News in brief
NHS needs £25bn in emergency cash, Theresa May told: NHS leaders are urging Prime Minister Theresa May to give the health service an emergency cash injection of £25bn before 2020 or risk a decline in the quality of care for patients and lengthening delays for treatment, reported The Guardian. An influential group representing NHS trusts said that the care provided by hospitals and GP surgeries will suffer over the next few years unless the prime minister provides an extra £5bn a year for the next three years – and a further £10bn of capital for modernising equipment and buildings. NHS Providers is preparing to release its own manifesto next week, calling on the Conservatives and Labour to end what it calls the austerity funding of the health service. Saffron Cordery, the director of policy and strategy, said its analysis showed that there was a “revenue gap” of £4.5bn-£5bn a year in 2017-18 and “each of the subsequent two years as well”. Hospitals needed that sum, said Cordery, to get rid of their deficits of £800m-£900m a year, fulfil new NHS commitments on cancer and mental health and improve their performance against key waiting time targets. The NHS also needed a further £10bn for capital spending on building and repairing premises, buying new equipment and modernising how care is provided, she added. That is the sum which a recent report commissioned by the Department of Health said the service needed for those purposes.
Revealed: Vanguards must give funding to STPs: NHS England has set out four conditions on vanguard funding including the requirement to dedicate 10% of this year’s money to sustainability and transformation partnerships (STPs), reported Health Service Journal (subscription required). A second condition was the requirement for sites to have “systematically implemented” the national vanguard framework by December and “achieved quantified benefits” to justify national and local investment. The other two conditions were the requirement to create guidance on the standard operational methods and ensuring the vanguard “will have made a visible positive contribution to wider national learning”. In the Next Steps for the Five Year Forward View, published last month, NHS England said national vanguard funding will be “available to STPs as a funding source to pay for excess emergency admissions growth in their area”. The document added: “The STP in which [the vanguards] operate will be able to use the vanguard funding provided by NHS England to pay for the lowering of: a) emergency admissions growth above the vanguard’s agreed local emergency 2017-18 contract volumes; or b) any emergency admissions growth for the vanguard’s patients above the 2017-18 national emergency admissions growth rate in 2017-18.”
Fears over bed blocking as delayed discharges double: The number of patients left waiting in hospital when well enough to go home has almost doubled in Edinburgh over the past year, new figures have revealed. A total of 188 patients waited three or more days to leave hospital in January this year, with critics blaming a lack of care home places and social support for the rise, reported The Scotsman. Figures from the Edinburgh Health and Social Care Partnership showed 71 hospital patients waited three or more days for a space in a care home in January 2017. Meanwhile, 85 patients waited three or more days for social care to be put in place at home before they could be discharged. A further 12 cases were also recorded. In January last year, 101 patients were delayed when ready to leave hospital. Derek Young, senior policy officer at Age Scotland, said the figures showed more needed to be done. “Unnecessarily long stays in hospital mean older people have less ready access to home comforts and their friends, neighbours and family who can help them out, and are more susceptible to acquiring infections. Hospital care also costs much more than services in the community. It was hoped integrating health and care services would break down these barriers, these figures show more work is required,” he said. Earlier this year health secretary Shona Robison announced a one-off cash injection of £2m to tackle the capital’s social care crisis. Green councillor Chas Booth, who obtained the figures, called for more action.
Better Care Fund ‘ruse’ to hide lack of funds for adult social care: The Better Care Fund, touted by the government as an integrated care initiative that would save money, curb emergency admissions and cut delayed transfers, has failed to achieve any of its stated objectives and has proved little more than a “complicated ruse” to conceal the lack of funds for adult social care, concluded a damning report from an influential panel of MPs. In a swingeing critique of the latest attempt to integrate health and social care services, the Public Accounts Committee said that the serious doubts it expressed two years ago about the ability of the fund to deliver on its stated aims had been realised, reported OnMedica. Furthermore, witnesses giving evidence to the committee “displayed an appallingly casual attitude to the targets that had been set for reducing emergency admissions and delayed transfers of care, both of which have actually increased”. The report stated that the Local Government Association (LGA) had told the committee that the fund was simply plugging a gap in money that had been cut from local authority budgets, while demand for care was rising. The fund had helped local authorities reduce cuts in services, and in some cases to set up new initiatives, however the LGA cautioned that it should not be assumed that by transferring some money into adult social care, improvements would inevitably be made.
Cancer patients diagnosed in A&E after being repeatedly rejected by their GPs, research warns: Thousands of people are being diagnosed with late-stage cancer in A&E due to GPs repeatedly misreading their symptoms, new research warned. Experts have described the research as “extremely concerning” new data which has revealed that among those who were diagnosed with the disease in an emergency setting, almost a quarter had visited their family doctor three or more times, reported The Telegraph. They included 31% of breast cancer patients who had attended three or more appointments, and 41% of those diagnosed with bowel cancer. Specialists said this illustrated the worrying ignorance many people have of the so-called “red flag” symptoms that should give cause for concern. However, campaigners said the figures were partly explained by the difficulty many face securing an appointment. Samia al Qadhi, chief executive of Breast Cancer Care, said: “We speak to women and men who tell us how incredibly distressing it is not to be taken seriously when they’ve found a possible symptom.” She said almost a third of people with incurable secondary breast cancer felt clinicians had not taken their concerns about being unwell seriously before being diagnosed. People who are diagnosed with cancer as an emergency have a worse prognosis than those diagnosed at an earlier stage.
CCGs cutting spending on mental health despite NHS pledges: Five areas in England are planning to cut spending on mental health services in 2017-18, despite being told by NHS England to ensure that they increase spending in line with physical health spending. A Pulse investigation has revealed that clinical commissioning groups (CCGs) in South Sefton, Scarborough, Isle of Wight, St Helens and Walsall are collectively spending £4.5m less in 2017-18 than they spent on services in 2016-17. Freedom of information responses received from 127 CCGs in England reveal that the total CCG spend on mental health increased by 4.15%. NHS England said in its Five Year Forward View for mental health in February 2016 that CCGs should spend an extra £1bn a year on mental health by 2020-21. Dr Chaand Nagpaul, chair of the BMA’s GP Committee, said: “This goes against the pronouncements of government that mental health will have priority, that we will see more support in the community, the promises we’ve had that there will be greater numbers of mental health workers in primary care. Cutting the mental health budget will have a reverse and damaging effect. This will simply result in patients, by default, turning to GPs when they have neither the capacity nor the expertise to deal with many of these patients. This goes against the grain of the pronouncements from NHS England and government.” NHS England’s Five Year Forward View for mental health requires CCGs to increase their spend on mental health services in line with their budget increases – the so-called ‘parity of esteem’ standard.
Drive to put GPs in A&E backed by £56m funding from DH: Hospital trusts across England have been awarded £56m to ease pressure on A&E next winter in a move that will kickstart plans to place a GP in every emergency department by Christmas, reported GPOnline. The £56m – allocated to 70 hospital trusts to support proposals to improve A&E performance next winter – is just over half of the £100m capital funding to support emergency departments announced by chancellor Philip Hammond in the spring budget. The government has said that the funding is intended to help hospitals achieve a target of 95% of patients presenting at A&E being admitted, transferred or discharged within four hours. Plans submitted by hospitals ‘include primary care streaming and co-locating GP practices within A&E departments to ensure patients are treated in the most appropriate setting’, according to a Department of Health statement. The funding allocation comes just over a month after NHS England chief executive Simon Stevens pledged that every A&E department in the country would have a GP at its front door by Christmas this year. GP leaders have warned that plans to put primary care services inside A&E could deepen the NHS crisis, and risk stripping GPs from existing services.
NHS hospitals won’t be paperless before 2027: A new report from Digital Health Intelligence concluded that the government’s target for all NHS hospitals to become paperless will not be met before 2027, reported DigitalHealth.net. Digital Health Intelligence has launched its CDMI+36 NHS technology adoption report, which has found that health secretary Jeremy Hunt’s NHS ‘Paperless 2020’ target will definitely not be met by English acute trusts. Based on census-level data of technology adoption by all English NHS hospitals, the report projected that all NHS hospitals will not be paperless until 2027 at the earliest, a decade away. The independent research report tracked progress against Digital Health Intelligence’s Clinical Digital Maturity Index (CDMI) NHS digital benchmark, analysing year-on-year adoption of 27 key categories of clinical IT systems by all NHS hospital trusts since 2013. While significant progress has been made in the uptake of some systems, the adoption of some of the most complex clinical systems – including electronic clinical decision support and advanced e-prescribing, which have the greatest potential to improve patient safety by cutting prescribing errors – remains slow. The report identifies reasons for the slow progress as repeated delays and shortfalls in national NHS IT funding, together with the ageing IT infrastructure still in place across many trusts, which prohibits the adoption of more advanced paperless systems.
Bolton boosts hospital at night patient safety with mobile tech: Royal Bolton Hospital is using Patientrack to better manage care for patients at night, improve vital communication between nurses and doctors, and manage staff workloads, reported Digital Health Age. Patients are receiving faster responses from nurses and doctors, now that Bolton NHS Foundation Trust has deployed the system. The trust is the first in the country to use Patientrack solely to help manage the hospital at night. The technology is helping to improve patient safety and to save time in co-ordinating crucial interventions for patients at night, while providing detailed evidence of real-time frontline pressures to senior hospital managers. Dr Simon Irving, acute physician and chief clinical information officer at Bolton NHS Foundation Trust, said: “Patientrack is helping to ensure doctors don’t become overwhelmed trying to find a phone or a PC, when they need to remain with a patient, and has removed the need for nurses to manually bleep only to wait for a response. Previously when doctors were bleeped they would not have access to the reason without logging on to a terminal. Now doctors working at night can accept, complete, and even reject when necessary, tasks assigned to them directly on their mobile phone, where they can review information without breaking them from their current task. We can also specify a minimum level of doctor to complete a task, boosting patient safety. The process is much more effective.”
Trust’s X-ray system down for days following ‘major’ IT failure: Barts Health Trust is recovering from a “major computer equipment failure” that disrupted its pathology and imaging services over the weekend, forcing it to limit the services to urgently only requests, reported Health Service Journal (HSJ, subscription required). An email sent to staff said the trust’s pathology system is back online but the disruption means it is working through a “backlog” of tests. The email, shared with HSJ, was from chief clinical information officer Tim Peachy. It said the IT failure was primarily a result of an “unexpected failure of a small number of physical disks on which data is stored”. Although the trust’s pathology systems are up and running, Barts is still struggling with its imaging system. It is unable to access archived images and cannot transmit images electronically. Peachy also said the trust has had to cancel some elective operations and is experiencing some delays in its outpatient services. Issues with the trust’s chemotherapy prescribing system meant its cancer teams must rebuild their paper records system “from scratch”. In an email sent to staff, the trust said it had to manually process blood tests and X-rays, and arrange for porters at its hospitals – The Royal London, St Bartholomew’s, Whipps Cross and Newham – to hand deliver results to clinicians. In a recent update the trust advised that “only critically urgent samples will be processed and staff are advised to not bleed patients unless it is critically urgent [and] critically urgent reports will be hand delivered by porters”. “Only urgent imaging will be performed and reported over the weekend,” it added.
Babylon Health raises £50m for AI diagnosis tool: Digital healthcare company, Babylon Health, has raised around £50m to further develop its artificial intelligence (AI) clinical diagnosis capabilities. Babylon said the new AI tool will help clinicians by providing them with a diagnosis of more routine conditions. Planned capabilities include using natural language processing to take notes in patient consultations. Speaking to DigitalHealth.net, Ali Parsa, founder and chief executive of Babylon, claimed the new diagnosis tool could potentially cut the cost of a consultation by 80%. He said the latest £50m will go towards “engineering and mass producing the technology” for the AI diagnosis tool, which will work in conjunction with Babylon’s existing simpler clinical triage app, symptom checker, video and text consultations and GP booking service. “If we can relieve the doctors from doing the mundane stuff, so they can actually get on with doing the stuff that machines will not be able to do for a long time, that’s the end result of where we want to be,” said Parsa. The potentially uneasy relationship between doctors and fast-evolving AI technology was tackled by Parsa in a Babylon press release: “This is about machines and medics co-operating not competing”. “Doctors do a lot more than diagnosis: artificial intelligence will be a tool that will allow doctors and healthcare professionals to become more accessible and affordable,” he said.
Survey shows nearly 70% of UK would use AI platforms to ease NHS pressures: A newly released survey has shown nearly 70% of UK citizens would be open to using artificial intelligence (AI) platforms that would ease pressures for the NHS, specifically primary care services, if their data was kept secure, reported the British Journal of Healthcare Computing. The poll, conducted by Censuswide in March for the Ada health tech startup, included2,000 people and revealed that approximately 70% of interviewees find GP services ‘less accessible’ now in comparison to statistics from five years ago. Therefore, a similar number of citizens said they used digital tools for self-diagnosis, although only 40% of them believe these platforms to be accurate; 30% of them added ‘online diagnosis’ worries them, while 20% said it confuses them. However, a different YouGov survey commissioned by PwC, published in a report earlier this month, showed half of the British citizens interviewed said they would not want to ‘engage’ with AI tools and robotics in healthcare. But the PwC report showed there was a ‘generally surprising high willingness’ amongst citizens from other European, Middle Eastern and African countries, to use AI tools, with the UK and Germany being the only two states where further scepticism was encountered.
Nurses take part in developing vital signs app: Nurses at a west London hospital trust have collaborated with an IT services company in developing an app to support monitoring the vital signs of patients on the wards, reported UKAuthority.com. Chelsea and Westminster Hospital NHS Foundation Trust has now rolled out the ThinkVitals app to all of its wards for adult patients following successful results from a pilot that began in 2015. The app was co-created with ThinkShield and used initially in the hospital’s acute assessment unit. Now around 400 nurses and healthcare assistants are inputting vital signs information – such as heart rate, blood pressure, temperature and respiratory rate – through handheld devices rather than paper based observation charts. The development was managed by a steering group that took regular feedback from clinical staff, following the principles of user centred design outlined in the Wachter Review on NHS IT. Dr Barry Quinn, assistant director of nursing at the trust, told UKAuthority: “What’s really fascinating about this is that the company and clinicians got together from the very beginning of its development. It was really engaging and the nurses and doctors have learned a lot about the opportunities and challenges of using IT.”
Salford Royal NHS FT nominates Pennine trust for fast follower scheme: Salford Royal NHS Foundation Trust, one of NHS England’s 16 acute global digital exemplars (GDEs), has nominated Pennine Acute Hospitals NHS Trust for the fast follower scheme. In an interview with the British Journal of Healthcare Computing (BJ-HC), Rachel Dunscombe, director of digital at the Salford Royal Group, revealed the establishment of the GDE scheme is meant to bring UK trusts to ‘the kind of levels of the best in the US’, creating a network of world class organisations of digital maturity. “For us, it’s about redesigning the pathways, it’s about digital offers, wearables, all those kinds of things, and actually moving to a position where we can say we’re up there with the best.” The fast follower scheme is set to include 20 trusts across the UK that will work closely with the 16 acute GDEs, adopting their digitisation blueprint, each getting £5m from NHS England that they will be expected to match. NHS leaders previously told BJ-HC four GDEs will get two fast followers and 12 will only get one. The Royal Liverpool and Broadgreen University Hospitals NHS Trust has nominated Liverpool Women’s NHS FT for the scheme, David Walliker, CIO at both organisations, told BJ-HC at the beginning of April. The Liverpool trust has reportedly also nominated an out of area trust for the fast follower scheme along with Liverpool Women’s NHS FT, although it is unsure if both of these organisations will actually be selected to take part in the programme. “We’re just waiting for confirmation on that because that would be quite an interesting approach I think, and probably the right thing for GDE because one of the outputs we need to deliver at the end of GDEs is the blueprint,” Walliker added.
New nurse staffing tool for hospitals endorsed by NICE: A new tool for carrying out advance planning of nurse staffing levels in hospitals has been endorsed by the National Institute for Health and Care Excellence (NICE), reported Nursing Times (subscription required). The Establishment Genie tool, which has been in development since 2014, allows senior nurses to input and review planned care levels provided by nurses and healthcare assistants compared to the budget available. It also allows them to review information including skill mix, the context a ward is typically operating within – such as its number of admissions, average fill rates for nurse shifts and its number of vacancies – and how much annual leave and maternity cover will be required. In addition, planned staffing levels for different wards can be compared with one another at three different points in a 24-hour period. Patient outcomes, such as the number of falls and pressure ulcers associated with certain staffing levels, can also be reviewed alongside potential changes to the workforce model. The Establishment Genie tool was developed by two healthcare management consultants, following discussions with around 30 hospitals in the UK, Australia and New Zealand about how to plan establishments for safe nurse staffing.
Opinions
NHS IT may be a loser from snap general election
NHS IT is unlikely to feature at the hustings, but the decision to hold a snap general election may further delay efforts to digitise health and care services, argues Jon Hoeksma, editor at DigitalHealth.net.
“A quick review of past digitisation targets is a useful reminder here. In 2003 the National Programme for IT originally aimed to roll-out electronic patient records across the NHS by 2006. The target proved wildly ambitious. Fast forward a decade later to 2013 and Jeremy Hunt said he wanted the NHS to be paperless by 2018, a target that soon slipped and was pushed out to 2020. A revised target that nobody, including Dr Robert Wachter and Jeremy Hunt himself, believe will be met.
“The most immediate impact of the general election on NHS IT is likely to be on further delaying the missing funds for the flagship global digital exemplar (GDE) programme. Will Smart, NHS England’s chief information officer, told leaders at a modernisation event last week that the money has finally been approved by Treasury, but the likelihood must be that it won’t see light of day this side of 8th June. This creates huge financial problems for GDEs who have proceeded on good faith on promises of national money, £10m each in the case of the acute exemplars.
“Then there is the awful deadening impact of purdah, which will – for the third year in a row – delay decisions on all manner of important policy issues, like a national position on information governance, for months to come. It is now a year since Dame Fiona Caldicott’s report was published with no sign of a response by NHS England.”
How a digital NHS saves time and money – and transforms care
Our hospital trust has introduced systems that released appointments and allow staff to spend more quality time with patients, writes Dr Afzal Chaudry, chief medical information officer at Cambridge University hospitals NHS foundation trust, in The Guardian.
“Imagine this scenario: a patient arrives at hospital for an appointment or an emergency, or is admitted for treatment and the clinical team can see their medical record in its entirety, wherever and whenever they need to. At Cambridge University Hospitals NHS Foundation Trust, that is what we set out to achieve when, seven years ago, we decided to invest in a sustainable digital future for our hospitals. Rather than relying on paper-based processes and simply replacing outdated technology as it became obsolete, we wanted to transform the way we care for our patients.
“For some of our staff the transition from paper to digital was not simple, even though they had access to the same information as before, just presented in a different way. Having ‘super users’ – hospital staff who volunteered to have extra training so they could help others – proved invaluable.
“As one of the UK’s highest rated trusts for the effective use of technology in providing high-quality patient care, not only will we continue to focus on using technology to deliver further improvements for our patients, but also as a global digital exemplar hospital we are committed to sharing our learning with others and helping the NHS embrace its digital future.”
Accepting the unacceptable? A physician’s perspective on frontline care
Ahead of the publication of a report by The King’s Fund on organising care at the NHS frontline, Royal Shrewsbury Hospital’s respiratory and general physician Elin Roddy shares the challenges and pressures of delivering care in a busy hospital.
“It’s 5.30pm on a winter Monday, already dark outside,” she says. “In the emergency department, four patients wait in the corridor with ambulance crews. The crews look weary, resigned to a wait. These are the same crews that should be responding to 999 calls but instead are trapped in a stuffy corridor waiting to hand over patients to staff who are overloaded and into beds that do not exist.
“The emergency department board is a mix of red and black signifying how long patients have waited – red is bad, but black is worse. Many of the annotations read ‘MBR’ – medical bed requested – meaning patients have been seen and assessed, but there are no beds for them. But the waits to see emergency department doctors are also long. The junior doctors here are under pressure, and the senior and middle grade staff in the department are already working a ridiculous rota just to keep things safe. Locums cover gaps in rotas. There’s nothing in the tank.
“I see many, tiny kindnesses on my travels. I see lots of patients getting good and compassionate care, and I see lots of colleagues bending over backwards to ensure that things get done. I see lots of patients and families waiting patiently, knowing that we are doing our best, thanking the staff for their hard work. And our hospital is not unique. These scenes are being played out up and down the country.
“But sometimes we don’t – can’t – notice them. We have made ourselves so used to this new ‘normal’ that noticing it all – the sub-optimal processes, the unnecessary delays, the broken promises – would make it impossible to come to work.
“But if everybody keeps stopping, who is going to do the work?”
