News in brief
Funding pressures are threatening NHS innovation, ministers warned: Efforts to develop and spread the use of innovative drugs and technologies in the NHS could be threatened by “unprecedented” funding pressure, a government commissioned review has warned. The interim report of the accelerated access review, commissioned by the Department of Health includes a stark warning to ministers about the dangers of compromising funding for research and leading teaching hospitals, reported Health Service Journal (subscription required). The report’s foreword, by review chair Sir Hugh Taylor, said the UK had “the potential to build upon our thriving life sciences industry, through which our economy as well as our patients will benefit”. However, he warned: “But we will lose ground if research budgets are threatened, if our leading academic hospitals cannot afford to support research or use the latest drugs and technologies to pioneer developments in the treatment of the most complex conditions, or if the wider system is paralysed by the cost pressures it is facing and fails to invest in the change and innovation it requires to deliver better care to patients more efficiently and productively.” Sir Hugh said the key question for his review was whether the NHS could continue to work “at the limits of science”, as promised in the NHS constitution, while “facing unprecedented cost pressures and constraints”.
Jeremy Hunt acts on ‘time-wasting’ referrals: Plans to stop GPs having to rearrange hospital appointments for patients have been set out by the government, reported the BBC. The Department of Health (DH) says GPs’ time is wasted by referring patients back to hospitals for outpatient appointments. The move is part of a range of measures being announced by health secretary Jeremy Hunt for NHS services in England. When people miss outpatient appointments they often have to go back to their GPs to be referred again for their hospital treatment. This adds to the mounting workload at practices. The DH says moves will be made ensure hospitals’ local policies prevent these cases having to go back to GPs. According to the department, 2.5% of GPs’ time is taken up by re-referrals – that is equivalent to the amount of time spent seeing about six million patients per year in England. Citing a report by the NHS Alliance, officials say that up to 27% of GP appointments could potentially be avoided if there was more co-ordination between GPs and hospitals and better use of technology.
Learning disability units to close in £45m plan to shift care into community: The NHS will close up to half its hospital beds for people with learning disabilities or autism, under plans drawn up in response to the Winterbourne View scandal. Around 2,600 people with learning disabilities remain in hospital, reported CommunityCare. That number will be cut by between 30% and 50% by April 2019, and community support options expanded, under a national plan to modernise care published by NHS England, the Association of Directors of Adult Social Services and the Local Government Association. England’s only remaining specialist learning disability hospital, Calderstones, will also be closed as part of the changes. The bed reduction will be achieved by providing more options to treat people out of hospital, the plan’s authors say. This will be delivered by 49 “transformation partnerships” of councils and NHS commissioners, and backed by £45m of NHS England funding. Partnerships will be expected to pool health and social care budgets in a bid to speed up discharges. The NHS will also pay a life-long dowry to councils for some long stay hospital patients who become the responsibility of social services. The dowry will apply to patients who have been in hospital for over five years on 1 April 2016. It is estimated around a third of current inpatients will qualify.
Data to underpin inspections – CQC: The Care Quality Commission (CQC) has issued a consultation suggesting it could revert to trying to spot problems using data and user feedback, instead of running full inspections of all the services it regulates, reported DigitalHealth.net. The inspectorate has been asked to model cuts to its central government funding of up to 40%. This follows reports that Treasury officials are looking to redefine the “ring fence” on NHS funding to include only NHS England’s commissioning budgets. This would put regulation – and other areas of health spending, such as public health – into the arena of “unprotected” Whitehall spending. Unprotected departments and services have all been asked to model cuts of 25-40% ahead of the spending review that is due to be announced on 25 November. CQC chief executive David Behan has warned his board that this could have “implications” for its inspection programme. Despite this, the consultation on the CQC’s strategy for 2016-21 seeks to project change as a response to “the way that health and social care is changing” and the success of its inspection regime. The consultation say the CQC will “complete comprehensive inspections of all services that we rate by the end of 2016.”
GPs’ care.data concerns ‘could resurface’, warns data guardian: GP and public concerns over NHS England’s ill-fated care.data record sharing programme could resurface when it relaunches next year unless there is an overhaul of its communications with GPs, the independent oversight lead has warned. National data guardian, Dame Fiona Caldicott told the House of Commons science and technology committee that NHS England had “a lot of work to do” to win back GP support for the scheme after the initial, botched launch, reported Pulse. She said the original rollout had placed a burden on GPs to undertake politically sensitive work which “they didn’t feel they had the support and guidance on how to do it”. In February 2014, care.data was shelved amid massive protests with just days until its national launch due to fears that patients were not informed about how it will be used. Since then the scheme has focussed on improving patient and GP communications and addressing security concerns. However, pilots across four “pathfinder” regions, due to start this September, were also delayed. Dame Fiona said: “It is a matter of opinion, but I think the criticism around that programme is still of an order where, if it emerges in its current shape, it may again run into similar criticisms. I don’t know that, but I think it is a bit of a risk. I would hate to speak for all clinicians… but I do think there would be quite a lot of work to get the professions, generally, on board, particularly with GPs who I think at the moment feel they were being asked to do something new, and politically sensitive, and they didn’t feel they had the support and guidance on how to do it.”
Ofsted-style ratings for cancer and dementia services: Patients will be able to see Ofsted-style ratings for local cancer, dementia and maternity services in one of the biggest transparency drives in the history of the NHS. Health secretary, Jeremy Hunt, will announce plans to “drive up standards” by introducing ratings for NHS organisations across the country from April of next year, reported The Telegraph. It comes amid mounting concern that patients suffering serious illness are victims of a “postcode lottery” of care across the country, putting thousands of lives at risk. The ratings will be checked by independent experts including Harpal Kumar, the chief executive of Cancer Research UK, and Paul Farmer, the chairman of the Mental Health Taskforce. By giving patients access to performance data, officials say healthcare services in local towns and cities will be more accountable to patients than ever before.
Concerns over future of NHS services hit record levels in over a decade: Public concerns over the state and future of the NHS has hit record levels, with the highest-ever number of people expecting health services to deteriorate, research by Ipsos MORI has found. The study, which looked at people’s perception of economic cuts and their effects on local services, concluded that the number of people concerned with the state service’s future is at its worst since 2002 – comprising more than half of those surveyed for the first time ever, reported National Health Executive. There are also indications that people think GP surgeries are getting worse, with around 38% of respondents thinking general practice services have declined over the past two years compared with 28% of those surveyed in 2013. There has been a similar fall amongst service users. People are also more dissatisfied with the quality of hospitals and care for the elderly, with roughly 35% of respondents believing they are worse than they were two years ago. Bobby Duffy, MD of the Ipsos MORI Social Research Institute, said: “The government’s arguments about the need for austerity do now seem to have taken a firm hold with the majority of the public, as people appear to be adjusting their expectations, and – for many services – don’t seem to be noticing a significant direct impact on service quality.”
Flawed GP data extraction system ‘misspent public money’: The Department of Health (DH) has admitted at a House of Commons public accounts committee hearing that public money had been “misspent” on the General Practice Extraction Service (GPES) IT system, which came in four times over budget and cost the taxpayer £60m, reported GP Online. Representatives from the DH, the Health and Social Care Information Centre (HSCIC) – which runs GPES after inheriting it from the NHS Information Centre in 2013 – and Atos, the IT company that designed part of the system, were grilled by MPs at the inquiry. The inquiry was held after a report from the National Audit Office found that the GPES IT system was “flawed, delayed and over budget”. The GPES was designed to allow NHS organisations to extract data from all GP practice computer systems in England. MPs on the panel said it was “quite clear that the project was a failure” and concerns should have been raised much earlier. Officials said the NHS Information Centre had “made a mistake” in agreeing a contract for the IT system that meant more money had to be ploughed in to fix problems and to make changes from the original specification.
Kelsey: November start on DMI data: NHS England’s director of patients and information, Tim Kelsey has said the commissioning board will write to trusts in November to kick off the first baseline self-assessment for a new ‘digital maturity index’, reported DigitalHealth.net. NHS England announced plans in September to put clinical commissioning groups (CCGs) in charge of defining how their local economies will achieve the ambition of being paper-free at the point of care by 2020. The first step in the process is that CCGs must have reported back on which providers they will cover by the end of October. In an interview ahead of a keynote speech at EHI Live 2015 next week, Kelsey said that while many CCGs have already reported back, NHS England cannot yet publish the footprints of all the roadmap areas. NHS England’s focus on “meaningful use” aligns with its hope to create a “meaningful use technology fund” to support the delivery of digital roadmaps. Providers and individual clinicians can receive payments if they can show that they are “meaningfully using” their certified EHR technology in ways that are also tightly defined. The first stage of meaningful use, which effectively required providers to deploy systems, is credited with leading to a big increase in the implementation of electronic patient records. Kelsey said: “Meaningful use in those terms is a very important concept and certainly the whole of this implementation programme as proposed is fundamentally around, not the installation of technology, but the degree to which this empowers change behaviours and transforms services.”
NHS 24’s computer system crashes on launch: NHS 24’s £117m IT system experienced technical difficulties only hours after going live this week. Staff at the special Scottish health board, which delivers online and telephone advice services, had to resort to pen and paper as the system failed, reported the BBC. Computer Weekly recently reported on an Audit Scotland report that revealed the replacement IT system was years behind schedule and costs had spiralled to £41.6m over budget. Capgemini delivers the applications for the system while BT supplies the hardware and infrastructure, as part of NHS 24’s Future Programme, which aimed to improve patient service, supported by modernised phone and online technology. An NHS 24 spokesperson said in a statement that the system worked well during the day and that “several hundred calls were managed smoothly” but close monitoring, as it moved into “the busier out of hours period, alerted us to concerns over IT system stability and we took a proactive decision to roll back to the existing technology platform”. There is currently no new go-live date set for the system, but NHS 24 said it is aiming to have a “new solution in place and to have our technology platform fully operational as soon as possible”, but that it will only implement it when it’s sure it’s safe to do so.
New electronic document management solution launched to boost NHS hospitals paperless drive: Healthcare providers will be boosted on their paperless journey through an innovative electronic document and records management (EDRM) solution that is being launched by IMMJ systems at EHI Live, reported eHealth News.eu. Its product, MediViewer can cut the time and costs associated with digitising medical records programmes, as well as optimise the chances for project success and clinical adoption. The EDRM system supports the NHS and other health providers looking to cut back on the millions spent on physical records storage by providing a ‘best of breed’ medical records management solution that has been specifically designed to meet their needs. Michael van de Weg, director of IMMJ Systems said: “MediViewer takes a smart approach to digitising healthcare information, and has everything a hospital would want from a healthcare-specific electronic medical document and records management solution, as well as the benefits of rapid return on investment and rapid deployment.”
Digital health expert to carry out ‘Berwick review’ of NHS: Health secretary, Jeremy Hunt, has said a review by international digital health guru Robert Wachter on how the NHS can become a world leading digital health system will be as pivotal to the NHS as Don Berwick’s review on patient safety. Speaking at the Health Service Journal (subscription required) annual lecture, the health secretary said that Professor Wachter would “conduct a review for the NHS on the critical lessons we need to get right as we move to a digital future”. “He will guide and inspire us as Professor Don Berwick did on safety,” Hunt said. Professor Wachter works at the University of California San Francisco, and is the author of the book The Digital Doctor. He has written on how moving to digital healthcare is an “adaptive” change requiring behavioural change, rather than just a “technical” transformation requiring a new process. Hunt said the NHS needed to be “humble” as well as “ambitious” in its approach to technology, to ensure that technology did not interfere with “the relationship between doctor and patient”. Professor Wachter’s review is expected next summer.
One in five care directors believe integration is progressing too slowly: Almost one in five local authorities think they are lagging behind when it comes to joining up health and social care services, according to a new poll, while nearly half claim they are moving forward slowly, reported LocalGov. And almost half believe the Better Care Fund has little or no impact either on care budgets and quality. The survey of local authority care directors, carried out by Health MJ and BT, found that only 8.3% felt they were “well advanced” when it came to integrating services with health partners, while a further quarter believe they are “quite advanced” and “progressing well”. However 48% say they are progressing slowly and 19% say they are not advanced at all. The results cast doubt over the ability of both sectors to drive up efficiency savings through closer integration. According to the directors surveyed, the key barriers to joining up services were a lack of technical knowledge and fear of cultural change. Click here to read the full results of the survey.
Elsevier launches Gray’s Anatomy 41st edition: Elsevier, a world-leading provider of scientific, technical and medical information products and services, has launched the 41st edition of Gray’s Anatomy: The Anatomical Basis of Clinical Practice. The latest edition of the renowned anatomical reference text used by medical practitioners and students alike has been meticulously revised and updated by a world-leading group of clinicians and anatomists building on more than 150 years of anatomical knowledge, reported eHealthNews.eu. The 41st edition is further enriched by new digital content on Expert Consult, an online platform that provides authoritative, world-class book content from Elsevier. Commenting at the UK launch of the new edition, the book’s editor-in-chief, Professor Susan Standring said: “As new techniques that inform our view of the internal landscape of the body have entered mainstream scientific or clinical use, the new perspectives on the body they afford have filtered into the pages of Gray’s Anatomy. I believe that the 41st edition not only continues that tradition but also breaks new ground with an interactive eBook.”
NHS hospitals tackle deadly condition through UK SME partnership: An NHS project to predict instances of acute kidney injury (AKI) and reduce avoidable deaths associated with the devastating condition, is to form the foundation of a keynote speech at EHI Live, reported eHealth News.eu. Donald Kennedy, managing director of specialist health technology developer Patientrack, will address the conference on how a genuine collaboration with clinical pioneers at Western Sussex Hospitals NHS Foundation Trust, supported by the government’s Small Business Research Initiative, is for the first time, creating a predictive tool that alerts clinicians to take preventative action when patients show signs of being at risk of developing AKI. Kennedy said: “We are fortunate to work with so many forward thinking hospitals that have turned to an agile UK SME to address the real needs of their patients, nurses and doctors. Being invited to address the keynote stream at EHI Live is a great opportunity to share some of these stories and in particular, to highlight how one collaboration is helping to tackle AKI, a very serious and deadly condition linked with as many as 100,000 deaths in England’s hospitals each year.” Kennedy will deliver his talk, ‘Predict, prevent and manage acute kidney injury (AKI): A UK collaboration to detect a devastating condition’, at 16.15 on 4th November 2015 in the EHI Keynotes stream.
Widespread cancer care variation means 20,000 patients miss out on early diagnosis: Nearly 20,000 people every two years are missing out on early cancer diagnosis because of widespread variation of treatment in England, Cancer Research UK (CRUK) has found, reported National Health Executive. Analysing Public Health England data from 2012-13, the charity found that almost half the cancer patients in Merseyside, for example, are diagnosed late. If Merseyside care was as good as treatment in south-west England, almost 1,000 more cancer patients would have had an earlier diagnosis and a bigger chance of beating the disease. Sara Hiom, director of early diagnosis at CRUK, said: “It’s unacceptable to see such variation across England, with some areas falling far behind others in prompt diagnosis of different cancers.” Dr Maureen Baker, chair of the Royal College of GPs, agreed that more needed to be done, but argued that GPs were already doing a good job of referring patients to cancer treatments. He said that 75% of cancers were detected after being referred after one or two GP consultations, Baker continued: “Giving family doctors right across the UK better access to diagnostic tools, such as MRI and CT scans and ultrasounds, would inevitably improve this event further, and this must be a priority. By investing in general practice – including access to diagnostics – now, we will be able to save both money and our patients’ misery in the future.”
Elsevier’s Arezzo puts GPs at the vanguard of improved cancer diagnosis: Elsevier is now able to support primary care clinicians and others to deliver high quality care in areas such as cancer diagnoses, referral rates and self-care through Arezzo, its active clinical decision support (CDS) technology, reported eHealth News. The product will be on show at EHI Live 2015 3rd to 4th November. Arezzo is an active CDS inference engine. Robert Dunlop, clinical director of Elsevier Clinical Solutions, said: “CDS should make the right thing to do, the easy thing to do. Yet in reality not all such systems deliver improved patient outcomes, and can prove an obstacle to better care. With Arezzo, it can be shown that putting active evidence-based guidelines in the hands of GPs directly at the point of care can help improve clinical practice.” Arezzo can help GPs make a cancer diagnosis much more quickly and with much more confidence by applying the latest NICE recommendations to an individual patient’s symptoms. It can also perform a “safety-netting” function so that patients with vague symptoms are flagged for follow up. Early diagnosis can help improve chances of cancer survival, and missed diagnoses are a real concern for the clinical community. Robert Dunlop will be speaking at 11.45 on 3rd November as part of the Digital Primary Care conference stream.
80 operations cancelled every day in Scots hospitals: More than 80 operations are cancelled in Scottish hospitals every day with a lack of bed space partly to blame for the delay in treating patients, reported The Scotsman. Figures show that 2,576 non-emergency operations (9%) were cancelled in August alone with nearly one fifth of these (17%) scrapped due to lack of capacity – such as shortages of beds and staff – at hospital. At NHS Borders, more than 12% of its planned operations were cancelled during the month. Of these, just over 60% were down to lack of bed space or other non-clinical issues- the worst rate in Scotland. Capacity issues generally hit hospitals the hardest in the winter due to high numbers of people treated onwards, particularly the elderly. Bed blocking – when patients are unable to leave hospital because the right level of social care is not in place for their return home – is now a major issue in Scotland. Health secretary, Shona Robison said she has made clear to boards that operations for patients with the highest needs must not be cancelled.
Opinion
Is London the worst place in the UK to die?
The Economist Intelligence Unit reported that UK is the best place in the world to die. But the picture in London is far less rosy than the national statistics suggest, writes Onkar Sahota on the Guardian’s Healthcare Network this week.
Sahota, the chair of the London Assembly health committee, recalls a powerful story recently told by Age UK of an 87-year-old lady who had lived alone with end-stage respiratory issues and who confided in her support worker of a child she had in the 1940s who was put up for adoption.
“Her dying wish was to make peace with this child. It put us on a bit of a mission. They tracked the daughter down to Canada and she made the decision to fly over. We were all present and it was one of the most moving things I have ever seen in my life. She passed away about two weeks after that but all she kept saying was ‘Now I am ready. I am ready to go’.”
Sahota argues how for every positive story of compassionate care like this, there are “too many people whose final days are filled with fear or pain, social isolation or loss of identity”.
“London is falling behind in the standards of care that people elsewhere in the UK can expect to receive. Shockingly, 70% of London hospitals cannot provide seven-day-a-week services for people who are dying, according to a report joint-authored by London Cancer Alliance, PallE8 and Marie Curie. Prioritisation and investment in end of life care is “significantly worse” in London than the rest of the country, with fewer than half of borough health and wellbeing boards in the capital including end-of-life care in their strategic planning.
“With London’s population booming and the debate firmly centred on the pressures of housing, are we just forgetting about those who are reaching the ends of their lives?”
Google wants to monitor your mental health. You should welcome it into your mind
The use of technology to track and treat mental illness is deeply worrying but sadly necessary, says James Kirkup the Telegraph’s executive editor.
“Next week, Dr Tom Insel leaves his post as head of the US National Institute of Mental Health, a job that made him America’s top mental health doctor. He’s going to work for Google. More precisely, he’s going to work for Google Life Sciences, one of the more exotic provinces of the online empire. He’s going to investigate how technology can help diagnose and treat mental health conditions. Google doesn’t just want to read your mind, it wants to fix it too.
“Wearable technology has been a hot topic in medical innovation for several years now. A growing number of people choose to track their own physical condition using FitBits, Jawbones and other activity trackers, tiny wearable devices that monitor your movements, pulse rate, sleep patterns and more. Once the preserve of obsessive fitness fanatics, “self-monitoring” has the scope to transform healthcare. The ever-increasing number of people with chronic conditions can track and electronically report their symptoms, reducing the number of routine (and expensive) consultations they need with medical staff and ensuring a quicker response to changes that do require direct professional attention.
“Dr Insel is part of a school of thought that suggests this technology is even better suited to mental health. The symptoms of depression, for instance, are inconstant, ebbing and rising without obvious pattern. A short consultation with a doctor once every few weeks is thus a poor means of diagnosis. But wearable technology allows continuous monitoring. A small portable device might monitor your tone of voice, speech patterns and physical movements, picking up the early signs of trouble. A device such as a mobile telephone.
“If you think the idea of Google assessing your state of mind and your phone monitoring you for depression is worrying, you’re right. But what’s more worrying is that allowing these things is the least bad option on mental health.”
Report highlights the need to harness innovation
The Senior Fellow to the Chair and Chief Executive’s Office of NHS England shares his thoughts on the Accelerated Access review interim report.
“The Accelerated Access Review (AAR) interim report highlights the importance of harnessing innovation in the NHS to achieve better quality and improved outcomes for patients.
“The recommendations in the report are encouraging for clinical trainees. The interim report has five emerging themes arising from the findings, which demonstrates the commitment in healthcare innovation from leaders across the health system.
“Firstly, patients need to be at the centre of healthcare innovation and they need to be given a stronger voice to ensure their views are represented.
“Secondly, in order for the health system to become sustainable, the NHS needs to accelerate and manage the entry of products and services which promise the most significant, potentially transformative impact in terms of patient benefit and overall value.
“Thirdly, the interim report recommends supporting innovators whether they are clinicians, researchers, entrepreneurs or companies both big and small.
“The fourth theme recommends the NHS must be an active partner in promoting innovation and must be incentivised to adopt new products and systems quickly and effectively. Finally, in order for the health system to deliver this change, we need to build on existing system structures and enhance these collaborative structures both to improve their reach and align commitments across the system.
“As a clinician, this review comes at timely point encouraging the importance of frontline staff in delivering change and developing a more sustainable NHS.”
Highland Marketing guest blogs
In a series of blogs in the run up to next week’s EHI Live, healthcare consultant Charles Gladwin of Informa Life Sciences looks at the paperless progress of the electronic prescription service, asks about the potential of health apps for all, and ponders whether all healthcare professionals should be given access to patient records.
