News in brief
NHS needs extra cash and overhaul, say health bosses: Drastic changes to services and extra money is needed if the NHS in England is not to suffer, health bosses say. A five-year plan for the NHS – unveiled by six national bodies – once again highlighted that an annual £30bn shortfall would open up by 2020, reports the BBC. It said changes, such as GP practices offering hospital services, would help to plug a large chunk of the gap. However, health chiefs said the NHS would still need above inflation rises of 1.5% over the coming years. That works out at an extra £8bn a year above inflation by 2020. The current budget stands at £100bn a year. But the plan – called the NHS Forward View – said this would only be enough if the health service became more efficient. To achieve this, the plan called for a rethink about the way services were delivered. It put forward a range of models – although stressed it was up to each local area to decide which ones to adopt. These include – larger hospitals opening franchises at smaller sites, as Moorfields Eye Hospital has done in London and smaller hospitals working as part of larger chain, sharing back-office and management services. Many of these measures are designed to curb the rise in hospital admissions and impact of the ageing population – the source of most pressure in the health service.
National systems to become ‘glue’ of NHS: Key systems will provide the “electronic glue” that will enable different parts of the health service to work together, according to NHS England’s Five Year Forward View, reports eHealth Insider. The report, issued this week by the commissioning board’s chief executive, Simon Stevens, sets out to try and close the £30bn gap that could open up between funding and demand by 2020-21. It says this can be done if the NHS takes action on prevention, on giving patients more control over their own care, and on “reshaping care delivery” around fewer acute centres and new models of community and primary care. It identifies “exploiting the information revolution” and “accelerating innovation” as two of the key steps towards achieving its vision. On the IT front, the report says that although it has “world leading” primary care IT, and general IT spend has reached “levels that might be expected looking at comparable industries and countries”, the NHS is not doing as well as it should be. The report blames the slow progress on “oscillating between two opposite approaches to information technology adoption – highly centralised national procurements and implementations” and “letting a thousand flowers bloom. The result has been systems that don’t talk to each other, and a failure to harness the shared benefits that come from interoperable systems,” it concludes, adding that NHS England will take a “different approach” in future.
Health technology companies with life-saving ideas to share £2.5m: The Small Business Research Initiative (SBRI) Healthcare has launched its latest competition, offering £2.5m of funding to companies working in priority healthcare areas, said National Health Executive. The competition aims to accelerate the development and NHS adoption of new technologies. The programme focuses on clearly identified NHS needs, bringing clinicians and business together at an early stage to harness the expertise of SMEs to develop effective solutions. Successful projects are fully funded through three phases of development – proof of concept, product development and delivery in the marketplace. “The SBRI Healthcare is creating new jobs, helping to develop strong businesses and bringing new solutions to solve identified NHS challenges that aren’t currently being met,” commented Karen Livingstone, director of SBRI Healthcare. “It is fantastic to see such promise at a relatively early stage in the development cycle of many of the new technologies. Early evaluation of this approach shows the products developed save lives and NHS resources and we look forward to seeing the fuller impact of the programme as more products reach the patient.” The competition closes on 9 December 2014, with winners announced in March 2015. Briefing events for business to learn about the competition will take place on 11 November (London) and 13 November (Leeds).
HSCIC data security report due February: A final report on the Health and Social Care Information Centre’s (HSCIC) data security programme plans is set to be completed by February next year, reported eHealth Insider. An update on the programme is included in a report on its wider cyber security work for its September board meeting. In June, the HSCIC announced that it would establish a data security programme across health and social care, after health secretary Jeremy Hunt asked the organisation to ensure that patient data is kept and treated securely across the health and social care system. The HSCIC set out a series of proposals that the data security programme would cover, including strengthening compliance through requiring certification that organisations are meeting information governance requirements and working with commissioners, and that regulators such as the Care Quality Commissioners include governance in the inspection regime. The proposals also include “providing an approved framework of suppliers of services such as penetration testing, security audits, physical security and training,” and putting in place an independent audit programme and national security strategy. The September report says the data security programme is being managed as part of the overall cybersecurity programme, and has encountered a number of delays “due to the complicated nature of the procurement process”. “However, these have now been resolved and the project team is confident in the timelines provided in the plan.”
GPs to be paid £55 for every dementia diagnosis under new identification scheme: GPs will be paid £55 per patient for each additional dementia diagnosis they make over the next six months in a radical move by NHS England to hit targets that GP experts said amounts to ‘cash for diagnoses’ and an ‘ethical travesty’, reports Pulse. The payment is part of a new ‘Dementia Identification Scheme’ unveiled by NHS England, which follows the contract agreement announced this month and sees GP practices paid for the net increase in dementia diagnoses they record from now until next April. General Practitioners Committee negotiators said they had again opposed the incentivisation of dementia diagnoses during recent negotiations for the 2015/16 GP contract and insisted they ‘did not have sight of nor approve’ the new enhanced service specification, while the Royal Collage of General Practitioners (RCGP) said that practices who have already diagnosed cases in a timely way will be penalised. The move has renewed controversy over the Government’s focus on raising GP diagnosis rates as part of its national dementia strategy, following reports that some Clinical Commissioning Groups were paying practices £200 for every diagnosis. NHS England has introduced the new scheme as part of a £5m funding boost for general practice, announced by chief executive Simon Stevens at the RCGP conference, to ‘spearhead the NHS drive to identify people with dementia’. The service – which is optional for GPs – pays for diagnoses only, with payment based on the net increase in the dementia register at the end of March 2015, compared with the end of September 2014.
Oxford University big data and IoT project to ‘create the NASA of biomedicine’: Care for cancer patients within the NHS will be radically improved through the combined power of such technologies as big data, informatics and Internet of Things-connected devices to sequence the genomes of individual patients, says Computing. That’s what a collaboration between the University of Oxford and the US-based Chan Soon-Shiong Institute of Molecular Medicine is hoping to achieve, with the two organisations announcing their partnership today at an event in London. The plan has the full backing of the government, with Minister for Life Sciences George Freeman MP, who was at the event, likening its ambition to that of NASA when it was aiming for the Moon. “We’re creating the world’s first at-scale dataset [of the genome], the NASA of biomedicine, which will help to shape the precision medicine landscape in the 21st century. Pulling together the two transformational technologies of genomics and informatics will allow us to practise in our health system a much more targeted, precise model of medicine for the benefit of patients,” Freeman added.
NHS hires foreign doctors to stave off winter crisis: Dozens of extra foreign doctors have been drafted in to help NHS hospitals head off a winter crisis, Jeremy Hunt, the Health Secretary, has announced, according to Independent. They are among 260 extra doctors who will bolster accident and emergency units as pressure continues to grow on hospitals across England. Extra numbers of junior doctors have this year opted to work in emergency medicine and they will be joined within weeks by new overseas recruits on fixed-term contracts, Mr Hunt has reassured MPs. The move comes amid fears among ministers that hospitals could find it difficult to cope if the country is hit by prolonged cold weather or a serious outbreak of flu or a vomiting bug. Meanwhile, 50 experienced medics from India, Malaysia, Egypt and the United Arab Emirates have been hired on fixed-term contracts starting next month. Mr Hunt said: “We know some parts of the NHS are under pressure. That is why we are investing in a record number of A&E doctors so patients continue to get treated quickly.” The recruitment drive was launched by the College of Emergency Medicine in partnership with Health Education England (HEE). Professor Wendy Reid, the HEE’s director of education and quality, said: “The overseas doctors had to pass rigorous English language and visa checks, and they signed contracts to ‘work, learn and return’ within four years.”
Fall in GP engagement with CCGs, NHS England survey finds: GP engagement with clinical commissioning groups has slightly fallen with only half feeling they are involved in decision making, according to an NHS England commissioned survey. Ipsos MORI was commissioned to carry out “360 degree stakeholder surveys” of the views of a range of partner organisations as well as CCGs’ member GP practices, for all the 211 groups. Those surveyed included local authorities, health and wellbeing boards, Healthwatch and other patient groups, providers and other CCGs. It found most organisations were “largely positive about the engagement they have received from CCGs”, with more than four-fifths saying they had been engaged. It was carried out in the spring, a year on from similar work a year earlier. It said most people were “positive about the extent to which CCGs listen to their views and act on them”. However it highlighted problems with engagement of GP practices, which are meant to control CCGs. The report said: “While GP member practices generally report that they have been engaged well by their CCG, and on the whole tend to rate working relationships within the CCG positively, the results show a general decline in engagement and relationships since [2013], and they are among the least positive of all stakeholder groups.” An NHS England spokesman told the Health Service Journal (HSJ, subscription required): “After a year of operation, the overall opinion of CCGs is really good. “GP member practices and CCGs are continuing to work together to strengthen and improve their relationships and engagement.”
UK wearable health tech market set to double: As many as 13.1m Britons may be wearing some sort of health and fitness tracking device by as soon as next year – a 100%-plus rise on the current total of 6.7m, claims the British Journal of Healthcare Computing. The prediction has been released by market research firm, Kantar that adds that 88% of the consumers it polled were also considering spending money on such a device. If so, that would be good news for the wearables health market but perhaps bad for free mobile app developers – as of that 6.7m, almost 90% said they used free software to measure their progress on a fitness programme or help them diet. The study estimates UK digital fitness fans have has spent somewhere between £225m and £375m on such solutions so far. The market research firm that mounted the study says that the UK health and fitness wearables market is still in its infancy, with brands targeting younger audiences, plus the sport and leisure categories, seem to be leading the way. “It is also interesting to see that consumers are happy to pay for apps and devices, which opens up additional opportunities for manufacturers and developers,” it notes.
Royal Free addresses merger RTT issues: Royal Free London NHS Foundation Trust has had to deal with 18-week referral to treatment data quality issues following its acquisition of Barnet and Chase Farm Hospitals NHS Trust earlier this year, reported eHealth Insider. Royal Free took over Barnet and Chase Farm Hospitals in July, inheriting a problem with the latter’s RTT waiting list times. In the trust’s July board papers, an RTT programme governance report acknowledges that the issue of RTT data came up during the due diligence and Monitor risk assessment phases before the acquisition. The report says RTT waiting time targets at Barnet and Chase Farm are not being met, “although by what margin is yet to be established”. “At [Barnet and Chase Farm] it was from 2013 onwards not known how long how many patients had been waiting, and so from October 2013 that trust ceased reporting its data, intending to resume doing so only when the position was ascertained. “External help was sought by the trust to achieve that clarity, but the picture turned out to be complicated, hard to disentangle and evidently involving substantial numbers of patients waiting longer than the standard.” An RTT programme report for the trust board’s September meeting says while data validation efforts are on track, data errors continue to be added to the system, creating further work.
Philips launches app to encourage women to be breast aware: Building on its commitment to fight breast cancer, Philips is launching a simple-to-follow app that encourages women to check their breasts regularly each month. Reflecting this global picture, breast cancer is also the most-common form of cancer in the UK overall, with around 55,000 people, including some 400 men, being diagnosed each year. As Building Better Healthcare understands, the Breast Aware app designed for iPads and iPhones, produced with Breast Cancer Care and free to download, gives a step-by-step guide to breast awareness, showing what to look out for in order to become more aware of any differences that may occur. Dr Emma Pennery, clinical director at Breast Cancer Care, said: “Whatever your age, size or shape, it’s important to take care of your breasts. “Getting to know how your breasts look and feel, so you know what is normal for you, is an essential part of caring for your body. Around two thirds of breast cancers are found by the person themselves, so it’s important to notice any unusual changes and report them to your doctor without delay.”
Ambulance trust plans referral system expansion: North West Ambulance Service (NWAS) NHS Trust will work with other ambulance and health bodies to implement information sharing system to address patient data challenges, reports Government Computing. The NWAS NHS Trust aims to deliver operational efficiencies across primary, secondary and tertiary care by expanding the use of an Electronic Referral Information Sharing System (ERISS) it has designed. ERISS, which was first implemented by the trust earlier this year, grants secure online referrals management and GPS patient data access to ambulance crews and urgent and social care providers in the region – including all North West Social Services. With the system having recently won an innovation award from a network body supporting NHS organisations across the North West of England, NWAS said that by holding the system’s intellectual property rights, it was able to assist other ambulance trusts in implementing the technology. “A strategy is in place to invest in interfaces to deliver further efficiencies across the health economy via direct messaging to primary, secondary and tertiary care solutions including patient record and referral solutions,” said Phill James, programme management officer at NWAS. James added that one of the trust’s key operational challenges in regards to accessing patient data was the vast range of records solutions currently in use by healthcare bodies across the North West.
Northumbria Healthcare NHS Foundation Trust join UK-wide social media campaign: As part of its commitment to further improve patients’ experiences, Northumbria Healthcare NHS Foundation Trust is pledging its support to a major campaign which has become a social media phenomenon. As ITV News understands, the trust is rolling out the national “Hello, My Name Is…” campaign in its health services in North Tyneside and health and social care services in Northumberland which encourages all staff, regardless of role, to introduce themselves to patients and service users. Dr Kate Granger, a registrar from Yorkshire specialising in elderly medicine, who was diagnosed with terminal cancer, launched the campaign after a hospital stay last summer when she found that many staff did not introduce themselves before delivering care. Determined to do something about it, Kate and her husband initiated a Twitter campaign with the mission to get as many members of NHS staff as possible to pledge to introduce themselves to their patients. In the last year, the campaign has had over 56 million contacts on social media and gained widespread support including from Prime Minister David Cameron, Secretary of State for Health Jeremy Hunt, Labour leader Ed Miliband and chef Michael Roux as well as NHS professionals across the country.
Opinion
Local leaders and MPs must embrace NHS England vision
Nigel Edwards, chief executive at the Nuffield Trust, comments on the report the NHS has been waiting for.
“Just as he did when creating The NHS Plan at the turn of the century, Simon Stevens has produced a commendable effort this time round.
“The report not only makes crystal clear that the NHS cannot continue with ‘business as usual’ if it is to meet the needs of a diverse and ageing population, but it also sets out a radical vision of the different approaches that local areas can take to adapt for the future.
“And the report helpfully attempts to reset the relationship between the NHS and public by not only encouraging people to take more responsibility for their own health, but also by recognising the critical role the NHS as an employer should be playing in offering incentives to staff to become healthier.
“Decades of top-down targets, financial incentives and punitive approaches have left the NHS hooked on being told what to do. Directives and requirements enforced by regulation have also been overused. Coupled with politicians’ desire to adopt eye-catching initiatives that work well on the campaign trail but melt away when enacted, patients and practitioners alike have been disempowered by this top down approach.
“The approach to change in the Forward View requires more organic and locally tailored approaches. This requires experiment, risk taking and the time and space to do the work. It also requires the long promised mind-set change away from central control.
“With NHS providers going into the red, and social care cut to the bone, the road ahead is not going to be easy. But the prize of a health service that works effectively to meet the needs of people inside and outside of hospital is too important to miss.”
Hospital IT is in a hopeless, fragmented mess
Dick Vinegar, columnist for The Guardian comments on the complicated and outdated IT systems in hospitals, many of which are unable to share patient records electronically.
“Back in the 1960s when I was a mere stripling in the data processing industry and the world of computers was “new and all”, two great truths were drummed into me: ‘an IT system will fail if the people who use it are not involved in the design’ and ‘top managers must drive the implementation, and accept responsibility for its success or failure.’ In the 70s and 80s, I learned a third: any widespread system must use data and communications standards, otherwise, the parts of the system will not talk to each other, and become a tower of Babel.
“GP systems have, for most part, followed these three great precepts, as they were built in the 80s by GPs, who had become bored of doctoring. From their intimate knowledge of GP practice, they developed systems that were doctor, nurse and receptionist-friendly. But, for the most part, hospitals ignored all three precepts, and as a result are in a hopeless fragmented incompatible mess.
“The problem is that for most hospitals, IT stops at the hospital gates. They have enough problems getting the wards within the hospital to communicate with each other. Most of them just cannot see the point in talking digitally to other local hospitals or to the GPs who send them patients – let alone to the patients themselves by email. The hospitals are jeopardising my care.
“What is to be done about this shambles? I am tempted to say: “Knock all their heads together”. But this is what Richard Granger, from 2002–08, tried to do with the National Plan for IT, and failed spectacularly. Tim Kelsey, NHS England’s director of patients and information, is trying to impose standards on hospitals by threatening non-conformists with sticks. I applaud what he is trying to do for standards, but he is in danger of being pilloried unless he goes easy on the sticks. We need somebody who combines a steely determination to impose standards with silky diplomatic skills to persuade hospitals to change their IT culture.”
Local integration needs national backing: Five steps for government
To secure sustainable health and social care systems national decisions about funding and access must be made, writes Joanna Killian, chief executive of Essex County Council, at Health Service Journal (HSJ, subscription required).
“To say ageing issues are at the top of our agenda in Essex would be an understatement. We are already a “super aged” county, where one in five residents is over 65. England as a whole won’t hit that figure for at least another decade. Essex had 44 per cent more residents aged over 90 in the 2011 census than in 2001. We forecast that the number of residents needing care and support by 2030 will be four times as many as today.
“The county is not alone in facing this care challenge. Nationally, NHS England predicts a £30bn gap between resources and demand in health alone by 2021. The social care gap is estimated to be £7bn by 2020.
“We are working hard with our health partners to look at how we can work more closely together and integrate health and social care. We have a complex environment, with five clinical commissioning groups, five acute trusts and two mental health trusts to work with – it’s not easy.
“We are making steady progress locally, but some barriers are so huge and beyond our control that we need a national policy change. It is needed not just to make integration easier – after all, integration is just a means to an end – but also to lock in a sustainable health and social care system for the future.
“The NHS and local government need to improve efficiency; the potential of technology needs to be radically explored and promoted in health and social care; and more needs to be done to ensure a steady supply of GPs.
“The harsh reality is that difficult decisions are required and the most fundamental of these require decisions and policy change by the national government. Decisions must be made about how the system is funded and how it is accessed. Local HWBs and councils do not have the legal authority to make the changes required. It’s time to be honest about the structural weaknesses in our health and social care system.”
Highland Marketing blog
In this week’s blog, Matthew D’Arcy finds a glaring omission in the Five Year Forward View.
