News in brief
Integrated care crucial – Labour: Integrated care “from home to hospital” is vital if the NHS is to reduce costs and address a sharp rise in long-term conditions, according to Labour’s new health and social care policy. The party’s 10-year plan for health and care also proposes integrating NHS 111 services with ambulance and out-of-hours services. According to eHealth Insider Labour’s plan states that the NHS “requires reshaping and improving services to meet evolving health needs like ageing, multi-morbidity, and mental health”, while also prioritising prevention to reduce demand. Ed Miliband outlined key details of the plans in an interview with Health Service Journal (HSJ, subscription required). He said implementation of his “national vision of integrated health and social care” would be evolutionary. In the interview, Miliband endorsed the NHS preferred provider policy but also stated there would be circumstances in which the private sector had a supporting role. The Labour leader insisted the decision on whether to meet NHS England’s £8bn funding requirement for the next Parliament would be a “matter for us [when] in government”. He also endorsed Andy Burnham as doing a “brilliant job” with a “really important vision” but declined to confirm he would be health secretary in a Labour led government.
Welsh Government allocates extra £20m to health and social care integration schemes: An additional £20m will be allocated to health and social care integration projects currently operating under the Intermediate Care Fund, the Welsh Government announced. The budget for the one-year fund was set at £50m for 2014-15 and it is being used to invest in services to keep older people in their own homes. Extra funds have been made available after the UK Government allocated a further £70m of revenue funding for the NHS to the Welsh Government in the 2014 autumn statement. The £70m will be invested in the Welsh NHS from April 2015 and £20m will be used to take forward a number of projects currently funded by the Intermediate Care Fund that have proven to be effective in keeping people out of hospital. A further £30m will be invested in primary care services and £10m will be used to support the redesign of ten key service areas including cancer, cardiac, diabetes and mental health. The remaining £10m will be used to create an ‘efficiency through technology’ fund, which will speed up the implementation of new ways of working in the NHS. Mark Drakeford, minister for health and social care services in Wales, told Community Care: “The 70m additional funding for the Welsh NHS in 2015-16 will go to develop specific projects that will have a real impact on high demand services and on reforming our health service.”
Nursing tech fund two winners informed: Trusts with bids for the second round of NHS England’s Nursing Technology Fund are being informed of their success. Several trusts told eHealth Insider (EHI) they were notified about the success or failure of their nursing tech fund bids last week. However, the fate of the £240m Integrated Digital Care Fund, is far less certain. NHS England launched the second round of the nursing tech fund last November, with applications closing a month later. Some £30m was awarded to successful bids in the first round, with £35m awarded this time around. Shortly after the fund’s launch, EHI reported that over a third of the £100m on offer in the two rounds of the fund had been withheld by Treasury, taking the total down to £65m. A NHS England spokesperson told EHI: “The Nursing Technology Fund has really empowered nurses, midwives and health visitors to carry out exciting and innovative work and it will continue to help provide safer, more effective and efficient care.” However, trusts are still waiting for answers about the status of the second round of NHS England’s technology fund. Sources have told EHI the tech fund has been slashed by £90m to shift money towards A&E pressures in the run up to the general election.
Low confidence that NHS will hit 2018 paperless goal: Health and IT professionals remain deeply sceptical that the NHS can be paperless by 2018, two years after health secretary Jeremy Hunt unveiled the ambitious target, exclusive Health Service Journal (HSJ, subscription required) research has found. Nearly three-quarters of respondents to HSJ’s second annual technology survey, carried out in association with CCube Solutions, agreed with a statement that the paperless by 2018 goal was “a great ambition but unrealistic”. The survey was carried out in November and December. Its publication comes two years after Mr Hunt’s January 2013 announcement of his paperless NHS ambition. Other key findings include: 69% answered “no” to the question: “Do you think the NHS leadership community (senior trust managers at board level, senior commissioners and clinical leaders) has enough knowledge about the potential benefits to efficiency and clinical outcomes improved IT systems can deliver?”; 75% disagreed or strongly disagreed with the statement: “NHS trusts have placed enough emphasis and/or resource on developing the technology to underpin integrated records required for integrated care to become a reality”; 70% agreed or strongly agreed with the statement: “The integrated care agenda will be held back because not enough attention and/or resource is being focused on developing technology to underpin integrated records.”
ICO content with community healthcare data protection: The Information Commissioner’s Office (ICO) has expressed confidence in the level of data protection understanding among community healthcare providers in England, reported Government Computing. However, the data regulator has reiterated the importance of basic security awareness among staff and guidelines on taking patient data offsite. In a report analysing data breaches linked to the nation’s community healthcare providers, the ICO said it had noted a trend in the sector for breaches resulting from information being disclosed in error. “Community providers are an increasingly important part of the NHS, providing cradle to grave services worth over £11bn a year. But they often involve staff working at remote locations or off-site entirely. This brings particular data protection challenges,” the regulator said. Since June 2013, all English health service organisations dealing with personal data relating to health and adult social care have been required to report information breaches through a Health and Social Care Information Centre reporting tool.
Interoperable electronic health records can revolutionise healthcare delivery in Europe: The growing use of clinical and non-clinical information systems, including patient administration systems, scheduling and billing, is fuelling the demand for electronic health record (EHR) technology in Europe, reported European Pharmaceutical Review. EHR and ePrescribing are now priority areas in digital health across Europe, accounting for 30% of total healthcare IT spending in the region. New analysis from Frost & Sullivan, European Electronic Health Records Market, finds that the market earned revenues of $2.74bn (£1.81bn) in 2014 and estimates this to reach $3.69bn (£2,44bn) in 2020. The study covers hospital and ambulatory EHR. The rising aging population, the need for remote monitoring and chronic disease management, and the establishment of health information exchanges are driving the European EHR market. The emergence of real-time patient data management and the transition to personalised healthcare delivery are lending further momentum to the market. “Uptake has traditionally been higher in the hospital EHR segment than the ambulatory EHR segment as hospitals have a larger budget than ambulatory clinics,” said Frost & Sullivan Healthcare Research Analyst Shruthi Parakkal. “In the next five years, however, the hospital EHR segment is expected to mature, while the ambulatory care market witnesses considerable growth.”
Open source to be big tech fund two winner: Open source projects will likely be the stand-out winners of NHS England’s tech fund two awards, eHealth Insider (EHI) has learned. Projects based on use of open source clinical software are expected to be largely spared the axe that has been wielded on other projects, after an estimated £90m was slashed from the £240m Integrated Digital Care Technology Fund according to EHI sources. NHS England had already indicated that it would afford preferential treatment to open source projects, allocating up to £20m of the original fund to open source initiatives. But with the Treasury thought to have now slashed the £240m fund by more than a third, hard choices are required on where the axe will fall. When the list of winners and losers is eventually made public, EHI understands that the majority of open source projects will be funded, with only a handful of the weakest projects missing the cut. This is likely to be in stark contrast to non-open source projects, which had been expected to receive funds, many of which will now receive reduced awards or no money at all.
Sharp rise in GPs offering online record access: NHS England has hailed a ‘step change’ in the proportion of GP practices offering patients online access to records over the past year, reported GP Online. But many practices face a huge challenge to meet a 31 March deadline for offering access to at least summary record data. According to NHS England national director for patients and information Tim Kelsey, preliminary data show that in December 2014, around one in three patients were registered at a practice offering online record access. The previous December, just 3% of practices offered this service. Documents published ahead of NHS England board meeting admitted: “Access to records is yet to become the norm and a number of anxieties expressed by the GP profession remain.” But the board papers added: “We are doing everything possible to ensure that 95% of practices will be offering these services by end of March 2015.” NHS England says 91% of patients are registered with general practices that offer the ability to book or cancel appointments online, up from 64% a year ago, and 88% of patients are registered with a practice that offers the ability to view or order repeat prescriptions online, up from from 64% a year earlier.
‘Telebooths’ to be considered as alternative to GP appointments in some Highland areas: A health board will consider the development of “telebooths” as part of an out of hours (OOH) service in rural areas, so patients can talk to doctors at a distance, reported Herald Scotland. It is part of the efforts by NHS Highland to tackle the pressure on provision created by a shortage of GPs. The exact nature of the booths or where they would be located, is still to be decided. They represent one of the ‘principles’ for a new model of OOH being mooted in a paper that goes before the board of NHS Highland next week. Other principles include routine weekend surgeries run by peripatetic staff in rural areas; greater community resilience through emergency responders and community health assistants; limited home visiting apart from end of life care, frailty, mental health crises; robust and integrated IT systems. According to the report by Gill McVicar, NHS Highland’s director of operations, north and west operational unit, the out of hours service in NHS Highland is: “a patchwork of piece-meal local arrangements which are increasingly difficult to sustain due to staffing models, lack of GPs working in the system, high use of locums and unaffordable costs”.
HSCIC clears data request backlog: The Health and Social Care Information Centre (HSCIC) told eHealth Insider it is on track to clear a backlog of data access requests by the end of the month. The HSCIC says it is also making progress in moving organisations onto new data sharing contracts with stricter controls, with 30% of existing customers having signed new agreements ahead of the February 28 target. In July, HSCIC chief executive Andy Williams said the organisation was dealing with a backlog of over 600 data requests, as well as around 70 new requests each month. In a report for this week’s HSCIC board meeting, programme manager Simon Croker said “progress has continued on target” to eliminate the backlog by the end of January. In the last two months, Croker said the total number of outstanding data requests has gone down from 355 to 210, with the “actual backlog” – requests received before August 1 last year – has been reduced from 181 to 46.
Public satisfaction with NHS near record levels: Public satisfaction with the NHS has risen to 65%, its second highest level ever, according to data from the British Social Attitudes 2014 survey published by The King’s Fund. The survey of 2,000 people, carried out between August and September 2014, found that 65% were ‘very’ or ‘quite’ satisfied with the NHS. The highest-ever public satisfaction level with the way the NHS runs was 70%, in 2010. The report, carried out before the problems in A&E this winter, found that satisfaction with A&E services rose to 58% (from 53% last year) despite much-publicised difficulties in meeting waiting time targets in 2014. Also, the overall levels of ‘dissatisfaction’ fell to an all-time low of 15%. Professor John Appleby, chief economist at The King’s Fund, told National Health Executive: “With the NHS a leading issue ahead of the general election, the British Social Attitudes survey provides a useful snapshot of how the public views the NHS. Public satisfaction with the NHS is high and has risen significantly, despite a year in which the service hit the headlines for financial pressures and difficulties with A&E waiting times.” GP services remain the most popular NHS service in terms of satisfaction, with a rating of 71% in 2014, but this was the lowest level since the survey began.
NHS England calling SMEs to Health Datapalooza: NHS England and UKTI are calling out to the UK’s dynamics SME software and producers of clinical apps to be part of a trade mission, to the upcoming Health Datapalooza event in Washington, DC from 31 May to 3 June 2015. Companies selected to take part in the delegation will benefit from an invitation to attend both the British Embassy and Health Datapalooza reception and a private, bilateral, corporate networking event the following day with VC organisations. To help bring these opportunities to fruition, the chosen suppliers will be given practical advice on positioning companies to stateside VCs, access to a UK branded exhibition area for networking and marketing collateral and a company profile in the UK delegation brochure. The cost of the trade mission will be approximately £1000 per organisation (for 1 person), excluding flights and accommodation. If you would like to express interest in joining this delegation and require further information on the selection process, in the first instance please email: ENGLAND.smenetwork@nhs.net and register your interest.
Opinion:
Better use of data could help prevent future NHS crises
Matthew Bryant, director of operations at Taunton and Somerset NHS foundation trust, says in The Guardian we need to get much better at using the information we have to predict the impact of changes in primary care, social care and community services.
“It has come as some surprise to me, as an operations director in an acute hospital, that even the more technical details of my world have become the subject of public debate, as one hospital after another has faced a crisis with emergency care.
“People seem to find it increasingly difficult to navigate their way around the complex NHS system of urgent care. There are real capacity and recruitment problems in primary care, leading more people to choose to go to A&E. Combine this with the uncertainties about the impact of the introduction of the NHS 111 helpline and it is easy to see why our A&Es are becoming overwhelmed. As hospitals are already penalised financially for increases in emergency attendances, this will add to the funding problems many acute hospitals are already facing.
“The key is to use data to plan and organise services in a more effective way. There is no data available for 111 that compares it to the position before it was introduced, but its impact needs to be evaluated. Too much of what we do is shaped by looking backwards. We need to get much better at using the information we have to help us predict the impact of changes in primary care, social care and community services – as well as underlying patterns of disease. If we do so we can provide NHS emergency services that meet the needs of patients, are good to work in and are cheaper to run.
“The ethos of most hospital care I have seen is that it is better for someone not be admitted to hospital if this can be safely avoided and we would support the transfer of NHS money to GPs and community services to provide alternatives to hospital care where there is evidence that these succeed.”
Brave, unglamorous: a good plan threatened by cultural risk
Alastair McLellan, the editor of Health Service Journal (HSJ, subscription required), says Andy Burnham produced a good plan, but there’s a threat of the NHS not being able to fully embrace it.
“In the none too glorious litany of healthcare policy announcements made in the run up to a general election,Labour’s 10 year plan for health and social care has the virtue of being relatively brave in content and tone.
“Labour’s policy is a well-judged rebalancing of the sector’s priorities when the things that happen before and after people come into contact with the NHS have become the greatest threat to its sustainability.
“Mr Burnham may not have persuaded his leader and shadow chancellor to be as radical as he would like in transferring budgetary control of healthcare to local councils, so he has to contemplate a longer time frame for change, but up to that point he is being given a free run.
“The sector is not going to change its way of thinking and adopt a “social” rather than a “medical model of commissioning” without a struggle. Cultural differences could, as one HSJ reader put it, result in “a 10 year arm wrestling contest between local authorities and GPs”.
“[Mr Burnham’s] challenge will be how to give trusts a more secure future without encouraging complacency. The special treatment in the policy given to not for profit providers – which have actually done as well out of the drive for competition as private firms and are just as disliked by some within the NHS – suggests they may supply a little grist to the mill.”
Future of News: Technology and changes in healthcare
The health editor of BBC News, Hugh Pym, examines the future of technology and its impact on healthcare.
“The business of health in the UK is flourishing. The UK is now the top destination for fundraising by life sciences companies, ahead of Switzerland, France and Germany. A report for the BioIndustry Association showed there were 460 biotech drugs under development in the UK, up 15% on the previous year. The so-called “golden triangle” of London, Oxford and Cambridge has the largest concentration of life science brainpower of any leading economy – with rival academic clusters geographically more widely spread.
“Health monitoring in the home, using wristbands, laptops and smartphones, offers the potential to change the face of healthcare. Sir Bruce Keogh, medical director for NHS England, told me in an interview that “the hospital of the future is in the home”. Sir Bruce raised the possibility that in a couple of decades time people will wonder why previous generations paid for large buildings with beds in them.
“The NHS is looking to make better use of constrained resources at a time of rising demand for care because of the growing and ageing population. There are major challenges as budgets are stretched. Technology is no panacea but the NHS sees it as a potential source of greater efficiency across the service.”
What are the options for electronic patient records in the NHS after NPfIT?
SA Mathieson, an analyst and a freelance journalist, analyses in Computer Weekly the options the NHS was left with after the failure of NPfIT.
“It is a common assumption that the NHS can’t do IT. This is untrue: most GP surgeries are computerised, the health services of the UK’s constituent nations have decent technology infrastructure including secure networks and email, and many hospitals departments have good specialist IT. What is true is that many hospitals lack comprehensive electronic patient record (EPR) systems. In England, this can be blamed on the disastrous £12bn National Programme for IT (NPfIT).
“The National Programme undoubtedly set many English NHS trusts back many years – but the coalition government abolished its ill-starred EPR work soon after gaining power in 2010, making it clear that individual NHS organisations would have to make their own choices in future. So what options have they pursued?
“A new commercial EPR will cost millions, perhaps tens of millions, of pounds. Open source software can provide a cheaper alternative in terms of licence fees, and is favoured by the Department of Health – such projects were encouraged in its most recent round of technology funding for trusts. However, projects are likely to require a capable IT department and a significant implementation budget.
“There are plenty of other ways in which major projects can go astray, such as weak management or oversight, too much ambition and rushed procurement – all of which applied to NPfIT. NHS trusts can draw benefits from the National Programme, through studying it as a case study of what not to do. What they can’t do now is use it as an excuse.”
Blog
In this week’s blog Chris Marsom explores why some health sector professionals think that the paperless ambition for the NHS isn’t achievable.
