News in brief
PM accuses junior doctors of “playing politics” over strike: Theresa May has accused the British Medical Association (BMA) of “playing politics” instead of putting patients first after it approved a “full withdrawal of labour” over five days later this month, reported Sky News. The prime minister said the deal offered to junior doctors was “safe for patients”, and added that the NHS had “record levels of funding”. She said: “The government is putting patients first, the BMA should be putting patients first – not playing politics.” Fears over the safety of patients have been raised, with figures suggesting up to 5,000 operations a day could be cancelled during the strike action. Five-day walkouts are planned every month until the end of the year as the dispute over working contracts rumbles on. Hospitals are drawing up contingency plans to cope with a planned five-day strike by junior doctors. The General Medical Council said the proposed strikes were “unprecedented” and warned about the impact on patients. Chief executive Niall Dickson said: “The decision of the British Medical Association’s leadership to call on doctors in training in England to take rolling, all-out industrial action is unprecedented and represents a serious escalation of this dispute. It is obviously a matter of great concern for everyone, especially for patients, and when so little time has been given for the NHS to make contingency plans. We recognise the frustration and alienation of doctors in training and indeed their right to take industrial action. The first priority must be to protect patients from harm.” The Guardian also reported that the senior doctors have voiced strong opposition to the series of five-day strikes planned by their junior colleagues, warning that the action will cause real problems for patients, the service and the profession.
Health committee raises concerns over NHS data-sharing, funding cuts and public health developments: PublicTechnology.net reported that the House of Commons Health Committee said it had identified numerous problems to do with healthcare professionals’ accessing necessary data and urged the Department of Health to review NHS Digital’s role in linking health and social care data. “Difficulties in public health teams accessing data to enable them to work effectively has emerged as a recurring theme in this inquiry,” the committee wrote in an annex dedicated to issues of healthcare data sharing. An article on National Health Executive revealed that the committee said a new minister should be appointed in the Cabinet Office to fulfil the government’s aim of integrating and promoting public health across other government departments. They said that although there has been progress on embedding health considerations in all areas of policy at a local level, this had been less successful nationally. The Nursing Times (subscription required) reported that the committee had warned that councils were at the limits of the savings they can make without adversely impacting services and said cuts to public health funding are a “false economy”. Not protecting funding for public health “will have negative consequences for current and future generations”, said the committee in its report, adding that further cuts would “also threaten the future sustainability of NHS services”. The report also considered the impact on public health services since responsibility was transferred to local government in 2013, under the Health and Social Act 2012. “The current system of sector-led improvement needs to be more clearly linked to comparable, comprehensible, and transparent information on local priorities and performance on public health,” said the report. In response, the Association of Directors of Public Health said: “We agree with the committee that local authorities should be held to account for the outcomes they deliver for their local population and the plans they have in place to improve those outcomes. Delivering this will require modest but additional funding for sector-led improvement.”
One in five patients suffer harm in Scottish hospitals: One in five patients claim they suffered harm such as bed sores, falls or mistakes with medication in Scottish hospitals, according to a major survey of Scottish inpatients, reported The Scotsman. A survey of more than 17,000 people found that overall satisfaction had risen to record levels but concerns remain around delays and poor communication. Patient campaigners called for action to tackle the persistent staff shortages at the heart of the problem. Margaret Watt, chair of the Scotland Patients’ Association, said: “The problem is the staff are under so much pressure that they don’t have the time to get it right. But these tiny mistakes can mean somebody’s life. The patients are always the ones to suffer. We need to take a serious look at the running of the NHS. It doesn’t matter how many new hospitals they open, the problems are still the same.” The Herald Scotland also reported that two in five patients have experienced delays when leaving hospital, with almost half of them waiting for up to two hours. The most common reason for delay was getting medication (56%). One in six said they stayed in hospital longer than expected waiting for care and support to be organised, up 3%. However the BBC reported that the 2016 inpatient survey found that 90% of patients rated their care as good or excellent. Also overall satisfaction with the hospital environment increased from 88% to 89% since the last survey in 2014, and overall satisfaction with hospital staff has remained at 91%.
‘Patients at risk’ from length of GP consultations: Patients are being put at risk by GPs being forced to carry out complex consultations in 10 minutes or under, the British Medical Association (BMA) has said, reported the BBC. The doctors’ union said patient care was undermined when GPs were forced to see as many as 60 patients a day. NHS England said consultation lengths were up to doctors and there were no national limits suggesting 10 minutes. However, the NHS Choices website does state that “GPs spend an average of 8-10 minutes with each patient” and advises patients to “plan ahead to make sure you cover everything you want to discuss”. The BMA, which published a report on “safe working in general practice” earlier this month, called for a reorganisation and warned that GPs faced “unsustainable pressure” from increasing workload and staff shortages. Dr Nicola Hulme, a GP in Cheshire, said she found NHS England’s comment about there being no national limit on appointment times “insulting”. She added: “With the high levels of demand, we have to run 10-minute appointments. To offer longer with the same number of appointments would extend our day to beyond the 12 hours we currently routinely work.” Dr Brian Balmer, of the BMA’s GPs’ committee, said that, in an ageing population, many patients had complex multiple conditions that needed longer to treat. He warned that many GPs were being forced to truncate care and deliver an “unsafe number of consultations”. He said consultations should be limited to 25 a day, about the same number recommended in many other EU countries. Dr Balmer added: “The consultation time needs to increase to 15 minutes with the government providing on its promised funding to make this work.”
Number of NHS providers in deficit falls by 20% since April: The number of NHS providers reporting a financial deficit fell by 20% in the first quarter of the current financial year, despite rising demand for services, according to NHS Improvement, reported Public Finance. Figures published by the health service watchdog showed providers are ahead of expected financial performance, with an overall deficit of £461m in the current quarter, £5m better than planned. This is despite a significant hike in demand that has seen a record 5.34 million attendances to A&E since the start of the financial year, a rise of 300,000 compared with the same period last year. Despite the increased demand, providers managed to treat, admit or discharge 89.31% of A&E patients within the four hour national target. Although this is way behind the target of 95%, performances in May and June “showed signs of recovery”. In May, it was reported that NHS providers had ended the 2015-16 financial year with a £2.45bn deficit, which was £461m worse than planned and three times the size of the previous year’s deficit. Moreover, since controls were introduced, trusts have saved around £500m compared to projected spend for this period. Jim Mackey, chief executive of NHS Improvement, said the results show that providers are able to get a better handle on their finances. Stephen Dalton, chief executive of the NHS Confederation, maintained that cuts to social care and public health, as well as increases in employers’ pension contributions, had put the NHS under additional unplanned pressure. “As the NHS moves on from a terrible financial year, we must use this critical opportunity to get the NHS back on track so that we can set the foundations for vital transformation plans to make progress,” he said.
New tax needed to fund NHS and care, says ex-minister: A new tax is needed to ensure the UK has a properly funded health and social care system, doctor and ex-Conservative health minister Dan Poulter has said, reported the BBC. The Central Suffolk and North Ipswich MP said that difficulties in arranging social care for patients was having a major impact on hospitals. Raising National Insurance “offers one of the simplest ways forward”, he said. The Department of Health said its plan to introduce a cap on care costs in England in 2020 had not changed. Mr Poulter said: “On the hospital wards I often see people who are medically fit to go home, but who are forced to stay in hospital because of difficulties arranging their social care package, or because of a lack of appropriate housing. A long-term plan to ensure a properly funded and sustainable health and social care system is urgently required.” He said a “health and care tax – perhaps introduced through raising national insurance” would provide a guaranteed income stream and “allow a legitimate debate about what is an appropriate level of taxation required to ensure a sustainable funding settlement”. A 1p in the pound hike in both employee and employer National Insurance contributions was used by Labour in its 2002 budget to pay for a £40bn rise in NHS spending over five years. Dr Poulter’s comments come after it was revealed plans are being drawn up that could see cuts to NHS services across England to meet £22bn in efficiency savings by 2020-21.
Scottish Conservatives call for more NHS funding for GP services: GPs should receive more funding to redress the balance where practitioners get less than 8% of the NHS budget for doing 90% of patient contacts, the Conservatives have said, reported the Evening Times. Ruth Davidson said there is “a real crisis” in GP care in Scotland. The Scottish Conservative leader visited a surgery in Edinburgh which is being taken over by the council to outline her pledge to provide more GP funding. She called for the share of NHS funding in general practice to rise to at least 10% of all health spending by 2020, alongside GP training, recruitment and retention targets. She said: “90% of people’s contact in terms of health is through general practice but it gets less than 7% of the NHS budget in Scotland. The Royal College (of GPs Scotland) said that’s got to change and we support their plans to increase the money within the health budget that’s directed to general practice because it saves money down the line.” She added: “GP surgeries in all parts of the country are just swamped under the weight and they cannot cope. Doctors are telling us they cannot cope, patients are telling us they can’t get on a list and they can’t get an appointment. Something has got to give, so we have got to get a really strategic look at how we support this.” Conservative health spokesman Donald Cameron said: “Extra funding for general practice would help us deliver a better local service for people right across Scotland, so you can actually get an appointment when you need it, instead of waiting at the end of a phone line.”
MHRA issues patient safety warning over medical apps: Apps designed to help patients monitor their health must be assessed to ensure that they are medically accurate and safe to use, the Medical and Healthcare Products Regulatory Agency (MHRA) has said, reported National Health Executive. The MHRA has published new guidelines designed to allow users and designers to see if their app complies with safety regulations. An increasing number of apps are classified as medical devices, used to gather and analyse data such as diet, heartbeat, or blood glucose levels. John Wilkinson, MHRA’s director of medical devices, said: “We live in an increasingly digital world, both healthcare professionals, patients and the public are using software and standalone apps to aid diagnosis and monitor health. Where apps or standalone software make a diagnosis or recommend a treatment, people should check for CE-marking before using their apps and developers should make sure they are complying with the appropriate medical device regulations. Patient safety is our priority. We continue to encourage people to report any safety or performance issues involving medical devices, including apps, to MHRA via our Yellow Card Scheme online.” The Yellow Card Scheme is used to collect and monitor information on suspected adverse drug reactions (ADRs) and adverse incidents with medical devices. The MHRA warned: “Apps that give incorrect diagnoses or prescribe inappropriate treatments may have severe, potentially life-threatening consequences.”
Southern Health NHS Trust boss Katrina Percy resigns: The chief executive of a troubled NHS trust has quit over “media attention”, reported the BBC. Katrina Percy said “the effect ongoing personal media attention has had on staff and patients” had made her position as boss of Southern Health NHS Foundation Trust untenable. Ms Percy had faced calls to quit after the trust was criticised over the way it investigated patient deaths. An NHS England-commissioned probe found 272 of the 722 deaths over the last four years were dealt with properly. Ms Percy, who was chief executive for nine years, said she “firmly believed” it was her responsibility to stay on to “oversee improvements”. She said she understood why “many will say I should have stepped down sooner given the very public concerns which have been raised in the past months”. Ms Percy said she was taking on a new role with Southern Health providing “strategic advice to local GP leaders”. Even while acknowledging that her position was untenable, the chair of the trust has agreed to pay Ms Percy the same salary in her new post, about £190,000. At almost every turn over the past year or so, when Southern Health have had an opportunity to do the right thing, they have invariably chosen a different course.
NHS 24 consultations could be conducted via web chats as part of new plans: Medical consultations could be conducted via confidential web chats under plans outlined by the new chief executive of Scottish helpline NHS 24, reported Herald Scotland. Angiolina Foster, who was parachuted into the role of chief executive at NHS 24 amid an IT fiasco, has outlined plans to expand the ways in which patients can obtain healthcare advice. Ms Foster reflected that those under the age of 35, in particular, choose to access information through their mobile phones – but not necessarily by making phone calls. She said: “Offering channel choice to people is both sensible because there’s channel preferences now, but also it is a way of making sure the services offered are economically delivered as well. For me, increasing the digital presence of our service offering is a way of getting closer to citizens. There are conversations happening out there that we need to be tapping into to understand some population need.” NHS 24 has already conducted a trial sending unsolicited messages about quitting smoking to people who mentioned their nicotine habits on Twitter. The web chats already offered by NHS 24 involve using a widget on the website front page to start a conversation. Across smoking, care and fit for work services they are conducting between 80 and 140 webchats a month. Within the specified hours, those who instigate a conversation, should get an immediate response.
Epic and Cerner link information exchanges: Two major NHS trusts are preparing to exchange information on shared patients from their different electronic patient record systems, reported DigtialHealth.net. West Suffolk and Cambridge University Hospitals NHS foundation trusts are in the final phases of testing to share data from their Cerner and Epic systems respectively. Two-way technical connectivity between the Electronic Patient Records is already in place. In a joint statement, Afzal Chaudhry, Cambridge University Hospitals’ chief medical information officer, and Dermot O’Riordan, chief clinical information officer at West Suffolk, said: “To our knowledge this is the first working example in the UK of interoperability between two major providers using different electronic health record products. Both West Suffolk and Cambridge University Hospitals, working with the full collaboration of Cerner and Epic, are very proud of this ground-breaking development that will enhance the care and safety of our shared patients. It is an example of our mutual commitment to interoperability.” The information available across both trusts will include; problems, medication, allergies, past medical history, recent results, details of procedures and operations and discharge summaries. Additional relevant material could be transferred on a patient by patient basis. Clinicians will have read only access to records from the other trust and all usage will be logged and monitored.
Google DeepMind is going to try and help the NHS treat head and neck cancer: DeepMind, a Google-owned artificial intelligence research lab in London, has announced its plans to explore whether its technology can be used to help the NHS treat head and neck cancers, reported Business Insider UK. Through a new partnership with University College London Hospital (UCLH) – the company’s third with an NHS organisation – Google DeepMind will aim to establish whether machine learning techniques could reduce the amount of time it takes to plan radiotherapy treatment for such cancers. Treating cancers that are found in the head and neck with radiotherapy requires a great deal of precision. Clinicians must “segment” the tumour from healthy tissue and feed this information into a radiotherapy machine which then kills off the harmful cells. Producing these detailed outlines can take clinicians up to four hours but Google DeepMind thinks that this time could be slashed to around an hour. “Our collaboration will see us carefully analyse anonymised scans from up to seven hundred former patients at UCLH, to determine the potential for machine learning to make radiotherapy planning more efficient,” Google DeepMind wrote on its website. Head and neck cancers affect more than 11,000 patients in the UK each year, according to Google DeepMind. The company pledged to treat patient data with the “utmost care and respect.”
Heart failure patients in Norfolk use self-testing tech: A self-testing service for heart failure patients has been launched by Norfolk Community Health and Care NHS Trust, reported DigitalHealth.net. In July, the trust initially gave six patients in the Norwich district a device that allows monitoring of their vital signs including blood pressure, temperature, weight, pulse rate and oxygen saturation in their own homes. The self-monitoring technology was provided by the Harrogate based company, Inhealthcare. The data was transmitted to the hospital community team via an online submission form or automated telephone service, and attached to patient record. Action can then be taken, if necessary, based on the readings. Mark Catling, medical devices operational manager at Norfolk Community Health and Care NHS Trust, said the technology will “offer huge, tangible benefits for both our patients and our clinical staff. Setting strict parameters on vital signs will allow staff to be notified and then respond quickly when alerted to anything of concern.” The devices were given to those who recently experienced heart failure or chronic obstructive pulmonary disease. There are 30 monitoring devices that will be used by patients for six weeks each; meaning up to 240 people could use the technology in the first year. Currently observations occur in clinic, at home or via telephone consultation. The aim is to reduce hospital admissions and cut travel costs. Bryn Sage, Inhealthcare’s chief executive, said: “If 30 beds are freed, there are beds for the system to take advantage of with a knock on effect across the hospital”.
Noble’s hospital’s paper records to be ditched as it goes digital: Paper records are to be a thing of the past for Noble’s Hospital, reported the Isle of Man Courier. The move was hailed as part of the government’s ‘digital strategy’ at a launch for staff. The presentation saw the minister for health and social care, Howard Quayle, announce a number of initiatives which will accelerate the introduction of digital ways of working across all parts of the hospital. Under the heading of ‘Digital Future’ the programme includes a range of changes which are designed to increase efficiency and deliver enhanced care for all patients. A key element of the programme is the scanning and digitisation of around 100,000 medical and maternity records. The digitisation of these records will mean that access to patient records by front-line medical and nursing staff will be significantly faster. With new records being created at the rate of approximately 7,000 sheets per day, the pressure on this space is becoming a real concern. Speaking to an audience of clinical and support staff at the launch of the Digital Future programme, Mr Quayle said: “Digital platforms ensure that those who need information have access to it, with patients themselves increasingly in charge of their own information.” At the same event, the executive director for acute healthcare, Michaela Morris, said: “Let me also emphasise that this is a major commitment, building on the work already undertaken across many parts of the hospital. This is a critically important initiative with real benefits to all the patients we serve. Many UK trusts have struggled to do this, but I am confident that we will achieve our goal of removing paper records by the end of 2018.”
Opinion
Patient safety: closing the implementation gap
Dr Suzette Woodward, national campaign director for NHS England’s Sign up to Safety campaign, reflects on the difficulty of introducing new methods to improve patient safety.
Writing on The King’s Fund website, she says: “Over the years many of us have tried to implement new measures to improve patient safety, but we are often forced to admit that things haven’t turned out as we had originally intended.
“In the past, the healthcare sector has assumed that it can implement changes in half the time and with a quarter of the resources used in other industries. But implementing change is a slow and haphazard process, and a complex challenge for many individuals and organisations. This means there is a gap between what we know improves patient safety and what is actually done in practice.
“Guidelines, in isolation, rarely change people’s individual practice. Through our work with The King’s Fund we have learnt that many factors can hinder effective implementation, including: failure to appreciate the complexity of a problem or the context in which change is required; complicated or unclear guidance; or using an inappropriate method of dissemination such as top-down instruction.
“Sometimes the proposed solution to a problem sounds as though it would work in theory, but then without the context having been properly considered it fails to deliver in practice. For example, prescribing alerts for GPs are intended to flag up possible drug interactions, or to warn them if the prescribed dose appears too high. This is a good idea in principle, but then because the alerts appear relatively often they can become irritating for an overstretched GP, and are often clicked off straight away.
“So can we encourage people to embrace changes that will be beneficial for patient safety in the long-term when they may only have five minutes in their day to sit down and look beyond their daily activity? To take up a new way of doing things means to give up the old ways, and if the perception is that the old practice is just fine then there needs to be adequate incentive.
“Implementation is more often about making smaller changes. It requires ongoing maintenance. Consequently, the problem of implementation needs to be owned by all of us. All of us need to better understand behavioural change theories, including motivation and social learning theory together with lessons from the behavioural insights world – and why some people embrace change while others hold back for a while.”
They’re not bed blockers, just older people who want to get home
Johnny Marshall, director of policy at NHS Confederation says the term ‘bed blockers’ can undermine the compassionate care the NHS was created for and has delivered for 70 years.
“The NHS is faced with a rising tide of demand for care combined with a tight rein on both NHS and social care finances. The impact of these pressures is seen across the health and care system. It manifests itself obviously in delayed transfers out of hospitals.
“Year on year these delays are rising, with more people staying in hospital when they don’t need to be there. It has an impact on the care of some of the frailest and most vulnerable people and is the subject of continued attention from the media, healthcare regulators and politicians. When media and commentators discuss this issue it’s only a matter of time before a certain horrible term is used – ‘bed blocker’.
“Language matters. How we talk about people reflects how we treat them and, in the health service, how we engage them in the care they receive. When we stop talking about people as people and instead use the language of the system (units, targets, blockers) we risk undermining the compassionate care the health service was created for and has delivered for almost 70 years.
“I rarely hear anyone who works in the health and care sector use this phrase. Those working with and caring for people see the individual. They know their individual stories and what matters to them.
“There is a quiet revolution under way in the NHS. It’s increasingly recognised that people should no longer be seen as passive recipients of their care but as participants in both the decision making process and the care they experience.
“This is the right thing to do and what people want. But it is also a response to people’s changing health needs. With more and more people managing long-term conditions, sometimes more than one at a time, the old “patch ‘em up, ship ‘em out” approach is a thing of the past. The health service needs to work with people to manage their own care, and this means understanding their individual circumstances, wants and needs. To do this well also means looking beyond the health service towards their family life and other institutions like local government, schools and community groups.”
Informed, inspired care
Lincolnshire Health and Care’s Gary James explains how the county’s new integrated Care Portal system will help transform healthcare for an ageing and widely dispersed population.
In an article on Hospital Healthcare Europe, he says: “The challenges we are facing today in Lincolnshire are the challenges of the future for the whole UK.
“As a healthcare system we need to deliver sustainable services for a rapidly ageing population. In Lincolnshire almost 10% of the county is aged over 75 – much higher than the national average. Over 14% of our population live in some of the most deprived areas of England and lifestyle conditions like heart disease and diabetes are forcing us to consider how and where we deliver services.
“Like many in the NHS, we’re trying to achieve all of this within a financial environment where budgets are increasingly stretched. In Lincolnshire, if we do nothing by 2020 we’ll have a deficit of over £300m.
“Lincolnshire Health and Care (LHAC) brings together the 13 health and social care organisations including the county clinical commissioning groups, acute trusts, mental health, community services, and the local authority. Together we’re responsible for the healthcare of over 700,000 patients.
“Individually and collectively we need to provide high-quality patient care, while delivering expected efficiencies, but we need to be intelligent about how we change services.
“Making arbitrary cuts often creates new problems that can cost more to fix further down the line, so at LHAC we’re taking a different approach – putting information sharing at the heart of our plans.”
Highland Marketing News
This week we have officially announced our appointment by GovNet Exhibitions as its official partner to manage communications for the newly launched UK Health Show 2016 taking place at Olympia, London on the 28th September.
