News in brief
Cash boost gives NHS a “fighting chance”: A £6bn increase to the NHS budget next year will give the health service “a fighting chance” of implementing the Five Year Forward View reform plan, experts have said. As part of the Spending Review, the government has confirmed it would increase health spending in 2016/17 as part of the £8bn additional spending pledged by 2020, reported Public Finance. Chancellor George Osborne said £6bn would be delivered by the end of 2016/17 and £4.8bn capital funding every year for the next 5 years. When the funding is added to the £2bn provided in last year’s Autumn Statement, ministers said the NHS would have been supported by an extra £10bn above inflation. The treasury documents indicate that £1bn will go on NHS IT over the next five years, reported DigitalHealth.net. The additional funding will allow the NHS to offer 800,000 more operations and treatments, 2 million more diagnostic tests, 5.5 million more outpatient appointments and spend up to £2bn more on new drugs, according to the Department of Health. As the NHS faces growing demands from an ageing population, it will also allow the development of better out of hospital services that will see more people treated closer to home, give patients greater control over their own care, and help prevent people getting seriously ill in the first place, reported Gov.uk. The additional investment will deliver a truly 7-day health service, with the services people need being offered in hospitals at the weekend and people able to access a GP at evenings and weekends. By 2020, everyone will be able to access GP services in the evenings and at weekends.
Spending review reveals 21% cut to non-NHS England health budgets: The removal of protected status from all Department of Health (DH) budgets not controlled by NHS England will see the pot of money that pays for health education, public health, and capital projects subjected to huge cuts over the coming half-decade, reported Health Service Journal (HSJ, subscription required). Spending review documents published this week show that a significant chunk of the £8bn of extra funding promised to NHS England will be secured by cutting the £15.1bn of non-ringfenced funding in the DH budget by £2bn in cash terms by 2020-21. The Health Foundation think tank has calculated that this amounts to a real terms cut to non-NHS England budgets of 21% over the five year period. The worst of those cuts will fall on the £10.3bn pot of DH revenue funding that pays for things including health education, public health, and the operation of arm’s length bodies such as the Care Quality Commission. According to the DH entry in the spending review “blue book”, that £10.3bn pot will be cut to £8.8bn in 2016-17. Health Foundation chief economist Anita Charlesworth told HSJ: “This is a massive exercise in robbing Peter to pay Paul.” She said that while NHS England stood to receive a real-terms increase of around £10bn since 2014-15, “much of that increase is coming from very substantial cuts in other areas”.
All councils must draw up health and social care integration plans by 2017: As well as confirming the fact that councils will be able to raise council tax by up to 2% as part of a new social care precept, Chancellor George Osborne has also announced social care funds for local government as part of the Better Care Fund, reported Public Sector Executive. As part of his Spending Review, Osborne will pour £1.5bn into the fund and make it available to local government in order to allow councils to finance social care. In his announcement, he said: “The truth we need to confront is this: many local authorities are not going to be able to meet growing social care needs unless they have new sources of funding.” And the social care precept, revealed earlier this week, could help raise an extra £2bn a year by 2019-20 if councils “use this to its maximum effect” and exclusively on social care. According to Whitehall, if these two new measures are taken together, councils would be able to increase social care spend in real terms by the end of the Parliament. “This will support councils to continue to focus on core services, and to increase the prices they pay for care, including to cover the costs of the national living wage,” the Spending Review document said.
Fears rise of UK care home closures after Autumn Statement: Care homes will be forced to close, the industry has warned, after the chancellor failed to deliver a substantial increase in funding in this year’s Autumn Statement, reported Financial Times (subscription required). Care-home owners including Four Seasons, Bupa UK, HC-One, Care UK and Barchester had written to the chancellor this year, warning that a failure to raise funding would mean “thousands of older people could be left without a home”. But their call fell on deaf ears and the industry warned the effect on care for the elderly could be devastating. Martin Green, chief executive of Care England, said care-home owners had asked for £3bn but instead received less than £500m, much of which was uncertain. “As a result of this, we will see care homes closing and greater pressure on the NHS,” he said. “The comprehensive Spending Review was a missed opportunity to establish a long-term and sustainable future for social care.” George Osborne, the chancellor, announced a £1.5bn uplift to the Better Care Fund by 2019/20 to be used to further integrate hospitals and social care. Phil Hall, director of healthcare alternatives at JLL, an investment firm, said: “George Osborne has promised jam today for the NHS and jam tomorrow for social care. The lack of a financially joined-up approach to health and social care will in the end help neither the NHS nor social care if patients continue to block hospital beds for the lack of a place in a social care setting.”
Budget for seven-day GP access doubled to £750m, announces Treasury: The budget for seven-day routine GP access has almost doubled in a year, with the Treasury announcing that it has allocated £750m to rollout the ambitious election pledge. The cost of the scheme will be up 90% on the £400m originally announced in 2014, but Pulse has learnt that this funding is likely to be recycled from other funding promised for general practice in order to prop up the scheme. The Treasury was unable to clarify to Pulse whether this £750m includes new funding, but the GPC has said that it “suspects” this is a rebadging of old money, potentially the £1bn “infrastructure fund” announced earlier this year to improve GP premises. The announcement of the increase in funding for seven-day access comes as a Pulse investigation reveals that only two of the 19 clinical commissioning groups (CCG) in the first wave of the seven-day “Challenge Fund” pilots have committed to continue fully funding the schemes long-term. Two of the wave one areas have completely scrapped seven-day working, and 13 CCGs are still reviewing their options, the Pulse investigation has found.
A&E waiting times ‘getting worse’: Waiting times in A&E departments across the UK are worsening as pressures grow in hospitals, figures have suggested. The data, collected by the Royal College of Emergency Medicine, showed 88% of A&E patients were treated or admitted within four hours – below the 95% target, reported the BBC. The figures are based on evidence submitted by more than 40 trusts – one in five of the total in the UK. Hospitals also reported significant problems discharging patients. In some places, a fifth of hospital beds are occupied by patients who are ready to leave hospital but cannot be discharged because of a lack of community services available to care for them. The problems have developed despite three-quarters of hospitals increasing their stock of beds to try to relieve the pressure, and a growing number of routine operations being cancelled. College president Dr Cliff Mann predicted the “worst is yet to come”. “The majority of hospitals have endeavoured to increase the number of beds available to cope. Despite this, elective operations have had to be cancelled and postponed as bed capacity is insufficient to cope. Plus the problems with delayed discharges have shown no signs of diminishing,” Dr Mann said.
NHS failures mean thousands suffer or die from severe sepsis each year: GPs and hospital doctors are failing to spot signs of sepsis – which kills at least 37,000 people a year in the UK – and are diagnosing the condition too late, experts said. Even when sepsis was suspected, a treatment regime to bring it under control was not always implemented quickly, reported The Belfast Telegraph. The review – from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) – said there are an estimated 200,000 cases of sepsis a year in the UK. It is a leading cause of avoidable death in the UK, and kills more people than breast, bowel and prostate cancer combined. Sepsis occurs when the body is overwhelmed by infection, which can lead to organ failure and death. In one third of the cases reviewed by NCEPOD where a GP saw the patient, not one of the four basic vital signs of temperature, pulse, blood pressure and respiratory rate had been recorded. When patients were sent in to hospital, no referral letter from the GP was available in 43% of cases. Dr Vivek Srivastava, report author, said: “I am very concerned about the serious lack of awareness of sepsis, and the reliance on the experience of senior hospital clinicians to diagnose it.” Dr Srivastava said treatment was simple, cheap and readily available.
NHS pre-tender targets next generation systems for clinicians: The NHS Commissioning Board wants to explore how improvements can be brought to clinicians who access service information at the point of care, reported Government Computing. It has issued a pre-tender to explore these improvements with a possible estimated future contract value of between £12m and £20m. NHS England is targeting the next generation of systems that provide clinicians with access to high quality accurate information about services, their service capabilities, and real time service capacity information and connections to booking and referral systems. The pre-tender explains that it wants to inform suppliers of prospective opportunities in connection with NHS England’s Digital Urgent and Emergency Care Programme in transforming urgent and emergency care. It says health care services operate seven days a week and there is a need to connect the public with the services that can meet their health and social care needs first time. NHS England has said it anticipates that new technologies can contribute to delivering this service for clinicians and staff. Its aim is to create “an authoritative source of information about health and social care services for clinicians to use at point of care. The information should include the clinical capabilities of the service, the type of resources that can be accessed, if the service is available, and include who can refer and if appointments are available to book”.
Patient opt-outs actioned by January: Around 700,000 patients who objected to having their identifiable data shared with third parties will have their wishes recognised by January next year, nearly two years after being offered the opt-out, reported DigitalHealth.net. The Information Commissioner’s Office has found that the Health and Social Care Information Centre (HSCIC) has failed to comply with the first principle of the Data Protection Act due to the objections not being enacted for so long. A letter from the Information Commissioner’s Office to HSCIC chair Kingsley Manning, included in this week’s HSCIC board papers, said the information centre expects to action the opt-outs by January 2016. DigitalHealth.net reported in May this year that the HSCIC was “extremely concerned” that 700,000 patient objections to having their identifiable data shared had yet to be enacted. The objections were registered as part of the launch of the controversial care.data programme, which will extract data sets from different organisations, starting with GP practices, and link them to an expanded set of Hospital Episode Statistics within the “safe haven” of the HSCIC.
Dorset tenders for shared care record: Dorset Council is looking to create a shared health and care record for the region and has launched a tender for a framework agreement worth up to £20m, reported Computer Weekly. The council is tendering for a “suitable supplier” to provide expertise, products and services to help deliver the record. The council has launched the tender on behalf of the local authorities and NHS organisations, including Bournemouth Borough Council, Borough of Poole, four hospital trusts, an ambulance trust and a clinical commissioning group. The tender notice, published in the Official Journal of the European Union, said: “This will enable the two-way transaction and interrogation of that data and will provide access to health and care professionals via a flexible, configurable and user-centred front end utilising modern, responsive and agile technical solutions.” The council is looking for a single supplier in the framework agreement, which will last for up to 10 years and is worth between £2m and £20m. The care record will pull and push data from GP practices, mental health, community and adult and children’s social care services to create a full view of the patient which can be accessed anywhere that patient is treated.
Socitm calls for more local focus from GDS: Public sector IT association Socitm has called on the Cabinet Office to ensure the Government Digital Service (GDS) extends its focus to local services, following the announcements on digital programmes in the government’s Spending Review. The announcements from Chancellor George Osborne indicated that £1.8bn will be made available to support the digital transformation of services over the next five years, including £450m to support the work of the GDS, money for the digitisation of tax services and to support healthcare IT, reported UKAuthority.com, but nothing has been provided to support local government’s digital plans. In a statement, Socitm expressed disappointment, saying the decision ignored the need to join up public services locally. “The Spending Review talks about digitising services and stronger collaboration between different parts of the public sector, but there is no further detail,” it said, adding: “There is no mention of any interest in or commitment to supporting the digital transformation of locally delivered services.” NHS Shared Business Services (NHS SBS) responded to the Spending Review announcement by urging organisations from public services other than healthcare to consider buying services through its frameworks, which include IT. Peter Akid, director of procurement at NHS SBS, said: “Police forces, local authorities, central government departments and hundreds of other public sector bodies have already started to spend tens of millions of pounds each year through frameworks that were originally designed for the NHS, achieving major savings that can help ensure frontline services remain sustainable into the future. Savings realised so far, however, are only the tip of the iceberg. We are happy to provide free access to any public sector body so that they can take advantage of NHS buying power and get best prices from suppliers in order to protect frontline services.”
Junior doctors’ strike: Government agrees to talks at Acas in bid to avoid walkout: The threat of strike action by thousands of junior doctors is hanging in the balance after Jeremy Hunt agreed to Acas talks between health officials and unions, reported The Telegraph. The U-turn came after the health secretary said last week that he would not agree to talks with Acas unless BMA officials came back to the negotiating table first. The union has welcomed the move from Hunt, however the BMA said it would not call off its threat unless the government removed its threat to impose a new contract if agreement could not be reached. The Department of Health said it reserved its right to do this, in order to fulfil a manifesto commitment to introduce a “truly seven-day” NHS. Three days of strike action are due to start on Tuesday, with two days of full “walkouts” by up to 40,000 junior doctors later in the month. The Academy of Medical Royal Colleges – which represents 21 medical specialities – urged the BMA to now suspend its threat of strike action, to allow “meaningful discussions”. The steps follow warnings from patients groups that a series of strikes could endanger lives.
London Ambulance Service rated ‘inadequate’ by inspectors: London’s Ambulance Service NHS Trust has become the first to be put into special measures after a recommendation by inspectors, reported the BBC. The NHS trust serves an estimated 8.6m people in the capital. Slow response times were highlighted as a major concern, along with a high number of unfilled vacancies. The trust said it had taken action to address its failings. Prof Sir Mike Richards, chief inspector of hospitals, said: “I am recommending that London Ambulance Service be placed into special measures, because I believe that this is the step necessary to ensure this vital service gets the support it needs to improve. The trust has been performing poorly on response times since March 2014. This is a very serious problem, which the trust clearly isn’t able to address alone, and which needs action to put right.” A Care Quality Commission inspection, which took place in June, found poorly trained staff, a lack of equipment and a reported culture of harassment and bullying. Trust chief executive Dr Fionna Moore, said: “We would like to apologise to Londoners and say how sorry we are that we haven’t come up to the standards they should expect of us and we are working really hard to address those issues.”
Government wants “long term partnerships” between NHS and private sector: The NHS will be encouraged to create “long term partnerships” with the private sector to develop new models of care and upgrade diagnostics services, reported Health Service Journal (HSJ, subscription required). The government’s comprehensive spending review, published this week, says partnerships between the NHS and private sector will be encouraged to “modernise buildings, equipment and services”; and deliver efficiencies, “especially where these partnerships support the upgrade of diagnostics capabilities and the development of new models of care, such as accountable care organisations and hospital groups”. No further detail is included in the spending review documents. However, HSJ understands the government is keen to explore greater private sector involvement in the development of accountable care organisations, hospital chains, diagnostic facilities and new care pathways. There is a hope that private sector partners would bring skills, capacity and finance in return for a share in any improvement in performance and/or finances. For example, private sector companies able to offer greater capacity for NHS cancer pathways might be encouraged by pledges on throughput. Those helping hospital chains become more efficient could benefit from any reduction in provider deficits. It is likely that this greater use of the private sector would be encouraged by enabling and incentivising local NHS commissioners and providers to explore partners.
£150m dementia institute will boost research, diagnosis and treatment by 2020: The UK is going to benefit from its first £150m Dementia Research Institute to accelerate the pace of research, develop new diagnostic tests and tackle the progression of the disease, Prime Minister David Cameron has announced. Medical Research Council, which will lead the institute, will open a competitive process in the new year to draw in universities that can host the institute itself, as well as to search for a director, reported National Health Executive. The new facility is expected to bring in world-leading experts, universities and organisations that can help drive forward innovation in fighting dementia, which currently affects around 850,000 people in Britain – a figure expected to double in the next 20 years. The building will have a central hub based at a university, but will also boast local links to universities across the country and build on existing dementia centres operating in the UK. It is expected to be operational before 2020. It will also seek to attract new partnerships with the biopharmaceutical sector in order to develop new treatments and ways of diagnosing the disease, as well as develop strategies for interventions that block its progression. Cameron said: “For far too long, this terrible condition has been ignored, down-played or mistaken as part of the ageing process. When the truth is – dementia is one of the greatest enemies of humanity. I have been clear that I want Britain to lead the way in tackling this disease, and we have already taken great strides,” he said, citing the increase in research, specialist training and awareness sessions nationwide. “This institute is another great step, and will allow us to draw together cutting-edge research tools and expertise to defeat this disease once and for all.”
Winter deaths “highest since 1999”: There were an estimated 43,900 excess deaths in England and Wales last winter, the highest number since 1999, figures from the Office for National Statistics (ONS) have shown. The report suggested most of the deaths involved people over 75, reported the BBC. The flu virus was a major cause of the rise, along with an influenza vaccine that was less effective than those of previous years, experts said. Commenting on the provisional statistics, Claudia Wells, at the ONS, said: “A major cause behind the rise was the flu virus, with estimates showing that the flu vaccine was not as effective this winter compared to previous years. While the cold temperature is a factor, most of last winter was warmer than average. Respiratory illnesses such as influenza and pneumonia were the underlying causes of death in more than a third of all winter cases. Large fluctuations in winter death rates are not uncommon and there were lower than average figures in 2013-14. But despite this experts warned this year’s figures are “notably high”. The Department of Health said the high number of excess winter deaths in 2014/15 was not unique to the UK, with 14 other European countries also reporting an increase in excess mortality.
Chief tech officer to replace Kelsey: NHS England will recruit a new “chief information and technology officer” to replace Tim Kelsey, reported DigitalHealth.net. Kelsey, who is currently director of patients and information at the commissioning board, is stepping down next month to take on a new role in Australia. The chief information and technology officer role will encompass strategy, commissioning and delivery assurance, with the delivery role played by the Health and Social Care Information Centre. An internal email sent to NHS England staff by chief executive Simon Stevens, said the new director will take “forward [Kelsey’s] leadership of the information and technology agenda for the NHS and wider system. The [chief information and technology officer] will chair the National Information Board and will ensure the benefits of technology investments in nationally funded programmes are realised, support local health and care systems to embed core digital standards in their services, and transform public access to information tools and services.” Kelsey has been with NHS England since 2012 and was appointed chair of the NIB last year, which is leading on the drive towards a ‘paperless NHS’ by 2018 and integrated health and social care records by 2020.
G-Cloud 7 supplier list revealed: The government has announced that 1,616 suppliers have been appointed to the G-Cloud 7 framework. The seventh iteration of the framework – which forms part of the Digital Marketplace – was launched this week. The number of suppliers is up 11.2% on the 1,453 suppliers appointed when the sixth iteration was launched in February, reported Public Technology. Commenting on the process, Deborah Saunby, sales and marketing director at G-Cloud 7 supplier Software Europe, said: “The process for joining the G-Cloud framework has been simplified since our previous successful submission in 2011. The online multiple choice questions made for a speedier completion, although there was still a couple of security questions that didn’t seem to fit with the type of service we were applying for and were too ‘black or white’. As a company with several cloud products, the new ability to copy products and services between sections also greatly aided in the overall submission process.” G-Cloud 5 services expired on 22 November, and G-Cloud 6 is due to end at the beginning of February 2016. However, the Crown Commercial Service said that it may be extended to ensure that G-Cloud 6 suppliers have time to apply for a place on the G-Cloud 8 framework.
Opinion
While the CSR deal is a success, it is far from an unmitigated one
Simon Stevens’ influence in achieving a frontloaded Comprehensive Spending Review deal for the NHS hogged the headlines but is only part of the story, says Health Service Journal editor Alastair McLellan.
“Before you judge the outcome of the Comprehensive Spending Review, consider this. The Treasury’s opening position was that NHS funding should be backloaded, arguing that the Conservatives’ manifesto commitments were for the end of the parliament. They probably expected to end up with growth spread evenly over the five year period. That the health secretary, after eight no doubt increasingly high pressure meetings with the chancellor, turned that round to a frontloaded settlement represents a very significant win for the NHS.
“Mr Stevens played a brilliant hand in this high stakes poker game. His audacious and unprecedented warning to the Chancellor that the CSR negotiations were on track to fail the NHS was the equivalent of the Prussians arriving at Waterloo to secure Napoleon’s final defeat. Even to the end he was making his influence felt; letting it be known that he was due to appear on Friday’s Any Questions – a suitably high profile platform from which to express his reaction to the settlement.
“However, while the CSR deal is a success, it is far from an unmitigated one. Inevitably an examination of the small print begins to rapidly take the shine of next year’s significant funding increase.
“NHS organisations will require an even greater degree of political cover as they seek to build the future while continuing to survive the present. At a reception for the Forward View Vanguard projects yesterday at Number 10, David Cameron promised to protect these “pioneers” from “arrows in the back”.
“The direct support of the PM is welcome; it is just one of the many factors that will need to play in the NHS’s favour if it is to prosper through a period of change that will dwarf the Lansley reforms in their complexity, breadth of impact and importance.
Mobile Technology – a New Infection Risk?
Mobile technology has made hospital doctors more efficient and improved patient care. However, an iPad, carried from ward to ward, can also be a means of spreading infection and creating an additional financial burden on the NHS, says Mike Casey, former NHS CIO.
“The rise in antibiotic-resistant diseases such as MRSA and Clostridium difficile a few years ago put hospitals on the back foot. Although robust efforts to tackle the spread of these diseases have seen rates tumble, even now 300,000 NHS patients in England develop a health care associated infection (HCAI) every year.
“Although trusts have been rigorous in implementing best practice guidance on HCAIs, such as that issued by Public Health England, there is one area that is easily overlooked – mobile technology.
“Forward-thinking trusts are already benefiting from the productivity and clinical safety improvements mobile devices can bring. Having spent many years as a CIO in a hospital trust, I’ve seen how mobile technology can transform working practices. The use of iPads at a patient’s bedside enables doctors to access and record information without having to waste time finding a desktop computer. It could be as simple as accessing a medical dictionary to check a particular detail, looking up the patient’s haematology or microbiology results, or showing the patient their X-ray or MRI images.
“However “mobile technology can bring increased infection risk. As doctors move from ward to ward with their iPads, they may be taking bacteria with them, passing an infection around the hospital. One US-based study that took swab samples from the electronic devices (both tablets and phones) of 106 hospital workers found that every device housed bacteria, either on the device itself or its cover.
“How can we fight back against HCAIs? NHS infection control staff using Apple iPads have been searching for adequate protection of the devices in the form of cases that are capable of being cleaned with standard infection control sprays and wipes. Cleaning the iPad directly with harsh infection control sprays invalidates the Apple warranty. I had a mission to help solve this problem and worked directly with NHS staff to design a new medical grade ruggedised case called the FlipPad.”
The King’s Fund response to the Spending Review
The Spending Review represents a good settlement for the NHS set against cuts to other departments, but falls a long way short of the settlement needed to place the NHS and social care on a sustainable footing for the future, says John Appleby, chief economist at The King’s Fund, this week.
“The additional funding for the NHS and the decision to frontload this money next year is welcome. However, a significant chunk of this will be absorbed by additional pension costs and dealing with provider deficits, leaving little breathing space for investment in new services and unlocking productivity improvements.
“The new funding will stabilise services in the short term, but smaller increases later on in the parliament and the requirement to implement seven-day services will leave budgets stretched to the limit. Attention will now shift to the huge challenge of finding £22 billion in efficiency savings by 2020/21, with the onus on the NHS to re-double efforts to improve productivity.
“It is clear that a large chunk of the additional funding for the NHS has been found through substantial cuts to other Department of Health budgets. The full details are not yet clear, but cutting the public health budget is a false economy, undermining the government’s commitments on prevention at a time when the need to improve public health is becoming increasingly urgent.”
Highland Marketing blog
In this week’s blog client services director, Susan Venables, sees health IT opportunities in the Spending Review.
