News in brief
Jeremy Hunt’s U-turn on social care ‘cost taxpayer £100m’: Health secretary Jeremy Hunt faces a growing backlash after quietly shelving a key Tory manifesto commitment to cap care costs for the elderly, as experts claimed that the policy fiasco has cost taxpayers up to £100m, reported The Guardian. Hunt has announced that the plan to limit care bills from next year to £72,000 for the over-65s and for younger adults with disabilities has been delayed until 2020. While Hunt insisted that his department was still fully committed to the policy, most experts believe that it has, effectively, been abandoned. The announcement has infuriated the Tory MP and chair of the House of Commons health select committee Sarah Wollaston, who has asked Hunt to explain his about-turn. In her letter to Hunt last week, Wollaston said it was “regrettable” that the decision had been made on a day the Commons was not sitting, and the day after a major speech by the secretary of state in which he had made no mention of the change. Wollaston, who is a GP, has also asked the health secretary to clarify what ministers intend to do to address the longstanding situation that people who pay for their own care are also subsidising those whose costs are inadequately met by local authorities.
NICE makes U-turn over publishing safe staffing guidance: Plans to publish safe nurse staffing guidance for emergency departments have been abandoned in a U-turn by the National Institute for Health and Care Excellence (NICE). NICE had previously said it would publish its finished work on safe nurse staffing levels in accident and emergency on its website this month, along with four evidence reviews of safe staffing in other settings such as mental health and community nursing. However, it has now said it will not make the information available to avoid pre-empting future work on safe staffing by new regulator NHS Improvement. One source in NICE told Health Service Journal (HSJ, subscription required) it had come under “pressure” from both NHS England and the Department of Health (DH) not to publish the information on its website because of fears it would become de facto official guidance that NHS trusts would feel under pressure to follow. The source said: “[NHS England and the DH] are trying to stop it coming out in that form. They wanted to control the information.” However, in a statement to HSJ the DH said the claim was “nonsense”. It added: “Existing draft work on safe staffing will be published by NHS Improvement as part of a package of supporting evidence for new guidance. What’s more, NICE will be involved in the final approval process for future safe staffing guidance.”
NHS Constitution updated to reflect current policy and new regulations: The NHS Constitution and Handbook to the NHS Constitution have been updated to reflect current policy and legislation, and to make the Constitution a more practical document, the Department of Health (DH) has announced. Several recommendations made by Sir Robert Francis QC following his inquiry into the failings at Mid-Staffordshire have also been incorporated, says the DH. These include prioritising patients; protecting them from avoidable harm; providing assistance that patients need; and staff compliance with guidance, reported OnMedica. The NHS Constitution now reflects a series of fundamental standards, below which standards of care must never fall, says the Department. “The Constitution is an immensely useful tool not only for patients but for NHS staff at all levels,” commented Sir Robert Francis. “So I look forward to it being fully integrated into everything the NHS does. It is important not only that everyone is familiar with the rights and responsibilities in the Constitution, but that they are a reality for everyone who offers or receives healthcare,” he added.
GP workloads “put patients at risk”: Patient safety is at risk because of increasing GP workloads in the UK, doctors’ leaders are warning, reported the BBC. The Royal College of GPs (RCGP) said the pressure of more consultations, complex cases and increased bureaucracy was causing fatigue and burnout. The RCGP said such difficulties would not be allowed to happen with pilots or train drivers. Dr Maureen Baker, who chairs the RCGP, said the problem needed addressing urgently, with waiting times getting worse and GPs having to work 11 and 12-hour days, which increased the risk of mistakes, such as medication errors. “Few of us would voluntarily board a plane flown by a visibly tired pilot or get on a train where we knew the driver had spent too much time at the controls – yet there are no methods or systems for addressing doctor and staff fatigue in general practice,” she said. Health secretary Jeremy Hunt promised extra investment, including the recruitment of 5,000 new GP’s and another 5,000 support staff, including practice nurses, during the Parliament.
Chelsea does e-obs on mobile: Chelsea and Westminster Hospital staff are using the ThinkVitals electronic observations tool on mobile devices for faster detection of deteriorating patients, reported DigitalHealth.net. The hospital has started rolling out 100 Samsung Galaxy TAB Active devices to staff in its acute assessment unit after completing a six-month trial within the department. The e-observations tool was developed in collaboration with clinicians at Chelsea and Westminster Hospital NHS Foundation Trust to help in early detection of patients at risk of developing sepsis, or of deterioration and unexpected cardiac arrest. As part of the trial, staff have been using mobile devices and large electronic whiteboards to see a ward view of patients and their conditions, allowing easier and quicker identification of those at risk of deterioration. Dr Gary Davies, consultant in respiratory and acute medicine, said: “By listening to clinicians and adapting an intuitive, user-friendly system to meet their needs, we now have a tool that can deliver significant improvements to patient care, and reduce mortality rates associated with sepsis. The complex nature of healthcare means there are challenges in implementing new technologies in hospitals, but by talking to the nurses and doctors using the technology, this has allowed clinical engagement to happen quickly and effectively.”
Doctors give their prognosis on emerging healthcare technologies: Healthcare apps and wearable tech have a long future in the treatment of patients, according to a panel of Primary Care Physicians (PCPs) interviewed as part of a newly launched Ipsos Healthcare study, reported eHealth News EU. “Digital Doctor” is the first study of its kind looking specifically at the attitudes of PCPs to new healthcare technologies. The annual study across the UK, France and Germany, will track trends in this emerging field, look to understand the level of engagement in new healthcare technologies, and identify concerns or barriers to adoption. The results show PCPs are wary of new health technologies, but 25% see a role for healthcare apps in the treatment of patients with certain conditions. As many as 72% have already used or recommended at least one form of digital health technology, and only one in five of respondents across all three countries think health and lifestyle apps are a fad. Although most are optimistic about the role of new technologies in the treatment of patients in future, the majority of PCPs don’t know what they want from digital health technologies. Gareth Phillips, MD of Ipsos Healthcare Western Europe, said: “It’s too early to say where the ‘sweet spot’ for healthcare apps and wearable tech will be. As we see developments such as Pharma companies investing in tech start-ups to drive new innovations, Digital Doctor will allow us to monitor take-up and attitudes among PCPs in this emerging market.”
NICE drafts ‘improved’ end-of-life care guidance: NICE has drafted new guidance proposals to support end-of-life care in the NHS following the abolition of the controversial Liverpool Care Pathway, reported National Health Executive. It aims to place the individual and their loved ones at the heart of decisions surrounding their care by helping doctors and nurses identify when someone is nearing their final few days. The draft also provides guidance about common symptoms that may be experienced at the end of life and relevant medication to prescribe. The new proposals are designed to address these failings by ensuring quality personalised care, clear communication and shared decision-making between a number of health experts rather than relying on just one doctor’s opinions. Sir Andrew Dillon, NICE chief executive, said: “Recognising when we are close to death and helping us remain comfortable is difficult for everyone involved. The Liverpool Care Pathway was originally devised to help doctors and nurses provide quality end-of-life care. While it helped many to pass away with dignity, it became clear over time that it wasn’t always used in the way it was intended. Some families, for example, felt that elderly relatives were placed onto the pathway without their knowledge or consent. The guidance we are developing will ensure that people who are nearing the end of their lives are treated with respect and receive excellent care.”
Microsoft meets secure email standard: Microsoft 365 is the first non-NHS email service to meet the secure health and social care email standard ISB1596, allowing users to send sensitive patient information. The Health and Social Care Information Centre confirmed earlier this month that the email functionality of Office 365, a group of business applications, has met the requirements for the standard, which defines the minimum functionalities for the secure storage and transmission of email. ISB1596 was published in February 2014 and is intended to make sure that email services adhere to information governance policies and principles and are set up to securely manage the personal and sensitive nature of health and social care data. All organisations delivering health and social care services in the UK are expected to use email services that meet the standard by June 2016. The only other email option for NHS providers that meets the standard is the internal email system NHSmail, which was launched more than a decade ago and has around 730,000 active users. Speaking to DigitalHealth.net, Suzy Foster, director of health and life sciences for Microsoft in the UK, said she expects a “peaceful co-existence” between NHS organisations that choose to use Office 365 and those on NHSmail2.
How open source electronic patient records deliver better software: The clinical and business benefits of the use of open source software in the NHS have been laid out in full in a challenging white paper from healthcare software pioneer IMS MAXIMS. The firm’s research director Paul Cooper has dispelled the myths surrounding open source software for the NHS and other healthcare providers by showing how its use can lead to greater clinical engagement, more flexible development, and greater value for money, reported eHealth News EU. Having released its own software as an open source product called openMAXIMS in 2014, UK hospitals can download and adapt their own electronic patient record for free from platforms such as GitHub. Implementation support can be bought from IMS MAXIMS or other suppliers, removing the dangers of vendor lock-in that affects many in UK health. “Open source software enables the collective aggregation and pooling of knowledge, skills and expertise from across a range of disciplines that can help identify errors, speed up development and encourage collaboration. Just as doctors do when they commit to sharing healthcare knowledge as part of their professional standards, the users and developers of open source software are all contributing to the greater good,” said Cooper. The white paper is available for download from the IMS MAXIMS website.
South Tyneside partnership delivering integrated care: NHS South Tyneside Clinical Commissioning Group (CCG), South Tyneside Council and South Tyneside NHS Foundation Trust is implementing a new integrated care model, which is proving popular with local residents, reported Integrated Care Today. Under the initiative, local teams of district nurses and community workers from South Tyneside NHS Foundation Trust and South Tyneside Council’s social workers and occupational therapists are working closely with local GPs to deliver better local services. The council has said that the new approach is making it easier for residents to access the necessary care whilst ensuring that fewer people need to be admitted to hospital and can receive care in their own homes. Dr Matthew Walmsley, a local GP and chair of NHS South Tyneside CCG, said: “By working together in a completely integrated way, we can provide more patient-centred care, which means better continuity of care, ease of access and more efficient use of the resources we have.”
Birmingham event showcases the digital revolution in youth mental health: Leading mental health clinicians, academics and young people saw the launch of a suite of apps designed to deal with the growing problem of youth mental health at an event celebrating the use of technology in the treatment of mental illness, reported eHealth News EU. Co-designed by clinicians from one of the largest mental health trusts in the country, and young people affected by mental illness, the apps show how mHealth can be a vital tool in the treatment of psychosis, attention deficit hyperactivity disorder (ADHD), and emotional resilience. Professor Birchwood, professor of youth mental health at the University of Warwick, recognised the potentially enormous impact of the use of technology in helping treat mental ill health in young people. “Half of most young people up to the age of 25 will experience some form of mental health issue. Getting help quickly and appropriately is crucial. We need to use youth-appropriate channels to give young people access to help, advice and interventions during a critical period when mental health problems develop.” Among those featured is ‘Silver Linings’, a ‘gamified’ app that encourages young people to self-manage psychosis and engage with their treatment so as to increase the chances of recovery. This app, alongside the Focus ADHD and Building Resilience apps, have been created by clinicians from Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT), app experts from Appadoodle, and young people themselves. “Silver Linings is about engaging young people using a medium they are familiar with, helping them in their recovery by better understanding psychosis,” said Dr Erin Turner, consultant psychiatrist from the early intervention service at BSMHFT.
Eleven trusts benefit from Lorenzo cash: Eleven NHS trusts in the North, Midlands and East have been approved tens of millions of pounds of central funding from the Department of Health (DH) to deploy CSC’s Lorenzo electronic patient record. Responding to a freedom of information (FOI) request from DigitalHealth.net, the DH confirmed that ten of these had been approved the maximum available support package of £3.1 million from central deployment funding. This funding is in addition to money that the DH has agreed to pay directly to CSC for both deployment charges and services charges. The DH has said it is unable to supply these figures under section 43 of the FOI Act, which says that information can be exempt from release if it is “deemed prejudicial to the commercial interests of any entity”. The DH says, it “either pays CSC for services they provide or, if the trust chooses to use another supplier or their own staff to do the work, the department reimburses the trust for the expense incurred after the work is completed”. Warrington and Halton Hospitals NHS Foundation Trust is the latest to confirm it is going with Lorenzo under this agreement.
Scotland to be home to pioneering medical centre: Scotland is to become home to the UK’s largest research centre for cutting-edge personalised medical treatments, reported The Scotsman. The new facility will be part of a UK-wide network aimed at developing innovative therapies that can be tailored to a patient’s particular illness. The Glasgow hub will bring together experts in laboratory medicine, including pathology, and informatics. It is to be based in the purpose-built Laboratory Medicine Building at the Queen Elizabeth University Hospital. Funding for six centres across the UK was announced, with Glasgow receiving the largest single award. The new Scottish facility will integrate with large-scale initiatives such as the Stratified Medicine Scotland Innovation Centre, the Precision Medicine Catapult, the Scottish Genomes Partnership and the International Cancer Genome Consortium. “Glasgow is central to stratified therapeutic development in the UK and worldwide,” said lead investigator Dr Karin Oien.
IBM Watson tackles heart disease with CVS Health: CVS Health will use IBM’s Watson technology to provide better services to patients with chronic diseases, reported Computer Business Review. IBM Watson will be used by CVS Health practitioners to analyse huge amounts of data, interpret and evaluate information, and develop knowledge over time. The partnership is focused on addressing issues faced by patients with chronic diseases, including hypertension, heart disease, diabetes and obesity. The technology is expected to help healthcare professionals to diagnose a patient’s condition which will help doctors and pharmacists to improve the quality of healthcare. Forbes cited CVS Health chief medical officer Dr. Troyen Brennan as saying: “This collaboration enables us to learn about how other sources of health information could help predict declining health or the need for an intervention for a patient with a chronic condition. For example, we can learn if information about a patient’s activity levels from a tracker like a FitBit could help us identify their risk for declining health.”
New online GP service offers £25 video consultations: A new private GP service offering 10-minute video consultations via a video link for £25 has been launched, amid concerns from GPs about how effective it will be, reported Pulse. The new service – called Push Doctor – has a network of over 7,000 GPs who are available from 6am to 10pm for appointments, and works through an app that patients can download. However, GPs warn that such services ignore how essential physical examinations are, while the General Practitioners Committee (GPC) said that patients will be forced to access these types of services privately until funding issues are resolved. Push Doctor Limited said the service is regulated by the Care Quality Commission and manned by “experienced family doctors” who have been “hand-picked and put through a rigorous verification and checking programme”. However, Dr Peter Swinyard, chair of the Family Doctors Association, warned the online service would not be adequate for many consultations because “it is an essential part of the consultation to be able to perform a physical examination”. Dr Swinyard explained: “Within limits it will be OK but even for something routine like prescribing contraception, I’d like to see a current blood pressure.”
Awards
Healthcare IT champion of the year: The voting is now open to find this year’s eHealth Insider Healthcare IT Champion of the Year. Click here to view the shortlisted candidates. Voting closes on Friday 11th September at 4pm. Good luck to all our shortlisted individuals. The winner will be announced at the EHI Awards ceremony on Thursday 1st October 2015.
Opinion
Caring, sharing and preparing
NHS England’s Director of Nursing, Hilary Garratt, looks back on the eight months since the Child Protection – Information Sharing system was launched.
In her blog this week, Garatt writes: “Last year, history was made with the launch of the Child Protection – Information Sharing system (CP-IS), the first national system of its kind. CP-IS flags children identified as vulnerable by social services to NHS staff if they attend A&E, an outpatient department or other unscheduled care settings, and also unborn children who are subject to a child protection plan.
“Having chaired the programme board that brought about CP-IS, and as professional lead in relation to safeguarding, I have been pleased and encouraged to see its spread and the increasing awareness of it, and I welcome the decision to employ a full-time clinical lead for CP-IS at NHS England.
“It is important that NHS Trusts and Local Authorities drive forward with their implementation plans for CP-IS to ensure that a greater cohort of children can be protected. Adopting a new system requires planning and changes, but every time an at-risk child is identified, this makes all the effort worthwhile. When information is not shared, children and young people can be placed at further risk.
“Child protection is, of course, about far more than having systems or procedures. It requires commitment, compassion and vigilance, demonstrated every day by so many health and social care staff and others. Their actions, often behind-the-scenes, deserve all our thanks.
“To safeguard a child is to safeguard the future.”
Population health management: lessons from abroad
In Building Better Healthcare this week, Colin Henderson, managing director at Orion Health UK, explores what lessons can be learnt from overseas initiatives aimed at integrating health and social care.
“Enlightened policymakers have moved beyond just looking at health and social care integration and are looking to population health management to safeguard the future of the people they serve” writes Henderson.
“Population health management recognises that people’s lives involve more than health and social care. Education, housing, and employment all have an impact on how people use those services. Integrated care is striving to achieve person-centred care, but the current approach is only looking at health and social care. Population health management sees the bigger picture.
Henderson suggests the UK could learn some valuable lessons from other countries aiming beyond integrated care and looking at population health management, including New Zealand: “Information sharing is crucial for care co-ordination and population health, but sometimes the fragmented nature of health and social care can act as a barrier. The devastating 2011 earthquake in Canterbury in New Zealand meant that policymakers, clinicians, technologists, and patients had to quickly ensure wider access to a patient’s information. Individuals needed access to appropriate care from a range of providers. Different agencies came together to take the necessary steps to share information between them. This has helped both service delivery and design.”
The conclusion according to Henderson? “There is no perfect system in place, but lessons from around the world can show the UK how to move beyond integrating health and social care. Policymakers and professionals should look ahead now, rather than look back on opportunities missed”
Simply spending more on the NHS is not the answer
Telegraph View: The National Health Service needs to be more efficient, and a national debate about how to do it is overdue.
“Despite being protected from the spending cuts implemented elsewhere in the public sector, and despite a Government promise to find an extra £8 billion a year to meet its rising costs, the NHS still faces a difficult financial future. Its executives estimate it must find £22 billion of savings from its £115 billion budget just to make ends meet.
“Previously, NHS chiefs have suggested this money could be found from “efficiency”, which implies doing the same work at lower cost. Now we learn that in some cases, it simply means doing less: hip and knee replacements and hearing aids are being rationed to save money.
“Some of the money-saving restrictions being put in place may well be sensible: asking patients to lose weight before receiving new joints, for instance, or asking them to stop smoking. Such changes in lifestyle will pay medical dividends to the patient, and financial ones to the taxpayer. There may well be scope for more, too.
“But others are much harder to accept, especially those that appear to fall mainly on particular groups. Joint replacements and hearing aids can deliver real improvements in the quality of life for older people. The decision to save money in this way is unduly harsh on them, so local managers should think again.
“At a higher level, these revelations are more proof that the current model of the NHS as a single state-run entity solely funded from general taxation will not be sustainable in an age when life expectancy, the sophistication and cost of treatment, costs and patient expectations are all rising fast. Simply pouring more money into health is not the answer. A national debate about fundamental NHS reform is now overdue.”
Blog
In this week’s blog Rob Benson looks at how doctors and young people are embracing technology for mental health, leading the way for health IT adoption across the NHS.
