environment, it’s possible to recover the whole system in the cloud, with patient data being made accessible from an alternative hospital.

“My advice would always be to speak to those with expertise in healthcare, those that understand the unique challenges of the sector and can provide you with the best advice to protect patient-critical data.”

Health and Safety warning for digital doctors
“Our ‘on-demand’ society is currently witnessing a growing portfolio of apps and digital solutions to help tackle long waiting times for patients and reduce the pressure on the NHS,” writes Mary O’Brien, CEO and co-founder of VideoDoc, in The Huffington Post.

“Technology is allowing for the provision of remote clinical services, via real-time two-way communication between the patient and the healthcare provider – although understandably there’s still caution about its ability to replace the human touch. But with the average waiting time for a patient to see a GP in the UK rising by 30% to nearly two weeks, there is clearly a need to cut down on in-person visits and telehealth certainly has the potential to provide much more than a sticking plaster to the situation.

“Whilst ‘phone consultations and email advice from a ‘family doctor’ are becoming common practice, video consultations are less widely used. However, as seen in the States and Ireland, they are helping to eliminate waiting times, provide immediate diagnosis or second opinion and, when introduced into the workplace, can drastically help to reduce absenteeism. It’s an exciting phenomenon that British business can ill-afford to ignore – but, as highlighted by the CQC [Care Quality Commission], it’s only going to be taken seriously at this stage if everyone plays by the rules, puts the patients first and accepts that cutting corners is no trade-off for convenience. 

“In my opinion, now is the perfect time to grow telehealth services to the UK. However, this will need to be in a way that doesn’t completely disrupt the way the NHS works – after all, it will never fully replace face-to-face consultations but should complement and support an already overburdened and straining system.”

The new financial year demonstrates just how tough things are going to get
In an article examining NHS funding and efficiency requirements, Edward Cornick, a policy adviser on finances at NHS Providers, forecasts an even more challenging year ahead for NHS trusts in the Health Service Journal (subscription required).

“The aim at a national level is still, officially, that the provider sector should have returned to balance in a year’s time,” he says. “But we know the provider aggregate deficit is likely to be touching £900m in 2016-17, meaning providers are already well behind the trajectory needed.

“Even getting to that total required huge amounts of unplanned one off savings that are probably going to be difficult to repeat in the year ahead.

“For the first time in 2016-17 providers operated under control totals. What is interesting about this is it allows us to quantify exactly what the system is asking providers to deliver in terms of financial improvement.

“Therefore as we move into next year, we are also able to see if the level of that ‘ask’ is increasing – we can clearly outline just what is being required of providers in the current funding environment.

“This year providers were asked to make cost improvements equalling on average 4% of revenue. However, next year, the ‘ask’ is even greater. Of those who have signed up to a 2017-18 control total (70% of the provider sector), the average CIP [cost improvement plan] requirement is 4.2%, and for acute providers it is 4.5%.

“Those 30% of providers who did not sign up to control totals next year were asked to deliver,” Cornick continues, “an annual CIP of some 6.4% next year, representing a 75% increase in demanded savings. For acute providers the average ask was even more, at 6.7%.

“Some will say tough savings are now up to the NHS to deliver. But if they say this, they must also understand just how tough those savings really are, especially when you consider the reliance on one-off savings in 2016-17. They are of a different order completely – even compared to the last few years of fallow funding.”

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